Ebola: a difficult and dark time for Sierra Leone

John Mattia.
Author:John Mattia
Posted on: Monday, 17th November, 2014

I work as an ophthalmologist and Medical Director at two CBM projects in Sierra Leone, the Lowell and Ruth Gess UMC Eye Hospital in Freetown and the Baptist Eye Hospital in Lunsar, which is situated about 100 km from the capital city.I am acting as Medical Director at the UMC hospital presently because of the absence of an ophthalmologist there.

Impact on CBM-supported eye-hospitals

The Ebola epidemic has significantly affected eye care work in both hospitals, especially over the last 3 months since the declaration of the state of emergency in the country. During this time several districts have been placed under quarantine, restricting the freedom of movement of people around the country.

There is increasing hardship because of the deteriorating economy. Many people have lost their sources of income because of redundancy from their jobs or losing their businesses. As a result of this we’ve experienced 60% reduction in patients’ turnout at the UMC hospital in Freetown and over 80% in Lunsar. Revenue generation in the two hospitals has also been significantly affected and we are struggling to find enough funds to pay salaries and cover the day to day running costs of each hospital.

The staff are given day to day updates and tips about the Ebola outbreak during our morning devotions. We have frequently emphasised the need for preventive measures particularly in the workplace. All patients visiting our hospitals are subjected to thorough self-hand washing either with soap or chlorine as well as temperature checks. It is compulsory for all staff attending to patients to wear gloves for any procedure that may require contact.

For the last week, all surgeries have been temporarily suspended because one of our colleague doctors was infected while treating a patient and is currently at the Ebola treatment centre. He was the head of the Kissy General Hospital - the hospital that we share the same compound with in Freetown. The general hospital has been locked down but the eye hospital where I work has continued to run.

He was a close colleague of mine. So far, 5 doctors have contracted the Ebola virus disease and died from it - he is the sixth and is fighting for his life. [Update: Dr Martin Salia, the surgeon from Kissy General Hospital, has been airlifted to the USA, where he remains in a critical condition - Reuters].

Personal impact

On a personal note, my family and I have come very close to contracting the Ebola virus in recent times. 2 months ago my wife had a caesarean section. She was operated on by the Spanish doctor who contracted Ebola virus disease in Sierra Leone and later died in Spain. The doctor had already started to feel unwell around the time of the surgery. He even fainted and almost collapsed towards the end of the surgery on my wife that day. Therefore I placed myself and my family in semi-quarantine for 21 days. I was really worried. I thank God that he protected me and my family.

My wife and baby are ok – we had a baby boy, his name is Victor Emmanuel. I gave him the same name as the doctor who delivered him, Dr. Manuel Garcia.

Impact on day to day life

The epidemic is now rapidly spreading and expanding in the city of Freetown. Everyone is living in constant fear and suspicion of each other, the epidemic has affected every aspect of life.

It has virtually paralysed large sectors of the economy in SL. International businesses on which the economy of the country depends have either moved out or significantly scaled down operations, resulting in the loss of much needed national revenue from such organisations or companies.

Many institutions have taken drastic measures to better manage their limited finances. One example is the Lungi International airport which has been compelled to slash salaries of workers by 40% due to the suspension of many international flights. Small businesses have experienced significant drops in daily sales as the purchasing power of most people in the country has reduced due to lack of jobs or mass redundancy in many institutions.

Local trade fairs called “lumas” used to be organised in different parts of the country on a weekly basis and were the source of income for most petty traders. However, as a result of the law on avoiding mass gatherings, these markets have been banned since the declaration of the state of emergency.The situation has also brought a significant reduction in income generation for these small scale traders also.

On the social front there has been virtually no form of night life since the banning of operations in all night clubs and cinema halls. Many Sierra Leoneans are ardent supporters of the European club football, especially the UK’s Premiership. However sports centres have been banned from operating so many fans cannot watch their teams live on television.

