Getting to Zero – But Staying There?

Village quarantine released - from BBC

Village quarantine released – from BBC

The last chain of Ebola transmission is almost stamped out. This means the set of contacts exposed to the last confirmed Ebola case are accounted for.

It was one year ago August 10 that Ebola was becoming a runaway train and WHO declared a global emergency.

Here’s the key points from Sierra Leone’s National Ebola Response Network report for the week ending August 16:

  • For the first time since the disease worsened a year ago, the country has gone 12 days with no EVD reported case. The country’s last case was recorded on 7th August.
  • There are only two patients undergoing treatment – at IMC Makeni. One has tested negative and will be discharged in the next day or so. The other is responding to treatment.
  • 585 contacts from Massesebeh village near Makeni were discharged from a 21-day quarantine on August 14.  A rapid response team quickly responded to one of the last confirmed Ebola cases, and quarantined the entire village. A few households and contacts remain under quarantine after cohabiting contacts tested positive.
  • There were 79 remaining potentially exposed contacts in the country. If no cases are recorded, the last set of quarantined contacts will be discharged on 29th August.
The important thing for Sierra Leone now is no new cases have been confirmed that can’t be traced to another previously confirmed case. For over a month, there have been no new chains of transmission.
To declare the country Ebola free, it needs to go 42 days with no new Ebola cases after the last case is discharged from treatment and the last quarantine ended. The clock would start on August 29. 42 days are two sequential 21-day Ebola incubation periods.
The ban on public gatherings was released last week, allowing crowds to enjoy Freetown’s beaches and throng bars and nightclubs for the first time in a year.
Liberia’s had a new case pop up over three months after being declared Ebola free. WHO is now considering whether a 90 day Ebola free period is a more prudent criteria to declare a country Ebola free.
So – not out of the woods yet.  But getting close.
A US physician working in Liberia and treated for Ebola says, not so fast. Getting to zero is not good enough; you need to stay at zero.  He notes: “there were more physicians on staff at Bellevue Hospital in New York City, where I was treated for Ebola, than were practicing in the three most affected West African countries combined. The dearth of health care professionals means that for many responders, there has been little respite. And since the start of the epidemic, nearly 7 percent of health care workers in Sierra Leone and more than 8 percent in Liberia have died from Ebola.”
We’re all not safe from Ebola he says, until health care systems in the three Ebola affected countries are expanded and adequately staffed.

What’s Going On With Ebola? Quite a Bit.

“What’s going on with Ebola,” a friend asked me today. “We hear nothing in the US.”   Actually quite a bit of good news happened in the last couple weeks.  And some not so good.

Good News The lowest level of new Ebola cases in over a year were reported last week. Guinea and Sierra Leone both reported only one new case in each country! The previous week there were only a total of seven new cases. Liberia had none.

This comes after four or five months of results stubbornly plateauing out at 20 to 30 new cases per week. All new cases came from the same few areas where it has not been stamped out, like the densely packed slums in Freetown and the same few rural villages.

New cases have also been coming from “known chains of transmission.”  ie., from the contacts of a person previously confirmed as Ebola positive. If they can keep focusing on known contacts, there’s more likelihood of stamping out the disease. When new cases pop up without any connection to a previously confirmed Ebola case, the epidemic is not under control.

Bad News –  Three of Sierra Leone’s recent new cases were in Tonkolili District in the north which hadn’t had a new case in over 150 days, like most of the country.

From WHO - contact tracers conduct interviews in Tonkolili District

From WHO – contact tracers conduct interviews in Tonkolili District

A man from a village there fell ill while in Freetown and carried Ebola back to his Tonkolili village. Family believed his illness was due to sorcery and a curse, and when he died, buried him (illegally) without following Ebola burial procedures.  Two of his family have since been confirmed as Ebola positive and moved to an Ebola treatment center.

This shows how easily Ebola can again spread, with just one case traveling across country. With new cases way down, this becomes a less likely event.

Good NewsRapid response teams are in place and immediately quarantined over 500 people in the affected Tonkolili village. They identified 29 high risk contacts to closely monitor. Rapid response teams are in place with WHO coordination and react quickly when new cases and any new chain of transmission are identified. The quarantined village has no additional new cases after a week. This is light years ahead of where things were last year at this time.

