The Western Surge began the day that I left. I hear that there has been an increase in calls for ambulances to pick up suspect cases. The “push” will continue into the New Year and will be accompanied by restrictions on gatherings, festivities and travel over the holidays.


On my last evening, the “surge” team met over dinner to review the day’s work and I handed over my responsibilities. I had finished my mission report, which was a very useful exercise in reviewing achievements and lessons learned and in making recommendations for future teams.

The trip back across the estuary to the airport was uneventful and the health questions, temperature check and baggage search straightforward. Waiting on the tarmac was the last experience of a warm African evening.

Lois and I were reunited when I arrived in Geneva early on Thursday morning. I hope to be reunited with my bag soon as it will be leaving Freetown 4 days late, due to a “technical problem”!

Thursday was taken up by technical debriefs and a mandatory visit to the WHO health services and psychologist. I handed over my UN certificate, which marked the end of my mission. Later, Lois and I celebrated with fondue at the Café du Soleil, our old haunt.

The efforts to control the outbreak will continue in the months to come and I will be watching closely, but for now, from afar.

It is Harmattan season. It is noticeably cooler in the mornings (low 20s), but still gets hot later. On sunny days, the bright light has been replaced by a haze. Yesterday, I saw cars covered with a fine layer of red dust brought in by the north winds.

Fridays are a day of colour. Everyone wears traditional clothing to work, which for both men and women can be very “sharp”. I passed smartly dressed men pouring out of a mosque after Friday prayers. The women were emerging from another entrance. I also saw many brightly attired people going into a large church and was told that services were held on Friday and Saturday, as well as Sunday, due to the pressure for space.

We have been building up for the surge, which will now start on Wednesday. The timing was dependent on a last minute decision by the President. The campaign is really a concerted effort to encourage sick people to present themselves and to get help. The level of trust in government is not high and even the proportion of people in the Western Area that believe that safe burials are important is surprisingly low. I gave two presentations to groups of district councillors and tribal heads. They were really engaged, demanded more involvement and asked many questions. I presented in English (of course), others in Krio. The questions were also answered predominantly in Krio. When the debate was animated and in Krio, I still got the sense of the concerns by catching the occasional word.

The new outbreak in Kono has received a lot of attention as a result of a WHO press release. I missed going out on the mission because of commitments to the Surge. You will see in the BBC story reference to the phrase used by the MOH Director of surveillance when he said that we were only seeing the ears of the hippo! The tip of the iceberg analogy would not have worked. Kono is the centre of diamond mining, but it seems that little of the profits accrue to the people. I hear that it is not unusual to see families walking down the street with pans to look for gems in the local river. The roads are bad and the support for the district health management team is minimal. If the outbreak is to to be controlled, there is a need for basics like cars and fuel for surveillance and contact tracing teams. The cars take a real beating on rural “roads” and even to reach one affected village can take hours. IFRC is setting up a holding centre which will be staffed by Canadians. They are on site already and supplies are coming in. The outbreak was going on for a time but not admitted to. As a consequence, at least three nurses and 2 sprayers working in the local hospital died. One of the drivers saw an illegal night time burial last week in the district capital. More social mobilization and community involvement in any action is absolutely necessary.

I am writing my mission report, which is a requirement for everyone before they leave. I have seen many staff busily composing their final words of wisdom in the days before departure. It is a great way of analysing what one has achieved and a way to make recommendations. Before she left last week, I had a long conversation with Eilish Cleary (Chief MOH for New Brunswick) who spent a month in Nigeria and one month here in Port Loko. She wrote this story for the Irish Times. It contrasts with the attention that is given to treatment centres and PPE-clad health care workers. They are, of course, “on the front line” but there are so many others involved in the “fight” – health workers, community workers, as well as the patients, families and friends.

Eilish and I are, of course, in favour of bringing in more public health expertise. This is echoed by John Kim, the President of the World Bank in a commentary for the New York Times. You may have seen Eilish’s other work reported in the Globe and Mail. We do need something to balance the negatives. We want to promote health, but what we have to say, i.e., do not hug, do not touch a sick person, keep your distance from those who you would naturally want to comfort, be proud of not caring in the way that you are used to. I expect that more and more people here will want to forget the outbreak soon enough, and then there is the danger that it will become endemic and just smoulder away for months.

I will depart on Brussels Airlines on Wednesday evening. This will mean catching a boat early in the afternoon to get over to the airport. At least it will not be in the middle of the night as when I arrived. I will be in Geneva early Thursday morning. I might just publish another post next week, but, in the meantime, thank you again for all of your comments and support!

What I have missed (not who I have missed!):
Terra Breads and a good espresso
Regular exercise outside
Salads
Good roads
Consistent WiFi
Drinking water from a tap

What I will miss:
The warm weather
The warmth of the people
The fresh fish
The WHO team

What I will not miss:
The smell of chlorine on my hands

The battle against Ebola will be fought and won in the Western Area. This sounds like a headline. Port Loko is still highly “active” but, with more isolation and treatment beds and better surveillance, the situation will improve there soon.

In and around Freetown (Western Area), with its crowded communities stretching out on both sides of the peninsula, the outbreak is increasing, as shown in the graph below. Ebola has been seen before in larger communities, but not in such a dense urban area. It is daunting. From December 14-31, there will be a “surge” of effort to find people  who are sick with Ebola-like symptoms and to promptly isolate and treat them. This will involve an increase in the number of beds available – for example, MSF Spain, MSF Switzerland, Emergency, MedAir and the Ministry of Health will all be opening new holding centres and treatment centres before the end of the year.There will also be four CCC-like units created in the sites that we scouted out last week. Until I leave in 11 days, I will be in charge of the WHO response in the Western Area. On top of this, there is now a new outbreak in Kono, at the far eastern end of the country.

I understand that there is a fairly harmonious relationship between religions in SL, to the extent, for example, that, where, at the opening of a meeting, the Moslem representative is not there, the Christian representative will say both sets of prayers. Despite the mix of 50% Christian, 50% Moslem, there is little evidence of the approach of the Christmas season, unlike the images of holiday preparation, trees and lights, I see in news from Canada. Early one morning, I did see one flashing star and, on my walk to seek espresso this morning, I heard an African version of the 12 days of Christmas. The Radisson Hotel has a (fake) Christmas tree, but that does not really count! Of course, the climate and relative equal length of day and night emphasize the distance from northern climes, where days are becoming shorter and colder. It is constantly between 25 and 30 degrees, with a humidity of around 80%. The rains seem to be almost over and then it will become even hotter.

I heard on a car radio the other day the kind of African beat and rhythm that Lois and I remember from our time in Zambia. On being asked how he would describe this type of music, the driver responded, “60’s”. He said that his generation refer to it as music for the “old man set”! I smiled….music obviously does evolve. For an alternative to the “Band Aid” Ebola appeal tune, listen to the song by Steady Bongo who is a Sierra Leonean institution.

I have been in touch with a few journalists here. This is a piece by a Canadian, now based in DC.

On the interesting people file, I recently chatted with someone from UK AID with whom I have been working regularly here. I discovered that he was in Zambia in the 1990’s, where, with his partner, he cycled (and canoed) the route of Livingstone’s last journey. This would have included the Bangweulu swamps, which Lois and I both know. The book of the trek is still available. He is now based in Dhaka and plans to cycle around Bangladesh, having constructed a rickshaw for his children attached to two bikes up front for himself and his partner!