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New Ebola cases popping up in Liberia

Unfortunately, Sierra Leone is not the only place where Ebola is picking up again: Liberia detected a new Ebola case on June 29, the first since March 20! According to media sources, a 17-year-old boy had died the day before and a routine test revealed that he had died of Ebola. This came pretty much unexpected and accordingly the number of contact persons is high. The number of new cases had risen to 7 in total. More than 100 people are quarantined.

What is still unknown though is how Ebola could “hide” for more than 3 months. The chain of transmission is still a mystery. According to WHO, it could have been sexual transmission. Because Ebola was detected only after the teenager has passed away, it’s difficult to reconstruct the line of transmission. To find out more, WHO conducted genetic sequencing of the virus that killed the teenager. It turned out to be similar to a strain of Ebola that was detected in Liberia end of last year and this makes a cross-border transmission from Sierra Leone or Guinea very unlikely. The only possibilities seem to be a chain of asymptomatic cases or transmission through a survivor.

Considering all this I want to bring up a “taboo” here in this area of Western Africa: It is unclear yet if female survivors can transmit the virus, and so it was thought that men are more or less “on the safe side”. But what about homosexual men? They are probably at the highest risk, just like with HIV. I never heard this being discussed in public. The few local colleagues I know well enough to ask them about their position on homosexuality looked at it more as a sickness and definitely as being “wrong”. So addressing homosexual men as a high risk group for Ebola is a difficult task – but urgently needed from my point of view. Reuters reported:

“In May, Archbishop Lewis Zeigler of the Catholic Church of Liberia said that „one of the major transgressions against God for which He may be punishing Liberia is the act of homosexuality.”

Maybe it’s better to leave some chains of transmission in the dark – for the sake of the victim.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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New surge in Ebola cases in Freetown

It was quiet now for some time, both in my blog as well as in Sierra Leone. The new infections went down and further down, we had days in a row without any new cases and it seemed to be only a small step towards an Ebola-free Sierra Leone.

But recently the pictures changed again. Below are the contacts followed as of 6th July, published by WHO. “No of contacts” means people who had been in direct contact with a confirmed positive Ebola case and who are quarantined as a consequence of that. WARD 374 refers to the area also known as “Magazin Wharf”, a slum area in coastal Freetown. While on Friday there was a total of 14 cases linked to Magazin Wharf, the weekend brought about another 5! One of them even with an unknown epi-link (at least that was the status yesterday).

map who

Most of those new cases are connected to one asymptomatic case of a pregnant woman who delivered in hospital without knowing that she is Ebola positive. The immune system of pregnant women is basically running on very low intensity during pregnancy to prevent that the body is “rejecting” the child. This – as turned out now – can “hide” Ebola. Fever and vomiting are reactions of the immune system that is trying to fight the virus. If this is not happening, there is no fever. Ebola was detected only after the delivery. Subsequently, more than 400 people entered quarantine in Magazine Wharf.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Ebola and poverty – a lethal combination

Why West Africa? There were quite a few Ebola outbreaks in the past, for instance in Uganda, but never before such a huge epidemic developed. It seems to be a fact that the extreme poverty in large areas of West Africa was a decisive factor in the spread of the EVD. But how exactly is poverty contributing to an epidemic?

To shed light on this question a bit, I want to start by distinguishing two different kinds of poverty: On the one hand the poverty of the people, on the other hand the poverty of the state. There are several reasons why Sierra Leone is not a rich country, most prominently corruption. The diamond mines, fishing grounds and beautiful white beaches, perfect for paradise-longing European tourists, should bring money into the state’s cashboxes. But like in many African states with rich resources, sadly, the opposite is the case. Criminality and corruption in the trade with exactly those resources keep countries like Sierra Leone trapped in poverty. The result is an almost non-existent social system, hospitals without any medicine or medical equipment, schools without books, streets without tar. It is these three factors that contribute considerably to the spread of Ebola: health, education and transport.

