Ebola: the ripple effect, by Brian James

The 117 emergency call is placed to the Ebola response unit. Within the hour, a medical convoy descends on the community from which the call came, complete with a military escort. Normally, few would have expressed any concern or interest at rumours of Mammy Marah’s fever spike but these are not normal times. The outbreak of the deadly Ebola virus has left many on edge and highly suspicious of the manifestation of any physical symptoms in neighbours, colleagues and acquaintances. The intimidating presence of the Ebola response unit has been cited as one of the myriad reasons for the rising body count accrued by the disease, as the sight of armed men triggers the instinct of family members to “protect” their Ebola infected relatives. Other explanations go that the Ebola response unit’s armed escort is for their protection, as initial reactions to their presence often turned violent. This resistance to Ebola health workers has been as much an obstacle to the fight against the disease as false alarms raised by the overzealous or mean spirited.

The Parallels
Sierra Leone is no stranger to violence and military action. Parallels have already been drawn between the 12-year civil war, which officially ended in 2002 and the recent Ebola outbreak, with some believing that the fallout from the current situation might prove worse than that of the rebel conflict. For many years, lack of infrastructural development in the country was blamed on the devastation left in the wake of the rebel conflict. It seems that just as the country is finding its feet and the rebel war is no longer a viable excuse for the lack of crucial systems in the country, yet another crisis has arisen threatening to set the country back further than it has come.

Like the rebel war, Sierra Leoneans first heard whisperings of the deadly virus from neighbouring Liberia. When cases were first discovered in Sierra Leone they were either treated with indifference or deliberately played down, not unlike the first outbreak of the war in Kailahun. Now that it has struck at the heart of the capital city, the world has once again taken notice and Sierra Leone is yet again in the world headlines for disastrous and tragic reasons. At the time of writing, the number of documented cases are well over the one thousand mark and there have been more than four hundred deaths.

The Reality
At first glance, the streets of Freetown appear to be normal, with people going about their business but the reality is anything but. There have been reports of people taking in infected relatives from the provinces and “hiding” them from the Ebola health units due to rumours of poor treatment in the makeshift Ebola centers that have been set up. An aggressive media campaign against the disease, particularly on radio stations has created a heightened awareness of the disease among the populace. With the exchange of body fluids being the major course of transmission of the disease, innocent forms of human contact such as hugs or handshakes are being avoided like the plague (no pun intended).

The first week in September is usually the time when the streets are a flurry of bright colours as children begin the first term of school in their new uniforms. This , however, is not the case as institutions such as schools and universities have not been given the go ahead to open their doors. Hospitals and medical centers that lack the facilities to treat Ebola have closed their doors. Coupled with the fear many share of coming in contact with the disease via unsterilized hospital implements or other patients, general health care has reduced drastically giving other diseases such as malaria, typhoid, cholera etc. a free reign to wreak their own brand of havoc.

Majority of Sierra Leoneans remember what it is like to go without such crucial services as health and education, the uncertainty of when they will be reintegrated into their lives. They also remember the feeling of absence left behind by those with the financial means to leave the country. After over a decade of peace, Sierra Leoneans in the Diaspora had begun returning home with the hope of rebuilding their lives and making their contributions to the development of the country. With the Ebola threat, many have returned to seek refuge in the West, selling off assets like houses and lands, which strongly suggest a lack of inclination to return anytime in the near future.

Completely blindsided by the threat, the government has been struggling to keep a handle on things but the glaringly apparent lack of a sound health system has made it difficult to do so. Many of the known Ebola cases involve health workers who have the most exposure to the disease. In trying to contain the disease, their risk is amplified in that they lack basic equipment and end up contracting the disease. Health workers have complained that they do not receive incentive commensurate to the risk involved in treating Ebola patients. At the time of writing at least four notable doctors in the country have succumbed to the Ebola virus in their efforts to contain the disease. With the already low number of health workers reduced even further, majority of Ebola patients are being left untreated. According to the Truth and Reconciliation Commission (TRC) report, some government soldiers cited poor incentive and lack of proper equipment as reasons for leaving the army and joining rebel forces, which further exacerbated the conflict. The situation appears to be repeating itself, as the only line of defence against total infection is being asked to risk their lives with minimal incentive. Because of this, local health workers are reported to have quit their jobs, further depleting the already low human resources.

What is the Government Doing?
To minimise physical human contact, government has ordered the closure of places where people congregate like corner cinemas, parties etc. but much larger gathering places like churches, mosques and government offices remain open, which keep the probability of physical contact high. Other actions like the reducing the number of people a taxi is allowed to contain or putting a ban on commercial motorbike riders after 7p.m. seem like tentative efforts to maintain the appearance of proactiveness and lack any kind of impact that people are desperate to see. Quarantine of communities suspected of infection has had varying levels of success but the continued spread of the virus shows that it is not as efficient as it should be.