On the other hand, exchange rate of the Leones to international currencies keeps on falling. There has been one main factor for price hikes especially for essential commodities such as rice and other foodstuffs.

The Ebola outbreak stated during the active farming season for most areas of the country. At the same time, epicentres of the disease were quarantined. This included whole districts and led to the disruption of most farming activities as farmers abandoned their farms.

Most people in quarantined areas have been prevented from getting engaged in their day to day business activities for their survival. This has resulted in hunger, and starvation for many people. To salvage the situation, the international aid agencies such as the World Food Programme and local Non Governmental Organisations have started helping out with food supply to affected people.

Impact on people with disability

We don’t have specific data on disabled people so far directly affected by the outbreak. However in any crisis situation people with disability are at greater potential risk of the negative impacts of that situation and this one cannot be an exception.

One of the major precautions to take to prevent someone being infected by Ebola is avoiding body contact. However, blind people, in particular, depend on their sense of touch and human guides to get around. The guide is usually a younger member of the family who is sighted. In such situations it can be difficult to prevent the spread of Ebola by body contact from the guide to the blind person or vice versa.

One incident made an impression on me a couple of weeks ago; I witnessed a blind couple walking along the street in Lunsar. They had a small boy aged around 10 years leading them. The wife’s right hand was placed on the shoulder of the little boy and the husband’s right hand was on the right shoulder of the wife. Such a manner of contact is a recipe for transmission of the virus.

The mental health patients and hearing impaired are also at greater risk unless the right preventative measures reach them in the right format.

Another major area of impact is on the source of livelihood for those disabled people who depend on the benevolence of the public. With the present economic difficulty they are less likely to get the same support as before. Some disabled people have also lost their care givers or bread winners to the Ebola virus disease.

On the other hand the majority of people who are avoidably blind cannot access eye hospitals under the prevailing situation to have their sight restored.

Public education and Ebola

As a medical doctor with some background knowledge about the deadly nature of past Ebola outbreaks in other countries, I knew that the country was in for big trouble immediately when we heard about the deaths of many people from unexplained diarrhoea and vomiting in a small town bordering with Liberia in late May 2014.

The outbreak in this small part of the country was mismanaged due to several factors. One was the lack of sufficient response from the Government coupled with the denial factor and resistance from the locals. If this small region had been cordoned off immediately this outbreak would not have reached this magnitude as it has now.

The illiteracy rate in SL is very high. As a result there is a lot of denial and resistance to the containment efforts of the Ebola virus disease. The communal lifestyle of most African homes, where overcrowding is commonplace, creates a suitable environment for the spread of the deadly or rapidly fatal Ebola viral disease. So unless people are repeatedly educated about Ebola and its preventative measures, it will continue to spread.

There is also the issue of traditional burial practices especially for society leaders, which has been one of the main ways that people have been infected with the virus.

Everyone has the right to life,and therefore access to informationfor the prevention of disease and the maintenance of health, so it is necessary to embark on disability inclusive awareness campaigns to capture all persons in society without discrimination.

Message to people in the UK

I want to take this opportunity to say a big thank you to CBM UK, to CBM Lomé [West Africa Regional Office, Togo]and to all those who contribute in diverse ways to offer resources to bring this project together.We thank you all for your generous donation.

We are still far from beating the Ebola virus disease in Sierra Leone. In fact, it is spreading faster than ever before, by a factor of 9 according to theAfrican Governance Initiative’s recent assessment. According to the latest official figures, 4683 people have been infected and close to 1200 have died, but even these are underestimates.

Meanwhile as I said before, the 6th medical doctor to have contracted Ebola is a young surgeon and close colleague of mine who is presently at the treatment centre in Freetown fighting for his life.

So once more we thank you all for standing by us during this difficult and dark period in the history our country.

Your contribution is certainly directed towards a worthwhile cause, for which you will receive god’s richest blessings in return.

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