It is clear that few and poorly equipped hospitals contribute to an Ebola epidemic. The strict isolation measures which are necessary are too much to take for the health stations. To carry all this know-how and equipment into the country from abroad, via foreign aid organisations and governments, takes time. But during this time Ebola is already spreading. The low level of education of a big proportion of the Sierra Leonean people is also contributing to the spread of the disease. Many people are illiterate and cannot read all the information sign boards and news articles, unless they display also pictures. Many people have difficulties understanding the concept of a “virus” as such. And I have to admit it is not easy to grasp that a tiny particle, not visible for the human eye, causes such a terrible sickness. On top of this Sierra Leone has a really poor road network. Sick people have to be carried quickly to the next hospital, but that is far from possible. Many villages can only be reached by jeeps, some even only by boat. Transport is adventurous.

These unlucky preconditions are met by the poverty of the people. A study of the Njala University (http://www.ebola-anthropology.net/case_studies/village-responses-to-ebola-virus-disease-in-rural-central-sierra-leone/) showed that many people avoid seeing a doctor due to economic constrains. In case a family member falls sick, the first strategy is to just wait. Maybe spending money on transport to the next health facility can be avoided? Also the expenses for the treatment. In case it is NOT Ebola, the treatment is not for free in Sierra Leone. Most families wait apparently for 2-3 days before coming to a decision if seeing the doctor is necessary. In case it’s unavoidable money has to be borrowed from friends and extended family. Again a few days pass. Until the patient is ready to go, the phase of highest infectiousness is reached already. During the transport it’s hard to avoid now to infect others, the driver or other passengers. And that’s how the epidemic is spreading.

The outbreak of Ebola might happen more or less by chance. But the spread depends very much from the specific location. And Sierra Leone was clearly the wrong place.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Regional cooperation in the fight against Ebola?

From my point of view, close regional cooperation in the fight against Ebola sounds like the most natural thing to do. Guinea, Sierra Leone and Liberia are neighbouring countries and their cultures are closely related. Nevertheless the fight against Ebola was done mostly alone, each country on its own.

Lately in the discussions in Sierra Leone it was popping up again and again that the borders to Guinea should get closed down. People were claiming the strong involvement of military and police. I’m wondering if such measures can contribute at all to the desired results. Indeed, Ebola started from Guinea and was carried over the border at the very beginning of the epidemic. But in the following months the virus was spread by Sierra Leoneans within their own borders. Nevertheless, each case in the border province Kambia leads to the immediate suspicion a border crossing traveler had caused it:

150326 EbolaAusGuniea

What difference makes it anyway? All countries are facing the same situation. With many new cases in the border region of Guinea and Sierra Leone, wouldn’t it make much more sense to start a border-crossing programme to curb the spread of the disease? Social mobilization, awareness raising, more media attention? The number of cases is proof that there is not enough action taken in this regard. Instead it’s preferred to put the blame on the respective neighboring country. Not surprisingly, both countries, Sierra Leone and Guinea, take it in turns to close their borders.

End of March Guinea closed the border to Sierra Leone:

http://www.nytimes.com/2015/03/31/world/africa/guinea-border-closed-over-ebola-fears.html?_r=0

This did not concern Sierra Leoneans, who were demanding as well that the borders should be closed down. Here a fragment from WhatsApp, 17th May:

WhatsApp Guinea

I can only hope for a stronger sense of regional cooperation in the recovery phase. Welthungerhilfe got active in this regard already: two weeks ago there was a workshop held for members of DERC (District Ebola Response Centre), where two participates from Guinea were invited. Furthermore, Welthungerhilfe started a cross-border programme that is targeting Ebola-affected areas threatened by food insecurity in Sierra Leone and Guinea. Nevertheless – much more should be done to promote regional cooperation. Especially European organisations could share their experience in regional cooperation and encourage governmental bodies to kick-start cross-border knowledge exchange.

