World's Slow Response To Ebola Leaves Sierra Leone Villages Scrambling

Dec 5, 2014
Originally published on December 12, 2014 11:05 am

If you think the fight against Ebola is going well, here's a grim new number: 537.

That's how many new infections were reported in Sierra Leone in the past week. It's the highest weekly tally in any country since the West African outbreak began.

International governments and aid groups have scrambled to open Ebola treatment centers in the country. But, because of safety concerns, many of these centers are accepting only a fraction of the number of patients they were built to serve.

In the meantime, most sick people are being directed to makeshift, government-run centers. Some of these are simply schools or other government buildings re-purposed into a "community care center" — a place for people with Ebola symptoms to be isolated.

Bai Marrow Lamina Ngbathor, who heads up a chiefdom of several hundred villages in Sierra Leone's rural north, is helping transform a school into one of these care centers.

The facility is a lot more basic than the full-fledged treatment clinic that is supposed to serve this District--but which is only treating about ten patients while it scales up. That place was built with funding from foreign governments, including the U.S., and has a sophisticated in-ground plumbing and sanitation system.

Here at the school, workers are digging a big hole in the ground. "Those are the toilets for the suspected cases to use," Lamina Ngbathor says.

The treatment offered at the school center will also be a lot more limited — medication to bring down a fever and rehydration salts that patients can drink with little help or supervision. In contrast, at some treatment centers, patients are getting intravenous drips for fluid replacements and direct attention from staff.

Still, though, Lamina Ngbathor and his team have stood up this community care center in a matter of days. He walks into a room where there are 11 metal cots.

"This place was a classroom," Lamina Ngbathor says. A chalkboard on the wall still has a lesson written on it. "My name is Hawa. I'm a girl. I'm 4 years old," Lamina Ngbathor reads off the board.

These community care centers — and larger holding centers — were originally conceived of as temporary triage outposts. Health officials intended them to be places where people who might have Ebola could be isolated while they waited for an Ebola test result. If the test came back positive, then a person would be sent onto a proper treatment facility.

But right now, there's no better place to go. So sick people are getting stuck at these triage centers, many will likely dire here. Effectively, the main function of this place seems less to help sick people than to prevent them from infecting others.

"If we allow those sick to be in the community, Ebola will spread," says Lamina Ngbathor. "And all of us will die."

But a few miles down the road, at a similar but larger holding center, I Dr. Corrado Cancedda with the aid group Partners in Health is trying to change this approach. He says this idea that so many Sierra Leoneans have to die while the international response scales up is unacceptable.

Cancedda asks, Why should people here get a lower standard of care than Americans or Europeans? "Everybody deserves the same level of care. That should always be our goal and our guiding principle."

So Cancedda has begun turning this existing holding center into a full-fledged treatment facility, with IVs. He's also bringing in medical workers from overseas and trainers in a matter of days, not weeks.

And Cancedda totally rejects the idea that Ebola has to be such a deadly disease. "Ebola kills so many people here [in Sierra Leone] because there's not the resources to take care of patients properly," he says.

As soon as possible, he wants to start using lab tests to monitor organ function and tweak electrolyte levels — the things that American and European hospitals have been doing to support their Ebola patients.

"Let's bring the tools, and then the mortality rate will go down," Cancedda says. "There's no reason why it couldn't be 20 percent, or 10 percent, if you diagnose patients early enough before they're sick."

The key to getting there, Cancedda says, is to maintain a sense of moral outrage — the conviction that as long as people are dying, what you're doing is never enough.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

Let's face it; Americans are paying less attention to Ebola. The drama of a handful of cases in the United States seems to have ended for now. Also, the U.S. election is over, leaving politicians less reason to hype the danger. But if you're in Sierra Leone in West Africa, this is more than a cynical tale. Last week alone, 537 new infections were reported in that country. That is the highest weekly tally in any country since this outbreak began. International governments and aid groups are scrambling to open treatment centers in Sierra Leone, but that is not easy. NPR's Nurith Aizenman reports.

(SOUNDBITE OF ARCHIVED RECORDING)

BOB BONGOMEEN: And what is PPE?

