We were driving back to the hotel from the WHO office the other evening, when I saw an older man walking up the street. He was probably in his late sixties. I realized how few people of that age I had seen here. The life expectancy in SL is around 45 years. It is unjust that the chances of a Sierra Leonian reaching my age are small.
As I have written before, there are many other threats to health in SL besides Ebola. In December, the government will undertake a mass drug administration for malaria in the areas of intense transmission. It is assumed that an increased mortality in children has probably resulted from closure of many peripheral health units during the Ebola outbreak. It is hoped that the government action may also reduce the risk of admitting a person with malaria only into an Ebola isolation ward during this period. With the diversion of the meagre public health resources to Ebola, there is also concern about people not getting their TB and HIV medication. On Dec 1, there will be announcements by UNMEER and the National Ebola Response Centre about progress toward the 70-70-60 targets (isolate at least 70% of EVD cases and safely bury at least 70% of patients who die from EVD by 1 December 2014 – 60-days). I trust that World AIDS Day, also on Dec 1 will not be eclipsed.
Targets are useful as long as the information used for assessments is reliable. Last Saturday and the following Tuesday, I went out into the Western Area (Freetown and rural), with UNICEF and the District Medical Officer looking at possible sites for CCCs. At one village, we were told by a schoolteacher that 60 people had died from Ebola, the last one being 4 days before. He reported that the system for picking up sick people just does not work. In another community, where, with the help of an NGO they have started building their own CCC, they had seen 40 deaths from Ebola, the last one that morning. In addition, there were 12 people sick in their homes with nowhere to go. The official data appears to show a better picture, but anecdotes seem to contradict this.
I have often mentioned the daily ritual of hand-washing on entering public and UN buildings. The common implement is a bucket with a lid and a tap. To my surprise, these are called “Veronica” buckets. I discovered why. It was a smart, low tech, invention by a Ghanaian, and was borne of necessity.
Other threats to health here are roads and traffic. Some of us got an unsettling reminder of this on Friday, when our car skidded on a dirt road, went into a ditch and flipped right over. We were all wearing seats belts and fortunately no one was hurt. The road was well maintained by a mining company, but speed and gravel do not mix well. Our mission to Moyamba and Bonthe came to an abrupt end!
We had to wait for our back-up car from Freetown and were in a large market place. This was almost totally deserted as it is in the centre of an Ebola “hot spot”. When the disease hit neighbouring districts, people came to Moyamba Junction to see the local pharmacist who was “treating” cases. He became infected and there was a large funeral where traditional practices were followed. As a consequence thirty to forty people were infected, thus starting chains of transmission which are now close to coming to an end. These “amplifying” events have been a significant driver of the outbreak. There has been a lot of effort put into “sensitization”, through messages on the radio, posters and loudspeakers on trucks broadcasting the word, but these have to be followed up by community-by-community engagement and mobilization. This is being facilitated greatly by local chiefs in the rural areas. One of the local staff was recounting that in Freetown, communities were disrupted during the war making this kind of approach very challenging in the urban area.
The CCCs that I have written about are achieving the isolation and basic care that we had planned. One of them was set up across from a peripheral health unit. WHO has just released the story behind this CCC.
A fellow Canadian and I were given a pumpkin pie by someone from UK AID, who was (happily for us) unaware that Canadian Thanksgiving and American Thanksgiving are on different dates. It was delicious! We shared it with three Canadians and one American, as well as with colleagues from Egypt, Cuba, Spain and Italy.