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Philippe translates Julias articles to English language so that more people can have access to her reports and information.

Prevention is the key

Its a challenge to find the right tone for criticism. Ebola has lead to an exceptional situation. No one, no NGO, no government was prepared for the strong outbreak. All do what they can. Everyone here is overwrought. Sometimes I am still annoyed when I see where money goes.

I mentioned it already: Money that flows into treating of Ebola patients, saves one life. Money that flows into the prevention of Ebola, saves many lives. Still more money goes into the treatment, as this current UN-graph shows:

Financial Requests for Ebola Response to UNMEER
Quelle: Financial Requests for Ebola Response to UNMEER

An example that made me indignant comes from USAID. In a „Innovation-Competition for new approaches and ideas in the Ebola response a project has won which has developed a new type of protective suit for medical personnel! With all sympathy and admiration for all doctors and nurses who take part in the fight against Ebola within a life-threatening situation: A new protective suit will never end the outbreak! That is a bit of faith- wearing a life jacket could prevent a ship from sinking.

I think this is airy and generally a fail. The aim must be to suppress contagion to 100%. My friend and co-editor of this blog Rene asked me what it would cost to impose quarantine in Sierra Leone for three weeks. Schools and universities are closed anyway. Many people have lost their jobs. Why not declare a general curfew for three weeks. Nobody leaves their living space except medical personnel and police officers. In a country where the majority of the population makes less than 1.25 US dollars a day, a 21-day curfew with full supply should not cost that much actually. Approximately 6 million people live in Sierra Leone, so we are talking about an amount of less than 200 million US dollars. To date 1.9 trillion US dollars were spent.
I think the logistical coordination might be complicated, some measures may be impractical. It is hardly possible to control a whole country from one day to the next. I previously worked in North Korea. So I know a bit about surveillance. And there will be still the issues that the Welthungerhilfe encounters already: drinking and household water, waste disposal, common toilets for entire streets etc. pp.

Of course, I have no solution. But there is one thing I am sure of: Prevention is the key in the fight against Ebola.

This article is a translation of Julia’s original article in German language.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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101°F fever without Ebola

During preparation time in Germany my colleagues and me made jokes about what actually happens when you get an ordinary flu during the Ebola period in Sierra Leone. I had the honor to experience it quicker than I had preferred.

After less than two weeks in the country I suddenly felt tired. I could not sleep that night, feeling alternation of too hot and too cold. Before regular taking temperature in the morning it was obvious that I was sick. 101°F at the ear. What now?! Temperature is taken at each corner: At the hotel entrance, at the office entrance, at checkpoints throughout the city, in restaurants. Fortunately it was Sunday and I could remain on the hotel premises.

Luckily there is a simple way to find out if it is a common cold or something more serious: Paracetamol. If it is effective,  Malaria and Ebola can be excluded as a cause. And it helped. I was actually not particularly worried because I know my body and I know that I catch a cold very quickly if air conditioning is present. Nevertheless, of course, people will be wary about every small detail. Itchy skin? Can Ebola cause skin rash? And what is that, bleeding gums? Does it stop soon or is it extraordinary? Nobody stays cool under those conditions.

Good advice we got at the training in Bonn: Definitely take Malaria prophylaxis. The symptoms of Malaria and Ebola are similar at the beginning, and especially newcomers can not avoid all mosquito bites. Personally, I have decided to take Lariam and had no side effects so far (Lariam is known for psycho-activity, nightmares, depression and even suicidal attempts are not unknown).

Meanwhile, my cold is as good as gone. But I want to avoid further fever incidents if possible. It was not a glorious time.

This article is a translation of Julia’s original article in German language.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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Safe and dignified burials

Much is heard these days in Sierra Leone of so-called safe and dignified burials for Ebola victims. But what exactly is it?

First, which procedure was customary in Sierra Leone before Ebola? According to religious affiliation this may vary. The majority of people belong to the Islam, the second largest group are Christians. Common is that the farewell of deceased takes place within the family circle and includes the ceremony of washing the dead. The washing ceremony is perceived as an essential part of a proper burial.

At the beginning of the Ebola crisis, safety issues were taken radically more serious than the sentience of the local population. If Ebola patients died in treatment centers they were enfolded with two layers of plastic and buried quickly. The family was informed by phone after everything had been done. The relatives had no chance to see their loved ones. A traumatic experience.

By now this approach has been reconsidered. Notably the IFRC developed the concept of the safe and dignified burial and organizes burials in many parts of the country. After the death of a patient or if a person is found dead at home, s/he will be, unfortunately there is no other way, still be wrapped in two layers of plastic. But then follows a funeral rite in which a priest / Iman and the relatives can participate. There is a safety zone of 5m and the family will see the deceased only covered. But at least they can take part. The German website Gemeinsam für Afrika wrote the following about it:

Even a few months ago chaotic scenes took place in Sierra Leone on such occasions. Many relatives wanted their Ebola-dead not to be put into plastic bags and been taken away. Again and again the police came with tear gas. Meanwhile, the widespread education about Ebola via radio, street theater, house-to-house visits and poster campaigns shows more and more impact. People are increasingly willing to seek help. Auxiliary services such as grief assistants give them the opportunity to tie in traditions without putting themselves at risk. Information on this service are spread amongst others through the district administrations and their healthcare teams.

