''All that is necessary for the triumph of evil is that good men do nothing'' - Edmund Burke


S I E R R A  H E R A L D

Vol XI No 3

The tendency sometimes to protect perpetrators for the sake of peace...doesn't help society. Impunity should not be allowed to stand. - Kofi Annan on Waki report

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Saturday July 26, 2014 - The Ebola outbreak spreads death, chaos and confusion exposing the chaotic and rudderless ship that is Sierra Leone's health delivery system. Lead doctor in the fight against the scourge succumbs to the ravages of the pestilence as beasts of no nation try to make politics out of a terrible situation.The lead doctor in the fight against ebola Dr Khan contracted the disease. We wish him a speedy recovery.

Reports from Nigeria that a man from Liberia had died from a disease that is largely suspected to be the deadly ebola has got alarm bells ringing, not only in Lagos where the man died but in the whole of Nigeria and indeed the sub-region. It is a stark reminder about the warning from the World Health Organisation that until and unless the proper emergency health procedures are in place and quickly too, we are in for great trouble - a trouble that strikes even the most careful if our guard is down in the fight against the deadly ebola disease.

On the same day that the death of the Liberian was reported from Liberia, we also heard that the relations, community members and friends of one affected woman stormed a health facility in the capital Freetown and have had the suspected victim removed from the care of the health personnel who had been taking the necessary measures at isolating the suspected case.

The BBC's Tomi Oladipo has this report, part of which reads - "A hunt has been launched in Sierra Leone's capital, Freetown, for a woman with Ebola who was forcibly removed from hospital by her relatives. Radio stations around the country are appealing for help to find the 32-year-old who is being described as a "risk to all". She is the first Freetown resident to have tested positive for the virus. Meanwhile, Nigeria's health minister has confirmed that a Liberian man has died of Ebola in Lagos. According to the Reuters news agency, he collapsed on arrival in Lagos on Sunday and was taken from the airport and put in quarantine at a hospital in the Nigerian city.

On the hunt for the woman who fled from the health unit, the UK Guardian newspaper wrote - "Saudatu Koroma of 25 Old Railway Line, Brima Lane, Wellington," the announcement said. "She is a positive case and her being out there is a risk to all. We need the public to help us locate her." Koroma, 32, a resident of the densely populated Wellington district, had been admitted to an isolation ward while blood samples were tested for the virus, said Sidi Yahya Tunis, a health ministry spokesman. The results came back on Thursday. "The family of the patient stormed the hospital and forcefully removed her and took her away," Tunis said. "We are searching for her."

One article has put the finger squarely on why the battle against the scourge in Guinea, Liberia and Sierra Leone has been so difficult and frustrating -

"Fighting one of the world's deadliest diseases is straining the region's fragile health systems, while a lack of information and suspicion of medical staff has led many to shun treatment. Earlier this year, a man in Freetown tested positive for Ebola, although he is believed to have caught it elsewhere.

According to health ministry data and officials, dozens of people confirmed by laboratory tests to have Ebola are now unaccounted for in Sierra Leone, where the majority of cases have been recorded in the country's east. While international medical organisations have deployed experts to the field in an attempt to contain the outbreak, the World Health Organisation (WHO) said poor health infrastructure and a lack of personnel were hindering their efforts.

"We're seeing many of these facilities simply don't have enough people to provide the constant level of care needed," Paul Garwood, a WHO spokesman, told a news briefing in Geneva on Friday.

These are a number of key factors that are making it so difficult to fight the Ebola outbreak in Sierra Leone - 1. Ignorance about the viral infection as this is the first time it is affecting the sub-region.

2. The government health delivery facility is at best a rudderless and leaderless effort that needs all the best hands on deck and

3. The lack of respect for the confidentiality of patients by health workers who would use any and all opportunities to finger people they suspect could be showing symptoms of the disease.

"When ebola first struck Pujeh, a village deep in Sierra Leone’s forested interior region, residents did what they always do when a mysterious illness brings death: they consulted the traditional healer. But the elderly herbalist soon caught one of the world’s most contagious diseases, and then became a source for spreading it as visitors streamed in. By the time officials had pinpointed Pujeh as a hotspot for the disease months later, dozens had died.

“The people living in these areas said there’s no such thing as ebola,” said a district doctor who spoke on condition of anonymity. “They have their traditional beliefs and their traditional cures and they look up to their traditional leaders. Until we can bring the traditional leaders onside, it will be very difficult to convince them that ebola even exists.”

As the death toll from the latest outbreak of the world’s deadliest virus climbed to 467 – far exceeding the previous most lethal outbreak which killed 254 people in Congo – officials and health workers are battling a surge of infections propelled by misinformation and doubt about the disease’s existence on one side, and mistrust of scandal-hit governments on the other.

A doctor in Sierra Leone said patients’ families often attempted to break them out of treatment centres – often successfully. “Some of them are in denial and that it is something they can treat at home, and faith healers are one of the problems for us. When you have patients disappearing like that, you don’t know where the virus will appear next.”

