Chaos and paralysis hampering the fight against Ebola in Sierra Leone

The Sierra Leone Telegraph: 27 August 2014

Ebola isolation ward being set upAs millions of dollars in private donations keep pouring into State House in Freetown, it is becoming more apparent that money may not necessarily solve the Ebola crisis, in an ever increasingly chaotic and uncoordinated environment.

There is serious confusion as to the powers, roles and functions of the plethora of agencies and bodies, who continue to get in each other’s way, as they struggle to tackle the common enemy – Ebola.

The presidential Ebola Task Force established a month ago by president Koroma does not have clear terms of reference. Yet there is the false impression that it is responsible for setting out and coordinating the practical actions, measures and rules of engagement for all the Ebola agencies – including the ministry of health.

The ministry of health and its beleaguered minister on the other hand, has long lost the confidence of the health workers and doctors.

Since the death of Dr. Khan, Dr. Modupe Cole and the dozens of nurses and ancillary staff, due to the failure of the ministry to behave responsibly towards its employees, there is now deep suspicion about the sincerity and capability of those running the ministry.

As one Sierra Leonean doctor wrote on social media two weeks ago; “We’re asking ourselves what was done for Dr. Cole. Was his treatment just left to MSF? What extra did the SLMDA and MOHS do to make sure we do not lose another doctor? Why should we continue fighting for a people if we’re not sure those that can, would fight for us when we need them? All these questions are being asked by us the junior doctors. We don’t want to be dead heroes today and forgotten heroes tomorrow. Who would take care of our kids or our old parents when we die? We’re feeling now like no one has our backs.”

There is real fear and panic among doctors and nurses in the country.

The international community have established what is known as the Ebola Emergency Operations Centre, with representatives drawn from the World Health Organization, UNICEF, the Ministry of Health and Sanitation, the Centre for Disease Control (CDC), Public Health England, MSF and DFID.

Other international agencies ploughing the crowded deadly Ebola field, include; the International Medical Corp (IMC), the International Red Cross, the World Food Programme, Action Aid and many others.

Ebola centre in GuineaBut the latest report of the ministry of health on the spread of the virus, paints a very grim reality on the ground, suggesting that despite the presence of almost every international health and humanitarian agency in Sierra Leone, Ebola is far from being controlled.

Yesterday, Tuesday 26 August 2014, the Ministry of Health and Sanitation Emergency Operations Centre reported that; the total number of cumulative confirmed deaths now stands at 355, with the   cumulative number of confirmed cases topping 955: Kailahun 440, Kenema 326; Kono 1; Kambia 1; Bombali 20; Tonkolili 13; Port Loko 57; Pujehun 7; Bo 35; Moyamba 9; Bonthe 1; Western Area Urban 30; Western Area Rural 15.

Yet amid this grim statistics, it is very easy to ignore the heart warming fact that 244 patients have so far survived the Ebola Virus and subsequently discharged.

The cumulative number of probable cases is 37 and probable deaths 37, while the total cumulative number of suspected cases is 58 and suspected deaths is 8 – all adding to a frustrating and worrying time for the people of Sierra Leone.

Another doctor – a Senegalese working for WHO has been declared Ebola positive, prompting the agency to pull its staff out of the Kailahun Ebola Treatment Centre yesterday.

In a statement Dr. Daniel Kertesz -the new WHO Representative in Sierra Leone, said that; “This was the responsible thing to do. The field team has been through a traumatic time through this incident.  They are exhausted from many weeks of heroic work, helping patients infected with Ebola. When you add a stressor like this, the risk of accidents increases.”

Health workers take blood samples for Ebola virus testing at a screening tent in the local government hospital in KenemaWHO says that it has sent a team to the town near the border with Guinea to do a review of the incident on the colleague who became infected, and try to determine how the health worker became infected, review the living and working environment of all the workers, try to identify factors that increase risk of infection, and address these issues.

“We recognize that this will interrupt the work in the field for the short term, but it ensures we protect health workers and help the community over the longer term,” says Dr Kertesz. “We are working rapidly to ensure we can return to the field as quickly as possible.”

