Ebola: 'Fear, denial and fatigue fuelling outbreak'

By Tulip Mazumdar
Global health reporter, Freetown

media captionObi Sesay says they must get the 'last hardcore' to 'take responsibility'

Health officials leading the fight against Ebola in Sierra Leone say fear, fatigue and denial are allowing the virus to continue to spread.

Cases had been falling sharply since the start of the year. But the decline has stalled and more than a year since the outbreak was first declared in Sierra Leone, new cases are still emerging every week.

The control room overseeing Sierra Leone's response to the Ebola outbreak is a former war crimes court building.

It is where national security forces, UN agencies and some British military personnel are trying to put an end to the worst public health emergency in modern times.

"We have not been successful in convincing a last hard core of the population to change their behaviour," said Obi Sesay, director of the National Ebola Response Centre.

"In the initial stages of the outbreak, we didn't need to find Ebola, it found us.

"At the second level we had people who self-identified because they listened to the Ebola messaging and they took precautions."

But he said a third "hard core group" is still extremely resistant.

image captionThree districts of Sierra Leone have consistently reported cases over the last couple of months

Driving through the capital, I notice much more traffic than during any of my previous trips when I was reporting from West Africa throughout the height of the outbreak. Traders are back out on the streets selling fruit and vegetables.

There are still lots of posters plastered everywhere, saying: "Call 117 if you get sick" and "A.B.C. AVOID BODY CONTACT".

Getting to Zero

Fourteen new cases of Ebola were reported in Sierra Leone last week, 10 of them in the capital Freetown.

Three districts in Sierra Leone - Kambia, Port Loko and Western Area Urban - have consistently reported cases over the last couple of months.

Dr John Redd, epidemiologist for the US Centers for Disease Control, said he expects the outbreak to limp on for some time.

"These last cases of a condition such as Ebola are very difficult to contain.

"We've seen that with other outbreaks as well. In the case of polio and smallpox, the end game in those epidemics has been very difficult."

image captionAs a sign of success, the main unit of the treatment centre has now closed
  • The British-built Kerry Town treatment centre opened on 5 November 2014
  • 92-bed capacity
  • Treated more than 450 patients
  • 67 NHS staff worked there
  • Taken over by private firm 30 June
  • Now decommissioned
  • Part of the UK's £427m aid package to Sierra Leone

But a major push to get to zero new cases, which started last month, does appear to be having some results in Port Loko.

The campaign has seen dusk-to-dawn curfews in some areas, and forensic house-to-house surveillance.

media captionA matron at Connaught Hospital believes people now "have confidence" in the National Ebola Response Centre

Camps have also been set up where "high risk contacts" are kept away from other people in their community for the three-week Ebola incubation period.

Authorities have also toughened up on enforcing controversial laws where patients refusing treatment, or families carrying out unsafe burials, can be fined or even jailed.

In the village of Kumrabai, almost 300 people were being monitored after the virus arrived there last month. An infected pregnant woman briefly stayed there.

image captionThe youngest of 46 people quarantined in five homes in her village is tested for symptoms

She later died, but she infected a teenager in the village who then met others in her community.

Now 46 people are in quarantine in five households. Their homes are cordoned off with orange plastic fencing.

UK-funded community volunteers visit each house twice a day for three weeks, checking for any potential symptoms of Ebola.

Anyone with three or more symptoms is taken to a treatment centre.

Abubakarr Kamara has been cooped up in his small home in the searing heat with 10 other family members for two weeks. He has another week of quarantine to go.

"I haven't been able to go to work on the farm.

"In the future, how am I going to feed my children?" he asked.

'Freedom seized'

Life in Sierra Leone remains at a standstill for many. Almost everyone lost someone they knew. Many more lost their livelihoods.

Emergency measures, such as restricted trading times and a ban on big public gatherings are still in place.

image captionMohamad Kamara believes he has buried about 1,000 people

Every single death that occurs in someone's home has to be treated as Ebola.

Bodies of Ebola patients are particularly toxic and with no fast diagnostic tests available to determine the cause of death quickly, this work will have to continue until the outbreak is over.

The teams are collecting 500 bodies a week. But they know the vast majority of deaths will not have been from Ebola.

image captionAny death at home has to be treated as an Ebola death even if it is unlikely the virus caused it

Nobody wants to take any chances though.

Mohamad Kamara is a trained engineer and Red Cross volunteer. He has been collecting bodies for 10 months now, and says he has buried about 1,000 bodies.

"It's really not easy to be conducting burials all the time, but that's the oath we take.

"We're not doing this job because we want to do it, we're doing it for society."

Away from all the biohazard gear and the constant smell of chlorine, some semblance of normality has returned to the capital, despite the current spike in cases there.

On the beachfront, music blares out from bars.

Young men play football and splash about in the water. Officially, these types of gatherings are banned in Sierra Leone.

I met Ayesha strolling along the seafront.

"My two older sisters died of Ebola," she told me.

"And one of their children also died."

Ayesha was kept in quarantine for three weeks after her sisters died.

image captionTough measures are needed to overcome the outbreak

"Life is rough for me right now," she said.

"We can't move forward, it feels like we're just moving back.

"Our freedom has been seized."

Back at the National Ebola Response Centre, Mr Sesay insists tough measures are needed to finally end the outbreak.

"We are winning the war, but it's not over."

"I know that a few months ago this was the sexy emergency. People's attention might have moved on but let's remember what we are doing is serving as first line of defence.

"If we don't beat it here we'll have to face it elsewhere."

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