July 29 2014
The first case of Ebola was confirmed in Kono District today.
Though Kono District—the region in which we work—has been spared from the Ebola outbreak until now, hundreds of people had been and continue to be infected in Kailahun and Kenema Districts which directly border Kono. The epicenter of the outbreak exists approximately 50 miles from our clinic. As the virus was first identified in West Africa this year, and as the outbreak has spread, we have been readying our staff and clinic to prepare for the disease should it come.
Now that Ebola has crossed into Kono District, it is crucial that we capitalize on our preparation by carrying out a carefully planned and adaptable response. At our clinic, we’ve implemented strict screening procedures with a protocol for isolating, providing supportive care and rapidly transferring Ebola patients to designated treatment centers in Kenema and Kailahun.
We’ve also worked with our partner Direct Relief to arrange for one of the largest shipments of personal protective equipment (PPE) and medications yet which has begun to arrive earlier this week. We are currently distributing the materials at our facility, as well as working with the District Health Management Team to stockpile supplies at high-risk, remote public clinics and Kono’s main referral hospital. We will also send supplies of PPE to Kenema Hospital, which currently has scores of Ebola patients admitted and which has recently had several nurses die from the disease. This week, Sierra Leone’s chief hemorrhagic fever physician at Kenema Hospital, Dr. Sheikh Umarr Khan, also contracted Ebola—likely because of inadequate PPE. Dr. Khan has since died from this untreatable virus.
A major challenge in the outbreak response has been the rejection—sometimes violent—of healthworkers, along with families hiding scores of suspected Ebola cases in their homes. However, we believe that the general interpretation of these responses—that Sierra Leoneans are ignorant of the disease and how it spreads—are misguided and verge on blaming patients for the way the outbreak has unfolded. There is hardly a Sierra Leonean, even in the most remote villages of Kailahun and Kono, that now does not understand what Ebola is and how it is spread. The near-daily "Ebola parades", posters, banners, "mass-sensitization" campaigns and radio jingles are well-intentioned, but do not address the complex community-level processes that are unfolding throughout Sierra Leone.
Rather, we believe that the lack of respectful and dynamic community engagement on the disease has created intense fear in affected communities. When communities see patients brought to their village’s clinic with the signs and symptoms of typical tropical diseases, immediately separated from their families and then sent away to a far off referral hospital by men in white suits where the patient will likely die and be buried in isolation—it’s no wonder neighbors and relatives are afraid to bring other sick family members to the clinic.
We believe that the lack of humane and respectful, but still urgent and cautious, care—even for the relatively small number of Ebola patients—along with a dearth of communication and engagement with family members about what is happening to their relatives may be at the core of many of these community-level challenges. In this type of emergency, many of the core values of respectful care-giving can be brushed aside under the pretext of urgency: patient communication and counseling of patients and families to make appropriate healthcare decisions, attending to their fear and lack of understanding in terms that are meaningful, and working to make families and communities feel considered and a part of a patients' trajectory through care. Healthworkers should acknowledge, publicly, how frightening this disease will be for affected communities and how difficult it is for families to part with loved-ones to likely die in isolation wards. Such sympathetic gestures would serve to align the priorities of communities and the public health response--or at least provide a starting-point for productive interaction. Instead, it seems, healthworkers' interactions with patients and families have often been intensely confrontational, and we fear that more draconian measures to identify and isolate patients may ultimately do more harm than good.
Ultimately, we recognize that social factors are the most important determinants of how this outbreak is stopped and future outbreaks are contained. Encouraging communities to stop eating bush-meat in a region where malnourishment is rampant and such locally-available meat offers the only source of protein is not realistic. Instructing people to change behaviors such as hunting and caring for sick family members at home--which they have been practicing for centuries— requires personal and community engagement in a sensitive manner. Better coordination and broader improvements in the healthcare system will also ensure that referral mechanisms can more swiftly identify patients and transport and treat them in appropriate facilities.
Our frontline preventitive response of protocols, supplies and precautions will help to protect our healthworkers and creates a safe and efficient treatment and referral network should an infected individual arrive at our clinic. However, these measures do not address the root of the outbreak. This public health crisis requries sensitive and direct education and advocacy to create a more unified and informed response from the ground-up. That is why we are providing technical support and advocacy at both the local and national levels on the need for more sensitive community education and on the ways such engagement can be implemented. Dr. Bailor Barrie, Wellbody’s Co-founder and Chief Strategic Officer, is appearing weekly on the Sierra Leone Broadcasting Corporation radio to discuss the outbreak in a more respectful and locally-appropriate manner. We are also working to prepare new guidelines for nurses and public healthworkers to use when interacting with affected patients and communities so that Kono may be spared from the devastating panic has undermined effective response in much of Sierra Leone.
A more culturally-informed response based on on-the-ground realities is, in our opinion, the most effective and realistic approach for slowing down, and eventually halting, this epidemic in the near future.
Related tags: Ebola