Nat’l Geo: Why Freetown can’t conquer Ebola and the provinces are

A January 27th National Geographic article on the December – January  “surge” to fight Ebola is the first one I’ve read that really gets it.

It’s called “How Ebola found fertile ground in Sierra Leone’s chaotic capital – How poverty and fragmentation in Sierra Leone’s capital city fueled the spread of the deadly Ebola virus.”  I found this on the Nat’l Geo Twitter feed, so it’s up to date as of the end of January.

Starting in Freetown, the reporter notes the usual mix of urban density and poverty that fuels contagious disease outbreaks, and hinders eradication.

But he goes on to recognize an “overlooked factor (that) continues to complicate.” He notes Freetown has had 50% of all Ebola cases, but has only 30% of the country’s population.  And it’s a “mishmash of people” from all tribes and all parts of the country.  No unifying culture or leaders. Only elected councilors, short term by nature, who never really develop trust and respect with the people they represent. And it goes both ways; they often don’t show respect for people they represent either.

Traditional leaders tackle Ebola   The reporter then goes upcountry to Kenema and interviews paramount chiefs there. He hears a chief describe how he went on the radio when they succumbed to the epidemic. He demanded people isolate the sick and stop washing dead bodies before burial and other Secret Society rituals.  He arrested violators for eight days and fined them Le500,000 ($120), a huge sum there.  His translator commented, “the chief is the only person who could ever stop secret societies.”

Bumpeh Chiefdom Paramount Chief Charles Caulker announces gov't Ebola funding for all chiefdoms to his Ebola task force.  Dec 2014

Bumpeh Chiefdom Paramount Chief Charles Caulker announces gov’t Ebola funding for all chiefdoms to his Ebola task force.       December 2014

Kenema formed an aggressive Ebola task force with all local leaders. They went from being one of the two early hotspots in August, to declaring themselves free of Ebola in December.  They’ve since had a smattering of new cases, probably travelers coming from other outbreak areas. These were quickly contained.

With strong district and chiefdom Ebola committees, the epidemic is nearly stamped out beyond western and northern urban areas.  Strong hands-on leadership of traditional leaders was pivotal in influencing change in high risk behaviors among their residents. Chiefs have a good pipeline of information and authority to take action when unsafe behavior didn’t change.

Paramount chiefs united to take collective action, and with government funding in December for all chiefdoms, new Ebola cases rapidly plummeted in January.

To reach people in Freetown, the government is using elected councilors and hired monitors, most of whom don’t hold much sway with disparate groups of uneducated, Ebola weary urban dwellers.

It’s not hopeless. Monrovia managed it. But it’s going to take systematic and strong action – and done swiftly.

 

 

 

Sierra Leone Schools to Reopen in March

No sooner did I post yesterday on schools opening in Guinea and Liberia, than the Sierra Leone government made their announcement.  They plan to re-open schools from in March.

Moyeamoh primary schoolIt’s no wonder the pressure has been on to get children back in school.  Students will have lost eight months of this school year come March.  The longer kids in Sierra Leone are out of school, the less likely they are to return. Especially teen age girls. I’ve seen various reports of the pregnancy rate for girls out of school rapidly rising in recent months.

When 60% of your population is under the age of 25 and out of school, you’re literally holding up the country’s development and future success.

Good news in the Ministry of Education’s announcement is the government will pay school fees for secondary school boys as well as for girls.  Their program to pay junior high school fees for girls was just getting off the ground before Ebola struck. This was to incentivize parents in keeping girls in school beyond primary grades.  Primary school is free.

With the big economic hit families have just taken with the Ebola crisis, the decision was made to pay secondary school fees for boys, too. It wasn’t made clear if this includes senior high students.

Most people outside Africa aren’t aware that public secondary schools across the continent are typically not free. Student fees pay for much of day to day operating expenses. For families living on $1 and $2 a day and with multiple children, $25 annual school fees are a big hit.

A large cast of government and donor players attended the yesterday’s announcement: ministers of Finance, Health, Education, Social Welfare, Energy, Water Resources, CEO of NERC and donor partners including US Embassy, CDC, Red Cross, World Vision, WFP, UNDP, WHO, UNICEF and DFID (UK Dept for Int’l Development).

