Magical Laser Thermometers

Nina outside Crown Express -- a lunch spot

Susan checked on landing in Brussels

Laser thermometers (actually Non-Contact Infrared Thermometer With Laser Targeting) are ubiquitous in Sierra Leone at the moment.  Because fever is one of the symptoms of Ebola, it is assumed that if you don’t have a fever you are not sick and therefore not contagious.  One’s temperature is taken before one enters government ministries, businesses, and hotels.  The person manning the thermometer points it at your head for a few seconds, then turns it around the show you the display.  The front-desk staff at our guesthouse were very proud of their laser thermometer and, when they remembered, rushed to use it on us when we returned from our interviews at the end of the day, crying out “35.1!” or “36.2!”

 

As we travelled around Freetown our vehicle was sometimes stopped at checkpoints where we were all asked to come down, wash our hands, and have our temperatures taken.  (The Red Pump checkpoint I wrote about earlier is an example.)  However, we found that we could often pass through checkpoints without having to come down to wash our hands or have our temperatures taken if we claimed we had hand sanitizer in the vehicle (which we generally did.)  I don’t really understand the logic there, but in practice is seemed a way not to have to stop NGO vehicles.

 

It might sound like a good strategy, but we found many problems with the ubiquitous use of laser thermometers.  First, people did not always know how to use them.  They would wave them around in the general direction of the person instead of properly aiming them.  Someone from the CDC said that the thermometers need to be calibrated regularly, and they were generally not.  Sometimes the thermometers were simply not working.  At one checkpoint I was told my temperature was 32° Celsius (or 89.6° Fahrenheit).  I’m not sure, but I think I would be pretty ill if that were the case, but the man checking believed that I didn’t have a fever and that was enough to pass.  

 

So, if the thermometers often didn’t work, why were they so omnipresent?  I believe it is because they gave people a sense of efficacy, at least something they could control.  Indeed, as we work through our data and our findings, I think one of our main conclusions will be that many of the actions taken (everyone washing hands, banning public gatherings, closing shops at 6PM, etc.) were not in line with the actual risks of transmission, and made people feel themselves to be under constant threat with no real recourse.  This is why the theatre of the checkpoints was likely more important than any actual public health benefit. 

Before this outbreak I had never seen a laser thermometer in Sierra Leone.  We heard that at first the thermometers were feared, that people suspected they might be a kind of Ebola gun (after all, they had never seen the machines before Ebola came around).  Over time, they became accepted and even in demand. During our interviews we asked some questions about Ebola testing, and interestingly a few people seemed to believe that the thermometer itself was a kind of Ebola test and not just a thermometer.  One respondent told us that the “guns” had the power to look right inside your body to see if the Ebola was in there. 

Near the end of our stay, we were fortunate to shadow a tracing team and see them in action as they monitored quarantined houses. We discovered that although there is a spot on the tracing form for recording everyone’s temperature every day for 21 days, the contact tracers weren’t supplied with thermometers.  Nina and I got checked going into any fancy ex-pat place for the duration of our stay, but the actual contact tracers who were following up with people who may have actually been exposed to Ebola did not have thermometers.  What a crazy misallocation of resources!

returning to school