The coverage of the Ebola outbreak in West Africa by U.S. media has often seemed unremittingly grim. So it was with some trepidation that I boarded a plane for Sierra Leone. I was part of a field assessment team assembled by Project HOPE, the international humanitarian organization. The country’s first lady, Sia Nyama Koroma, invited us to lend our support in figuring out how best to contain the Ebola outbreak.
What we found was surprising. While a great deal of work remains to be done, the inertia and disbelief that characterized the early reaction to the outbreak has largely disappeared. Sierra Leoneans, with the help of a wide range of international partners, are banding together. If their efforts gain momentum, the stage is set to contain the outbreak and prevent even more suffering and death.
We were a bit of a motley crew. Our leader was Project HOPE’s Director of Special Programs, a U.S. Army veteran with 32 years of experience carrying out projects in disaster zones. Merck Vaccines lent two of us: a physician/epidemiologist and former state health officer with experience in outbreak control, and a pharmacist/epidemiologist with 27 years of military experience. Massachusetts General Hospital sent a nurse with extensive knowledge of infection control and relief experience abroad. There was even a consultant from Interhealth Canada who has overseen the construction and management of health care facilities in many developing countries.
I do not want to gloss over the reality that Ebola has hit Sierra Leone hard. The number of cases is second only to Liberia’s. But there is hope too. In some settings we heard that as many as half of those who contract Ebola survive. While such a death rate is still extraordinarily high, it is significantly better than the 30-percent survival rate that has often been quoted. We heard from several clinicians that aggressive fluid intake seems to be the critical ingredient for survival, which suggests that as the treatment system improves, survival should too.
And life goes on. People figure out how to cope. The vast majority of the six million or so people who live in Sierra Leone are not infected. We noted that some, as people everywhere will do, have developed a kind of gallows humor. One story we heard was of a man who thanked God when he learned he did not have Ebola – but did have HIV.
Initially, fear, mistrust, conspiracy theories and lack of understanding about how Ebola spreads hampered the outbreak response. By the time we arrived, however, things had changed markedly. Billboards, bumper stickers, posters, and media outlets described the symptoms of Ebola and how to call for help. The political leadership – we met with the president, the first lady, several ministers and many other officials – is deeply concerned and active. A national Emergency Operations Center is beginning to coordinate efforts across organizations and government ministries.
Most impressively, local people were stepping up to help their communities. In one region we met a group of community members organized by the local public health unit to do some of the most dangerous and heartbreaking jobs, like staffing the local burial team. The burial team members must don full protective gear in very hot temperatures, and handle the highly infectious dead while grieving family members look on. Other community members were arranging care for children orphaned by the outbreak. I found myself wondering who in my community back home would step up to do such critical and demanding tasks were we faced with a similar situation.
The system to control the outbreak is growing and strengthening. People are told to call a toll-free number if they have symptoms, and a patient-transport vehicle comes to ferry them to an Ebola care center, where they are tested for the virus. Those who test positive are then moved to an Ebola treatment center. The burial rituals that helped fuel the outbreak initially are now not permitted. Support tools for those who must remain at home until beds are available are being developed. Constant and fastidious attention to infection control in every one of these steps is the key to success. To be sure, there are still not nearly enough beds, lab services are inadequate, there are not enough transport vehicles, some still handle the dead as they have traditionally, and infection control is too often spotty. But efforts to address these shortcomings are vigorously underway.
I hope that the sense of fatalism about the Ebola crisis will fade. While it will be quite a few months and many deaths before the outbreak stops, and sustained help is still badly needed, I believe that these new efforts will turn the tide.