Saturday 17 August 2019

Ebola crisis: Life... and death in the 'high-risk' zone in Sierra Leone

'By the time I had test results, my family had gotten virus from me'

Jason O'Brien

Jason O'Brien

THE ambulances racing through the rutted streets of Kenema no longer turn on their sirens. It is one of the underwhelming attempts by authorities to improve the psychology of weary and wary locals, for whom any medical emergency registers as another suspected case of Ebola in their city.

The first cases in Sierra Leone were admitted to Kenema Government Hospital in May.

Doctors remove a dead man from the new Red Cross Ebola treatment centre on the outskirts of Kenema in eastern Sierra Leone. Photo: Mark Condren
Doctors remove a dead man from the new Red Cross Ebola treatment centre on the outskirts of Kenema in eastern Sierra Leone. Photo: Mark Condren

It was believed then to be the only facility in the country with the appropriate equipment, and the only place that could safely manage care of people with the often-deadly virus in a treatment centre.

Those beliefs have been shattered.

In the four months since, thirty medical professionals alone have contracted Ebola and died while working there. A further 366 confirmed Ebola deaths have been registered at the makeshift centre.

Now, the district’s medical officer has confirmed that staff shortages due to a fear of catching the virus means that some of the desperately-ill 65 patients currently in the facility may be going hungry. 

A weary health worker at Kenema General Hospital in Sierra Leone begins to remove his personal protective equipment following a stint inside the hospital's Ebola Isolation Unit. Photo: Mark Condren
A weary health worker at Kenema General Hospital in Sierra Leone begins to remove his personal protective equipment following a stint inside the hospital's Ebola Isolation Unit. Photo: Mark Condren
Army and Police officers lock down part of Sinnah Street in Kissy Town, Kenema, Sierra Leone. Photo: Mark Condren
Members of the Ebola body management team remove dead bodies from a make shift morgue at Kenema General Hospital in Sierra Leone. Photo: Mark Condren
Medical staff get suited up. Pic:Mark Condren

“It may be that when the food comes prepared from outside there are not enough staff to bring it to the patients as the staff must wear (spacesuit-like) personal protective equipment in the high-risk zone and can only wear that for 45 minutes,” Dr Mohamed Vandy told the Irish Independent yesterday.

“So that may be behind those stories...”

Families all over Sierra Leone are preparing as best they can for a three-day Government-enforced lockdown. Photo: Mark Condren
Families all over Sierra Leone are preparing as best they can for a three-day Government-enforced lockdown. Photo: Mark Condren

Two nurses – speaking on condition of anonymity – had earlier claimed some patients in the Ebola treatment centre had, in fact, died of hunger. Dr Vandy denies the claim.

Equally macabre reports emerged Saturday of separate, striking workers at the hospital attempting to get sick Ebola patients to leave the high-risk zone and move to the low-risk zone, thus potentially mixing with unprotected people while carrying the highly-contagious disease.

Simple but stark posters just like these, paying tribute to health workers who died from Ebola, adorn walls and noticeboards all around Kenema General Hospital in eastern Sierra Leone. Photo: Mark Condren
Simple but stark posters just like these, paying tribute to health workers who died from Ebola, adorn walls and noticeboards all around Kenema General Hospital in eastern Sierra Leone. Photo: Mark Condren

The police were called.

“There is an issue over pay for some local workers but we are confident that it will be sorted by Monday,” Dr Vandy said.

The 80 striking nurses and support staff – recruited nationally to boost numbers – deny attempting to entice Ebola victims from contaminated areas.

They haven’t been paid for two weeks.

Agathe Jacob (22) who lost her husband and two children to Ebola in Kenema, Sierra Leone. Photo: Mark Condren
Agathe Jacob (22) who lost her husband and two children to Ebola in Kenema, Sierra Leone. Photo: Mark Condren

They say they are now owed approximately  1m SSL (€150) for their work inside the tented ‘high risk’ zone where they treat the sick, clean up body fluids, disinfect contaminated equipment, and collect and bury the bodies.

As the number of healthcare workers who have been hit by the virus continues to rise, they are questioning the rate of ‘danger money’ for their roles to be asked, and outsiders are questioning their equipment and training levels.

“Those workers said they would refuse to do their job of disinfecting medical staff that had been in high-risk zone,” Dr Vandy said. “It was a terrible threat.”

*****

EBOLA is a very real threat for those living in Kenema, in Sierra Leone, in west Africa, and beyond.

This outbreak emerged in March in neighbouring Guinea, before crossing into Liberia the following month and into Sierra Leone in May.

Unlike previous outbreaks, the situation has not been contained, with the death toll passing 2,400 last week – and the World Health Organisation (WHO) warning that more than 20,000 could eventually catch the disease.

“Before we had to deal with a lot of denial,” one NGO worker says. “Now it is fear. People are drinking chlorine because they think that helps.”