Hopefully, this means promises on paying schools fees and providing sanitation services for schools will be kept and delivered promptly.

For the whole announcement, see the Sierra Leone State House website.

Arlene Golembiewski, SFSL executive Director

 

Schools reopening in Guinea. Is Sierra Leone far behind?

School re-opened this week in Guinea. Liberia has targeted for February.  This is a big milestone in the whole Ebola crisis to be celebrated. Happy new year for students and parents alike.

Schools must have practical procedures in place, including hand washing stations around the school, daily temperature taking with no-contact thermometers, an isolation area set aside for anyone with illness symptoms until they can be safely moved, and ongoing contact with health authorities.  Liberia Gov’t Ebola protocol for reopening schools.

Sierra Leone needs to get their new Ebola cases at or near zero before they can re-open schools. Principal Kaimbay in Rotifunk said it’s more practical to re-open schools in the provinces as compared to Freetown & the bigger cities. They typically have fewer students and more room in classrooms to keep students observing “no touch.”

Hopefully, this day is not too far off. The Ministry of Health’s daily Ebola case report had only 7 new cases for January 20th from only 3 of 14 reporting districts!

January 19 NPR story:  School’s Back on in Guinea: Reading, Writing, Temperature Taking 

Connecting the Dots: Sierra Leone – US Shared History

Connecting the Dots: Sierra Leone – US Shared History

Today is Martin Luther King Day in the U.S. to honor Dr. King.  Soon it will be African American History month in February. When I think of these dates now, I think of the shared history between Sierra Leone and the U.S.

I thought I would repost an article I wrote last year. Click here: “Connecting the Dots: Sierra Leone – US  Shared History.”

Unloading rice to the threshing floor

Unloading rice harvest Bumpeh Chiefdom – Nov 2013

I sometimes ponder the events that would have taken place in Bumpeh Chiefdom where Sherbro Foundation works. It’s a coastal area involved in the slave trade long ago in the 18th century.

But I think about more than just the slave trade. I’m thinking again today about the deep connections between our two countries – connections most people have no knowledge of.  Last year I wrote:

When I now travel down the Bumpeh River and visit traditional rice farms and villages, I remain mindful that there is a special link between Americans and the people of Sierra Leone.  Our people are kin.  Whether black or white, our histories and cultures are inextricably linked.”

A number of African Americans who have tested their DNA have found they’re of Sierra Leone descent. DNA can be matched to various tribal group in Sierra Leone. I keep reading of more people, like Maya Angelou and Colin Powell who found they are DNA – Sierra Leoneans.

I hope when tourism resumes in Sierra Leone, more people will make a trip to Sierra Leone to learn about our shared history. People of all races will find it fascinating to learn about where and how this whole story started.

My own journey changed the way I think of our two countries today, not just in the past. We are connected – and should remember that.

From Ebola Hotspot to Zero

From Ebola hotspot to zero new cases. This isn’t a dream.  It’s reality today in a number of  parts of Sierra Leone.

The media was blasting news through December about a country out of control with rising Ebola numbers.  Yes, the capital Freetown and northern cities like Port Loko have had high levels of new cases making Sierra Leone now the hardest hit country in the Ebola epidemic. They also put the whole country at continued risk because people continue to travel between districts.

So, am I an optimist talking about zero? I drafted this story a week ago and hesitated to post it for concern people would think this is just wishful thinking.  It isn’t.  In the last month, numbers have been steadily coming down. The Sierra Leone Ministry of Health’s daily postings of new Ebola cases have gone from 72 cases per day December 1, to 55 cases per day December 24, to 29 cases January 2.  January 12  was 19 new cases – for the entire country.

Eight of 12 districts in the country have achieved zero new Ebola cases for varying lengths of time.

So, what’s going on? I’m in weekly phone contact with Bumpeh Chiefdom in Moyamba District. I hear what Paramount Chief Caulker and paramount chiefs around the country have been doing in the last month. “Christmas was canceled.” Instead chiefs and other local leaders visited all parts of their chiefdoms with the task of influencing those resident behaviors that have been so resistant to change. In Sierra Leone’s culture, it’s the chiefs who have the authority to give people the difficult expectations on Ebola, like no traditional burials with washing of dead bodies  And chiefs can hold their people accountable.  More on this in another post.

