The first news story on the BBC world Service radio here was, for once, not Ebola but the shootings in our national capital. Everyone expressed concern and great surprise. I have not been able to view the videos but got a good sense of events. It must have been really worrying for those in Ottawa and the country.

Meanwhile, we all keep fighting the threat or perceived threat of Ebola. I think that the response in the US is becoming disproportionate e.g., quarantining of returnees to NY State. Workers here are wondering what we will have to face by the time we return to our home countries. One US NGO staffer I talked to wanted to be away for just two weeks to move her belongings from DC to Geneva. At present, she will have to try to avoid landing in New York, but still has to stay in the US for three weeks, taking her temperature twice daily and reporting to CDC.

There is still a lot of denial here, which is, perhaps, not surprising. The stigma for infected families is high, and sometimes survivors and orphans are shunned. If Western countries had to face the same, would we be any different, even given our greater acceptance of how infection is spread? Sierra Leonians who travel are also suffering discrimination. On the radio I heard one person state that “we may not be infected but we are all affected”.

I have talked about the influx of assistance. This can put a strain on UN organizations and NGOs who work here permanently, with new and constantly rotating staff, as well as disruption of long standing programs. In addition, offers of help, like the well publicized Cuban contingent, are not as straightforward to take up as might appear at first sight.

Our first Community Care Unit (previously called ECUs) should open this week, with three more to follow soon after. We are having to train workers to be safe and will have to ensure tight oversight. At a training session last week, the local Paramount Chief showed his leadership by encouraging the workers, but also by ordering all village chiefs to turn up. He then proceeded to take them through the facility to show them how it would function; an influential, impressive and powerful man.

The UN system does look after its staff here, with medical services, security assessments of hotels, limitation of transport to UN vehicles, and requirements to get permission to travel outside of Freetown. The creation of an outpost in a remote village in Koinadugu Dstrict, to investigate a new outbreak and build an isolation unit, will create particular headaches for the organization’s security arm. I just wanted to re-assure you that our well being is a high priority!

I may be able to report more on the outbreak investigation and plans soon, but can say that last week an advance team took 8 hours to travel 300km to the district and then another 8 hours to travel 40km into the mountains to access the affected village.

Meanwhile, features of daily life continue to fascinate; trucks and cars on the road laden with charcoal, wood, rice, palm oil and plantains bound for Freetown. I had forgotten how delicious fried plantain is! The buyers can charge double in the city for what they pay picking up supplies put out on the roadside. One can often see small scale furniture makers who produce beds chairs and dressers. I asked what kind of wood was being used to make shelves and stands for chlorine buckets in our CCC and the answer was “forest wood”. I was shown such a tree, but was none the wiser.

We are protected somewhat in the city as, when the power goes off, which is not infrequently, a generator comes on in the hotel and WHO offices. In Port Loko the power is only on from 7pm to 7am. Power meant a fan and being able to sleep with a breeze blowing into my mosquito net when I stayed there on Wednesday night. The next night I was able to get a room with AC and hot water! It is always very hot and sticky and more so inland. 30 degrees during the day is usual but the humidity is also high. Thunderstorms and heavy rain will continue for a while longer.

Finally, while Canada is well into the hockey season, soccer is on every TV screen here. I have seen many cars sporting Manchester United colours and yesterday, people were glued to a match between Real Madrid and Barcelona. I have been out running twice and am not alone. I suspect that most of the young men who are exercising as well are budding soccer players.

I very much appreciate your notes of support and am very lucky to have the ability to see and talk to Lois on most days! The occasional sight of Jade and Rhys and chats with Mish, Steve, Chris and Shiny are precious.

A good piece of advice here, is to try to achieve something that will hopefully have some influence on stopping the epidemic. That might seem obvious, but inevitably we do spend a lot of time responding to “fires”, planning for the short-term, coordinating, travelling between meetings and trying to get a sense of what is really going on. The latter is really difficult to assess, but it seems that the epidemic is still entrenched in Freetown, the Western Area, Port Loko and Bombali.

My task is to coordinate the roll-out of Ebola Care Units. WHO is responsible for the technical aspect and training, but we are in charge of setting up the first four as a proof of concept. Then NGOs, probably funded by the UK, will set up many more. These will be small, 8 bed facilities, in tents, built by local labour with a lot of local material. The objective is to provide isolation for cases close to their homes, when there are no treatment beds or beds in holding centres or where transportation is not available. Hopefully, we will have 4 operating next week.