Farmers in this village will unfortunately be separated from their fields for 21 days during the rainy season, a critical time for planting rice and other crops. People understand the critical need for the quarantine and are cooperating. They’ll hopefully get support for the condition of their farms.

Great NewsA trial of a new vaccine was found to be 100% successful in protecting against Ebola!  Ring vaccinations were conducted because Ebola cases have dwindled to such a low level. This technique was used years ago in testing small pox vaccines.

Ring vaccinations means people at risk within the ring of known contacts of an Ebola case were vaccinated, instead of just random people. So, you’re testing and hopefully protecting at the same time – which proved to be the case now.  A control group of potentially Ebola exposed people were also vaccinated, but not until 10 days after potential exposure. Sixteen Ebola positive cases were found in this group, prompting study leaders to recommend immediately vaccinating all participants in future studies. They asked for the vaccine to be made available for all exposed people during the period of continued testing and vaccine approval.

And there needs to be expanded studies.. The two groups in the study had only about 2000 participants each. A large group for initial human trials, but not enough for high statistical confidence. In larger study groups, the effectiveness will likely drop below 100%. But even 80% effective is a real break through.

Good NewsThe vaccine was fast tracked by a global team of collaborators. This included the Division of Infectious Disease Control at the Norwegian Institute of Public Health, the Wellcome Trust, the government of Canada, Doctors Without Borders (MSF), the London School of Hygiene and Tropical Medicine and manufacturers Merck and NewLink.

It took only eleven months to reach this point of human trials with demonstrated efficacy. Other less promising trial vaccines were discarded along the way. The study team also had to coordinate with Guinea officials to reach urban slums and rural villages not easy to incorporate into a high profile study on short timing.

It shows this can be done. It’s not common for a new vaccine to be tested in the midst of an active epidemic. But this was no usual epidemic. It had global implications.

You’ll note the US doesn’t figure into the team of global collaborators. Our FDA drug testing procedures are more conservative and approval procedures more bureaucratic. I read under normal conditions, this kind of vaccine development and human testing could have taken a decade. US FDA take note.

Still, the statisticians will have the last say.

So-so NewsHaving a vaccine quickly available in large quantities and easy to use in remote, difficult to reach rural villages remains a challenge. It’s hard today to administer well established vaccinations and health care in general in the affected Ebola countries. Rolling out a new vaccine to remote places with no refrigeration will not be easy.

Convincing suspicious and illiterate people traumatized by the Ebola epidemic will also take a strong outreach and education approach.

It’s not known how long protection from a new Ebola vaccine would last.  Small pox is a one time vaccination. Yellow fever lasts for ten years. Typhoid is only good for 3-5 years depending on oral or injection administration, and it’s only about 60% effective.

Hopefully, the global aid community will address vaccine cost as they have the vaccine study design and testing. Everyone has learned the whole world is at risk of Ebola until it’s permanently stamped out everywhere. Like small pox.

It was one year ago now that the Ebola epidemic in Sierra Leone was a run-away train. We watched paralyzed in fear, not knowing what action to take. What a difference a year makes. Especially when the best minds around the world join up together.

Show Us the Money: How Ebola Crisis Money Was Spent

Show Us the Money: How Ebola Crisis Money Was Spent

Here’s an issue I’ve been waiting to see made public: how global aid money was spent in the Ebola emergency.

Amy Maxman’s recent Newsweek story will change the way you look disaster aid. Maxman managed to spend enough time in Sierra Leone and probe in the right places to illuminate some of the Ebola crisis’s most exasperating issues. I posted her February story on how the capital Freetown’s new Ebola case rate was not going to zero. She astutely noted Freetown has no traditional leaders with authority to lead the fight in their own communities, as they effectively did in the provinces.

Now she’s written about how global Ebola aid money was spent in Sierra Leone during the epidemic’s peak. Again, she’s spot on. How is it possible only 2% of foreign aid reached frontline Ebola workers?  Read on.

It’s hard for outsiders responding to an emergency to know how to donate efficiently — quickly and with the highest impact. Foreign governments and major foundations want to send money, but not actually spend it. They have to trust other organizations with local connections to act on their behalf.

Actually, foreign governments and foundations pledged Ebola aid money. The wheels of bureaucracy turn slowly, emergency or no emergency. Less than half the $3 billion aid pledged reached the affected Ebola countries by the end of 2014 when the crisis peaked and was declining.

