Sierra Leone: Tracing Ebola in Tonkolili

When the Tonkolili District reported a new case of Ebola on 24 July 2015, it marked a change in the Sierra Leone Ebola response. A rapid response team was despatched to manage this new source of infection, the first case in that area for more than 150 days. It resulted in a whole village being quarantined, and showed how quickly Ebola can travel and that no district can let down its guard until there are zero cases of Ebola.

Ebola contact tracers at work in Tonkolili, Sierra Leone WHO/S. Gborie

WHO immediately sent more than 20 staff, logistics and supplies to the area. “We are deploying more technical staff with the required expertise to Tonkolili District because getting it right in Tonkolili is a must and is critical in getting to zero at this stage of the outbreak” said Dr Anders Nordström, WHO Representative. Epidemiologists, social mobilisers, contact tracing mentors, coordinators and operations teams were mobilised from other districts.

Not sorcery, Ebola!

The resurgence of the deadly Ebola disease drew attention to Massessehbeh village. It was the last residence of the confirmed Ebola patient, a young man who had fallen ill and travelled there from Freetown. The community had provided care for him in his illness and buried him after his death at the Masanga hospital. Family members had attributed his illness and death to sorcery and curse, and treated his care and burial as an ordinary case, not suspecting it was Ebola.

After his death and confirmation that it was from Ebola, all his contacts were identified, including health workers, staff and nursing students at the Masanga Hospital, family members and friends. The case left a trail of 507 people placed in mandatory quarantine in Massessehbeh village, where 29 of them were considered high risk contacts. Two – the mother and maternal uncle of the deceased were transferred to an Ebola Treatment centre where they too have tested positive for Ebola.

"By the time we finish the quarantine, our fields and crops will be badly affected. But we will abide by the regulations so that we all can put this outbreak behind us". Foday Koroma, Sierra Leone

Quarantine in Massessehbeh

Situated at the Magburaka-Matotoka highway, Massessehbeh was placed under guard after 24 July. Red tapes on both sides of the road prevent passers-by from turning into the village. Residents in this small village of about 600 people are predominantly subsistence farmers.

However, their activities have been interrupted and they are spending the rest of the 21-day quarantine confined within the surroundings of their houses in the village. “This is a difficult time for me and my people, children, youths, everyone”, said Foday Koroma, Chief of Massessebeh village.

Their basic needs are being catered for by WHO and partners. Surveillance, contact tracing, social mobilisation and psychosocial activities have been intensified as control measures for immediate response to prevent further transmission should any of the people in quarantine develop the disease. Partners have increased their activities with improved coordination.

Their fields are unattended. "We are always engaged with our livelihood activities but now we can’t go to our farms. By the time we finish the quarantine, our fields and crops will be badly affected. But we will abide by the regulations so that we all can put this outbreak behind us". Everyone here expressed similar concerns but at the same time, they think ending Ebola is more important.

Fighting fears and misconceptions

Foday Kamara is a Data Clerk at the Magburaka Government Hopital. He lives and works in Magburaka, the district headquarter town of Tonkolili District. But his 4 children, wife and extended family live in Massessehbeh. Though Foday was not one of the people quarantined in the village, he however returned to Massessehbeh to join his family and community members in quarantine.

Foday Koroma, a data clerk, decided to be self-quarantined to support his village in the fight against Ebola, Sierra Leone WHO/S. Gborie

He asked his supervisors to be excused from duty. "I decided to be self-quarantined because I know that there are a lot of fears and misconceptions among the people, especially our old folks, about Ebola and the whole issue of quarantine", said Foday.

He said he was given the privilege during the first 3 days of quarantine to go round the village together with contact tracers and social mobilisers, "that are not from here", to reassure his village and to reduce the fear and misinformation. "Coming back to join them and explaining to them about the quarantine has reduced a lot of tension among the people".

A week has passed without anyone showing signs and symptoms of the disease since the village was quarantined. However, Foday says, “We still have more days to go and we would be very very lucky if we go through this without any new case”, he added.

WHO and partners' response

There has been a huge inflow of partners to support the response. Their activities are being coordinated by the Tonkolili District Ebola Response Center in collaboration with the United Nations. WHO increased its staff and physical presence hugely over the last week.

So far, all the contacts mainly from 3 communities have been listed and are being monitored for Ebola signs and symptoms. The contacts include a number of health workers and routine patients from the 2 health facilities where the patient sought treatment when he developed signs and symptoms.

Social mobilisation activities have been increased to heighten vigilance in communities and to dispel rumours and fear which have been some of the major challenges in the Ebola response. Local structures including traditional and religious leaders and community groups have also been engaged to own the response and to mobilize community resources for the basic, and psychosocial needs of the contacts being monitored.