A miniscule number of health workers across the world has ever worn the personal protective gear required for Ebola, so it is hardly surprising that there have been problems in the US and Spain, with apparently hasty training. We have the task of training health care workers in rural SL to perform at the same level, for their protection and the protection of others, in the ECUs. This is a tall order.

I visited Port Loko and saw ECUs under construction. I heard from a local MP about his task of dispelling myths about Ebola. This included fears that a person went into a centre for treatment, had a needle in their arm (for a specimen) and were sprayed with chlorine and then died. It is not hard to understand how some would think that the first was injecting the virus and the second caused death.

It is probable that there are many uncounted cases in villages and that when new beds, such as ECUs are open, sick people will emerge. We shall soon see.

There are posters everywhere about “kicking out Ebola”, and encouraging people with symptoms to call the 117 hotline. On the way out of the hotel the other morning, we saw two men with loud hailers walking up the road broadcasting prevention messages. Meanwhile, life goes on as it has to, where people live from day to day on meagre earnings, but there are no schools open for children. Large businesses are suffering; our hotel only has WHO staff as guests.

In the villages, rice and palm kernals are laid out to dry, but the disease is not far away. Opposite one the ECU sites, I saw a burial team at the local health centre. Another health centre that we stopped at did have Ebola cases, but there were no warning signs at the entrance. I was told that it was a “dangerous place”.

I am working from my hotel today, trying to write SOPs for the ECUs, but also fielding calls and meeting with others staying here.

More next week!

Click on the pictures for the captions!

I had to hit the ground running after arriving in Freetown at 0630 on Thursday morning. The plane arrived at 0330, but the airport is a long way across the river from the city.
Thursday was spent getting a security briefing, phone, cash from the bank and initial meetings. Commerce and street trading are busy, but Ebola warning signs are everywhere and all the bars are closed. I did see a woman, who I presumed to be a local resident, wearing an “I love Ottawa” t-shirt!

Handshakes are out and chlorine handwashes and temperature checks are in.

I am spending most of my waking hours working, and that includes Saturday and Sunday. The situation is not very good in many areas and the impression that I get is that this is still an uphill battle. As I said in my first posting, there are numerous partners, but the great majority are collaborative and highly motivated to succeed. I am working with dedicated people.

I am staying at a hotel on the ocean with many other WHO staff. So far, the food has been good and I ate barracuda for the first time last night. On Saturday, the person whom I am replacing had a farewell party, which hopefully the police do not decide is a mass gathering. It also celebrated the Spanish National Day when Christopher Columbus landed in the “New World”. I almost declined the invitation!

I spent this morning with UK AID and a large group of British soldiers. This was a new experience!

I am off for a site visit to Port Loko tomorrow.

Happy Thanksgiving!

My time in Geneva was short. I saw the mountains flying in, but did not have much time to look up after that. I was rapidly re-immersed into the WHO culture and all of the activities around Ebola. Many old friends and colleagues are working on the outbreak and it was good to meet up with them again. They remain dedicated and resilient despite external as well as internal pressures.

Even though I have not yet landed in Sierra Leone I have a number of working hypotheses. Lois will recognize, but not agree with, this approach!

In West Africa, and beyond, the response to Ebola is not chaotic but is certainly very complex. My public health pragmatism with be essential. Countries outside those affected, the UN system, and international governmental and non-governmental organizations are engaging on their own terms. They all have mandates and are making choices as to how, when and where to be involved depending on their interests, expertise, and willingness to become embroiled in the response. This makes coordination and adherence to a strategic plan very difficult. Also, in an affected country it may be seemingly well directed at the national level, but it is not straightforward to translate programmatic decisions into local action where community buy-in may not be present. I will let you know how well this analysis holds up!

There is good news from some areas of Sierra Leone but then not so good news from newly affected districts. I will be responsible for rolling out Ebola Care Units throughout Sierra Leone. These will be community based and are sorely needed where there are no treatment centres and where communities need local facilities for isolation and basic care. The person whom I am taking over from leaves on Saturday, so that we will be talking a lot over the next couple of days. I will be based in Freetown but will undoubtedly be travelling all over.

The training in Geneva was very much about personal safety and security and I have had to add a large medical kit as well as a mosquito net to my luggage. That, as well as a few more bottles of hand sanitizer! So, I will be looking after myself.
More to come…