The government does not appear willing to restrict general movement via an indefinite lockdown, which will keep physical contact reduced to its barest minimum until the virus runs out of hosts. Rumours flying around that government intended to impose a countrywide 21 – day curfew prompted many to begin stocking up supplies in their homes. When it was eventually announced that government had no such intentions, people questioned what actions, then, the government was planning on taking.

A nationwide three-day lockdown period was enforced from the 19th to the 21st September, during which teams visited various homes to conduct sensitization on prevention against the virus and distribute soap for hand washing. The efficacy of this drive is subjective in that the Government reported “massive success,” while some individuals were highly sceptical that a five-minute talk and a bar of “soda soap” would make any kind of impact on the crushing effects and lightning fast transmission of the disease. Thousands of people are reported to have defied the lockdown and crossed the border into neighbouring Guinea, proving that the enforcement of the lockdown was lacking in some areas.

Some have advocated for a much longer lockdown period but others like taxi drivers and market traders claim that this would be too extreme a measure that would adversely affect their work. The government seems to agree with the latter. Perhaps it is the fragile state of the Sierra Leone economy that is being protected. With businesses closing down almost on a daily basis and the highly lucrative tourism industry taking an especially bad hit, government has reported a loss of over 70 billion leones in revenue since the outbreak of the virus. It estimates that it stands to lose over 200 billion in coming months. An indefinite curfew, which would apply to all trade and business, could stall the economic engine altogether. For whatever reason the government has chosen not to implement an extended curfew, the reality remains that the only a drastic action of some kind will curb the spread of the virus.

What is the International Community Doing?
In times of crisis it is not uncommon for African countries to look to Europe and America for answers. Sierra Leone, which is among the countries in the world most heavily reliant on foreign aid, is certainly no stranger to this phenomenon. China is one of the biggest donors so far with massive contributions of cash and logistics. The Bill Gates Foundation is reported to have made a donation of $50,000,000 to the fight against Ebola in West Africa – its biggest donation yet. There have been other donations from countries, individuals and institutions to the ongoing effort in Sierra Leone. Almost as large as these donations, however, are flying accusations of misappropriation of funds and “Ebola profiteering”, which contribute to an atmosphere of distrust and suspicion that resources are not being maximised on the Ebola effort. The extent to which this is happening is unclear but it has prompted prominent musician and film maker Jimmy Bangura to speak out against it in the media. The arrival of 30 British troops holds the promise of the British government to make available 700 Ebola treatment beds and construct a treatment center in Kerry Town. With makeshift Ebola centers overwhelmed by the sheer number of patients and the lack of proper facilities, the arrival of the British is certainly welcome but the conservative treatment the center will be providing might succeed in merely slowing down the threat instead of eradicating it.

The Fallout
The disastrous potential of the Ebola virus in not just Sierra Leone but West Africa as a whole is difficult to calculate. Skyrocketing air ticket fares and limited air travel to and from Sierra Leone have made it all but impossible for most Sierra Leoneans to leave the country and seek refuge elsewhere. Some who have left, Sierra Leoneans and foreign nationals alike, have been unable to escape the effects of Ebola in their lives as they are treated with high levels of suspicion, even to the extent of being refused medical treatment and employment.

Estimates as to how many people will become infected in coming months number in the hundreds of thousands. While efforts to sensitize the public about Ebola and provide treatment for the infected have had varying levels of success, it is clear that the spread of the disease is steadily on the rise.

The decision of some people to “protect” family members who are infected with the disease only encourages further transmission. The Ebola virus has reopened old wounds of fear and paranoia among the populace, which, in themselves can be every bit as dangerous as the disease itself. With a reeling economy, a health system that is unreliable at best and thousands of school children sitting at home, it is imperative that in terms of decision making the government pull out all the stops and the Ebola threat be brought to a speedy conclusion. If the present situation is allowed to deteriorate further, the painstaking developmental strides that the country has made in the past 12 years could come undone.

Brian James is a Sierra Leonean fiction writer. He holds a degree in Mass Communication and has published a number of short stories in various anthologies; On the Road to Godiva (Book of Voices, 2005), Devils at the Door (Dreams, Miracles and Jazz, 2008), Simple Economics (Caine Prize for African Writing – Work In Progress, 2009) and The Dark Man (The Price and other Stories, 2013).

He is also a screen writer, having written fifteen local dramas. These include Dagadi, Beauty Curse and Thorns of Vengeance, all of which were produced in Sierra Leone in 2012.

James currently resides in Freetown with his wife and three sons.

This entry was posted in Ebola and tagged . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s