Is Sierra Leone prepared for Ebola?

The Sierra Leone Telegraph: 6 April 2014

When a deadly outbreak of cholera took place in both Guinea and Sierra Leone two years ago, scores of people died.

In Sierra Leone, the government was heavily criticised for lack of preparedness and poor leadership. Health care systems were unable to respond effectively to the cholera outbreak.

Poor sanitation and overcrowding, especially in the capital – Freetown, makes for a rapid spread of any communicable disease in Sierra Leone.

Now Sierra Leone is faced with an even more deadly disease – Ebola, which is suspected to have crossed the border from Guinea.

So how prepared is Sierra Leone for an Ebola epidemic?

Latest report from the health ministry in Guinea, says that at least 86 people have died from Ebola hemorrhagic fever.

A crowd angry about the Ebola outbreak,  is reported to have attacked a centre where victims were being held in isolation, prompting an international aid group to temporarily evacuate its team, officials said Saturday.

The violence took place yesterday in the southern town of Macenta, where at least 14 people have died since the outbreak emerged last month. The mob who descended upon the clinic accused Doctors Without Borders health workers of bringing Ebola to Guinea, where there had never previously been any cases.

Some young people threw rocks at the aid workers, though no one was seriously hurt, said Sam Taylor, a spokesman for Doctors Without Borders.

Guinean officials have confirmed 111 suspected cases of the viral disease, which broke out three weeks ago along the northern border with Sierra Leone.

Medecins Sans Frontieres (MSF) describes Ebola as “one of the world’s most deadly diseases.”

“The priority is to isolate suspected cases,” said MSF, which has set up two isolation facilities in the most affected districts, Gueckedou and Macenta, both in southern Guinea.

Senegal’s Interior Ministry decided to close its border with Guinea until further notice to prevent the spread of the disease, according to Senegal’s state news agency.

“In partnership with the Ministry of Health, we have set up a dedicated ten-bed facility in Guéckédou town,” says Marie-Christine Férir, MSF emergency coordinator. “We have also started working on a facility in Macenta. It is essential that all patients showing symptoms of the disease must be put on treatment rapidly and isolated from the rest of the community.”

“We are doing everything we can to treat the patients with dignity, whilst at the same time protecting the community and family from possible contamination,” says Férir.

The disease mainly spreads by direct contact with a patient’s blood, faeces or saliva.

The MSF team is therefore trying to minimise potentially dangerous contact between the patients and their families, whilst still maintaining family links.

They are also focusing on ‘contact tracing’, identifying people who have been in direct contact with Ebola patients and who could therefore have caught the disease.

“Our Ebola-specialist doctors go by foot from village to village in areas where there have been cases,” says Férir. “They trace people showing symptoms of the disease and bring them to the dedicated facilities for medical care.”

No specific treatment exists for Ebola, but medical care can reduce the symptoms, halt the development of the disease or reduce a patient’s suffering, says MSF.

MSF health promotion experts also inform the community about how the disease spreads and what steps to take to avoid contamination. “Above all, we must avoid widespread panic,” says Férir.

“That is why it is so important to spread correct information so people understand the disease and how to protect themselves.”

MSF has transported several tons of material by air, enabling the rapid set-up of isolation facilities and ensuring there are sufficient medical supplies and protective outfits for the teams to work through the coming weeks.

Although Sierra Leone’s Chief Medical Officer – Dr. Brima Kargbo, has declared that “Ebola is everyone’s business” there are doubts once again as to the preparedness of the ministry of health in dealing with this deadly disease.

And so too are the country’s members of parliament, who last week summoned the Chief Medical Officer to meet with the parliamentary committee for health, and answer questions about the country’s preparedness for the virus..

The people of Sierra Leone are not in any state of mass panic, but would like to know what steps the government is taking to ensure that lives are protected.

Whilst confirming that several people have died in neighbouring Guinea and Liberia, Dr. Kargbo sounded far too casual to inspire much needed confidence in the ministry of health’s capacity to deal with the disease.

And rather than taking his precautionary message to local communities across the country, Dr. Kargbo was giving lessons to MPs on how to avoid contracting Ebola.

