Oct 4  Sad update to this story: everyone, save three small children, in the three quarantined houses have contracted Ebola and passed away. 14 adults and the 17-yr old girl pictured here. The 3 children have reached the 21 day point with no symptoms, and are being released.
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I was shocked to hear that all of Moyamba District was put under an Ebola isolation order last week, and Bumpeh Chiefdom was further isolated within the district. And worried about the welfare of my friends in Bumpeh Chiefdom where Sherbro Foundation does our work.

I soon learned more that shocked me, more than four months into the second and more rapidly growing wave of Ebola in Sierra Leone. My heart aches for these people so far away, and there’s so little we can do from here. But one important action is helping.

After a three-day national shutdown to try to contain Ebola cases, it may have seemed that the cities were starting to get a grip on the deadly virus, which is spread by contact with bodily fluids.

But there’s still no full logistical plan nor Ebola-equipped health care in rural areas –the majority of the country — to manage cases in new Ebola hot spots. What are the practical next steps, when there are so few resources, when there are so many obstacles in a subsistence society?

Isolation and quarantine are the government orders. But with no further plan and coordination of services, avoidable Ebola cases can happen — and more unnecessary deaths.

This 17-year old girl is another kind of Ebola victim.

Pregnant with her first baby and quarantined in a village just outside Rotifunk, she got no prenatal care in her last weeks. When the baby came, she was left to deliver on her own. Even her own mother was afraid to come to assist. The baby was stillborn. The young mother got no assistance to ensure the placenta was fully removed and she had no complications. She remains untended in quarantine.

“If there had been the opportunity of suing the state to court, I should have been the first person to do that,” Rotifunk Ebola task force team leader Ben Alpha’n Mansaray said via Facebook.

“Once you are quarantine, you are sentenced to death. They need care! They need hope!”

About 1.2 million people in the country are now under isolation orders in the Sierra Leone government’s efforts to stop the spread of the disease. Isolation means a cluster of new Ebola cases occurred, requiring a more drastic measure.  People can move around within the isolated area, but no one can come in or go out. Individual homes are quarantined to further isolate new cases.

Alpha Mansaray delivers hand washing stations and Ebola prevention message to villagers.

Quick action by Bumpeh Chiefdom’s Paramount Chief Charles Caulker to quarantine contacts of the first Ebola case in early September has kept the disease contained to a small village on the outskirts of Rotifunk. Rotifunk itself, seat of the chiefdom of 40,000, remains safe.

Ten days ago, the dreaded virus emerged in new cases among the quarantined people. Eight people total have died, and two early cases made it to a treatment center.

Quarantine sounds like a straight-forward measure. You restrict people to their house who may have been exposed, and wait through the 21-day incubation period to see if they develop the disease. But in an impoverished rural area like Rotifunk, the logistics are anything but simple.

They are nightmarish.

• There’s no local holding center to isolate new Ebola cases from those not sick until they can be carried to a treatment center. In close quarters of a quarantined house, the sick can quickly infect those not sick.
• The few Ebola treatment centers (only in far-off cities) and ambulance service are beyond overloaded. Rotifunk made repeated calls for five days and got no response. With no Ebola-equipped local health care, the sick are left on their own. No one comes near. The sick only got sicker.  Three died waiting for an ambulance to arrive.  Three others made it to the district capital holding center — two hours to go only 17 miles on a pothole ridden dirt road  — but died waiting for a bed opening up in a treatment center.
• Inexperienced ambulance teams that did finally appear are fearful even with some protective equipment, and wouldn’t assist Ebola patients into the ambulance. If sick patients could drag themselves 25 feet and climb in on their own, they were taken to a holding center. If not, they were left to die at the quarantine house.  One man died the following day.
• People in quarantine have great difficulty getting adequate food or daily clean water. These are people who rely on their daily labor to buy their daily food. Some are lucky when family or friends send food. Others are at the mercy of generous local residents.
• Water is especially important to keep the sick hydrated. When a water container is used in quarantine, it must be considered contaminated. Disposables are unheard of. If the quarantined are near a river, they can collect their own water. If not, they wait for a Good Samaritan to bring water and pour it into their container left outside.
• Other medical emergencies like malaria, typhoid, maternity cases or increasingly common chronic conditions like hypertension get no care in quarantine – resulting in unnecessary complications or deaths.

When new Ebola cases appear in a quarantined house, the 21-day quarantine clock starts again for those showing no Ebola symptoms.  They could end up in quarantine for five, six or more weeks. When left in the same infected house, their likelihood of getting Ebola only grows.

The central government Health Service orders there be no movement of people under quarantine. Security (army or police) are stationed to enforce this. No safe houses have been provided despite repeated reports of Rotifunk’s situation. Some well people, like this pregnant girl, moved to an outdoor bathhouse (just concrete) in an effort to protect themselves while waiting out the remainder of their quarantine.

Bumpeh Chiefdom’s  isolation order came last week without notice, separating parent from children, farmer from fields needing planting, family from breadwinner who went to market and has the only money or food to feed the others.

When I read of whole villages being decimated by Ebola, I can now better understand why. Quarantine can lead to the sick quickly infecting those not sick with nowhere to go. Villages may self-impose quarantine to isolate the sick. With sick people and no indoor plumbing or easy to access water, houses quickly become filthy. Disease spreads. Mothers delivering babies and small children with malaria get no medical care.

How can this awful situation be improved?  One simple solution is to build temporary makeshift huts and pit latrines as local Ebola holding centers, to separate those becoming sick until they can be moved for treatment. With very minimal funding, these could be locally built. But they’re not forthcoming. Ambulance service calls need to be coordinated, and drivers trained and held accountable for delivering patients.

There is something important we in other countries can do: Help to buy simple hand-washing stations for Bumpeh Chiefdom. Sherbro Foundation paid for 200 such plastic stations and disinfectant in August. Forty stations were set up in public places around Rotifunk in one week.  160 more followed for chiefdom villages in August.  Chief Caulker said, “These have been very, very effective. You see them constantly in use with people washing their hands throughout the day.”

Chief Caulker would like 200 more hand-washing stations to supply remaining villages. Villagers get Ebola sensitization training and weekly reminders from Rotifunk volunteers on the importance of frequent washing to prevent Ebola and other diseases like cholera, typhoid and dysentery. Behaviors on personal hygiene and sanitation are changing.

Sherbro Foundation works directly with the Bumpeh Chiefdom Ebola task force to quickly send all donated dollars so they can buy these life-saving supplies. Please consider donating right now!  $20 buys one hand-washing station and two bottles of disinfectant.  Donate online here.

Nothing is easy about managing the Ebola outbreak in Sierra Leone. But coordination and common-sense local solutions could help. When coordination between the central Sierra Leone government and rural traditional leaders during emergencies is missing, key opportunities are lost.

Innocent people are the losers when critical decisions aren’t made quickly. It means unnecessary and tragic loss of life.