People in Sierra Leone are not only fighting this invisible, deadly virus, they are fighting against huge amounts of poverty (the country is among the bottom countries on the Human Development Index) and a grossly inadequate social welfare system. Sometimes they are fighting with no supplies, like the cases we heard of a maternity nurse who was performing deliveries without gloves and the driver who couldn't access chlorine to clean her ambulance of the remains of human suffering. It angers me to hear of these situations, which should not happen in an epidemic of this proportion, but it's hard to know who's to blame. To Susan and me it really seems like everyone, from the Ministry of Health to the CDC, to the international and local NGOs, are working hard and trying their best. The most heartening stories for me to witness were those about ordinary about Sierra Leoneans fighting for each other. As we prepare to fly home from this beautiful, heartbroken country, these are the hopeful stories that I want to tell.
My favorite prevention story was told to us by staff at CCYA, a local NGO that focuses on young people's development and leadership. Their staff were involved in a case where a family wanted to dignify their dead father with a burial in his hometown. To get through the checkpoints, the family sat the dead father in their car and dressed him like a passenger. They then headed to their father's hometown and asked their relatives their to receive them. The relatives initially said yes, they would receive them, as is customary. While the corpse was making its way to the hometown, community members intervened with the relatives, pleading with them not to accept the corpse and the people in the car who were exposed to Ebola (Ebola corpses are very contagious). Many community members, including CCYA's leaders, spent time convincing the father in the household not to accept the corpse. He eventually conceded and refused the visiting family. Several people in the car with the corpse later died. This story speaks to me about the power of community-based networks to intervene, persist and ultimately prevent transmission.
We also witnessed first hand how Sierra Leoneans are working hard on surveillance and quarantine. We tagged along with a district surveillance officer, Musa (a medical student), and a contact tracing team in Freetown. Musa was assigned to the area where he lives so he knows the streets well. He had the lab reports from the command center and it was his job to go out and follow up on the positive cases. We visited two households that he had recently quarantined due to a woman who had recently tested positive and was now in a treatment unit. There was a rope around the two quarantined households and the people were out in their yards. Musa and his team spoke to them on the other side of the rope. The families were quite agitated and upset about their conditions. Food and supplies had not been delivered to them. There was also a man there who had traveled to the area from up-country and resented the fact that he had to be quarantined. Musa and his team spent at least half an hour convincing the people to stay under quarantine and asking them to be patient for the supplies (as I mentioned earlier, coordination of supply delivery is a problem). They also told the husband where his wife was taken for treatment. It was impressive to see Musa and his team -- how much they had learned about the dynamics of the epidemic, how committed they were to doing their jobs and connecting people to resources, and how they seemed to care about the people they visited.
The effects of this epidemic on children are the hardest for me to see. We saw one very poor, quarantined household where a mother lost her infant to Ebola. There were about 12 children, most of them toddlers and babies who were all climbing on top of each other, and they had about 3 meters space to play. The mother's look of trauma was one that I will not forget. And all the shell-shocked parents and children can't leave, they have to just sit there for 21 days while they watch their children and hope they will survive. Musa couldn't do much for them except check to see if anyone was feeling unwell. I felt badly that more couldn't be done. It's hard in this outbreak - you can't even reach out and comfort someone, you can just hand them something across a rope.
But there was another story about children that was somewhat positive. We went with Musa to a quarantined household where three children, ages 8, 4 and 2, were sitting inside with the corpse of their dead father. Their mother had already died of Ebola. The burial teams had not come to pick up the father's body for over 24 hours and there was a rumor that the burial teams were on strike because they had not been paid. Community members were gathered outside the house and were very concerned, none of them wanted to touch the children because they feared they were contagious, but they were worried that the children would starve. With Musa and the CDC's help, a burial team finally arrived. Musa then called the child protection hotline to take the children to an orphan interim care center, but the person who answered said their vehicle was not working. After many phone calls and a visit to UNICEF by Susan, a vehicle was dispatched to get the children.
Susan and I are glad that we came here. I have to admit that it was a hard time to be away from the U.S., with our own country's problems to work on and wanting to be a part of that. It was also scary to come to a place where we knew that we would be at risk. But it wasn't as scary as we imagined. We enjoyed listening and hearing ordinary people's stories, and learning more about the challenges in stopping this epidemic. Susan even offered some suggestions which I am proud of her for and I hope will be heard. She suggested that the radio, which everyone listens to, offer some programming specifically for children who are not in school (this was also done during the war). We have heard that people are now working on this. She also suggested that the child protection teams be better integrated with the surveillance teams, which seems very important to caring for orphans and also for mitigating the spread of the disease through children.