Responding to this decision by WHO, Alex Bonapha – the chairman of Kailahun District Council wrote:

“The exodus of the WHO health team from Kailahun District has just taught me one big lesson today again. It shows that as a people our dependence on this foreign aid should be limited to finances.

“It is about time we developed our human resource within the health sector to enable them handle crises like this. Experience on the ground has shown us that they are no better than us in handling epidemiological issues. No matter what happens, our boots will continue to be on the ground.”

There is something very troubling about the chaotic and disjointed approach to managing the Ebola crisis in Sierra Leone. And that is the allegation of negative rivalry among some of the agencies working on the ground.

Ebola - president koroma with Un chief in presidentAs one of the country’s journalists commented yesterday; “There is huge rivalry between WHO and MSF. I’ve been speaking to stakeholders and I am appalled that there’s no national leadership to let these badly-needed organisations not toy with our welfare and wellbeing.”

But there are serious questions as to where leadership, authority, control and direction lie, in this chaotic fight against Ebola in Sierra Leone.

Is president Koroma in charge? Is the ministry of health in charge? Is the presidential Ebola Task Force in charge? Is the Ebola Emergency Operations Centre in charge? Is MSF in charge? Is WHO in charge?

Who is in charge of the overall coordination and direction of the Ebola war in Sierra Leone, no one knows.

“No one knows how the Senegalese on non-clinical duty in a high risk environment contracted the virus…. One thing that I see through this is that these so-called partners of the ministry of health (MOHS) may be taking critical unilateral actions and decisions on the ground, without consulting MOHS. And therefore it may not always be possible for MOHS to give the support that only Government can give.

“I think MoHS needs to review and reassert ground rules of engagement at this time, otherwise lives could be put at risk unnecessarily.  Just to close by stating that my understanding is that WHO has no clinical role out in the field, and so it is strange that one of theirs gets infected,” says one of Sierra Leone’s senior journalists yesterday.

United-Nations - logoLast week, the United Nations Resident Coordinator in Sierra Leone – David McLachlan-Karr said that his appeal for $18 million funding from the international community  is in support of the implementation of four main interventions: clinical management through the World Health Organization; social mobilization and awareness raising through UNICEF; surveillance and contact tracing of persons who may have come into contact with Ebola (UNFPA); and providing logistical support through the World Food Programme (WFP).

Is the UN office in Freetown going to grab the Ebola crisis by the scruff of the neck and provide the necessary coordination and direction, or will it also continue to sit on its hands while waiting for more funding to arrive?

At the conclusion of the Africa – US Summit in Washington last month, the World Bank was pleased to announce that it had secured $200 million to help fight Ebola in West Africa. It seemed then that money was no object.

Iraqi crisisBut three weeks on, and with over 1500 people dead in Guinea, Sierra Leone and Liberia, it is obvious the international community has failed to prioritise Ebola, as Western leaders step up their co-ordinated response to the political crisis in the Middle East, costing billions of dollars.

As president Koroma said rather unreassuringly two weeks ago; “I believe the international community should rise up to the occasion….I think we have made an appeal to the international community and we have taken the measures that we should take, but we still do not have much response and I am disappointed at them over the delays to respond to the situation.”

Perhaps Alex Bonapha – the chairman of Kailahun District Council, says it all, when he said:

“The exodus of the WHO health team from Kailahun District has just taught me one big lesson today again. It shows that as a people our dependence on this foreign aid should be limited to finances.

“It is about time we developed our own human resource within the health sector to enable them handle crises like this. Experience on the ground has shown us that they are no better than us in handling epidemiological issues. No matter what happens, our boots will continue to be on the ground.”

1 Comment

  1. A comedy of errors was dramatised by the national authorities at the outset (still continuing) and now the government is playing the blame game with the international community. At the outset of the disease, the government was plotting to sneak in the third term agenda for the presidency therefore their attention was not fully focussed where it should have been.

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