The good, the bad and the ugly of the 72-hour lockdown scenarios in Sierra Leone as revealed by posts and news outlets

 Posted Sunday September 21, 2014

 

By Tamba Morkway-sossah

http://tambasosa-troubleshootingzone.blogspot.com

 

We have seen snippets of reports saying a number of dead bodies, human bodies were discovered in houses with relations unwilling to allow the lockdown burial teams to take over and safely remove the bodies while others speak of burial teams not turning up to do their designated duty because of a lack of logistics - there is not enough of personnel and ambulances to cope despite the empty streets.

One news outlet, TheBlaze/AP has this headline - "Ebola Crisis Sparks Fighting, Fleeing as Sierra Leone Struggles Through Second Day of Lockdown" with its account on setbacks and success incidents -

"Some in Sierra Leone ran away from their homes Saturday and others clashed with health workers trying to bury dead Ebola victims as the country struggled through the second day of an unprecedented lockdown to combat the deadly disease. Despite these setbacks, officials said most of Sierra Leone’s 6 million people were complying with orders to stay at home as nearly 30,000 volunteers and health care workers fanned out across the country to distribute soap and information on how to prevent Ebola.

In a district 12 miles east of Freetown, police were called in Saturday to help a burial team that came under attack by residents as they were trying to bury the bodies of five Ebola victims, Sgt. Edward Momoh Brima Lahai said.

A witness told state television the burial team initially had to abandon the five bodies in the street and flee. Lahai said later the burials were successfully completed after police reinforcements arrived.

In northern Sierra Leone, health worker Lamin Unisa Camara said Saturday he had received reports that some residents had run away from their homes to avoid being trapped inside during the lockdown. . “People were running from their houses to the bush. Without wasting time, I informed the chief in charge of the area,” said Camara, who was working in the town of Kambia. But the streets of the capital, Freetown, were empty Saturday except for the four-person teams going door to door with kits bearing soap, cards listing Ebola symptoms, stickers to mark houses visited and a tally to record suspected cases. Although early responses to the disease have been marred by suspicion of health workers, Freetown residents on Saturday seemed grateful for any information they could get, Kargbo told The Associated Press.

“Some people are still denying, but now when you go to almost any house they say, ‘Come inside, come and teach us what we need to do to prevent,’” Kargbo said. “Nobody is annoyed by us. The charity group Doctors Without Borders warned it would be “extremely difficult for health workers to accurately identify cases through door-to-door screening.” Even if suspected cases are identified during the lockdown, the group said Sierra Leone doesn’t have enough beds to treat them.

Other Freetown residents, however, were having trouble making it through the three days. “The fact is that we were not happy with the three days, but the president declared that we must sit home,” said Abdul Koroma, the father of nine children in Freetown. “I want to go and find (something) for my children eat, but I do not have the chance,” he said.

Report from Reuters news on the first day of the lockdown -

"Streets in the capital of Sierra Leone were deserted on Friday as the West African state began a contested, three-day lockdown in a bid to halt the worst Ebola outbreak on record. President Ernest Bai Koroma urged people to heed the emergency measures as health workers, some clad in protective biohazard suits, went house to house, checking on residents and marking each doorway they visited with chalk.

Radio stations played Ebola awareness jingles on repeat and encouraged residents to stay indoors. "As they are fighting this Ebola, we pray that it will be eradicated. That's what we are praying for," said resident Mariam Bangura as she waited at her home in Freetown's West End neighbourhood. Other residents looked out over the normally bustling seaside city from windows and balconies.

In Freetown, teams got off to a slow start, waiting several hours to receive kits containing soap, stickers and flyers. A few police cars and ambulances, sirens blaring, were the only traffic on the otherwise empty streets. One emergency vehicle was seen stopping at a house to take on a patient.

Medical charity Medecins Sans Frontieres, which has been at the forefront of the effort to contain the epidemic, warned last week that the lock-down could lead to the concealment of cases, potentially causing the disease to spread further. An official for the United Nations children's agency UNICEF, Roeland Monasch, said, however, that the "Ose to Ose" campaign, which means "house to house" in local Krio, would be helpful. "If people don't have access to the right information, we need to bring life-saving messages to them, where they live, at their doorsteps," he said.

The New York Times had this -

There is no large-scale treatment center for Ebola patients in the capital, Freetown, so many patients have to be placed in a holding center until they can be transported to a facility hours away — that is, if an ambulance can be found to pick them up and if those packed facilities have room. The countrywide lockdown showed the desperation among West African governments — particularly in the three hardest-hit countries, Guinea, Liberia and Sierra Leone — as they grapple with an epidemic that has already killed more than 2,600 people and shows no signs of slowing down.