I am very impressed with Mama Salone's people. I will be thinking of them and hoping hard that they win this fight soon. I hope to come back some day and enjoy some good times together.
Ah tell god tanki,
~Nina
My favorite prevention story was told to us by staff at CCYA, a local NGO that focuses on young people's development and leadership. Their staff were involved in a case where a family wanted to dignify their dead father with a burial in his hometown. To get through the checkpoints, the family sat the dead father in their car and dressed him like a passenger. They then headed to their father's hometown and asked their relatives their to receive them. The relatives initially said yes, they would receive them, as is customary. While the corpse was making its way to the hometown, community members intervened with the relatives, pleading with them not to accept the corpse and the people in the car who were exposed to Ebola (Ebola corpses are very contagious). Many community members, including CCYA's leaders, spent time convincing the father in the household not to accept the corpse. He eventually conceded and refused the visiting family. Several people in the car with the corpse later died. This story speaks to me about the power of community-based networks to intervene, persist and ultimately prevent transmission.
We also witnessed first hand how Sierra Leoneans are working hard on surveillance and quarantine. We tagged along with a district surveillance officer, Musa (a medical student), and a contact tracing team in Freetown. Musa was assigned to the area where he lives so he knows the streets well. He had the lab reports from the command center and it was his job to go out and follow up on the positive cases. We visited two households that he had recently quarantined due to a woman who had recently tested positive and was now in a treatment unit. There was a rope around the two quarantined households and the people were out in their yards. Musa and his team spoke to them on the other side of the rope. The families were quite agitated and upset about their conditions. Food and supplies had not been delivered to them. There was also a man there who had traveled to the area from up-country and resented the fact that he had to be quarantined. Musa and his team spent at least half an hour convincing the people to stay under quarantine and asking them to be patient for the supplies (as I mentioned earlier, coordination of supply delivery is a problem). They also told the husband where his wife was taken for treatment. It was impressive to see Musa and his team -- how much they had learned about the dynamics of the epidemic, how committed they were to doing their jobs and connecting people to resources, and how they seemed to care about the people they visited.
The effects of this epidemic on children are the hardest for me to see. We saw one very poor, quarantined household where a mother lost her infant to Ebola. There were about 12 children, most of them toddlers and babies who were all climbing on top of each other, and they had about 3 meters space to play. The mother's look of trauma was one that I will not forget. And all the shell-shocked parents and children can't leave, they have to just sit there for 21 days while they watch their children and hope they will survive. Musa couldn't do much for them except check to see if anyone was feeling unwell. I felt badly that more couldn't be done. It's hard in this outbreak - you can't even reach out and comfort someone, you can just hand them something across a rope.
But there was another story about children that was somewhat positive. We went with Musa to a quarantined household where three children, ages 8, 4 and 2, were sitting inside with the corpse of their dead father. Their mother had already died of Ebola. The burial teams had not come to pick up the father's body for over 24 hours and there was a rumor that the burial teams were on strike because they had not been paid. Community members were gathered outside the house and were very concerned, none of them wanted to touch the children because they feared they were contagious, but they were worried that the children would starve. With Musa and the CDC's help, a burial team finally arrived. Musa then called the child protection hotline to take the children to an orphan interim care center, but the person who answered said their vehicle was not working. After many phone calls and a visit to UNICEF by Susan, a vehicle was dispatched to get the children.
Susan and I are glad that we came here. I have to admit that it was a hard time to be away from the U.S., with our own country's problems to work on and wanting to be a part of that. It was also scary to come to a place where we knew that we would be at risk. But it wasn't as scary as we imagined. We enjoyed listening and hearing ordinary people's stories, and learning more about the challenges in stopping this epidemic. Susan even offered some suggestions which I am proud of her for and I hope will be heard. She suggested that the radio, which everyone listens to, offer some programming specifically for children who are not in school (this was also done during the war). We have heard that people are now working on this. She also suggested that the child protection teams be better integrated with the surveillance teams, which seems very important to caring for orphans and also for mitigating the spread of the disease through children.
I am very impressed with Mama Salone's people. I will be thinking of them and hoping hard that they win this fight soon. I hope to come back some day and enjoy some good times together.
Ah tell god tanki,
~Nina
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