Big Aid may have been frustrated in the past by immature and ineffective African government systems, and sometimes out-and-out corruption. So, many foreign governments and foundations bypassed the Sierra Leone government, and gave Ebola aid funds to the World Health Organization and Western nonprofit organizations. Some sent a few experts, like the US Center for Disease Control, to advise and train Sierra Leone government agencies or do diagnostic tests.

Most individual donors don’t understand how aid organizations actually spend money.  I didn’t until I got personally involved with a rural Sierra Leone community.

Crises don’t happen in convenient places. Aid organizations either don’t have staff in the affected country, or in the remote places they’re needed. And in the Ebola emergency, they didn’t have the right kind of staff. Infectious disease ward nurses, sanitation crews, burial teams and community mobilizers were needed — all speaking local languages and able to respond to local customs on life and death matters.

IMG-20150115-WA0000Ebola started and spread in remote villages. To reach these places, foreign aid organizations would be confronted with a total lack of familiar infrastructure. It takes 3-5 hours to drive 50 miles on impossible roads to reach small villages – with the right 4×4 vehicle. They’d find nowhere to stay or eat, difficulty buying bottled water or petrol, no electricity, no toilets, no internet connection, of course, and unreliable cell phone coverage. There’d likely be no Sierra Leone government presence, and therefore, no local host or suitable building to work in.

They might find no one to be go-between with the community. They wouldn’t speak the local language and could encounter suspicious, even hostile, villagers they’re trying to serve.

So, unless you’re Doctors Without Borders experienced in setting up mobile MASH units, you subcontract your work to locally based nonprofits. These nonprofits may in turn need to hire more local, but inexperienced, people to deliver emergency services.

Most local nonprofits are not rurally based. They typically are in Sierra Leone cities, and they don’t necessarily have rural relationships or speak tribal languages. But they are at least in-country. These nonprofit workers drive to a town or village for a few hours and leave, having limited impact. But they spend lots of money nonetheless on staff, new employees, training, new vehicles and travel expenses.

The funding pie quickly shrinks. Every time work and funding are handed off to another government, another agency within a government, or from a global aid organization to country and regional groups, a slice of the funding pie is eaten up.

Maxman found less than 2% of the billions of Ebola aid money made it to frontline Sierra Leone health care and sanitation workers. She found a UK report that only 7% of EU funding for a Liberian Ebola program reached frontline workers. This is not exceptional. Before the Ebola outbreak, I asked Bumpeh Chiefdom Paramount Chief Caulker about development aid distribution. He said it’s common for only 10% of aid money to reach people in his chiefdom as actual goods and services. Twenty percent would be good for non-emergency aid distribution.

Where did the rest of the Ebola aid money go? Much of donated money is going to highly paid foreign aid organizations and their employees. Or to pay for military flown in to build treatment centers that took so long they were hardly used. Salaries of foreign aid workers sent over – that could be 6-figures – are counted in the emergency aid figures. And they may get extra hazardous duty pay. They fly in, stay in expensive city hotels designed for foreigners, and travel in air-conditioned SUVs. Some were flown by helicopter daily to field centers. And they seldom engaged directly in what we thought we donated our money for – caring for people sick with Ebola.

In emergencies, spending money efficiently is not the prime objective, as Maxman found. Speed is. But without established programs, that speedy spending in the Ebola emergency led to many mistakes and missed objectives. And cost many lives.

A vicious circle continues. With the crisis over, foreign organizations pack up and go home. Under-developed local health care services are no better off. They can’t self-support the next crisis because we keep relying on foreign emergency aid organizations, instead of investing in building Sierra Leone’s health care capability. Yet we quickly forget how expensive emergency aid is.

What’s the moral of the story? Certainly, you should understand the organizations to which you’re donating in an emergency. What is their track record in the country you’re trying to help?

Consider small nonprofit organizations doing grassroots work in a country like Sierra Leone; don’t be automatically dubious. Find their websites and check what they’re doing.

Sherbro Foundation was able to quickly fund life-saving programs for 40,000 people with very few US dollars.

