I have been “in the field” all week and was glad to get back to my hotel in Freetown.  Electricity at all hours, air conditioning and a hot shower should not be taken for granted!  Our first CCC opened on Monday and had ten patients yesterday. At least one person has died of Ebola after admission to the CCC. The second CCC opened today.

I was in Port Loko for the CCC opening, and traveled to Koinadugu district on Thursday, to the centre of a new outbreak. The roads are bad, as can be seen in one of the photos. The truck that is stuck is from WFP and is supplying food. Our staff have set up a temporary CCC in one of the villages, to be replaced by something better in the village school next week. One of the blackboards has the remains of a lesson from June 20 – the last day of classes. There are many confirmed cases in this chiefdom.

I am becoming more expert on things like the need for motorcycles for surveillance staff, ambulances, packaging for lab specimens and satellite internet equipment. At first, the only way to keep in touch was for someone to climb a nearby hill where there was a cell phone signal.

On journeys through the villages, it is common  to see rice and chillies drying, and oranges, plantain, melon, mango and other fruit and vegetables for sale. Behind this, there is another story. In affected areas, many families are unable to harvest their crops due to illness or the loss of relatives, so food is in short supply. In addition, the price of rice, the staple, has doubled while, in areas of intense transmission, markets have been closed down in a bid to stop large gatherings. At the same time, iron mines are still operating, but with workers who are kept totally apart from the outside world for weeks at a time, so that Ebola is not introduced.

In Kabala, a WHO person responsible for social mobilization spoke with religious leaders this week. Most leaders, Moslem and protestant, attributed Ebola to divine punishment.  Fortunately, they can accept how it is transmitted and do support prevention messages. Despite this, and the support of Chiefs in spreading the word, people in the villages are still carrying out traditional burials with close contact with their dead relatives. I asked a nurse why people might not come to the CCC if they were sick. She said that they were traditional people who prefer herbs for treatment. Others have recounted that they believe that Ebola has been brought in by nurses who poisoned the wells. Most leaders are working very hard to encourage changes in burial practices and beliefs, but these are deeply engrained and understandably very difficult to influence.

I passed a girl of around four years cleaning up the front “step” of her hut, using the omnipresent short reed broom. In the country, I have regularly seen children, not much older than Jade, carrying bundles of wood, washing and plastic jerry cans of water on their heads. Ebola attacks all ages, but the mortality is slightly less in the young and the plight of orphans is mentioned often in meetings with NGOs and government. For those who survive, a certificate of discharge is an important piece of paper that helps them to be accepted back in their community, if they can find a relative left to look after them.

On a lighter note, I do get to run at weekends and this morning at dawn, took a road past large bushes of bougainvillia to the long sandy Lumley Beach. This would be a good place to come as a tourist in better times…

I really appreciate all the comments on the blog and your continued good wishes. If you feel like supporting the effort, you could consider donating to MSF or Plan International. I have been really impressed by Plan’s support for the CCCs.