In Sierra Leone as in the other two countries Liberia and Guinea, the lack of information coupled with distrust of officials has led to opinion leaders/the educated adding a worrying aspect to the fight and hence facilitating the spread of the disease -

"The disease has also revealed alarming mistrust between citizens and public office holders in a region with shocking corruption levels. Ebola was initially viewed as a government conspiracy to depopulate Sierra Leone’s Kailahun district, and fierce resistance to the arrival of health workers culminated in the stoning of a Doctors Without Borders vehicle. A nurse at the Kailahun MSF clinic all suited up for her work. We wish all of them well.

In Liberia, many remain adamant the outbreak is a hoax from government officials seeking to distract from a series of recent scandals, or for health officials to rake in public funds. “I will say this loud, the government of Liberia has come up with a new strategy to divert the Liberian people’s mind,” student Alfred Randall said. “We understand the issue of ebola, ebola is real, we agree the virus is a very terrible virus, but ebola is not in Liberia,” he said."

US public radio NPR has a story headlined - Rumor Patrol: No, A Snake In A Bag Did Not Cause Ebola -

"A lady had a snake in a bag. When somebody opened the bag, that made the lady die." That's the beginning of a story that Temba Morris often hears about the origins of Ebola.

Morris runs a government health clinic in a remote village near Sierra Leone's border with Guinea. According to the story, somebody else then looked inside the bag. "And the one who opened the bag also died," is what Morris hears next. The snake escaped into the Sierra Leone bush. So there you have it: Ebola is an evil snake that will kill you if you look at it.

The striking thing about this story, which is told and retold, is that Ebola really did come here from Guinea, and it currently is out of the bag. But narratives like this are a dangerous distraction when health officials are dealing with a virus that spreads by human-to-human contact — and a lack of knowledge about how to stay safe. In the remote north-eastern corner of Sierra Leone, dozens of new Ebola cases are being reported each week. As the virus spreads, so do rumors about the terrifying disease.

The first is that Ebola doesn't exist. Some say it's a ploy to extract money from the international aid agencies. Others say the people aren't dying from Ebola, they're dying from a curse. Then there are people who accept that it exists but have unorthodox ideas about how it got there. In the initial days, some people said it could spread through drinking water and mosquitoes.

Given that it kills the majority of the people who get infected, Ebola is scary enough. If you believe it's water- or mosquito-borne, it becomes almost overwhelmingly frightening.

The other central theme that pops up in many of the rumors about Ebola is that the white people brought it. A plague hits, and then a bunch of foreigners in spacesuits come and whisk away the corpses in shiny white body bags.

There have been stories that this is all a scheme to harvest organs from the locals. So when some people got sick, they fled to the forest or hid with relatives, making it more likely they'd infect others.

Some towns in Guinea have refused to allow any foreign health workers to enter at all. Dr. Tim Jagatic of Doctors Without Borders says the misperceptions are understandable:

"We created a hospital, and a lot of people started to get sick and die. It's very difficult for them to make a connection that we are here to help." Winning the communications battle is critical, he says: "The most effective way for us to be able to end this epidemic is to focus on public health measures. It is learning about how this disease is transmitted, increasing the level of hygiene amongst the people in the villages, demystifying and de-stigmatizing this disease.

"Officials and several hundred researchers who have poured into all three countries have scrambled to disseminate public information, seen as key to containment. But when the outbreak first began, popular text messages circulating in Guinea said an antidote could be found in a concoction of hot chocolate, coffee, milk, raw onions and sugar.

“Ebola, ebola, ebola. I hear it everywhere,” said Adama Sherry from behind her market stall in Sierra Leone’s Tombo, a fishing village as yet unaffected by the virus. Sherry admitted she couldn’t list the symptoms, causes or precautions. Nearby, a local school had recently emptied out when word spread of routine blood tests being carried out – rumour had it that the needles would infect children with ebola.

Liberia’s health ministry has begun putting images of ebola-ravaged corpses in newspapers and on television. “They are very graphic but it is working – people are starting to see that ebola is not just a spiritual thing that you can cure through going to church,” Nyenswah, the deputy chief medical officer, said.

Ironically, survivors often face a “second disease” of stigmatisation. Aissata Bangoura’s family have refused to speak to her since her husband died in March, even though she has been declared virus-free. “During my husband’s wake, I was left standing by myself. People I have known my whole life didn’t want to approach me. As far as they’re concerned, I’m a widow and a leper,” she said.

It took some time for the public to appreciate the effects of cholera and what can lead to devastating consequences as it is with all disease outbreaks that are "new" and now having had to cope with that outbreak. The ebola outbreak would appear to be quite a handful as ignorance forces many to reassure themselves, without any medical logic, about ebola and how it can be "cured" not knowing that there's no cure. This is not helped by an uncaring government led by a rat whose sole interest lies in how much he and his cronies can harvest from the misfortunes of the population.