UNIDENTIFIED RECRUITS: Personal protective equipment.

NURITH AIZENMAN, BYLINE: Bob Bongomeen is instructing 23 recruits in a critical skill, how to stay alive while working in an Ebola ward. We're soldiers, he says. The chlorine spray are bullets. The protective suit...

BONGOMEEN: That is our armor, the defense that we use to stop any infection.

AIZENMAN: Bongomeen's a sanitation expert, brought in from Uganda for this new Ebola treatment center in Sierra Leone's rural north. It's been built by the aid group International Medical Corps with foreign funding. The local men and women sitting in a ring of folding chairs around Bongomeen have been hired to work as cleaners.

(SOUNDBITE OF ARCHIVED RECORDING)

BONGOMEEN: What fluids could we easily get in contact with?

UNIDENTIFIED RECRUIT #1: Sweat.

BONGOMEEN: Sweat.

UNIDENTIFIED RECRUIT #2: Stool.

BONGOMEEN: Stool.

UNIDENTIFIED RECRUIT #1: Vomit.

UNIDENTIFIED RECRUIT #2: Saliva.

BONGOMEEN: Saliva, blood...

AIZENMAN: The stool, vomit, blood of someone with Ebola is highly infectious. It's why hundreds of health workers treating Ebola patients have gotten sick themselves. And it's the reason International Medical Corps has been taking things slow. Their facility is designed to treat 50 patients. For now, they're taking in 10. They open Monday, and they want to phase up safely.

BONGOMEEN: The safety and protection protocols is the one thing that we don't negotiate with. There's not so much room to play with that.

AIZENMAN: This is something you hear a lot in Sierra Leone right now. Ebola has been surging through the capital and northern districts since September. Yet, it's taking the international community weeks to build and full open promised treatment centers. In the meantime, most sick people are being directed to makeshift government-run centers like this place.

BAIMAUR LAMINANGBATU: So can I just take you along the building now?

AIZENMAN: Yeah.

Baimaur Laminangbatu heads a chiefdom of several hundred villages. We meet in one of them, in front of a one-story, yellow cement building surrounded by jungle.

So this place is normally a school?

LAMINANGBATU: It was a school, yes. It was closed because of the Ebola. Now we are using it as an Ebola holding center.

AIZENMAN: The chief has asked some neighborhood teenage boys, who have no school to attend for now, to hack away brush to clear a path for ambulances.

(SOUNDBITE OF HACKING AWAY BRUSH)

AIZENMAN: The care on offer is limited. Officially, these holding centers are supposed to be triage outposts. But with the real treatment centers so backed up, many people may end up dying here. Effectively, the main function of this place seems less to help people than to prevent them from infecting others.

LAMINANGBATU: If we allow that sick to be within the community, it will spread. And all of us will die.

AIZENMAN: Nearby, another holding center is being expanded.

(SOUNDBITE OF HAMMERING)

CORRADO CONCEDA: Well, this is the entrance to the red zone.

AIZENMAN: Dr. Corrado Conceda is with the aid group Partners in Health. And he says this idea that Sierra Leoneans have to die while the international response scales up, it's unacceptable. He asks, why should people here get any lower standard of care than Americans or Europeans?

CONCEDA: Absolutely, everybody deserves the same level of care. That should always be our goal and our guiding principle.

AIZENMAN: Conceda has begun by helping to turn this existing holding center into a full-on treatment facility, using IVs and bringing in overseas staff and trainers in a matter of days, not weeks. He says there's no time to build from scratch. And he totally rejects the idea that Ebola is such an exotic, unbeatable disease that it has to kill so many people.

CONCEDA: No, no, no. I mean, it does here. But it does here because there's not the resources to take care patients properly.

AIZENMAN: As soon as possible, Conceda wants to start using lab tests to monitor patients' organ function and tweak electrolyte levels, the things American and European hospitals have been using to support their Ebola patients to such great effect. The key to getting there, he says, is to maintain a sense of moral outrage. As long as people are dying, what you're doing is never enough. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.