The bitter Ebola pill president Koroma must now swallow

The Sierra Leone Telegraph: 30 August 2014

The latest unconfirmed report of the death of another Sierra Leonean doctor in Kenema; and health workers going on strike, due to lack of pay and unavailability of protective wear; and stories of a body found lying early this week on a street in the Western area of Freetown; as well as the number of confirmed Ebola cases in the last two days estimated at 40, sadly suggest that the government is still struggling to get on top of this crisis.

Whilst the sacking of the health minister is welcomed, it is obvious now that lack of leadership is just the tip of the iceberg.

The ever increasing problem of logistics, transportation, contact tracing, tracking of suspected cases, feeding of those quarantined – suspected of ebola or otherwise, and the difficulties of managing the isolation and treatment centres, are now becoming a nightmare for the government.

Yesterday’s restructuring of the Ebola Emergency Operation centre in Freetown and the expansion of the Ebola ministerial committee, will do very little in solving the complex organisational and multi-faceted issues that are emerging, across every district in the country, except Koinadugu.

Something fundamental has to change. WHO must now be given full and unfettered responsibility for managing the Ebola crisis in Sierra Leone, as part of an overall West Africa Strategy.

In Freetown, there is only one ambulance that is traversing the entire stretch of the capital.

Apart from the handful of doctors and nurses that are still risking their lives with inadequate protective wear, there are very few trained paramedics on standby to attend emergencies.

Citizens are personally responsible for transporting their loved ones judged to be emergency cases to Connaught hospital – assuming they are brave enough to do so, without risking the very high probability of having the patient taken to far away Kenema or Kailahun.

There are doubts as to the effectiveness of the new Public Health Law, which imposes custodial sentence on anyone believed to be harbouring a suspected Ebola patient.

But how would Pa Sorie who lives in a remote village in Freetown, be able to make that all important obligatory assessment as to whether his wife Fatmata, who has been burning with fever all night and vomiting, has got Ebola, in order to avoid being arrested under the new Law?

In a country where more than 80% of the population are either prone or susceptible to malaria and gastro-intestinal virus, due to poor sanitation and hygiene, it is not uncommon for most Sierra Leoneans to frequently present with some – if not all of the early stage Ebola symptoms.

Nevertheless, the new Public Health Law makes it mandatory for all citizens including Pa Sorie, to refer anyone whom they suspect of carrying the Ebola virus to the authorities, or face two years in jail.

While such tough measures have some merit in some circumstances, especially where Ebola-like symptoms are rare, it is obviously clear that the government must now prepare itself to building more prisons to accommodate the huge number of anticipated defaulters of this Law.

And in a country with 30% literacy, trying to use a hammer to crack a monkey nut is unwise.

The new Public Health Law does not make provision for the imposition of sanctions on those that are maliciously reporting suspected Ebola cases, as in some parts of the country, is now becoming an all too familiar occurrence.

To add to Pa Sorie’s wife’s complex health condition, she also suffers from diabetes, heart disease, blood pressure, low viral immunity, and sickle cell.

A very high percentage of people in Sierra Leone are invariably sufferers of these multiple conditions, apart from malaria, and are now vulnerable to Ebola.

Since gaining independence in 1961, healthcare in Sierra Leone has been delivered through secondary and community health services – hospitals and local centres.

Hence, the alarming absence of an organised, well resourced and coordinated primary care service, acting as a buffer between patients and secondary care services, continues to expose government’s inability to look after the sick and promote the wellbeing of its citizens.

Daily Global media reports of countries like Sierra Leone unable to cope with Ebola, because of poor health care systems that have now been overwhelmed, are truly becoming nauseating.

When president Koroma took office in 2007, he knew that the health care system in Sierra Leone was rated as one of the worst in Africa, and desperately in need of restructuring and funding.

What did the president do to solve this basic human problem?

The government with the help of the international community, created further pressure on the already broken healthcare system, by introducing the Free Healthcare Programme.

By whipping up demand for more hospital beds, doctors, nurses, medicines and equipment, the country’s healthcare system simply crumbled under the weight.

In response to the rising demand, the government went cap in hand to other countries for help.

The number of Sierra Leonean doctors, nurses, paramedics, and other health specialists, has not kept up with demand; nor has there been any appreciable growth in the number of new hospitals and community health centres since 2005.

Resultantly, each time there is an epidemic of some sort in Sierra Leone – be it cholera, typhoid, and now Ebola, thousands die and many more are left scarred by disease for the rest of their lives.

According to the latest WHO report, over 20,000 people will contract Ebola in West Africa before 2015.

And there is little doubt, with the current appalling efforts at managing the Ebola crisis in Sierra Leone, the number of Ebola victims is likely to rise to 5,000 by January next year.

But it need not happen this way, if only the Koroma government that has proved itself to be ineffective in dealing with the crisis, to simply step aside and allow the WHO to take full and unfettered responsibility for managing the Ebola crisis in Sierra Leone, as part of a West Africa wide strategy.

Yesterday’s announcement by president Koroma to restructure and swap people around is only prolonging the agony and muddying the already murky waters.

What is needed is a completely new organisational and management approach to this crisis, which must include the following:

1. The ministry of health reporting to the WHO office in Freetown
2. The disbandment of the Presidential Ebola Task Force
3. WHO forming a new National Ebola Crisis Management Board, comprising of the minister of health, three senior doctors, the Inspector General of Police and the Army Chief of Staff
4. All Ebola funds – existing and new will be managed by WHO
5. All doctors in Sierra Leone, nurses, and health ancillary staff – including Ebola burial teams will be employed and controlled by WHO
6. All Ebola transports and logistics will be controlled and managed by WHO
7. All Ebola treatment Centres and hospital wards will be financed and managed by WHO
8. WHO will be responsible for budgetary planning and spending, including the procurement and supply of personnel, materials, ambulances, medicines and equipment needed to combat the virus
9.  WHO will co-ordinate the activities of all health agencies working on the ground, including MSF, IRC, etc
10.  WHO will be responsible to the parliament of Sierra Leone, where the WHO country director will deliver weekly progress reports to parliamentarians – financial, number of cases, etc
11.  All persons involved in the Ebola crisis, including doctors and nurses will wear clearly marked WHO uniforms

On Thursday, the African Development Bank announced funding of $60 million for Sierra Leone, Liberia and Guinea to help combat the disease. WHO itself has now secured over $300 million for this purpose.

So far, it is estimated that president Koroma has collected about $10 million from private and public donations for the Ebola crisis. This money should now be handed over to WHO.

The decision by president Koroma to hand over full responsibility to WHO for managing the Ebola crisis, as proposed above, is a necessary and magnanimous policy decision, which should then release the government to focus on the huge challenge of turning the fast declining economy around.

President Koroma may find this Ebola pill rather bitter to swallow, but it is necessary, if the Ebola virus is to be eradicated from Sierra Leone.

This pill must also be taken by Ellen Sirleaf of Liberia and Alpha Conde of Guinea, as part of the new West Africa wide Ebola strategy.