Ebola: 'Isn't that over yet?'
When I told people earlier this month that I was off to West Africa again to cover the Ebola outbreak, the resounding response was, "Isn't that over yet?"
The short answer is no, but there is a lot more to it than that.
The outbreak has been "nearly over" for months. So while "Ebola fatigue" is understandable, it's also potentially extremely dangerous.
There are still around 20-30 new cases a week in the three worst-affected countries.
Before this outbreak, those numbers would have constituted a major epidemic, but we live in very changed times.
At the height of the outbreak, West Africa was seeing hundreds of new infections a week.
But it only takes one new infection to spark a massive epidemic.
As you walk around Sierra Leone's capital Freetown, you feel the desperation of a city willing with all its might for the end to Ebola in its midst.
Emergency measures have been in place for over a year, which have included trade restrictions, overnight curfews and an "avoid body contact" policy.
Every death at home is presumed to be from Ebola, and that means people in biohazard suits turning up on grieving families' doorsteps to remove the bodies of their loved ones.
If you are suffering from Ebola fatigue, imagine what it's like for the millions of people living alongside this invisible killer, which appears to have made itself quite comfortable in West Africa.
Every other Ebola outbreak has lasted just a few months and has affected only a relatively small geographical area.
Before now, the biggest outbreak infected just over 300 people, killing around 280 in the Democratic Republic of Congo. This outbreak has so far claimed at least 11,284 lives.
Authorities have been able to stamp the virus out relatively quickly in past outbreaks by doing the following:
- Identifying all cases of Ebola, identifying all those who had close contact with those people
- Following those contacts for the 21-day incubation period of Ebola and
- Isolating anyone showing symptoms of the virus quickly so they don't infect anyone else.
The problem with this outbreak was that by the time the virus had been identified in the porous border region between Guinea, Sierra Leone and Liberia, Ebola had already started spreading on an unprecedented scale.
So why did no-one notice this earlier? Because no-one was looking.
Let's put all the criticism of the World Health Organization and other international agencies aside for a moment and look at the response in the three affected countries themselves.
West Africa had never seen Ebola before. But the three infected countries also didn't have the basic health systems in place to pick up on one of the world's deadliest diseases. Or the lab capacity to diagnose it.
The virus was confirmed only when samples were sent from Guinea to the the Pasteur Institute in France.
Sierra Leone only had 136 doctors caring for a population of 6 million before the outbreak struck, that's compared with around 233,000 licensed doctors in the UK looking after 64 million people.
There are very few hospitals outside urban areas.
If people are sick, they tend to travel short distances to see traditional healers, rather than attempt a difficult and expensive journey to the nearest health centre.
This was our team filming on a road in Gueckedou in south east Guinea where the outbreak started, imagine trying to get a desperately sick person to a hospital in that.
Since Ebola struck, the already weak health systems have been brought to their knees.
Hundreds of millions of pounds have been spent on dealing with the outbreak, when this disaster could have been avoided had similar amounts of money been put into strengthening health and surveillance systems.
That work is under way now. At a donors' conference earlier this month, countries pledged $3.4bn (£2.2bn) to build up health systems in all three countries, including £246m from the UK, which made one of the largest single pledges over the next two years.
No longer 'sexy'
We saw some of the money already pledged being put to use at Freetown's main hospital, Connaught Hospital.
A new infectious disease unit is being built, and a key focus among staff is effective infection prevention control.
No-one is allowed into the hospital until they have been screened for Ebola. Cleaners in protective gear patrol the wards with disinfectant.
The accident and emergency area, which was almost deserted when we visited the hospital in October due to fear of both patients and staff, is now bustling with people seeking treatment.
Hospitals that were deserted or had to close because patients and staff were too scared to attend are now welcoming people back.
But it is with 221 fewer health workers who died of Ebola in Sierra Leone.
Ebola death toll:
- Guinea: 3,783 cases, 2,512 deaths
- Liberia: 10,672 cases, 4,808 deaths
- Sierra Leone: 13,250 cases, 3,949 deaths
- Nigeria: 20 cases, eight deaths
World Health Organization figures up to 19 July
Fighting Ebola longer term isn't about medics in biohazard suits, or ploughing money into temporary treatment centres, all of which, as Sierra Leone's director of the Ebola Response put it to me, "makes a much sexier health emergency".
It's about the less exciting but more important and time-consuming strengthening of health systems, and that includes the very basics of building roads to get to health facilities and training the medics and community health workers to diagnose and treat people.
It's a daunting and expensive task, but it's crucial.
It would mean next time a deadly virus hits - and it is a question of when and not if - these countries will be strong enough to fight back.