Nevertheless opinions are divided whether these are dignified burial conditions or not. There is a great social pressure in the communities: If a wife does not mourn loudly over her deceased husband or her deceased children, hugging and washing them, people may start talking bad about her. Grief must be publicly celebrated, if one does not want to lose his reputation as loyal family member.

Such deep-seated behaviors can not be changed overnight, no matter how long one appeals to sanity. Meanwhile, even the country’s president has called the population via television to suspend traditions and reintegrate them into everyday life not before the Ebola epidemic is gone. Unfortunately, I still hear almost on a daily basis of cases in which the dead were washed.

This article is a translation of Julias original article in German language.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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Greater Ebola infection risk for women?

A discussion on Twitter has made me pursue the question if women and men have a different risk of contracting Ebola. Already previously I had heard various theories. One said, for example, that women in West Africa have traditionally the role of being the care-giver within the family.

A Sierra Leonean colleague told me that if she herself would become sick, she has to rely on the mother of her husband. Her husband would not even participate in the care. This seems to indicate that women have to bear a greater risk. Additionally children are also associated usually stronger with mothers. If a child gets Ebola the mother is exposed to a high risk. The UN, for example, already integrated a gender-sensitive approach in their fight against Ebola.

But what do statistics say? Ugochi Daniels from UNFPA (United Nations Population Fund) said on Ebola Deeply, that the mortality rate of pregnant women suffering from Ebola is extremely high: 90%.
This means that a pregnant woman suffering from Ebola is practically sentenced to death  together with her unborn child. Overall the rate is at 70%.

The WHO Ebola response team, however, has in the last published report found no evidence that women do have a lesser survival rate than men. 51% of confirmed and probable cases of Ebola were male, 52% of the fatal cases were male, and 49% of the convalescent cases. Thus, the statistics show: Ebola is encouragingly gender-balanced.

I do not want to say that therefore possibly special needs of women should be ignored in the Ebola-Response. Pregnant women and mothers should get special attention, in my view, because their survival is directly linked with the life of two people. Nevertheless, the figures show that we have to look exactly on the cases if we want to fight Ebola. We should not act on assumptions even if it sounds tempting for a NGO to focus on the supposedly vulnerable group of the female half of the population.

This article is a translation of Julias original article in German language.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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Rescued and forgotten?

By now there are several thousand people which have been cured from Ebola and have been released from hospitals. Here they are called survivors. But how does the live of a survivor proceed?

Survivor Abie Forna, age 35, with her husband
Survivor Abie Forna, age 35, with her husband By User:JuliaBroska [CC BY-SA 4.0], via Wikimedia Commons

At the moment of leaving the hospital they should obtain an official certificate which states they are healthy. Additionally they should receive a packet with vitamins and medicine to strengthen their body. At least in theory. Personally I have met survivors which did not receive any of the above. Often they still have been very weak. I do not know how much time it will take to completely recover. This will probably also depend from various things such as the individual constitution of the patient, age, history of diseases, and more… In fact I have even heard that for a healthy person who receives quick help the chances of surviving Ebola are not so bad after all. Since in many cases the victims are poor, living in precarious hygienic conditions and often were not previously in good health, even quick help will not be enough.

In addition survivors often return to very difficult family relationships. Often other family members are ill or even dead. Frequently that includes the head of household and breadwinner. Families were also at least 21 days under quarantine and have consequentially lost all their earnings. Theoretically also post-quarantine households should receive a supportive food package but so far it seems to happen only on rare occasions. And from a food package alone people will not get a new job.

According to the NGO „Médecins sans Frontières‘ (MSF) about 30 people have survived the infection by the Ebola Virus in Guinea. They try to keep themselves and their fate in the background. Because if their story would be known, they and their families would face exclusion, expulsion and attacks.

In short, the survivors are celebrated as heroes on paper but in practice they are abandoned. A few local NGOs have taken initiatives to involve survivors in awareness campaigns. I welcome this very good initiatives personally. Rene raised the question during an interview with me if survivors are immune to Ebola. Meanwhile, I have the answer: Yes, they are immune! This means there is great potential to involve survivors in nursing care.

Happy are those who have defeated the aggressive and dangerous viral disease without serum. Among them the willingness is great to help others, so Charbonneau. This is especially true for people who have some form of a medical background. „These people are very interested to contribute their knowledge and communicate. This is a very big opportunity, „says Charbonneau. „You could, for example, help orphans or children who are still in hospitals and are under quarantine.

