Cases of Ebola were first confirmed in the east of Sierra Leone, near the border with Guinea, at the end of May.
Even before the Ebola outbreak, people in Sierra Leone had limited access to medical care and the health system was both under-resourced and overburdened. Médecins Sans Frontières (MSF) was working in the country at Gondama, near the city of Bo, running an emergency paediatric and maternity hospital as well as a midwifery clinic in response to the devastating levels of maternal and infant mortality in the country.
When the first cases of Ebola were confirmed in Sierra Leone, the Ministry of Health asked MSF to intervene. Teams opened an Ebola management centre (EMC) on the outskirts of Kailahun town on 26 June, where testing and care was available for those people suspected of having the virus. MSF teams also launched outreach, health promotion and disease surveillance activities, and trained local health staff. Community health workers were trained to deliver messages about how people could protect themselves from Ebola and what to do if they showed signs or symptoms of the disease. An MSF psychologist provided support to patients and to families who had lost loved ones. As the virus quickly spread across the country, patients arrived by ambulance from locations up to 10 hours away. The EMC had a maximum capacity of 100 beds. In addition, MSF constructed a small maternity unit in October where pregnant Ebola patients could receive specialised care within the high-risk zone.
Bo, Southern Province
In September, MSF opened a second EMC five kilometres outside Bo, which was more easily accessible from most parts of the country. The centre was extended to accommodate 104 beds. MSF teams carried out outreach, health promotion and surveillance activities, trained local health staff and offered support to the Ministry of Health’s activities.
Also in Bo, MSF launched a third Ebola project focused on offering specific, structured and targeted training for other organisations to enable them run EMCs safely. The training sessions took place in MSF facilities or in those of the other NGOs to help them start activities. In total six other organisations were trained.
In early December, as health facilities in the country’s capital, Freetown, became overwhelmed, MSF opened an EMC in the centrally located Prince of Wales secondary school. There were 30 individual rooms for suspected Ebola cases and 70 beds. A new design was used which meant that the intensive care ward could be viewed through Plexiglas and patients could therefore be better monitored by staff who did not have to wear protective gear.
MSF started conducting outreach, health promotion and surveillance activities in nine sub-districts of Freetown to support the government coordination body, National Ebola Response Centre (NERC), in mapping and following up on Ebola contacts. Epidemiologists visited the areas and had daily meetings with staff from the World Health Organization, the Ministry of Health and the NERC to support the response system and help where possible. Teams also provided training on disinfecting houses.
Magburaka, Northern Province
On 15 December, MSF opened a fourth EMC in Magburaka, Tonkolili district, again, with critical complementary activities including outreach, health promotion, surveillance and training of local health staff. A rapid response team was established in Magburaka to be deployed quickly wherever new cases appeared in the country.
Infection control issues, and antimalarial distributions
Many Sierra Leonean health staff on the frontline of the outbreak were infected as a result of caring for patients, because they lacked the necessary protective gear and knowledge about the transmission of the disease. Up to 10 per cent of local health workers are estimated to have died, leaving government health facilities with even fewer staff than before the epidemic and unable to cope.
In October, MSF suspended its obstetric and paediatric projects in Gondama. Due to the strain on resources as a result of responding to the Ebola outbreak, MSF could not guarantee the extremely high quality of medical care needed to treat patients or the protection of its staff from Ebola infection.
Meanwhile, women suffering complications in childbirth and people sick with malaria and other diseases were reluctant to seek care at government hospitals for fear of contracting Ebola, and untold numbers of people are thought to have died from non-Ebola-related diseases in 2014. In December, to address the threat of malaria and to avoid confusion with Ebola due the similarity of initial symptoms, MSF recruited and trained some 6,000 volunteers to carry out a four-day, door-to-door distribution of antimalarial treatments in partnership with the Ministry of Health. Some 1.5 million people in the Freetown area were reached. Another distribution campaign was carried out in January 2015.
Patricia Carrick – MSF nurse
The woman’s upper body was curved around one middle bed leg, her legs wedged around the opposite middle bed leg, her lower legs and feet protruding from under one side of the bed, her face from the other, staring up into a blank nothing, her mouth stretched wide, the desperate death-mask I am coming to recognise. She was still breathing but could not respond, even to moan.
Despite training in Brussels, briefing in Freetown and Bo and Kailahun, an ever-increasing pile of tales of misery, and my own past experience, I admit I was dumbfounded. I began to reach toward her and realised there was nothing, nothing to be done. I turned to Konneh stupidly and, bless him, even from within the depths of my PPE (personal protective equipment) and his, he had the compassion to say it to me in words – "We cannot do anything for her, Patricia." We could not move her, lift her – we could not even wrest her from under the bed. We had no proper equipment, we had limited time and energy; we had come for other tasks, the discharge of survivors.
To read more, visit blogs.msf.org/patricia