We funded 90% of the Ebola prevention work that Bumpeh Chiefdom led itself, with chiefdom leaders and volunteers.  They focused on prevention, not waiting for people to get sick. We sent $9,000 USD by wire transfer, and they directly received $9,000 in local currency within days after we agreed on objectives.

For $9,000, the chiefdom got results. They kept Ebola out for over 50 days, while it was raging all around them. After two isolated cases at Christmastime, the chiefdom again remains Ebola-free.

That $9,000 would have paid the hotel bill for a single foreign aid worker “consulting” in Freetown for only a month and staying at the Raddison Blu for $270 nightly.

Grassroots organizations like Sherbro Foundation are not involved in Sierra Leone for the short term.  We’re continuing the work of community development.

Blaming the Victims – Pregnant Girls Banned from Sierra Leone Schools

Blaming the Victims – Pregnant Girls Banned from Sierra Leone Schools

There will be a number of Sierra Leone girls who want to come back to school when they reopen that won’t be allowed to.

Pregnant girls are being banned from school.  From an outsider’s point of view (mine), this smacks of blaming the victim.

Fatu is one of the Bumpeh Chiefdom girls who should have been taking the senior high entrance exam last week.  Instead, she’s waiting to give birth as a single mother.

Walter Schutz Secondary School studentsWhen Sierra Leone President Koroma first made his announcement in February that schools would reopen, he publicly stated all children should return. He specifically encouraged pregnant girls and young mothers to come back to school.

The Ministry of Education recently recanted this, saying pregnant schoolgirls are a bad moral influence on other students.  They will not be allowed to attend school while “visibly pregnant.”

These pregnant girls were victimized once, and now they’re being made to pay again.

It’s been estimated as many as 30% of Sierra Leone schoolgirls became pregnant during the Ebola crisis. I doubt there was a sudden lapse in morals in this many girls in the last nine months. There have been many reports of an increase in sexual violence across Sierra Leone triggered by the Ebola crisis. Men lost employment and girls were home, out of school. Constant stress from fear of Ebola, lost income and restricted movement is fuel for sexual predators, as described in this BBC interview.

There’s many variations on this, from rape to coercion, from “transactional sex” to misplaced emotions. Emotions were running high for all during the Ebola crisis, including teenage girls. When you’re bored, depressed and feeling hopeless, it can be easy to seek comfort in the wrong place. Add to this the lack of health care services and contraception during the Ebola crisis. Needing money to cope financially or seeking to boost self esteem resulted in terrible consequences for many girls.

Behind the statistics there’s real people, and their life stories are not simple.

Center for Community Empowerment & Transformation Executive Director, Rosaline Kaimbay told me about some of these girls in Bumpeh Chiefdom who won’t be returning to school in April.

Fatu finished JSS3 (junior secondary school 3) last July and was ready to start senior high. Her mother separated from her stepfather when he made it clear he wanted to take another younger wife; a girl of eighteen, not much older than Fatu. He abandoned the family, including his own five year old son, Fatu’s stepbrother.

Fatu’s stepfather is actually her uncle. He was a local warrior called a Kamajor that fought to save Rotifunk when it fell under rebel control during Sierra Leone’s long civil war. His entire family was killed by rebels, including his younger brother – Fatu’s father.

He took Fatu’s mother as his wife, which is common. A widow needing support and protection often becomes the wife of her brother-in-law. Now over ten years later, he wanted another young wife of his choosing. It would be easy to cast him the villain, but he’s led a difficult life. He’s been a victim, too.

It’s not clear how Fatu became pregnant. Girls like Fatu are ashamed to talk with Principal Kaimbay about what happened and hide their pregnancy as long as possible.

Fatu lost her father; then she was abandoned by her stepfather and the father of her baby.  Now she’s forbidden to take the one route that could be a way out for her and her baby – returning to high school to complete her education at a high enough level to give her job skills.  She’s banned at least until after the baby is born.

What are her options? If her mother can manage to take of the baby – supporting another child – Fatu could return to school after she gives birth.  If they live in town where the schools are, or have friends where she could stay, she may be lucky and pick up again on her education. These are big if’s.

If not, she would be another statistic among the five out of six girls who don’t complete high school. Another who remains stuck in a cycle of rural poverty so hard to escape.

