This article was first published on Ebola Deeply.
By Cinnatus Dumbaya
After last weekend’s lockdown, Sierra Leone’s Ministry of Health said that Bombali district, along with Kambia and Freetown, is one of the last hotspots in the battle against Ebola. Cinnatus Dumbaya sat down with Dr. Emmanuel Conteh, coordinator of the Bombali district Ebola response center, to discuss the lockdown and the ongoing response.
Ebola Deeply: Bombali, like the rest of Sierra Leone, has just completed a three-day stay at home exercise in a bid to isolate suspected cases. How did it go?
Conteh: We are still [tallying figures] across the district, so we have not put together a comprehensive report yet, but based on my personal observations and the reports I have been getting, I will say the three-day stay at home exercise was very successful. The people of Bombali were highly cooperative this time around. We got more sick alerts than death alerts. On Saturday alone our ambulances picked up more than 50 sick people. Only one of those cases has tested positive. Previously we were getting more death alerts than sick alerts.
Ebola Deeply: How was the situation in Bombali before the lockdown?
Conteh: In the past couple of weeks, we had an upsurge in cases. But before that time, we had a zero run for eight days until an infected person was conveyed from Aberdeen in Freetown to Rosanda village in Makeni. So far, we have recorded 59 confirmed cases at Rosanda and 42 deaths. But our response to that situation is really good; we are on top of what we are doing. I will say that the whole episode is really subsiding.
We have line-listed and categorized all the Rosanda contacts according to the level of risk and those who are considered high risk have been isolated.
Ebola Deeply: According to Ministry of Health figures, the death rate among recent patients at the closest Ebola treatment unit to you in Matheneh has been unusually high, between 70 and 75 percent. Earlier in the outbreak, patients were being treated at a different Ebola treatment unit, in Magbenteh. Why was that unit shut down?
Conteh: You are quite right. To be very candid, before the closure of Magbenteh treatment unit, the survival rate was 66 percent and that was really good. But because we were doing really pretty well in Bombali and the cases were going down, there was some kind of national decision that we should shut down some Ebola treatment units that didn’t have lab facilities. So it was decided that the unit at Magbenteh should be shut down, allowing the focus to shift to Matheneh (where there is a lab facility). We hoped that we had almost won the war. But then we had a hike in cases and Matheneh was overwhelmed. I don’t want to [speculate] until we hear from the experts at the World Health Organization (WHO) and the Centers for Disease Control (CDC), but I think this is a factor behind the recent high death rates.
Ebola Deeply: How have communities in Bombali district changed behavior in order to combat Ebola? Is the washing of dead bodies still a problem here?
Conteh: It is an ongoing threat. Our teams in the field are still reporting that people are still washing dead bodies. About three days ago in Kasasi Safroko Limba, an unsafe burial was reported. We heard that another village in Sanda Loko had also conducted unsafe burials, so we went there and asked the chief why [this was happening]. They were reprimanded. This is worrying! We have the capability to respond to all deaths and any other emergency alerts from communities, but we cannot succeed if the communities in Bombali district do not cooperate.
I’ve been sharing experiences with colleagues in the south and east of the country, in areas that have been doing well in the fight against Ebola. I've been curious to know what they are doing that we are not. Some of these areas, like Kailahun in the east, and Pujehun in the south, have recorded zero cases for more than 60 days now. I found out that they have succeeded because the people there do not compromise the laws. They own the fight. It’s the opposite here.
Until our people step up and own this fight, we’ll find it hard to catch up with our compatriots in the south and east. Until this week, we were getting 100 to 140 death alerts per week. Before someone passes away, he or she must have been sick for a couple of days at least, but nobody was reporting this. It’s worrisome for us. But we will not relent; we are moving around and talking to our people.
Ebola Deeply: Do you think all the death alerts were Ebola-related?
Conteh: I will tell you that 99 percent of the swabs taken are Ebola negative, negative! They are non-Ebola cases, but people are dying because of other ailments.
Ebola Deeply: Could that be because people are no longer visiting health centers and hospitals out of fear of contracting Ebola there?
Conteh: I think so, but we have been asking people to call the hotline if they are sick, and we will respond swiftly. We tell them that if they alert us, we’ll take them to Matheneh hospital and carry out a test on them. Five to six hours later, if they test negative for Ebola we take them to the government hospital for treatment. But this method of informing people about this hasn’t been working well for us. People are not reporting their illnesses.
Ebola Deeply: Do you have any more thoughts on why this could be?
Conteh: Yes! People have just been too lawless. There is a high level of indiscipline. And Ebola is here to test our level of discipline. Recently, female genital mutilation (FGM) was reported among the people of Kalangba Gbendembu Ngewahun. Can you imagine?! With all of our campaigns and engagement about the dangers of FGM during the time of Ebola, they still went ahead secretly to conduct it, even though the authorities have banned it.
In the area of Kamranka, a chief breached the law to conduct burial rites for a close friend of his who passed away. These are the kind of attitudes that are derailing the fight against Ebola. I have already ensured that the chief was dethroned, and all those who participated in that decision were dealt with accordingly.
Ebola Deeply: What are you doing to restore faith in the health system?
Conteh: The challenges are Herculean, but we will surmount them. Our international partners are committed to working with us in rebuilding the health system; we will refurbish our hospitals and our peripheral health units and I hope that will improve people’s confidence to [go back to them]. We have started engaging people by going to communities and meeting them. This will help us break barriers and rebuild trust.
Ebola Deeply: You sound downbeat. Are you tired? How optimistic do you feel that Bombali can beat this?
Conteh: I am very optimistic. I am a winner, and I know we will win this fight very soon with the support of our communities. We are all working very hard with the help of our partners. I am optimistic because most of the high-risk Ebola contacts are now on our radar and we are closely monitoring them five to six times a day. So I am sure that very soon we’ll conquer this. The people of Bombali will rise to the challenge. I want to assure you that Bombali will not be the last district in Sierra Leone to come out of Ebola.
At the same time, frustration is setting in for many people. Like many Sierra Leoneans, I am tired. This is not my job. We have the military guys with us; they are also tired. They want to go back to their normal routines in their barracks. But we are all aware that this country started with one case and today we are talking about 8,000 cases, so people shouldn’t be complacent.
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Cinnatus Dumbaya is a contributor to Ebola Deeply.
[Photo courtesy of Ebola Deeply.]