The Welthungerhilfe has launched its first project which involves the reintegration of survivors funded by the german Federal Ministry for Economic Cooperation and Development. They deserve better than to be forgotten.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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So what actually is the problem?

I wish there would be an easy answer to that question. An answer that I could give to both sides. To people in Germany who are wondering why the Ebola epidemic now remains undefeated for months. And to the people of Sierra Leone in particular. A simple answer that can be conveyed in a sentence.

But this answer does not exist. The problem is too complex . Actually, everything in the combination of „Extreme poverty – Ebola – West Africa“ is a problem. Just to give a few clues here is my brainstorm:

The number of trained Sierra Leonean doctors is tiny ( I guess less than 50 nationwide ) . The hygienic conditions are bad, many people share simple toilet facilities. At the beginning of the outbreak people did not believe the government as the relationship between government and people is bad, there is no trust. There are too few foreign doctors willing to come. The German media describe Ebola as uncontrollable, which is wrong and only stokes fear. Sierra Leone is a high risk country for malaria. Ebola initially has the same symptoms as malaria and is therefore often denied. Local burial rituals include the washing of the dead, which is an activity that puts family members at high risk contracting Ebola as well. The local culture is strongly related to body contact, the people are very close to each other. In Sierra Leone, guests will never be rejected, the people are very hospitable. The international reaction came too late and too slow. Too many NGOs and UN organizations are circling around coordination, while at the bottom little is going on. Too many resources go into treatment rather than primarily focusing on prevention and containing the spreading of Ebola. This problem is actually well known from HIV. See William Easterly

„The White Man’s Burden“

There were unfortunately a number of other disasters this year, additional to Ebola, so the media interest was quickly gone.

That is what I think in 5 minutes after a month of working in Sierra Leone. Once again the fair question rises what the individual can do, yes, what a single NGO can reach.
But there is fortunately a simple answer: Damn much.

For four weeks I worked every single day as project administrator for the German Welthungerhilfe in Freetown. The administrative effort for donations and donor funds, as for instance money from the German government, is enormous.

Welthungerhilfe brings food packets to the people affected by Ebola in John Obey in Sierra Leone. By User:JuliaBroska [CC BY-SA 4.0], via Wikimedia Commons

To put the local auxiliaries in a position to provide locally soap, chlorine, educational materials, food packages for households under quarantine, we need to capture every single step in writing.  We are just starting a project in which 33,000 household kits will be distributed. This means 33,000 signed delivery notes. In the end, everything has to fit together: it must have been bought exactly what has arrived at the warehouse. The same number of household kits must leave the warehouse as reaches the local beneficiaries. Sometimes I wonder if that is part of the solution or part of the problem. But all that has emerged from the debate about accountability of humanitarian aid. But that is another story that I will tell another time.

This article is an English translation of Julias original article in German language.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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Your home is your prison

People within households with a confirmed Ebola case must not leave their house for 21 days. That is the Ebola incubation period. Only if no other household member becomes ill within 21 days, all will be able to breathe a sigh of relief.

I want you to imagine that. 21 days inside the house. Day and night. Together with the whole family, mostly confined space. The house is marked with a ribbon, this line must not passed by anyone, neither from inside, nor from outside.

  • What do you eat?
  • What do you drink?
  • How do you buy coffee, cigarettes, mobile top-up?
  • How do you get water to wash clothes?
  • Where do you get charcoal for cooking?
  • And most importantly – How can you earn your living?

photo by User:JuliaBroska [CC BY-SA 4.0], via Wikimedia Commons
Local resident in quarantine.
By User:JuliaBroska [CC BY-SA 4.0], via Wikimedia Commons
At the beginning of the Ebola epidemic it was the government’s strategy, to put entire villages under quarantine. The villages were completely sealed off from outside, but the villagers were able to move freely within the village. The result: An extremely high rate of infection within entire communities. A single case of Ebola could lead to the death of two-digit numbers of villagers. The Welthungerhilfe objected to it in the first place and campaigned for household quarantine. The advantage is that a small group of actual contact persons cannot infect a whole village. The disadvantage is that it is much more costly to identify and seal off individuals. Nevertheless, otherwise it will not work.

We bring a package of food, drinking water and hygiene products to each family in quarantine every week. Neighbours have an integral part in the success of the quarantine period as they have to care for everything else. Money and goods are put on the red line. Three meters back from the line is the safety gap for every interchange. Sometimes I wonder how that would work actually in Germany. Amazon would probably would make the deal of the millennium…

But people need more than just food and water. Humans are social beings. People need tasks and employment. People need solace after the loss of relatives. A perspective. Hope.

This article is a direct translation of the source article by Julia:
http://ebola-in-sierra-leone.de/quarantaene-nach-ebola-fall-21-tage-gefaengnis-im-eigenheim

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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