Sherbro Foundation’s girls scholarship program focuses on helping the most vulnerable students like Fatu who are serious about their education. As more girls progress into senior high, we especially want to help senior girls stay in school and graduate. This includes young mothers.

Fatu fits the profile in all respects. Mrs. Kaimbay calls her a brilliant student. She could do well.

There’s hope for Fatu and girls like her if she can make her way back to school. She needs our support, not blame.

You can support girls like Fatu.  Donate to Sherbro Foundation’s Girls Scholarship Program.

Remember – Sherbro Foundation is all-volunteer. So everything donated goes to the Scholarship Program.

Back to School, but Not Back to Normal

Back to School, but Not Back to Normal

How do you reopen Sierra Leone schools closed for seven months by a country-wide health epidemic? What do you do when the Ebola epidemic is still not completely over, and you’re afraid to send your children back to school?

Sierra Leone schools reopen in April. But it won’t be like just turning a faucet back on. Teachers and students scattered when Ebola suspended school last year to be with family in home towns and villages. Getting students back will be a process.

ebola hug

Rotifunk teachers returning to school demonstrate an Ebola hug.

Ebola is not yet gone.  It continues to ebb and flow in the capital and three northern districts. Another three day countrywide shutdown starts today, Friday, March 27 to try to stamp out remaining Ebola cases. Everyone is ordered to stay home Friday through Sunday. They continue to observe the strict “no touch” policy of the last eight months and no public gatherings.

Then, Monday, March 30 last year’s ninth graders are the first to come back to school to take their senior high entrance exam. The exam was canceled last July when Ebola escalated.

What are parents to do?  Keep your child at home where you believe it’s safe, or safeguard their future and let them test their way into senior high?  Skip Monday’s test and they’ll be waiting months again for another chance.


Community Empowerment & Transformation project leader and local teacher, Abdul Phoday

I texted Center for Community Empowerment & Transformation volunteer and local teacher Abdul Phoday to hear what’s going on. “Everyone is still scared of one another,” he said. “People do gather, but with some distance because of the virus. Some of the girls who are supposed to be present for [this week’s exam review] are absent because of teenage pregnancy. They have been idling so long, they were confused by some bad boys, and are now pregnant.”

“The few who are present are not enthusiastic as usual, for they were a long time out of school. But we are doing our best to bring them on board, even though it’s not easy.”

Phoday and other teachers only have one week to prepare their students for the senior high entrance exam. They normally spend a whole month in a concentrated study camp.  His school has been the exam’s district champion for the last two years. “So, we want to keep the title,“ Phoday said. “Really, it’s out of love [we do this] as we are still getting fluctuational Ebola results so everyone is still scared.”

Principal Rosaline Kaimbay attended a workshop last month to prepare principals to reopen schools. She said she’s satisfied the Ministry of Education has considered the risks and made provisions for these.  Still, getting everything needed in place and implemented locally will be a big effort.

Safety first  The first order of business is making the physical environment safe after Ebola.  Fortunately, none of Bumpeh Chiefdom schools were used as temporary Ebola holding centers needing decontamination.

IMG_1908Maintaining the Ebola “no touch” policy is still needed. This means enough classroom space to keep students separated by three feet. Primary schools often pack young children in classrooms with 2 or 3 kids to a desk. They are to get additional desks to spread students out.

Sanitation at rural schools is a real dilemma. Students need to regularly wash their hands. But most schools have no water sources on-site. There’s usually no clean water nearby; not even a well. Schools are lucky to have latrines, let alone toilets. Hand washing provisions were never made. “Policy makers in Freetown don’t come upcountry and don’t know sanitation conditions here,” lamented Paramount Chief Charles Caulker.

Bumpeh Chiefdom schools will have to resort to the public handwashing stations used during the Ebola epidemic  –  buckets fitted with a faucet and chlorinated or disinfectant treated water that will need to be carried there. Supervising 200+ children washing their hands each time they come on-site will be a time consuming chore for teachers.

taking temps at school Conakry

Liberian teacher takes daily student temperatures.

Likewise, teachers will need to take each student’s temperature every day with no-contact thermometers they’ll be supplied with. Will morning assembly songs and announcements be replaced with the hand washing – temperature taking regimen to keep on schedule?

