Fighting Ebola in Sierra Leone: ‘The world is not safe

All over Freetown, buildings, vehicles and people are being commandeered in the fight against Ebola. In the suburb of Wilberforce, in an old building for the telecommunications company Airtel, a dozen students loiter on a wall waiting to relieve staff from the trauma at the Ebola hotline they are manning.
Outside, the din of ambulances would not be noteworthy until the driver and passenger appear in regulation yellow overalls, mask, goggles, hood and visor.
Every ambulance is now an Ebola ambulance in Sierra Leone’s capital where an invisible malevolent force has taken hold, causing fear and untold grief as the dying and the dead infect families and friends in their wake.
According to the World Health Organisation, there have been 5,235 confirmed, probable and suspected Ebola cases in Sierra Leone, out of 13,703 worldwide, and 1,500 deaths.
Inside the call centre, cancer biologist Reynold Senesi talks to four soldiers. They have been brought on board following a political reshuffle which has put the defence ministry in charge of the war against Ebola, a move everyone applauds.

Health workers walk to pick up a four-month-old baby victim of Ebola in central Freetown. Photograph: EPA

Three months ago, Senesi was working on launching the country’s first oncology unit. That has been put on hold as the team he manages doles out compassion and promises of dispatched ambulances to 1,300 Ebola calls a day.
“Last week we had a patient who lost her mother, her father and her cousin. They were all lying there and the burial team hadn’t collected them,” said Rebecca Trye, 24, one of Senesi’s 135 staff. “I felt so sad because you can’t do anything. She asked for my name and she called again the next day and she was crying because they still hadn’t been collected.”
Three desks away, Ibrahim Sesay takes a call pleading for a toddler to be rescued. “The mother was buried and the father was dead. They said there was a two-year-old child left in the house. He kept knocking on the door calling for his dad. The baby was already infected.”
Most of the staff at the 117 hotline are students, freed from their studies because all schools and universities were shut when the state of emergency was declared.
In the foothills enveloping Freetown, Major Henry Bangura has also been redeployed. His team converted an old police training camp into a 100-bed Ebola treatment centre in three days last month during a three-day lockdown.
In the city centre, British doctor Oliver Johnson, who has worked in the Connaught hospital for two years, tells of similar heroic work. In an attempt to keep the hospital open for general care, he and his team converted the triage in the Connaught hospital into a 16-bed isolation unit in just five hours.

Health workers carry the body of an Ebola virus victim in the Waterloo district of Freetown. Photograph: Reuters

But the tireless work of those living in Sierra Leone is not proving enough to catch the disease whose victims easily outpace the number of beds being built.
Between fielding calls in another hectic day at the Connaught, Johnson says a change in mentality is needed to bridge the chasm between grand plans hatched in Washington, New York and London and the urgent needs on the ground.
He says he is impressed with the “joined up thinking of British government” efforts with a 100-bed facility due to open in the suburb of Kerry Town and five more hospitals scheduled to open before the end of November.
But while locals can convert buildings within days, the British hospitals are taking two months to build and there is scepticism that the remaining facilities will be built in four weeks. “Time is against us. Kerry Town is part of the solution but it’s not going to be enough any more,” says Johnson. “We’ve moved from one or two cases a day to more than 30 cases a day in Freetown, and by next month maybe we will be getting 60, 70, 80 positive cases a day, so that 100-bed unit in Kerry Town will be full in 48 hours,” he says.
In the new command centre in Freetown there is a sense that the management, at least, of the epidemic in the capital is under control. Burials are being completed within 24 hours. But there is little to celebrate.

An Ebola care training course at the University of Seirra Leone’s faculty of nursing, Freetown. Photograph: Ministry of Defence/EPA

The large whiteboards charting dozens of live cases show why the infection rate is out of control. Patient number two is 38-years-old. Status: “Weak, 8 people in the home”. That’s eight people who now needed to be quarantined. Next is an 18-year-old. Status: “28 weeks pregnant. Epilink (husband, sister-in-law, brother dead”. Then there’s a 12-year-old girl. Status: “Can walk. 4 in house”. Ebola is indiscriminate. Last on the list is a one-year-old Ebola suspect. She is from a quarantined home with eight in the house.
In the district of Port Loko up the coast there are reports of people dying on verandahs and corpses rotting in homes. One woman lies dead on the floor of a hospital after a struggle to give birth. There are no labs, isolation or treatment units in the district. The Cuban doctors who had been due to work in a new clinic in Port Loko sit frustrated in a Freetown hotel after the NGO assigned to manage the facility pulled out.
If the World Health Organisation’s worst projections come to pass, Sierra Leone needs up to 4,800 beds by the end of November to contain the outbreak. Even with the 700 beds promised by the British, the capacity will not be reached.
“There’s no way that by the end of November we are going to be where we need to be unless we start parachuting in ready-made treatment centres in containers,” says Sinead Walsh, the Irish ambassador and a senior development expert who has thrown all her office’s weight into the Ebola fight.

Health workers transport the body of a person suspected to have died of Ebola in Port Loko, on the outskirts of Freetown. Photograph: Michael Duff/AP

Johnson and others, including Stephen Gaojia, the coordinator for the national Ebola response, are advocating a mass and immediate programme of upgrading existing health facilities rather than wait months for international standard hospitals to be built by outsiders.
“I would rather have 40 NHS volunteers on the frontline fighting this outbreak today than 400 in January when it may be too late,” says Johnson. What is needed is a different strategy with dozens of small 10- to 15-bed units which can be run by international experts.
But red tape, growing hysteria in the US and the UK over volunteering, and the attitude of some international NGOs mean resources are not being deployed quickly enough. NHS volunteers have yet to arrive and Johnson questions whether any will be permitted to work in the local facilities he is advising the Sierra Leonean government on.
“I think we’ve got to move our mentality from saying ‘let’s provide the best possible building, that is the dream scenario’. All we need is a room, with some buckets of chlorine and a burns pit outside and a fence around it, and something that is pretty basic, but that is safe and effective.”

Prayers are made for a victim of Ebola in Freetown. Photograph: EPA

He says NGO experts flying in with their sometimes “patronising” ideas for a rotation of one month and flying out again doesn’t help. “I’ve been at meetings, where I’ve just been a bit embarrassed at some of the NGOs that have been there who are shouting at this guy at the ministry. He’s a one-man directorate who has not stopped working for six months, who doesn’t have internet, who doesn’t have a driver and has been absolutely been on the frontline for six months,” says Johnson.
Gaojia says it has been a challenge to get experienced clinicians from overseas, but he is hoping solidarity from his African neighbours will lead to an influx of experts from places like Uganda which have already experienced Ebola. “As long as Ebola remains in any country, I don’t think the world is safe,” he said. “The longer it continues in this country, the worse it gets for the rest of the world.”
But there are no celebrations. Achievements in the burials team are a step in the right direction, but will come to nothing unless the chain of transmission can be broken.
A secondary health crisis is growing. Malaria, a major killer, has gone unreported for three months. Women are no longer giving birth in health facilities. Contraception handouts have dropped by 70% leading to fears of an epidemic of teen pregnancies and a doubling of severe acute malnutrition killing children under five with mothers struggling to earn money for food, says Walsh.
She believes the numbers dying from this secondary crisis will eclipse the Ebola death toll. “The world has never seen this before. The tool kit to fix it doesn’t exist. It’s very hard to see the solutions without a really large injection of resources from the rest of the world.”