Tuesday, July 29, 2014
Ebola Diary 2
Paul Conton 

The nightmare continues. The news in the past week has been unremittingly bad. Ebola in Pujehun. Ebola in Bombali. Ebola in Wellington, Ebola in Tonkolili. Awareness Times reports only four districts are unaffected, and then, just last night, the Minister of Health says all districts now have cases.Sometimes I wonder whether we can escape national extermination by this plague. The number of new cases continues to rise – we now have more than Guinea, which reported its first case some two months earlier than we did ours. Cases are springing up in new areas, some of which do not even have medical services; an outbreak in a village in Pujehun, in which several members of one household die and the rest of the village panics and flees to areas unknown, presumably taking the virus along with them. In Freetown, new reports about confirmed Ebola cases in hospitals; in one case relatives of the victim forcibly remove her and are declared wanted by health authorities. This story makes headlines on BBC news for more than a day. Nurses in Kenema, at the epicenter go on strike and express a complete lack of confidence in the hospital management and by implication in their own Ministry of Health. They want MSF to come and take over the Ebola unit. Three nurses in the Ebola unit in Kenema die of the disease, and the doctor in charge, Doctor Khan, is confirmed to have caught it. Another prominent BBC News headline story. And yet another: A Liberian national flies to Abuja on a commercial airline, is detected and isolated at the airport and dies of Ebola a few days later. Nigeria puts its borders on red alert. Flights to Sierra Leone are reported cancelled.

African unity is often on display at inter-governmental gatherings, but how long before our African brothers start thinking about imposing travel restrictions? Jammeh did it as soon as he heard of the outbreak, and he was criticized for it, but it doesn’t seem so far fetched now. The worst case scenarios run through my mind. At this rate of transmission, I cannot see how this outbreak will end.

The quotes from the MSF and WHO websites are ominous: “We came too late”, “villages already had dozens of cases”,“racing against time”, “the tip of the iceberg”, “Since my arrival 12 days ago we buried more than 50 bodies and this number does not include burial of people who died in their homes”, “without more resources the fight against Ebola may prove to be too difficult”

These people seem uncertain of the outcome of this battle. These are foreigners in my country, here to help us, deep in the hinterland of Kailahun district, revealing their frank assessment of what’s going on, whilst our Ministry of Health continues to maintain its veil of deception, based on the fiction that only laboratory confirmed Ebola cases are ‘real’ Ebola cases.

The great danger of scaling down the figures, as our Ministry of Health is doing, of deliberately underestimating the numbers, is that it delays or reduces the robustness of the response both by our government and by the international community. In some sense, this deliberate policy of the Ministry of Health, to only report laboratory confirmed cases, when all the indications are that many, many cases have not been laboratory tested has contributed to the escalation of the crisis.

I listen to a public health expert on the BBC, safe somewhere in England, downplay the virulence and assert that it should not be difficult to control. I think he may be guilty of underestimation. This virus, if allowed to take hold, would challenge the most advanced health systems in the world. Did I read somewhere that viruses would eventually take over the entire world? Is that what we are seeing here?

In my 60 odd years, I’ve never experienced something like this. This may be something the world hasn’t experienced. At least not in a few hundred years. A disease with no known cure, whose transmission mechanism is not well understood. A virus that, if we are to believe the prevailing wisdom, can be transmitted through shaking of hands or by a casual brushing of arms. If someone brushes past you in the street you could catch it. A virus that cuts down doctors and nurses who attempt to challenge it. A virus that oozes blood out of all body orifices, that is at its most dangerous when it has finally killed its victim. A virus that requires any one going near it to be dressed in impervious full body protection, from head to toe, in the heat of tropical Africa. Ten times more dangerous than HIV. A hundred times. And HIV caused near panic in the West when it first appeared there thirty or so years ago.