Stress management  Teachers are getting training on stress counseling for students. Those who are Ebola survivors, or who lost one or both parents or other family members are still traumatized.  Being stigmatized as an Ebola family further adds to their stress. They may not yet be fully accepted by the community. These children need extra support, and their peers need more education that they pose no risk to the community.

The epidemic has put everyone under great hardship and economic stress. Then, there’s chronic stress from constant fear of the invisible enemy called Ebola.

Making up for lost time  Everyone may need stress management with the school regimen they’re being asked to follow. To make up lost time, school will be held six days a week, including Saturdays, for 25 weeks. School will push through July and August, the heavy rain months when many students are normally back home helping plant rice on family farms.

I remember as a Peace Corps Volunteer trying to teach during the rainy months. We’d have to stop during an especially heavy downpour when it sounded like horses galloping over the metal roofs and you could hear nothing else.  Walking miles to school on muddy roads in downpours is miserable.

Back to school campaign  Our Rotifunk partner organization, the Center for Community Empowerment and Transformation (CCET) plans a back-to-school and public health campaign. Made up primarily of local teachers, CCET will be going door to door in Rotifunk and village to village in the chiefdom, encouraging parents to send their children back to school.

IMG-20150105-WA0001The way to answer parents’ questions on Ebola and the remaining risk is to reach out to them in their villages.  CCET will continue public health messages on recognizing Ebola and other common disease symptoms, and what to do if you believe someone is sick.  Local nurses will join in and assure people of the safety of community health clinics.

Pregnant girls and new mothers especially need counseling on seeking medical care. They’re still afraid of getting Ebola if they go to hospitals and health clinics to deliver and for pre and postnatal care. They’ve been delivering at home. More lives across the country are being lost in childbirth and from complications after birth than from Ebola.

Young mothers and their parents need to be encouraged on the girls returning to school.  Becoming a mother does not need to end their education. Rather, they and their babies need the benefits education brings more than ever. But village girls face the dilemma of leaving their new baby with parents in order to go to Rotifunk for secondary school.

The Ebola epidemic has been incredibly hard. Getting life back to some semblance of normal is far from easy.

Arlene Golembiewski
Executive Director

Ebola: When Culture Confronts Science

Ebola: When Culture Confronts Science

Respect people’s deeply seated cultural beliefs on things like burial during an emergency? Seek to understand and make some accommodation when the family is grief stricken and at their most vulnerable?

I’m posting a link to the second of National Geographic reporter Amy Maxmen’s articles on Ebola, people and culture.  This one gives a good overview of burial practices in Sierra Leone and why people have been so unwilling to give these up.  Even when confronted with the risk of death themselves.

Maxmen reports with both facts and sensitivity. Maybe it takes National Geographic and its long legacy of studying and reporting the world’s cultures to bring this kind of understanding behind the headline news.

Culture confronts Science  “The problem was that the people handling the intervention only looked at this as a health issue; they did not try to understand the cultural aspects of the epidemic.”

from National Geographic - adapting burial practices

from Nat’l Geographic – adapting burial practices. Start with prayers. Use white, the Muslim color of mourning.

Sierra Leone people are deeply spiritual, and there’s different tribes and subcultures. The escalating Ebola crisis was really about confronting cultural beliefs and changing unsafe behaviors. Outside health care and aid workers calling the shots came armed to fight Ebola only with science. There was no time for culture.

Yet for Sierra Leoneans, it was all about culture. With death – unexpected, tragic death – you automatically index to your most fundamental cultural beliefs.

When it became clear Ebola wasn’t ending quickly, respect and cultural accommodation finally came into play. The right things started to happen, and the Ebola epidemic started to decline. Families began to accept burial by strangers who had before seemed like anonymous body snatchers, throwing their loved ones in the back of a truck like trash. People started trusting health services more and calling for help.

Could this whole tragic episode have been shortened and lives saved with a different mindset?  Who knows. Read the whole National Geographic article and decide what you think.


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 

Innovations aid Ebola health care workers

Good things can eventually come out of crisis. Like these two innovations for Ebola health care workers.

The first is a much improved design for the “space suits” health care workers must wear when caring for Ebola patients. Lives of workers have been lost because of contamination, especially when removing their protective equipment. Vital patient care is probably missed because workers can’t tolerate the heat generated in wearing these suits and have to leave hospital wards within an hour.

from National Public Radio

from National Public Radio

US Agency for International Development staged a competition for improved personal protective equipment design.  Researchers and students at Johns Hopkins University Center for Bioengineering Innovation and Design (CBID) had the winning design.