While governments in the region have already cordoned off large swaths of territory in hopes of containing the outbreak, none have attempted anything on the scale of what is being tried here. The government says it wants to visit every residence in this country of about 6 million, with the aim of instructing people in how to stop the disease from being transmitted and to find out who is harboring sick people, with potentially deadly consequences.

In the streets of the capital on Friday, one woman lay curled in a fetal position, eyes shut, precariously balanced on cardboard sheets next to an open gutter in front of locked storefronts. From a wary distance, the anti-Ebola volunteers said she had high fever. Hours of calls had produced no ambulance. A small crowd, including the police, soldiers brandishing guns, presidential advisers and spectators taking cellphone pictures of the immobile woman, milled about.

A medical worker said two more bodies in the vicinity needed attention. But still there was no ambulance. “They are not responding; they say they have lots of cases now,” said a volunteer, Alhassan Kamara. Finally, a rickety ambulance pulled up, more than five hours after the initial calls, the volunteers said. But the loosely outfitted attendants refused to pick up the sick woman: they had no chlorine spray and said it was not their job. A loud anti-Ebola jingle played on a car radio. It took a second ambulance, and the president of a moped club who quickly suited up in protective gear, to get the sick woman bundled off to uncertain care.

On nearby streets, other volunteers were going house to house to warn people of the disease’s dangers. Normally clogged streets in the capital were empty, stores were shut down tight, and pedestrians were rare on the main thoroughfares. “The situation in Freetown is very worrisome as cases increase,” said Michael Goldfarb, a spokesman for Doctors Without Borders. “Without an immediate, massive, and effective response, there could be an explosion of cases as has been witnessed in Monrovia,” he added, referring to the capital of Liberia.

Whether Sierra Leone’s lockdown will constitute an effective response is open to question. Despite the mobilization, the volunteers hardly appeared to be thick on the ground. In some neighborhoods, residents said they were yet to see any of the green-vested young men and women who had volunteered.

In other neighborhoods, the volunteers — many of them students, all working for no pay — complained that there was no response to their knocks at most houses. If they arrived without supplies like soap or chlorine, residents were not interested in speaking with them, the volunteers said. Where there was a response, it was often followed by cursory admonitions to residents to wash their hands, report on neighbors suspected of illness and wear long-sleeve shirts at the market. At one house, several volunteers talked loudly at once about hand washing, leaving the residents visibly dazed. At another, they were amazed to discover residents who were supposed to be under quarantine because of their suspected exposure to Ebola, but were actually unguarded and free to roam about. At still another, one gave out questionable information about the Ebola virus — seeming to contradict some basic precautions.

Well into the morning, the house-to-house visits had yet to begin in Kroo Bay, a densely populated neighborhood of iron-roof shanties where roughly 14,000 people live, despite officials saying they would start at dawn. The police cruised into Kroo Bay on a pickup truck, yelling at residents to go indoors and warning of imprisonment. People simply stared at the officers and continued lingering as the police drove off. “The policeman is doing his thing, and I am doing my thing,” said Kerfala Koroma, 22, a building contractor. “We can’t even afford something to eat on a normal day. How can we get something now?”

USA Today has this observation - "As the lockdown took effect, wooden tables lay empty at the capital's usually vibrant markets, and only a dog scrounging for food could be seen on one normally crowded street in Freetown. Amid the heat and frequent power cuts, many residents sat on their front porches, chatting with neighbors. Ambulances were on standby to bring any sick people to the hospital for isolation. More than 2,600 people have died in West Africa over the past nine months in the biggest outbreak of the virus ever recorded, with Sierra Leone accounting for more than 560 of those deaths. Many fear the crisis will grow far worse, in part because sick people afraid of dying at treatment centers are hiding in their homes, potentially infecting others. However, international experts warned there might not be enough beds for new patients found during the lockdown, which runs through Sunday."

The BBC adds - "During the curfew, 30,000 volunteers will look for people infected with Ebola, or bodies, which are especially contagious. They will hand out bars of soap and information on preventing infection. Officials say the teams will not enter people's homes but will call emergency services to deal with patients or bodies. Volunteers will mark each house with a sticker after they have visited it, reports say.

On Thursday, President Ernest Bai Koroma said: "Extraordinary times require extraordinary measures." He urged citizens to avoid touching each other, visiting the sick or avoid attending funerals. Freetown resident Christiana Thomas told the BBC: "People are afraid of going to the hospital because everyone who goes there is tested for Ebola."