 

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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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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Ebola destroys the economy

A lot was said and speculated already about the negative impacts of Ebola and Ebola curbing measures on the local economy. Quite some time, I must admit that I didn’t have a clear picture myself. The reported facts seemed to be contradictory. However, now I think it’s basically proven: Ebola damaged the economies of Liberia, Guinea and Sierra Leone considerably.

Newspaper articles report of severe impacts on the petty trade.

Small Businesses going down2-1

It is claimed that the travel restrictions imposed had a big negative impact. Overland travel was strictly controlled for an extended time period, and farmers claimed not being able to reach markets, whole sale markets couldn’t be reached by small traders anymore and so on. In the newspaper article, Mrs Bio reports that her products are laying for months in the shelves, waiting for customers. And also a study of UNDP is citing a member of the governmental trade department:

“Ebola is killing thousands every month, but the restrictions in the fight against Ebola destroy dozens of businesses every day.”

 

The report (“Impact of the Ebola Virus Disease on Business Establishments in Sierra Leone”, UNDP, December 2014) shows, that 9 of 10 businesses report a significant reduction in the production sector. This resulted in the loss of employment opportunities. 3/5 of all businesses claim, they were forced to reduce their staff. I know one example: A Lebanese supermarket close to our office is about to close down. The owner said, the business was reduced considerably because of Ebola and for 2015 he is not expecting any betterment. One of my colleagues told me that Liberia entered a phase of regression already, being rooted in the months-long fight against Ebola. Here in Sierra Leone the Ministry of Finance claims that the annual growth dropped from 9% to 4%. But I think those numbers are not yet verified.

 

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Ebola – The world starts to lose interest

It’s known since about one week now: UNMEER, the United Nations Mission for Ebola Emergency Response, the first UN emergency health mission ever, will come to an end June 30th. UNMEER started on September 19th 2014 and it was clear from the beginning that it will be a short-term mission. However, as usual at the end of an emergency intervention there remains one question: What comes next?

infographic_-_4_pillars_1

The National Ebola Response Centre (NERC) will lose its most important supporter with UNMEER – also financially. That leaves the question how the countrywide Ebola response will be coordinated and continued. Even though Ebola is more or less under control in Sierra Leone by now, there are still about 1-2 new cases every day. Until end of June Sierra Leone will not become Ebola free, that’s for sure. 42 days have to pass without new cases before an area is officially declared Ebola free, counting from the day the last patient was discharged or passed away. counting from the day of the last safe burial or second negative test (Thanks to @HaertlG, twitter). That means, NERC will have to find new support. But whom? And who will take the lead in the Ebola response? There is much to do in the rehabilitation phase, preventive measures have to be started and hygiene programmes initiated. There are different possibilities who could take the lead, e.g. the Ministry of Health or the Organisation of National Security (ONS). As an employee of a civil society organisation I do hope that the military will play no major role anymore.

On top of that, many donors are phasing out their programmes in June / July. After that it will be difficult for organisations like Welthungerhilfe to get funds for post-Ebola rehabilitation projects. If Sierra Leone will succeed in banning Ebola from the country in the long run will partly depend on the quality of projects that are initiated now.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Ebola in Sierra Leone – the fight is on since one year now

The 25th May 2015 marked a special day: It was exactly one year since the first confirmed Ebola case occurred in Sierra Leone. One year trapped in horror, closed schools, unattended fields, destroyed economy. One year in which a single virus caused more than 3,500 deaths. Hundreds of children became orphans. And the fight is still ongoing.

11329837_989956607703040_967547803513050205_n

The people in Sierra Leone are tired of the restrictions imposed by Ebola. They are tired of being scared of Ebola. Impatience and annoyance spread widely. Here is a fragment from the WhatsApp group “WHH Ebola Response”:

Screenshot_2015-05-28-11-39-54

President Ernest Bai Koroma invited survivors to mark the sad anniversary and encouraged the public to abstain from stigmatization. He renewed his promise that all survivors who can present a genuine certificate of discharge will enjoy free health care in future. Until the 25th May, 4,013 survivors were registered nationwide.

http://reliefweb.int/report/sierra-leone/ebola-clocks-1-year-president-pledges-support-survivors

Also Welthungerhilfe WHH will focus in the upcoming months on support to Ebola survivors. In the centre of our efforts stands economic support: food aid, cash transfers as well as counselling and preventive health care. We hope to give hope to the survivors who carry a heavy burden already. I’m hoping so much that Sierra Leone has only a few weeks left to suffer from Ebola. We ourselves at Welthungerhilfe want to go back to normal, back to our agricultural development projects and long-term perspectives that we’re trying to offer.