Simple but critical changes should make their design easy to produce at cost comparable to today’s PPE.  The suit opening is in the back, away from where most workers would encounter infectious fluids during patient care. A break-away zipper design makes it easy to remove without touching yourself. A battery operated pump blows cool air into the suit.

Any worker around the world needing full protective equipment  will benefit from the improved design. For the whole story, go to National Public Radio:

Another innovation is paying Sierra Leone health care workers using mobile money.

Health Care workers are putting their lives on the line every day. They’re putting their families at risk of exposure as well, should they become ill, and of financial ruin if they, the family breadwinner, are lost.  To compensate them, they’re being paid extra hazardous duty pay.

Timely distribution of payroll is difficult around a country like Sierra Leone without electronic payment systems. Or even efficient and safe ways to distribute paper vouchers in all corners of the country.

with mPesa, a worker sends money to their rural family by mobile.

With mPesa, a Kenyan worker sends money to their rural family by mobile.

Here’s how you can ensure Sierra Leone health workers get paid on time: mobile money. This works like direct deposit, except it doesn’t go to a bank account – which most people don’t have. It goes instead to your mobile phone account – which most workers do have, even in rural areas.

You can then use your mobile kind of like on-line banking, where you send money by keying in commands on your phone. You can send money to remotely pay bills to a vendor’s mobile phone account – all without using a bank or the hassle of getting and transferring cash. It’s done similarly to purchasing minutes for your mobile phone.

Mobile money systems like mPesa have become popular in bigger African countries like Kenya and Nigera. They’ve recently found its way to Sierra Leone, but with limited use. Perhaps this application for health care workers will demonstrate its value to more people and accelerate its use.

The UN is responsible for paying the extra hazardous duty pay to Sierra Leone’s health care workers. Mobile money is a good way to ensure secure and fast transfer of payment to hundreds of workers around the country.

“In two months, we’ll ensure Ebola becomes a thing of the past”

“In two months, we’ll ensure Ebola becomes a thing of the past”

Here’s one of the most under-reported stories in Sierra Leone’s Ebola saga – and potentially one of the most impactful.

“The chairman of the Council of Paramount Chiefs, PC Charles Caulker has said that within the next two months [paramount chiefs] will ensure that Ebola will become a thing of the past.

“He made this statement at a meeting with the Deputy Minister of Local Government …. at the Bo District Council Hall on December 3.” (ExpoTimes – Dec 6)

Chief Caulker (blue sports suit) inspecting chiefdom checkpoint.

Chief Caulker (blue sports suit) inspecting chiefdom checkpoint.

How can Chief Caulker make such a bold statement?  He can because he has done just this in his own Bumpeh Chiefdom. He’s sustained no new Ebola cases now for nearly 60 days, despite Ebola present all around in neighboring chiefdoms. 

Why have more paramount chiefs not had a greater impact to date in eliminating Ebola? A clear game plan was needed describing the few high impact activities to control Ebola. The chiefs have pooled their collective experience in facing Ebola and defined this plan through the National Council of Paramount Chiefs (NCPC). They call it “Breaking the Chain of Ebola Transmission.” The plan leverages the chiefs’ unique responsibilities and local authority at the village and neighborhood level to stop the virus from being transmitted person to person.

The other gap has been lack of funding to implement the necessary activities in all chiefdoms.  On December 3, the government finally addressed this with $1.2 million in funding for the 149 chiefdoms across the country provided by the World Health Organization.

The Spectator newspaper reported: “The Chief Executive Officer (CEO) of the National Ebola Response Centre (NERC), Major (Rtd.) Alfred Paola Conteh, on Wednesday 3rd December, 2014, disclosed that US$1.2 million has been sourced by his office for the 149 Paramount Chiefs in the country. … the CEO maintained that Paramount Chiefs are very instrumental in the fight against Ebola.

The money, according to Major (Rtd.) Alfred Paolo Conteh, is meant to get the Paramount Chiefs up and running in their continued fight against the Ebola disease …”

The National Council of Paramount Chiefs (NCPC) Chief Caulker leads developed a concept paper that outlined steps he and other paramount chiefs have used to keep Ebola out of their chiefdoms. The paper serves as a template for each chiefdom to enact byelaws on this chiefdoms use as their local “law.”

