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!