Another resident in Kenema, in the east of the country, told the BBC families were struggling because the price of food had gone up. In the hours leading up to Sierra Leone's lockdown, there was traffic gridlock in Freetown as people stocked up on food and essentials. Cities and towns across the country were quiet without the usual early morning Muslim call to prayer and the cacophony of vehicles and motorbikes that people wake up to here. Thousands of volunteers and health workers have assembled at designated centres across Sierra Leone and started moving into homes. But they had to wait for hours before their kit - soaps and flyers - could reach them. MP Claude Kamanda, who represents the town of Waterloo near Freetown, told local media that all the health centres there were closed, hours after the health workers and volunteers were meant to assemble for deployment to homes. He complained that the delays were not helping the campaign.

While we await reports from other parts of the country and what lessons that could be gleaned from this compulsory stay at home for seventy two hours that should end today, we cannot help but notice a thread running through - the discovery of more dead bodies and the reluctance of families to give them up.

We still have not got any report as to why the relations of the dead are refusing to hand over the bodies. Is there a fear that even if the poor individual took his/her last breath while succumbing to other ailments, they fear the body would be treated as Ebola-infested/infected and hence buried in an undignified manner? What provisions have the authorities made for the proper burial and identification of burial sites so that relations can know where their loved ones are interred?

Another theme running through the exercise is the handing over to soap bars to households. Fair enough as the Ebola virus is easily killed off using soap...yes soap and water. With running water a luxury for the many poor, where would they get the water for washing their hands? Where would they get potable water for cooking purposes and other chores in a country whose capital Freetown has a recent history of water shortages with owners of trucks carrying large containers of water doing a roaring trade with the noveau riche?  How will the poor get water?  How will this work out in rural and other non-city areas where the stream and river is the main source of water?  Will they be prevented from going out to the streams as the lockdown is enforced?  If so what provision is there for our rural folks?

For a capital where the disposal of human waste is a problem in an overpopulated situation, have mobile lavatories been set up?

Have centres selling basic essentials been made available to take care of the urgent needs of households?

The United Methodist Church of Sierra Leone is one of many religious groups that have has been playing its own part in this campaign.

"United Methodist Communicator Phileas Jusu has a pass from the government to travel during the three-day lockdown with teams of health workers who will be going from house to house identifying cases. Since mid-August, Yambasu and Bishop John Innis, leader of the church in Liberia, have been in partnership with United Methodist Communications, sending daily SMS text messages about health information and spiritual care to the district superintendents and pastors in Sierra Leone and Liberia.

Future messages will address topics such as proper handling of the dead and safety guidelines for events such as worship, weddings and funerals, Yambasu said. Yambasu predicts the lockdown will be hard for people who sell products in the marketplace and those who provide public transportation. “Prolonging the lockdown would be unbearable for the market women, taxi drivers and traders who eke out a living from trading,” he said. Yambasu said Sierra Leoneans now live “in a state of shame and embarrassment, loss, pain, grief, panic, suspicion and superstitions.”

In one community that has a high rate of infection — Port Loko — Yambasu said there is a rumor that a “witchcraft airplane that crashed in the town is causing many people to die.”

The economy is in disarray as the cost of essential items skyrocket while people are losing their jobs because businesses and institutions are closing. Schools normally start in September, but exams have been deferred nationwide and schools forced to close. “No one knows when schools and colleges will reopen,” Yambasu said. “This places our children’s education at risk.”

Churches are also suffering because religious activities like pilgrimages to holy lands, weddings, camps and pastor’s retreats are all suspended. Some churches have even cancelled regular Sunday services. The United Methodist conference office has had to make changes. “We have temporarily scaled down operations by sending on leave some of our staff including the most vulnerable workers who use ‘poda poda’ (public transport) to come to work each day in order to reduce the risk of contracting the disease,” he said.

Yambasu said the conference’s Ebola response team is developing a plan for next steps including:

•Establishing holding centers and effective ambulance services in the three United Methodist health facilities — UMC General Hospital Kissy, Freetown; Mercy hospital, Bo; and Rotifunk hospital.

•Developing a comprehensive psychosocial care program for Ebola patients in holding centers and isolation units and survivors and surviving families of Ebola victims.

•Putting in place a survillance team that will conduct periodic site visits to ensure that protective kits are actually being used by health workers.

•Developing an integrated Ebola/malaria response program that aims at adressing the escalating malaria situation in the country that has now been swallowed up by the Ebola epidemic.

•Continue with interfaith response programs and collaborating with other organizations such as the Religious Leaders Task Force on Ebola and faith-based relief groups, through resource sharing, networking and other advocacy programs. “In Freetown, a young woman died of appendicitis because she was taken to two separate hospitals and no doctor was willing to touch her,” Yambasu said. “Her appendix eventually ruptured and she died. This means that it is no longer Ebola alone that is killing people. People are now dying of very common diseases that can easily be treated.”