From the Field: Battle Against Ebola Continues in Sierra Leone



Women at a health center in Sierra Leone.

A team from Direct Relief is traveling through West Africa to better understand the needs of health care partners and formulate long-term strategies for strengthening health systems devastated by the Ebola outbreak. Our Director of International Programs and Emergency Preparedness and Response, Andrew MacCalla, shares his observations from Sierra Leone below.

I’m generally very impressed with the response of the people to try and end the Ebola epidemic. Everywhere you go, your temperature is taken with an infrared thermometer. It happens going into a restaurant or hotel or office building. When you drive into a new town, you have to stop at a checkpoint that’s usually organized and staffed by the community. They make you stop the car, roll down the windows, and get everyone’s temperature.

The thermometer is held up to your face for a few seconds, it beeps, and they show you your temperature. Since it’s in Celsius, it took a few times to realize what was normal, or good, or not Ebola. Apparently you don’t want to be much above 39 degrees. And if you are, they’ll stop you, wait a few minutes to take it again in case you were just temporarily hot or nervous.

If you’re still high, you’ll head straight to an Ebola treatment center or community care center where they can now give you a blood test to determine if you have the virus. Just a month ago, the testing capacity was not what it was now, and so you’d have to stay and be monitored until your fever went down.

In Aberdeen, another town directly across the road from our hotel in Freetown, there has been a recent spike in cases in a small, extremely poor part of town. The Ebola response strategy there was to post the military at the edge of town and not allow anyone to come or go. The word is that they’re being treated well—they get the food and money they need. But it was quite a harsh scene to drive by a town guarded by the military knowing that the strategy was containment even now that they’ve proven Ebola can be fairly effectively treated.

Generally though, the sense is that this is going to be beaten down to zero pretty soon. Even now, the daily case counts are down to about 12-14 per day, which is still high, but a huge drop from the 100s they used to report every day. And while people are still vigilant and cautious (I haven’t shaken anyone’s hand since I’ve been here…a right hand crossed over your heart is the preferred greeting now), it’s still hard to fight your human instinct to touch another person.

Every time I’ve met someone, my instinct is to shake their hand, and it feels rude and awkward not to. Today, when we visited Makeni General Hospital, a doctor we were with (who hasn’t been practicing medicine in some time) went up to a woman who had just delivered a baby and was in some pain. He touched her arm to see how she was doing after noticing a large pool of blood on the floor, and the other doctors immediately hollered at him, reminding him that he wasn’t wearing gloves. But it was his instinct, as it is most of ours. It’s human nature.

We went inside the surgical ward where they perform five C-sections per day. Normally, what would stand out to me would be the fact that there was no surgical light, ultrasound machine, anesthesia machine, or sterilizer. But today what I noticed was the air conditioners were broken, and now that doctors have to wear full body personal protective gear during a surgery that could last hours and its 90 degrees in there; it was stifling.

After we left this hospital, which clearly needed support and is struggling against terrible odds of Ebola and a total lack of equipment, it occurred to me that I had read a New York Times article about this hospital a few months ago titled, “A Hospital from Hell” and after re-reading it just now, I realized we were given a tour by the doctor quoted in the article. He was nearly my height, probably younger than me yet he’d been practicing six years, skinny as a rail, and what he kept saying was, “This is a referral hospital for the entire northern region of the country, can you imagine?”

Things are not all bad, however. The midwifery school we visited today that we helped start nearly five years ago is a beacon of light for the community and for the women who attend it. It’s been closed because of Ebola but they are set to start up again in March and resume classes for the roughly 150 men and women who attend. According to many, the kits they get when they graduate that Direct Relief provides them a great deal of pride to receive it before going to work in their post.

And the labor and delivery clinic that we equipped is said by all to be the “best in the region, if not the country” thanks to the delivery beds, midwife kits, sterilizers, and other supplies that were donated.

We’ll see what the next days have in store.

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