Minister of Local Government and Rural Development, Hon. Diana Finda Konomanyi celebrates 42 days without Pujehun district recording a single new case of Ebola.

Minister of Local Government and Rural Development, Hon. Diana Finda Konomanyi celebrates 42 days without Pujehun district recording a single new case of Ebola.

Today, many parts of Sierra Leone have learned how to control Ebola, and they have achieved zero new cases.  Quarantines are lifted after 21 days. To be declared “Ebola free,”  the magic number is zero new cases for 42 days.

Pujehun District was just declared the first Sierra Leone district Ebola free, now more than 42 days.  Pujehun is in the southeast corner, away from current outbreak areas.  They’ve only had 31 cases total to date. But they note they share a border with Liberia, and only their strict procedures have kept Ebola out of the district.

Kailahun and Kenema districts are the two original Ebola hotspots in the East where the disease first crossed over from Guinea. They both declared themselves with no new Ebola cases for 21 days or more. A few cases returned, but with fast reporting and treatment facilities available, they’ve been able to stop further spread. Five other districts are at or near zero for a number of days.

This Reuters story describes where Kailahun district is today and how they did it.  The last 21-day quarantine on a home was lifted on December 30.

Opening new check point between Bumpeh & Ribbi chiefdoms

Opening new check point between Bumpeh & Ribbi chiefdoms

Bumpeh Chiefdom, where Sherbro Foundation does its work in Moyamba District, lifted a 21 day quarantine last week, leaving them today with no Ebola cases.  They had gone more than 42 days Ebola free.  Then a family in the remote SW corner of the chiefdom crossed back and forth between Bumpeh and neighboring Ribbi chiefdom, carrying Ebola with them. It resulted in two deaths in early December in Bumpeh Chiefdom, and more in Ribbi Chiefdom.

The village homes involved were quarantined. New chiefdom led check points were set up to stop movement between the chiefdoms with 24/7 monitoring .  Bumpeh Chiefdom’s Paramount Chief Caulker had no choice but to arrest and fine the Section chief and village chief involved for not reporting these Ebola cases.

This was the first instance in the country of chiefs being arrested for not carrying out their duties under the new Ebola by-laws.  They’re subject to six months imprisonment. It’s this kind of strict accountability that will stamp out Ebola.

It’s now been about 21 days and surprisingly, no new Ebola cases came out of the Bumpeh Chiefdom village quarantine.  Chief Caulker speculated that perhaps all the earlier sensitization training paid off. Perhaps villagers involved in the burial understood they could become infected and improvised ways to protect themselves.

 

Ebola treatment – doing it right

We could have used this approach to Ebola treatment in Sierra Leone a while ago. Small and decentralized – placed in the community where needed.  Fast start-up.  But we’ll take it now.  At least we’re learning from the whole Ebola experience and how to respond.

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From Deputy Chief of Mission Kathleen FitzGibbon, US Embassy, Freetown  https://www.facebook.com/sierraleone.usembassy?fref=nf

January 5, 2015

Today, we participated in the opening of a 20-bed Ebola Treatment Unit in Kontorloh Community, Wellington. With USAID’s Office of Foreign Disaster Assistance funded this collaborative effort with the local community, a local non-governmental organization called Lifeline, the Ministry of Health and Sanitation, Oxfam, and Med Air, an international NGO that will operate the facility. The U.K. government provided funding for construction. This facility is a “pilot” in the sense that it is a small facility, constructed in just a few weeks time, right in the heart of a deeply affected community. The scale of this operation allows us to be flexible and responsive to local needs. There are approximately 105 workers at the facility. I was inspired by the enthusiasm of the health care workers, who proudly showed off “scrubs” made by a local tailor. Most of these young health care workers are from the surrounding area and many of them are Ebola survivors. MedAir officials told us that they made hiring survivors a priority because they had been through Ebola and could provide motivation and encouragement to others going through the illness. The health care workers demonstrated for the community how patients are admitted and informed them that the decontamination solution does not spread Ebola. We hope that this local solution engenders trust and can convince residents to send sick relatives and neighbors to the treatment unit. What I saw today is a community determined to stop Ebola.