Sierra Leone still struggling with Ebola outbreak

KOIDU, Sierra Leone — The rapid response team has arrived and the chaos is easing, but medics in a remote Sierra Leonean district are struggling to control a local Ebola outbreak when it’s too late to nip it in the bud.

A deployment of medical workers and equipment to Kono District has been the fastest so far in Sierra Leone, a country with nearly half the total Ebola cases,- under a strategy of tackling epidemic hotspots before they get too big.

But officials say responses need to be yet faster to fight the fever that has killed more than 7,000 people across West Africa.

In Koidu, the capital of Kono district, people continue to die of what is thought to be Ebola while others seem unaware of the risks. A Reuters reporter saw a young man lying on a city street, vomiting. He died there before an ambulance could come.

An almost hysterical soldier ordered bystanders next to the highly contagious corpse, who were wearing open-toed rubber flip-flops, to stand back. “This is the reason we have Ebola. Your bad habits. Look at you, in slippers, in slippers!” he yelled.

Less than a month ago, conditions were far worse. A small team of local nurses left at the makeshift Ebola center were so afraid of patients they resorted to throwing packets of medicine inside, according to two U.S. doctors on the scene.

Suspected and confirmed Ebola patients were mixed together, sometimes next to corpses. A single trolley was used to move the dead and mattresses were soiled with diarrhea.

While fellow Americans celebrated the Thanksgiving holiday in late November, the two doctors witnessed a descent into chaos in Kono, about 450 km (280 miles) east of the capital Freetown.

“By Thanksgiving things had exploded. The hospital was getting overrun by Ebola patients,” said Dan Kelly, one of the doctors and founder of the non-profit organization Wellbody Alliance. Ten staff at the center caught Ebola and five have died so far.

Shortly afterwards, help began to arrive in Kono, which lies in the diamond mining eastern province, and the Red Cross is building a 30-bed treatment center.

The buzzwords in the international strategy for stamping out the nine month-old epidemic – which has hit Liberia and Guinea as well as Sierra Leone – are “rapid response”: quickly mobilizing flexible teams to prevent new hotspots from emerging.

“Speed really matters. Our experience in communities in all three countries, is that if we can get rapid response teams very quickly we can stop a cluster,” Dr Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention (CDC), told reporters this week.

CDC says this has been done this successfully in one Sierra Leone district and now the same tactics are being used in Kono.

But help needs to arrive when case numbers are still low. “Right now we are seeing an intensive influx of resources and it’s a good example of a rapid response,” said Kelly, 33 from San Francisco. “But we need to be proactive, not reactive next time.”

In Liberia, the Medecins Sans Frontieres group sent a team within two days after a case was confirmed in one isolated village. A 12 bed treatment center was built within eight days. “It’s about nipping it in the bud when it’s still small,” said an MSF spokeswoman in Liberia.

Fernando Fernandez, a member of the European Commission’s Ebola response team in Freetown, said this was not yet being matched in Sierra Leone. “Kono is the fastest response so far in the country. But we have to be much faster than that. We should be aiming at what they are doing in Liberia.”

THIN RESOURCES

In Koidu, rumors of the previously abominable conditions at the Ebola center spread fear among local people, causing families to hide the sick and bury the dead in secret.

Recently a two-year-old arrived dead at the facility; her mother had kept her at home for three days with a fever because she was worried about conditions.

Even now, the district has just two ambulances and officials complain one of them spends half the time in the garage. Two of the drivers have died from Ebola. Patients are sent to the town of Kenema on a three hour journey via a bumpy dirt road crossing the mountains.

There is no laboratory for testing cases and swabs have to be sent to a town more than 100 km (60 miles) away. On many days, burial teams cannot cope with all the corpses.

At a military command center, housed in an office for diamond workers, only about half a dozen soldiers are present. The surveillance desk is empty, although its staff are due to be built up. A military briefing note seen by Reuters said the center needed a regular power supply.

A lack of resources meant aid workers could not evaluate the number of cases in Kono. “The case count did not look that bad from Freetown. But the problem is you can’t know the scale until you have enough people on the ground,” said Colin Basler, a CDC epidemiologist in Kono.

Authorities are trying to manage over 400 people who came into contact with Ebola sufferers under quarantine.

Paul Saquee, chairman of the Kono council of chiefs, had mixed feelings about the help. “Was the response rapid enough? No. But is it too late? No,” he said.

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