Their fear is driven by confirmation of horrific symptoms including internal haemorrhaging and organ failure, a painful and undignified death for approximately 50pc of those who contract it – but mainly the ease at which it can be contracted.

“I was helping children who were sick and I was careful, but they are children so it’s difficult not to touch them,” Agathe Jacob, a softly-spoken 22-year-old, tells us at a facility for Ebola survivors.

“That’s how I got it. I think so. I was initially told it was malaria and I treated myself for that.

“But by the time I had the test result (for Ebola) my husband my two children had got it from me.”

Ms Jacob worked as a nurse in the Ebola centre at Kenema Government Hospital. A fellow nurse and friend tested positive at the same time.

“She died, and I survived but we had the same treatment,” Ms Jacob says. “It was God’s will.”

It was also, she says simply, “God’s will” that her husband Ibrahim (22) and sons Suare (2) and Papa (eight months) passed away in July.

She wipes away some tears, and smiles wanly when asked how she attempted to come to terms with their deaths. 

“I was in hospital when they died. I did not know where I was, I didn’t know who I am,” she says.

“For a week I was all over the place – they even said that I was dead.

“I was hopeless then, but I survived, if this is survival.”

Agathe breaks down in tears.

With her young family now taken from her, she admits quietly she is still struggling for hope.

******

KENEMA Government Hospital has flitted in and out of the international headlines in recent weeks.

But it is not because almost 400 of Sierra Leone’s 1,300 deaths from Ebola since May have happened or been confirmed here.

It is because one of the nurses caught the virus and survived. That in itself, as Agathe can attest, is not unusual - but this particular nurse was from England, and the first Briton confirmed to have the virus.

William Pooley told The Guardian last week: “Those wards A and B when I first started were pretty grim.

“Corpses, blood, the place was really dirty – people just dying in quite unpleasant ways... there were not enough materials, there was no running water, no sheets or towels to clean a patient with. They might be incontinent, they are often confused, so you can imagine, with diarrhoea and vomiting, patients get in horrible condition.”

He intends to return, but any major improvements to his workplace are not immediately apparent.

The Ebola facility was established on the same site as ordinary medical operations – but most of the other wards have since been deserted, and the scattered, dilapidated low-rise buildings are ‘no go’ areas for most.

A non-scientific examination of movement between low and high-risk zones by staff in the tented Ebola treatment centre, and the wearing and removal of the protective gear, yesterday again raised questions about equipment and training levels.

Patrick Senassie, a local programme manager for aid agency Goal, pointed out that head nurse Issa French is now the most-senior member of staff.

“There is no senior doctor in the hospital now after another WHO doctor contracted Ebola here last week and left,” he told the Irish Independent.

“It would have 65 nurses ideally but it’s never been higher than 35. Right now it is nowhere near that.”

The WHO doctor continues to fight for his life. As mentioned earlier, at least 30 medical staff have been infected and while died working here, including the internationally-lauded Dr Sheik Hummar Khan.

That stark figure also includes five from a six-person laboratory team who died on consecutive days last month, amongst them Drs Hawa Sambh and Sahr Ek Fayia. 

On Saturday the facility stopped taking patients with Ebola or suspected cases of the virus.

*****

THE Red Cross has never operated an Ebola treatment centre anywhere before. It does now.

Before it opened the 60-bed facility on the outskirts of Kenema last Saturday, it ensured that a graveyard was completed and volunteer undertakers were trained in international best practice.

An ambulance with the siren off carried the first case - a male nurse from Freetown - to the facility through the streets of Kenema on Saturday afternoon.

Three more joined him that day. One of these – a man in his 30s – bled out Saturday night.

So the new graveyard is already in use.

However, the difference in procedures, sanitation, expertise and equipment – but mainly resources - here is immediately apparent.

But Kenema Government Hospital will continue to burst at the seams – the Red Cross facility will only take a small number of Ebola cases as its 19 international medical staff and 80 locals slowly scale up the operation.

They, at least, have boots on the ground, but the international response has long been hampered by a reticence to engage – understandable or not – which has left the burden largely on the ill-prepared local authorities.  

But this is not solely a local problem.

And ahead of a three-day countrywide “lockdown” in Sierra Leone later this week, it is obvious it will not simply go away if it is ignored.

“During the last three weeks there was a drop in the number of cases but in recent days we are learning of Ebola in places not previously seen – and this is a big issue,” Paul Wamai, area co-ordinator for Goal, which was involved in the construction of the Red Cross facility,

“For example, the town of Bo sent nine samples last week and seven were positive. People are saying that MSF are alarmists, but they are right.”

As far back as June, Medicines Sans Frontiers (MSF) said the outbreak was “totally out of control”.

Life – and, to a greater extent, death - in the Government Hospital suggests the same, in Kenema at

Click here to find out how you can donate to GOAL

Jason O'Brien is the NNI Foreign Journalist of the Year.

Irish Independent

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