Challenges and innovations

Today we heard about some of the many challenges in this epidemic. These have not necessarily been reported by the popular media so I will share them here:

• Surveillance (tracking the number of Ebola cases in the country) is difficult and imprecise. Health workers who come into contact with a suspected case of Ebola are supposed to fill out forms that give very basic information about the person, including name, date of birth, etc.  They are also supposed to fill out whether the person traveled or had a contact with someone with Ebola, but this information is rarely filled out.  All the data are written by hand and then later entered into a computer. Right now the data entry to the computer is about two weeks behind the written forms.  Also each person is given a unique identifier (a sticker with a number on it) that is supposed to identify their blood for the health care worker and the laboratory. There have been some problems with people putting the stickers incorrectly on the forms.  All this makes it difficult to know who is getting Ebola and who is at risk for getting it.
• People want to know what are the risk factors for Ebola - who is getting it and how. But if the system can't collect the basic data described above, right now it seems impossible to collect more complicated data about how Ebola spread from person to person.
• There is limited coordination among agencies with similar missions. For example, WHO and CDC both have epidemiologists in the field who are supposed to be working with the contact tracers, workers who go to people's homes to find people with Ebola and ask them who they've been in contact with.  There is speculation that some households may be counted twice. Another example is that different agencies provide different goods. For example, each house that is quarantined with a case is supposed to get a bucket with oral rehydration solution, food, gloves and bleach so that others in the household can protect themselves.  We heard that there are different agencies providing each of these goods, and as a consequence these goods are not being delivered regularly. 
• Ebola can be treated with good hydration. However, when people with Ebola ride in ambulances to the treatment centers (which can sometimes be 5 hours away on a bumpy road), they are not given water to drink. 
• People can't find their loved ones. A person with Ebola can be taken to any one of the 10 treatment centers in the country and their families don't know where they go. Also a lot of people have the same names, making tracing loved ones even more challenging.

We also heard about some interesting innovations:

• Dignified burials are very important to the people of Sierra Leone, but are difficult to achieve given that corpses are so infectious. People are currently forbidden from attending funerals or burials. Corpses are treated swiftly by the burial teams. We heard from one woman today that when her mother died of Ebola, her mother's corpse was thrown on the ground in front of her community and sprayed with chlorine. This episode was naturally very upsetting to her daughter.  
• Nevertheless, we heard of two improved practices today when it comes to burials. One is that burial teams are allowing bereaved loved ones to provide white clothing that is buried on top of the corpse (it is a Muslim tradition to clothe people in white before burial, but because of Ebola the corpse cannot be wrapped in the cloth).  Family members are also allowed to see the burials from a safe distance. Some say that developing strategies to bring about dignified AND safe burials will be key to controlling this epidemic.