In the centre of all this confusion and lack of direction has been the news that the lead doctor in this fight Dr Shek Umar Kahn has also been laid low after he contracted ebola while caring for the hundreds of our unfortunate colleagues. Latest reports say he appears to be pulling through as he would no doubt be trying to work out where he could have got it wrong.

Reports that he was infected while working at the government-equipped and run Kenema hospital has not come as a surprise to many who have been watching the unfolding deadly drama in the country. Indeed health workers engaged in the fight went on strike at the Kenema hospital when at least three of their colleagues died from ebola and the fact that Dr Kahn was removed from the Kenema centre to the MSF-run Kailahun centre speaks volumes of the government health delivery system.

There lies another angle the government would not want to admit - that the Kenema hospital facility is just not up to scratch and the facilities in place are just not adequate to help health workers and those in isolation from spreading the disease. Reports talk of proper care and discipline in Kailahun as MSF tries to educate, inform and calm down a people who had never experienced such an outbreak and it would not be surprising to hear of the mushrooming of house to house "doctors" claiming to have a cure for ebola in the hope of making money.

The government for its part has been making quite a lot of unimpressive noises with even missions abroad claiming to be fighting ebola in Sierra Leone while in reality the outbreak is been used as an opportunity to showcase just how the uncaring cabal headed by the corrupt rat cares.

Exploitative companies raking in profits from the backs of the country's resources have also stepped in - using it as a photo opportunity to placate a gullible public about how they care - never mind the devastation of the environment in the wake of their exploitative resource-thieving activities.

Kindly take a second look at what we carried on our pages after the 2012 audit report dealing with health delivery and other issues was published. These excerpts highlight a tip of what is wrong with the government health delivery system that the rat and those who feed fat from his droppings would rather have covered as they sing praises to the smoke and mirrors rat on how he is the best beast for Sierra Leone.

8.23.6. Reagents And Other Working Instruments Not Supplied To The Laboratory And Dental Units

Reagents and instruments needed for the running of the laboratory and the dental units were not supplied to the units. It was recommended that reagents and consumables should be made available to those units for the effective execution of their work and that the Hospital Care Manager must provide documentary evidence on why reagents and consumables were not provided to those units. It was also recommended that the processing tank in the X-ray unit should be replaced within thirty days of the receipt of the report.

8.24.2. No Strict Internal Medical Waste Control System The rat - pondering his next move to stay in power and steal more of the peoples' wealth as ebola ravages the country

Even though several recommendations had been made in the past for the Hospital Management to institute written guidelines regarding the management of medical waste, no such action was taken. It was also noted with dismay that in some instances medical waste (Including sharp object and used needles) were not separated from the general waste that was eventually transported to a general dumping site. Furthermore, there was a garbage dumping spot closer to the Hospital premises designated for the transfer of rubbish, even though, the Hospital through the Freetown City Council, was paying the Freetown Waste Management Company, a total amount of Le 3,000,000 per month for the clearing and transfer of rubbish to the general dumping site. In order to prevent the spread of communicable diseases and to mitigate the risk associated with medical waste, it was recommended that the Hospital Management should make every effort to develop an internal Medical Waste Management Policy. Such a policy would address issues relating to the identification of the various forms of waste, the storage, transporting and the risks associated with medical waste which would will have the benefit of ensuring that all the concerned parties were aware of the cause of action to take when dealing with waste.

The Medical Charity MSF has what it calls - Operational Update on the outbreak in West Africa dated July 24 - "As the Ebola outbreak continues to spread, with 1,093 cases and 660 deaths now reported across west Africa, MSF is stepping up its response in the most affected areas.

While the number of cases in Guinea has declined significantly, in neighbouring Sierra Leone and Liberia, more and more people are being infected with the virus. With resources already stretched, health authorities and international organisations are struggling to bring the outbreak under control.

In the past three weeks, MSF has trained more than 200 community health workers to deliver essential health messages to people in their villages about how to protect themselves against Ebola and what action to take if someone shows any signs or symptoms of the disease.

MSF will now focus its efforts on halting the spread of the disease in the area straddling the border between Sierra Leone, Guinea and Liberia borders, where the population is very mobile and people continue to transmit the disease to different villages. The team will scale up its health promotion and outreach activities in the villages in this area, and reinforce the alert system so that any new suspected cases can be identified promptly and transferred in MSF’s ambulance to Kailahun for treatment."

Our thoughts are with the relations of those who have died not knowing what ebola is all about as well as those battling the symptoms in the hope that they will be among the lucky ones to recover from the incurable affliction. We salute the frontline health workers who put their lives at risk every day, every hour, every minute, every second and every moment. They mourn colleagues who have died but still continue their work in the hope that they would be able to contain the contagion.

We salute you all and wish you well.

Yearning for the mother country?

The right choice is Kevin McPhilips Travel

©Sierra Herald 2002