 

 

 

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Ebola and corruption

Around mid of December there was an extremely interesting article on foreignpolicy.com. It some time ago now, but I still want to use the article as the baseline of today’s blog post. The topic is of timeless actuality in Sierra Leone, not only in Ebola times: corruption.

http://foreignpolicy.com/2014/12/10/sierra-leones-ebola-epidemic-is-spiraling-out-of-control/

In rankings by Sierra Leone is the lowest third of countries, meaning, corruption has always been an issue. In the recent history of development aid in Sierra Leone there were a few spectacular cases of corruption (see link), involving government authorities on the highest level. The government set up an anti-corruption commission, but regarding the above mentioned article the effectiveness of this group should be put in question.

There are other sources who claim that Ebola funds did not end up where they were mend to end up. Rumours have it that the cement sells in the country increased dramatically in the last months. Why? They say that authorities started to renovate their private properties. Hard to believe that it is a coincidence that they have the money for refurbishment right now. But, as said, it’s all rumours – of course.

From my personal view I can confirm that the turnover of money is extremely high at the moment in Sierra Leone. Also Welthungerhilfe is spending a lot of money in project implementation, mostly that of the British and German government. That requires a considerable administrative effort, otherwise the rightful use of the funds cannot be guaranteed. And that’s one of the reasons why I’m working 7 days a week at the moment. I can only speculate how the considerably greater sums of money that were disbursed directly to the Sierra Leonean government by foreign governments are being administered. Many representatives of local governments took on two jobs at the same time: Still working for the government, they also apply regularly as consultants for international NGOs. How that can possible be managed time-wise is up to question and one can only assume that their governmental tasks are being left unattended.

What is really worrying me is not the money that might have been lost. Concerning is the “lessons learnt”: It’s easy to make money with a health emergency in the country. That points to the central question: Has really everybody here a genuine interest in getting Ebola to “zero”?

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Despite Ebola: Schools re-open in Sierra Leone

On the 14th April, schools reopened in Sierra Leone. For the first time since I arrived in November I see on my way to work lots of children in colourful school uniforms on the streets. According to the media it’s 1.7 million children countrywide, approximately 35% of the population.

I chatted a bit with my national colleagues, almost all of them are parents themselves, to find out how the “Ebola-safe” school opening is organized. Three staff member, mostly cleaners or guards, were trained to measure the temperature of the children and how to mix the chlorine solution for hand washing. Every morning they follow the same procedure as at our office door: Thermometer ready and hands under water.

SchulePrimary school in John Obey.

In case a child is found to have a high body temperature, it is moved to a special isolation room. If the state of the child is not getting better, the school will contact the Ebola emergency line 117. Until the present day, that was luckily never necessary. I heard in Makeni, the capital city of the province Bombali, they had to isolate 2 children. However, soon it turned out that they were harmless.

Usually the school year in Sierra Leone started in September and went until June / July. In the rainy season they had holidays. Considering that 2/3 of the school year already passed the government “moved” the school year from April to December. At least that’s what I heard. The government further announced that there will be no tuition fees for the next 2 years – as an incentive to make sure that all children are indeed going back to school. I just hope this decision doesn’t mean less or lower salaries to teachers or less equipment for schools…

Of course I also asked my colleagues if their children were looking forward to go to school again: All of them answered with a clear YES. They said their children found it extremely boring to sit at home. Understandable, after 8 months in a row.

Welthungerhilfe supported the re-opening of schools in Freetown with the provision of hand wash stations, chlorine and soap.

 

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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