Bumpeh Chiefdom launches Ebola program.

Bumpeh Chiefdom launches their Breaking-the-Chain-of Transmission program.

The NCPC used the paper to co-author a “Breaking the Chain of Ebola Transmission” document with the Ministry of Local Government and Rural Development (MLGRD). Changing long held beliefs and customs on burials and caring for the sick has stymied ending the Ebola epidemic.  MLGRD Minister Diana Konomanyi-Kabba said, “solutions to end Ebola need to be fashioned out of and implemented within the framework of local leadership.” (Awareness Times)

In a second meeting last week in Kenema launching this initiative, the Kenema mayor declared Ebola eliminated from Kenema District. Two months ago Kenema city was plastered in the news as one of two early epicenters out of control, with hospitals overflowing and bodies in the street.  Mayor Keifala said, “they had encouraged local authorities to form taskforces in their respective chiefdoms to coordinate activities for the eradication of Ebola.” Politico – December 6

Deputy Minister of Local Government and Rural Development Hadiru Kalokoh, who came to Kenema to launch the paramount chiefs’ project there said, “his government recognised the role of Paramount Chiefs in ensuring development in their localities. He said the president was convinced that the chiefs were the answer to the fight against Ebola.

What will paramount chiefs actually do to eradicate Ebola from their chiefdoms? They are leading a four-prong approach:

  1. Daily door-to-door home visitations by village headmen to check for sick people and isolate them from the rest of the village. Immediate calls to district health teams will initiate Ebola testing to confirm and move cases for treatment.
  2. Safe burial procedures with immediate reporting of all deaths to chiefdom authorities. Paramount Chiefs have the authority to take custody of dead bodies in their chiefdom and ensure Ebola testing and safe burial teams are arranged.
  3. Checkpoints at chiefdom borders manned 24/7 to monitor all movement in and out, and turn away people who are not residents or who appear sick. Checkpoints are strategically placed for vehicle, river and foot traffic.
  4. Continuing sensitization of residents to reinforce Ebola symptoms and actions to protect themselves.
Bumpeh Chiefdom volunteers educate in small villages.

Bumpeh Chiefdom volunteers educate in small villages.

$1.2 million for this program may sound like a lot of money.  But divided among 149 chiefdoms, it averages only $8000 per chiefdom.  This is far less to achieve far more than funding for large NGO programs to “sensitize” the population.  Short one-time visits to towns and villages by NGO staff unfamiliar with the people will not change deep seated behaviors. Many inaccessible villages will be missed.

The paramount chiefs’ plan will not alone be the silver bullet to end Ebola. It has to work in concert with government services to isolate, transport and treat Ebola cases. More hospital beds are still needed. But it’s a major component that’s been missing to date. With Ebola so widespread across the country, a systematic way to identify any and all sick people and dead bodies, and immediately isolate them from the rest of the community has been needed. It’s also the most effective way to influence safe behaviors  countrywide using known and trusted community leaders and repeated contact.

This is why the chiefs call their plan “breaking the chain of transmission.” It goes to the source of the problem at the community level and stops further transmission.  Ebola started locally in a village. It will only end with comprehensive local action.

With Ebola now raging in urban centers in the west and north, the whole country remain at-risk. I asked Chief Caulker what can be done to control these areas. Handle them in the same way as a chiefdom, he said.

Divide a city like Freetown into sections and assign responsible section leaders to coordinate activities like chiefdom section chiefs. Further divide sections into neighborhoods for village equivalents. Use neighborhood leaders to do the daily home visitations and respond to suspected Ebola cases and deaths.

Sounds simple.  But it’s simple, strategic plans that usually works.  Chief Caulker, other Paramount Chiefs and Kenema District have shown what does works. With traditional leaders now fully engaged and funded, a major proven strategy is moving into place. Hopefully, the country can soon call Ebola a thing of past.

Sherbro Foundation is proud to have provided early funding for Chief Caulker’s Bumpeh Chiefdom Ebola program. It saved lives and allowed them to demonstrate the program’s effectiveness.

Arlene Golembiewski
Executive Director, Sherbro Foundation