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.

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

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.

November 19 update – Ebola-free 32 days and counting

“Things are better, relatively speaking.” Rosaline Kaimbay emphasized the “relatively speaking” when I called yesterday for an update on Bumpeh Chiefdom. But it was the first positive news in some weeks. There are no more Ebola cases in the chiefdom since they embarked on their Breaking-the-Chain-of-Transmission program two weeks ago.

Yet Ebola is raging in Waterloo, a large town on the main highway and the source of recent Ebola cases in Bumpeh Chiefdom. There are reports of over 700 dead of Ebola in the Western Rural area in the last 5-6 weeks, most coming from Waterloo. Ebola “refugees” have been fleeing places like Waterloo and carrying Ebola to rural villages. Places like Bumpeh Chiefdom in close proximity.

Setting up a check point.

But today there’s no Ebola cases in Rotifunk or the rest of Bumpeh Chiefdom. Why? The single biggest intervention is rigorously managed checkpoints at the main roads to stop “strangers” from entering the chiefdom and possibly carrying Ebola with them.  There are also checkpoints on the Bumpeh River that traverses the chiefdom and is the main traffic route for many of its 208 villages “downriver” as they say.

Young chiefdom men volunteered to supplement government security forces at checkpoints and monitor all traffic in and out of the chiefdom. They’re the ones rigorously enforcing, keeping chiefdom borders tight, and ensuring outsiders are turned away. They’re the ones sitting up for all night vigils with nothing to protect them from mosquitos except a camp fire. They take turns for naps in a 3-sided palm branch lean-to on hard benches of split bamboo – their improvised shelter.

Rosaline Kaimbay interviewed at chiefdom meeting.

Rosaline visits the checkpoints daily to be sure all is going well and lend support. She is Executive Director of Sherbro Foundation’s partner organization, the Center for Community Empowerment and Transformation, CCET, and principal of Prosperity Girls High School. And now, she’s part of the chiefdom’s Ebola task force. Rosaline is a do-er. If you need something done, get Rosaline. If it’s important to Bumpeh Chiefdom, you won’t need to look for her. She’ll be there.

Rosaline said she goes to the checkpoints daily for at least 30 minutes, maybe an hour, to personally assess. She heads out each day with the CCET motorcycle and a driver, the only practical way to get around these days. Maybe the only way.

We have six chiefdom men assigned to each checkpoint, Rosaline said. They rotate through, with five days on and two days off. I talk with people, bring them drinks, something to boost morale.

And the checkpoints are working. I asked what they do if someone tries to enter the chiefdom who doesn’t live there. They send them back where they came from, she said, the way they came in.

Chiefs like Mr. Kamara monitor village families.

It sounds rather medieval. But much of the country is under similar isolation orders, trying to isolate districts, and chiefdoms within districts, that have surges in new Ebola cases. This is Public Health 101 to isolate disease cases and keep them from spreading. It works.

Village chiefs are the next level of defense in the Breaking-the-Chain-of-Transmission program. Bumpeh Chiefdom chiefs are going door to door daily to verify no one has taken ill with Ebola-like symptoms, and there are no new visitors.  Reports are by cell phone real time, wherever possible.  Section Chiefs are responsible to report their village results to the Chiefdom task force.

Imagine if every chiefdom in the country mounted this kind of offensive to fight Ebola for even 21 days – the upper range for Ebola incubation. It would literally break the chain of Ebola transmission and the outbreak would be on its decline.

Identify – Isolate – Treat. If all three legs of the infectious disease control stool were reliably there, Ebola would come under control. Actively engaging and supporting traditional leaders to identify and isolate cases in their chiefdoms is the key. They play a role in getting cases promptly sent for treatment. No one else can do this systematically with cooperation of the people. No one else is already in place in every corner of the country.

There’s still a long uphill battle to eliminate Ebola. But for the first time in a long while, you get a sense the runaway train is starting to be controlled and slowing down.

Sherbro Foundation will continue to support Bumpeh Chiefdom in their Breaking-the-Chain-of- Transmission program. Our donations go to support the checkpoints teams with small weekly per diems, transportation costs and cell phone coverage. Village chiefs receive a $5 honorarium to recognize their service for three months of house to house checks. With gas at $5/gallon, transportation costs are high. Our support enables the Chiefdom task force to get around and ensure work gets done. We continue to supply villages with hand washing stations and disinfectant for public places.

You can make a difference and help eliminate Ebola, too.  Join us and donate at www.sherbrofoundation.org/donate

You’ll know exactly where your money goes, and that it’s actually working to stop the spread of Ebola.

Bonus: 100% goes directly to the chiefdom Ebola program. Every penny. We’re an all-volunteer organization and our small administrative costs are paid by a separate donation.

2^nd Bonus: It’s tax deductible for US residents. Sherbro Foundation is a 501(c)(3) tax exempt organization.

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