This is what he told the MPs in parliament, hoping that they would follow his instructions:

– “Do not touch the wound of an infected person with unprotected hands

– “Avoid direct contact with body fluids like blood, saliva, vomits, stool and urine by wearing protective materials, like gloves and goggles.”

That was the Chief Medical Officer ‘appealing to the people of Sierra Leone through their elected parliamentary representatives, to report immediately to a health facility if they should experience a sudden fever, diarrhoea and vomiting; or have recently contacted wounds or body fluids of a suspected infected person’.

Rather than putting together a comprehensive Ebola education programme and lead the campaign across the country, Dr. kargbo also told MPs that they should take responsibility for educating their constituents about the Ebola outbreak and the necessary preventive measures.

Ebola may be everyone’s business, but passing on responsibility of educating the public about this deadly disease is nothing other than dereliction of duty by the country’s Chief Medical Officer.

He should be out in the villages and towns with his team, raising awareness and setting up the necessary infrastructure to save lives.

A highly experienced Sierra Leonean doctor in the UK has expressed concern about the seemingly unpreparedness and relaxed attitude of the ministry of health in Sierra Leone.

Speaking to the Sierra Leone Telegraph yesterday, this is what she said:

What is more alarming about this outbreak is that, it is the first time the Ebola virus has infected humans in West Africa.

It was first found in monkeys in Ivory Coast in 1994. However, the first known human contact in Africa was in Zaire in 1976 and then spread to Sudan. In 2007, there was an outbreak of the virus in Uganda.

The most deadly strain of the virus – the Zaire strain – is now in Guinea. The virus is known to be carried in bats, monkeys, chimpanzees and gorillas.

The most common transmitters are fruit bats, which drop partially eaten fruits and pulp and then animals such as monkeys feed on these fallen fruits.

The virus is passed on via the saliva to the monkeys. Any human then handling the carcass of these animals, is susceptible and can carry the virus – which is highly infectious.

The virus then spreads from human to human through eating infected meat, breathing in droplets of the virus; or the virus can enter the body through the lining of the eye or cuts on the hands etc.

The virus can also be transferred from person to person in mortuaries or during traditional burial ceremonies where dead bodies are handled without barrier techniques.

WHAT ARE THE PRESENTING SYMPTOMS AND SIGNS?

It starts suddenly with aches and pains, high temperature, lethargy, nausea and chest pains.

It can then develop to sore throat, cough and breathlessness. Some people have stomach pain, diarrhoea and vomiting.

At this stage, most people would think they have very bad ‘flu – like’ symptoms.

The illness then develops into severe headache, confusion, extreme lethargy or agitation, seizures (fits) and sometimes coma.

The disease can progress to haemorrhage (bleeding) which is a very poor prognostic sign.

They can bleed from the skin and have numerous red or dark spots or widespread bleeding beneath the skin.

They could also bleed from the mucous membranes e.g. coughing up blood, red eyes, bleeding from the vagina, nose, gums, or bleeding from any puncture site e.g. a needle stick area whilst putting up a drip or giving someone an injection.

HOW CAN IT BE PREVENTED?

The Ebola virus is highly infectious and also highly contagious.

Avoidance of:

eating bush meat or any meat which is known to be contaminated. Avoid direct contact with anyone who is thought to have the disease – as it is spread though the saliva, diarrhea, vomiting and blood.

Avoid eaten fallen fruits half eaten by bats.

It is imperative that these people are in hospital isolated and with full barrier nursing procedures in place.

Anyone who is in contact with the patient should wear disposable gloves, mask, goggles, gown and sterile footwear.

These should be worn just before going to see the patient and then discarded as soon as the room is exited. This goes for visitors, relatives and medical personnel.

When washing or embalming the dead body of someone known to have died from Ebola fever, the same procedures should be in place.

At home, their excretions, vomit, contaminated towels, bed sheets, eating utensils should be touched only with gloves and face mask on.

CAN IT BE TREATED?

There is no specific treatment for this disease. It is mainly supportive treatment, so give oral or intravenous fluids to prevent dehydration, blood thinners to prevent coagulation of the blood,oxygen if they are breathless, painkillers, and antibiotics to treat any other infections.

Sierra Leone is at definite risk mainly because in the villages, most people live in forested areas with poor transportation, weak healthcare structures and lack of information about the disease.