Ebola dominates the media. All the indications are that the infection rate is increasing rapidly. The contacts appear to be multiplying faster than the government’s ability to trace them. I can see no easy way to end this. I don’t think the measures now in place will. Quite a few have suggested declaration of a public health emergency, which amazingly the government is yet to do. I would go even further. The time for half measures is past. There must be a critical mass of infected, beyond which our health system would simply collapse. If the critical mass is reached we would be in a very, very difficult situation. I would put the army on the streets, ban public gatherings and enforce a 22 or 23 hour nationwide curfew. It’s the surest way to reduce transmission of the disease, but it would need to be done for at least 21 days, the incubation period of the disease. And I would compile instructions and distribute health supplies for home care of Ebola patients, in case the health system becomes overwhelmed, as seems likely.

And yet, many of the people I come in contact with seem to view Ebola as something somewhat distant, something that will be contained fairly quickly. I go to my Dinner Club’s monthly dinner on Saturday, and Ebola dominates the conversation. Normally, members shake hands with each other upon entering, but tonight we simply bump elbows or clenched knuckles, with sheepish smiles. Everyone recognizes the situation as serious, but I’m not sure anyone else views it as potentially catastrophic. We make plans for our anniversary dinner at the end of August, at which we will invite guests and have a big dance. I’m not sure this is a good idea, but no one else expresses this.

The BBC reports that Liberia has closed its borders. Too late for them. And for us. The virus is already inside us. Closing the borders only helps those outside.

The BBC is featuring the outbreak more and more in its news. It’s consistent with my fears. “They” realize what’s happening. Of course they do. What will they do? Cut us off. Isolate us completely. Or come in massively and try to help?

Our President seems transfixed, trapped in a web of deception spun by his own Ministry of Health and his own desperation to claim success for his tenure, whatever the reality.

Mr Obama, Mr Cameron, come oh, come! World, come oh, come! Come and pay attention to what’s happening here! 'Our' Ebola may be out of control. 'Our' virus may be going viral. And if it happens it could become ‘your’ Ebola. And if that happens it could destroy you too. The (over)cautious bureaucrats at the WHO, in whose charge this problem now is, may not have the clout to solve this problem. They may be unable to look our President in the eye and say, “Mr President, you must do this. And you must do it now!”

Mr President, you went to Kenema Government Hospital yesterday and you found that the Ebola treatment center is no longer functioning, after the infection of Doctor Khan and the death of the nurses. You no longer have an Ebola treatment center, Sir. The only one left in the country is the MSF center in Kailahun. They report on their website on July 11 that they have expanded their capacity to 65 beds. That’s all you have for specialist treatment of Ebola, Mr President. 65 beds!  The official number of Ebola cases from the WHO website, July 27, is 525, of whom 224 have died. You only have 65 beds, Mr President! Where are you going to put the Ebola patients? What happens if 500 more come down with the disease? Or 1000?  Who will look after them? Who will bury them? From July 24 to July 27 WHO report 71 new cases. Your health workers are running scared. You don’t have protective equipment for them all. What happens, Mr President, if Ebola starts springing up in all the hospitals and health centers around the country? What is the plan, Mr President? Yesterday at Kenema you said you would have one in a few days. That is a few days too late, Mr President. Mr President, take drastic action to stop the chain of transmission before you lose control! Control of everything and everyone, including your military and your police, because they are as afraid of Ebola as all the rest of us.

Is this the price to be paid for decades of deterioration? For not developing our health systems sufficiently? For not educating our people? For not providing adequate water and sanitation? For not developing our agriculture and animal husbandry so that people would not need to eat bush meat and bats, the suspected reservoir of the Ebola virus? For not building our economy to a strength that would enable an overwhelming response to such outbreaks? For tolerating filth in our cities and open defecation areas in our countryside? For not handling and displaying and storing our food in sanitary conditions and testing and inspecting our food chain? For violating all the public health rules and hoping that we will somehow, as always, muddle through? For moving backwards while most of the rest of humanity moves forward? For all the complacency and denial? Are we in some sense at fault for this? Or is it simply an accident of nature that could easily have happened to other peoples elsewhere?

Maybe I’m panicking and hallucinating. I’m too pessimistic, too negative, too critical. I’ve been told this before. Go into town and the streets are full. Shops and markets are open. Everyone is going about their business just as normal. Over the last week or two the lights have come back on almost one hundred percent, and I can work unhindered. Maybe in a few weeks time this will all have blown over. By God’s grace I will write a humble retraction and quietly close this diary.


...read Ebola Diary 1