The first time I went to work in Sierra Leone was in 1991.What I witnessed as a paediatrician in Africa during that first visit far exceeded anything I might have expected. The country’s infant mortality rate at that time was estimated to be 257 per 1,000 live births; today that figure is 182.
Since that first visit, I have continued to be involved with Saint John of God Catholic Hospital in Mabesseneh, which in 2005 was twinned with Barcelona’s Hospital Sant Joan de Déu. This partnership has enhanced cooperation between the two centres through aid projects and teaching programmes, always with the common objective of reducing maternal and infant morbidity and mortality.
With no hospital, where are the sick to go, who can they consult, what medication can they take? Although more than 20 years have passed since that first visit, I have often had the feeling when I am in Saint John of God Hospital that time has stood still: in rural areas of Sierra Leone, malaria mortality rates are still very high; the people have very little knowledge of the symptoms of the disease and what they should do when someone falls ill; mosquito nets, which have been successfully introduced in other parts of Africa, are still not in common use; and children still come to hospital with advanced disease and haemoglobin levels so low that it is almost impossible that they are still alive.
When the first confirmed cases of Ebola in Sierra Leone were announced five months ago, the Saint John of God Hospital asked us for help and the team in Barcelona responsible for the twinning partnership responded rapidly. We collaborated with other organisations working in Mabesseneh, particularly the German NGO Globolab, with whom we coordinated our response. On advice from Medicos Sin Fronteras (MSF), we sent isolation equipment, protective suits, and training videos, but the effort did not have the hoped-for results. In June, the spreading epidemic reached Mabesseneh, which is located about 2 kilometres from the town of Lunsar in the north of the country (Porto Loko district). Although the Ebola virus was confirmed in a patient who had been admitted with suspected disease, the test results were inconclusive and the final test was negative. Meanwhile, the virus got on with its task of amplification. The result: an empty hospital, infected healthcare workers, fear, panic, and eight deaths among the staff. Finally, a quarantine was imposed and the hospital was closed for disinfection.
With no hospital, where are the sick to go, who can they consult, what medication can they take? Even before the hospital was quarantined, the terrified population had stopped going there. Usually, at this time of the year—the end of the rainy season—the paediatric department is full, with two or three children in every one of the 40 beds. Before the hospital closed, there were only four children in the ward. Where are all the others? They are not coming to the hospital. Some of them believe that they will be inoculated with the virus in the hospital and others fear contagion. Yet others fear that they will be sent to the referral hospital for Ebola in Kenema, that they will be separated from their families or, in the worst case, that they will die and no one will be there to perform the funeral rites required by their religions, which are mainly animist.
The victims of Ebola are not only those infected by the virus; during an Ebola epidemic, mortality from malaria, diarrhoea, respiratory infections and other diseases also increases. To make things worse, when a population is quarantined supplies do not arrive and truck drivers refuse to travel to the area. At the same time, normal local production is affected. The result can be an increase in hunger. Ebola also weakens the social fabric. The first two nurses infected at Saint John of God Hospital ran away when they were diagnosed: one was found later in her house; the other fled to Freetown, the capital city, and finally died. We do not know how many others they infected along the way. Another nurse, who has not been infected and continues to work at the hospital, told me that her sister refused to let her enter the family’s home when she went to visit. Fear leads to panic and dehumanizes people. The day the hospital opened after the quarantine was lifted, a man died in the waiting room. He had a bowel obstruction had been unable to get medical care during the closure. No one approached him, no one covered the body, hardly anyone even looked at it. He might have Ebola—a disease much more deadly than even the statistics suggest.
Hospital Sant Joan de Déu’s blog Programa d’Agermanament amb Sierra Leona (Sierra Leone Twinning Programme) has closely followed the evolution of the epidemic in Sierra Leone since it started.
Victoria Fumadó is the technical director of the África Viva foundation and an Associate Researcher in ISGlobal’s Maternal, Infant, and Reproductive Health initiative. She is also head of the Infectious and Imported Diseases Unit of the Paediatric Department at Sant Joan de Déu university hospital in Barcelona.