Is Sierra Leone ready for the next epidemic? By Tulip Mazumdar

Global health reporter, Freetown, Sierra Leone Published duration 8 August 2016

media caption Ebola survivors Daniel and Cecilia Turay visit the clinic site where their lives were saved

It is not a question of if, but when. There will be another outbreak of some deadly disease in Sierra Leone at some point.

Every country in the world is at risk. Viruses do not care about borders.

Ebola was able to spiral out of control in such spectacular fashion here because Sierra Leone's health system was extremely weak.

When the virus came knocking, there was not a single laboratory in the country which could diagnose it.

There also were not enough doctors and nurses, not enough hospitals and not enough trust in the health system for people to turn up at clinics when they got sick.

But exactly two years since the World Health Organization (WHO) declared the Ebola outbreak a global health emergency, parts of the health system are probably in the best shape they have ever been in.

However, there are still "major shortcomings", according to the WHO.

'Silent epidemic'

"We are definitely more prepared [for a new outbreak] than we were when the Ebola outbreak started here in May 2014," said Dr Brima Kargbo, Sierra Leone's chief medical officer.

"We have rapid response teams ready, and can isolate people quickly if we need to."

The head of the WHO in Sierra Leone, Dr Anders Nordstrom, said that despite improvements in some areas, there was still much to do.

"During the outbreak patients and staff were not coming to hospitals.

"That has gone back to normal… but there are still major shortcomings in the health system.

"We have a big lack of trained healthcare workers. The quality of service is not good enough. Sierra Leone has the highest maternal mortality rate in the world.

"Around 30,000 women and children are dying every year in Sierra Leone for preventable reasons - it is a silent epidemic here."

Deadliest outbreak

image copyright Getty Images

Over 11,000 people have died from Ebola since the epidemic erupted in 2014 - a six-fold increase of victims since its discovery in 1976.

Some scientists say there's a risk the virus may become an ever-present disease in West African society.

The UK pledged £427m ($560m) towards responding to the Ebola outbreak, and strengthening the country's health systems.

The jewel in the crown to that response was the 100-bed Kerrytown Ebola treatment centre.

I visited the site a number of times during the outbreak. At its height it was a buzzing lifeline for a country that was overwhelmed.

Some 1,500 British troops deployed there to help build and staff parts of the site.

Save the Children took up the daunting task of running the main treatment areas.

Their medics saved more than 150 lives.

image caption Kerrytown at the height of the outbreak

image caption Kerrytown today

When I visited this time, it was derelict and decaying. A few stray dogs and a family of goats had taken up residence in what used to be functioning wards.

I went there with Kerrytown's first survivor, 18-year-old Daniel Turay, and his sister Cecilia. They lost 27 members of their family to Ebola.

Daniel said he had both heart-breaking and heart-warming memories of the site.

"When I was in the red zone it was horrible seeing people dying… but seeing the work the doctors were doing - even though they were risking their lives, they didn't relent.

"They went on to make sure that we survived. I told them that because of what you've done, I want to be like you, I want to be a doctor."

'Total mess'

As Daniel wandered through the empty tents and overgrown grounds, he was clearly very frustrated.

"The government said they wanted to establish a hospital here… but what I see really discourages me.

"It's something that hasn't been made a reality. It's a total mess to see it like this.

"There aren't many hospitals here. It could have been a benefit to the whole district."

The Ministry of Health has said it plans to make a maternity unit on the site by the end of the year. We did not see any building work taking place.

The solar panels for precious lighting, the drainage system and some of the structures were all still standing. These are rare commodities in a country desperate for more health facilities.

"There's a very small community in that area," said Dr Brima Kargbo.

"We are building a new hospital in the nearby area of Waterloo instead."

In the city's main Connaught hospital, which was overwhelmed with Ebola patients during the outbreak, a brand new shiny ambulance rolls into the refurbished accident and emergency department.

image caption The Connaught lab

Thanks largely to British investment, the ward can offer free care to patients for the first 24 hours.

There is also a new isolation and infectious disease unit, both developed by the King's Sierra Leone Partnership.

Consultant surgeon Dr Samuel Sesay oversees the new Accident and Emergency department and said: "Things have improved by more than 80%.

"When I look at A&E now compared to what it was like before, they are worlds apart. We are saving many more lives."

Training challenge

We headed up to the diagnostics laboratory, which is about to get a big refurbishment by the ministry of health and Public Health England.

The UK agency has already set up two labs in other parts of the country.

"The final objective is to avoid another massive epidemic, which obviously went well outside Sierra Leone," said Dr Autilia Newton, PHE head of mission in Sierra Leone.

"The biggest challenge is to train staff to ensure the system is sustainable by the Sierra Leone government once Public Health England is gone."

But the biggest challenge, and the biggest hope when it comes to saving lives in Sierra Leone, lies with people like Daniel Turay.

I met him again as he left his physics class for the day. He is studying hard to get the grades he needs to go to university to study medicine.

"Life saving is one of the most honourable jobs you can do," he told me.

In a country with only 200 trained doctors, Daniel's ambition - and his success - are crucial.

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