Sierra Leone communities organize Ebola response

Meeting of Ebola taskforce in Nimiyama Chiefdom, Eastern Sierra Leone, aiming to mobilize all community members in the fight against the disease. WHO/Saffea Gborie

“In our chiefdom we have the necessary structures in place — leaders of all the villages are part of the Ebola response and fully involved, we have an active surveillance approach, and the population is well informed,” explains Philip Musa Koroma, Deputy Paramount Chief of Nimiyama Chiefdom in Kono district in Eastern Sierra Leone.

He has just finished a meeting with the chiefdom Ebola Taskforce, where village leaders and representatives of civil society groups proposed and discussed solutions to the current situation. Aiming to mobilize all community members, this Ebola Taskforce embodies local, collective ownership in the fight against the disease.

"After I tested positive for Ebola in the district hospital in Koidu, I was transferred to Kenema for treatment. I think my full recovery was due to the early use of supportive medicines and intravenous fluid. I requested this treatment while still waiting for the transfer." Umaru Sow, head of Nimiyama community health centre, Sierra Leone

The chiefdom saw its first case of Ebola 2 months ago. In the last 2 weeks, more than 20 cases have been reported.

"Our great challenge is logistics. We don’t have ambulances. It takes a long time for teams to arrive while roads are difficult and distances are long," explains Chief Koroma. "The imminent construction of a Community Care Centre in our chiefdom and of an Ebola Treatment Centre in the district capital Koidu will help patients receive care early."

One of those who recognizes the importance of early care is Umaru Sow, head of Nimiyama main community health centre in the chiefdom. “I got infected when treating a patient who did not give me full information, so I assumed he would not be a possible Ebola case,” recalls Mr Sow. “After I tested positive for Ebola in the district hospital in Koidu, I was transferred to Kenema for treatment. I think my full recovery was due to the early use of supportive medicines and intravenous fluid. I requested this treatment while still waiting for the transfer.”

Timely and coordinated response

Authorities of Kono district were quick to react to the new wave of cases and to mobilize available resources both locally and from international partners. Kono district has 14 chiefdoms and each one has set up an Ebola taskforce with regular meetings at district level to coordinate the response.

Daily command centre meetings are chaired by the District Ebola Response Centre Coordinator and aim to coordinate incoming assistance from international partners now on the ground.

The first week of December, the World Health Organization (WHO) and US Centers for Disease Control joined the Ministry of Health and the National Ebola Response Centre in a mission to assist authorities to evaluate the situation. With assistance from the United Nations Mission for Ebola Emergency Response (UNMEER), supplies and personnel were flown in rapidly.

The International Federation of Red Cross (IFRC) helped Koidu hospital to better organize its temporary holding centre. The IFRC is currently building a new Ebola treatment centre (ETC) which will eliminate the need to transfer critically-ill patients via a 4-hour journey on a difficult road to Kenema.

The United Nations Population Fund (UNFPA) has just completed training more than 300 contact tracers and supervisors. UNICEF is supporting social mobilization, while the International Rescue Committee supported training of 45 hospital staff on safe infection prevention and control measures. Other partners such as the World Food Programme, Partners in Health and World Vision are also supporting the response.

WHO/Saffea Gborie

"The construction of an ETC will improve the situation as we will no longer need to move patients who test positive to Kenema," explains Mr Michael N'dolie, WHO Team Leader in Koidu. "The biggest issue remains mobility and logistics. We urgently need ambulances for case management teams and vehicles for burial teams and surveillance teams."

Non-Ebola health needs

Back in Nimiyama Chiefdom, the community health centre run by Umaru Sow is now closed. It needs to be disinfected since 7 Ebola patients came through the centre. All of Umaru’s co-workers are quarantined, as they had contact with him and with those 7 patients that slept at the centre before they were transferred to a holding centre in Koidu.

"People with non-Ebola needs now must walk more than an hour to get some assistance," Umaru adds. People are said to fear going to health centers for fear of catching Ebola there. According to a local midwife, a number of deliveries are now being done at homes assisted by traditional birth attendants.

"It takes time, but we hope when we reopen the health centre at the end of the month that people will be using it again."