MSF "Unable" to Take on Ebola in Kenema
Paul Conton 

MSF-SL head of mission Walter LorenziThe head of mission, MSF, Sierra Leone, Mr Walter Lorenzi, has said that MSF is unlikely to take over the running of the Kenema Ebola unit, as demanded this week by striking nurses in Kenema. Mr Lorenzi disclosed this during an exclusive interview with natinpasadvantage. He said that MSF does not have the resources to do this and they wanted other players including NGOs and the government to mobilize all the necessary resources to defeat the killer disease. He disclosed that MSF had a team in Kenema on Tuesday and Wednesday advising the health authorities about infection control measures in the wake of the high profile deaths of three nurses attached to the Kenema Ebola unit and the equally high-profile confirmation that Doctor Khan, the renowned head of the unit, had come down with the disease. Asked whether any MSF health workers in Sierra Leone had been infected with the disease he replied in the negative and added that in the whole period during which MSF has been combating the disease, starting with the initial outbreak in Zaire, the organization has only had one health worker who has contracted the disease. He maintained that rigorous discipline in following procedures was required among health workers to prevent infection. He added that to fight the disease many of the resources needed could be trained at short notice. He mentioned contact tracing, health information and burials as areas where resources were needed and could be trained and mobilized quickly by other contributors.


Mr Lorenzi said this was a new disease for West Africa, and it was important to avoid criticism; his organization’s role was to be part of the decision-making process and share experience and expertise. A comprehensive team would be needed to overcome Ebola, including nurses, epidemiologists, information specialists, psychologists and social workers. MSF could not do it all; more actors were needed. He opined that screening at checkpoints could contribute to reduce transmission.


Apparently acutely aware of the sensitivity of his position Mr Lorenzi, who declined to be recorded in video or audio (editor's note: We reproduce the independent reports of the two interviewers, based on their hand-written notes), was at great pains not to criticize any of the other players in the Ebola struggle. When asked why the neighbouring republic of Guinea appeared to be more successful in combating the disease than Sierra Leone he replied that that would require careful analysis of all the various socio economic and other factors. When pressed on this he replied that he was Italian and felt free to state his dislike of Berlusconi, but his interviewers were Sierra Leonean and could express their opinions at the next Sierra Leone elections. When asked about a recent apparent difference of opinion between MSF and WHO (MSF had declared the disease ‘out of control’ and a high-level visitor from the WHO, the assistant Director-General, made a point of assuring President Koroma shortly after that this was not their view) he maintained that this was merely a question of semantics and not a serious issue. When asked about internet reports that the US Department of Defense is heavily involved in the Kenema Ebola lab, researching aspects of biological warfare, he replied that the Americans and the US embassy would be the best people to put that question to. Throughout the 45 minute interview Mr Lorenzi was at pains to stress that the best approach at this point in the battle against Ebola was to have everyone united and focused on defeating the disease rather than pointing fingers and looking for people to blame.


Despite his modesty and caution, the grim facts in a week of turmoil in Sierra Leone reveal that MSF is at the forefront in the fight against Ebola. The terrifying spread of the disease in Sierra Leone in just the last few weeks justifies the earlier MSF assertion that Ebola was out of control. The call by the nurses for MSF to take over the management of the Kenema Ebola facility speaks volumes about the government nurses’ confidence in their own health authorities. An ailing Dr Khan was taken to the MSF field facility in Kailahun rather than being treated at the government Ebola facility collocated with the Kenema government hospital. This Kenema Ebola facility itself had been a source of controversy from the start of the outbreak, with patients from Kailahun, the source of the outbreak in Sierra Leone, being taken to Kenema rather than being treated in their district, close to their homes. MSF, on the hand, set up their Ebola treatment center in the field in Kailahun. What seems likely now, given the turmoil at the Kenema hospital, is that at least some of the infection that subsequently spread into Kenema district and thence to the rest of Sierra Leone, originated from the Kenema facility.


The aweful, shocking conclusion from this is that the people, literate and illiterate, who refuse to go to hospital when they fall ill, who are intensely suspicious of medical treatment, have at least some small basis for their fears: in this outbreak, as in others where infection control is poor, you may be more likely to catch disease in a hospital than outside it. The infection of government health workers provides additional ammunition for those already intensely suspicious of the government’s efforts to control the outbreak.

 President Koroma

Meanwhile a despondent President Koroma was shown on national television complaining to another high-level visitor from the WHO (this time the Africa regional director) that his health workers were being infected and assistance was needed from the WHO. His tourism minister was, around the same time, castigating journalists for reporting Ebola and scaring away visitors.

Interview with Walter Lorenzi, Chef de Mission, MSF-SL


Michel Smith

The Medecins Sans Frontiere (MSF) has attributed the acceleration in the spread of the Ebola virus to a number of factors, among which are:

(a) The density of the population in the affected areas.

(b) The traditional beliefs of the people in the affected areas, which make early detection of cases difficult as it is at times impossible to change people's set beliefs.

(c) Infrastructural development, such as the construction of roads, which provide unimpeded and easy movement of people.

(d) The proximity of towns and villages in the densely populated areas.

(e) Indadequate contact tracing methods.

(f) The strength of the response of the government to the outbreak.

(g) Inadequate resources to fight against the outbreak.

The disease, we have been told, is spread by a virus, as is the case with HIV/AIDS. Reinforcing the bodies of victims greatly enhances the chances of survival as it helps fortify the immune system in its fight against the virus. The method being applied by the MSF in the Kailahun district to build the resistance of potential victims is to provide adequate nutrition and constant rehydration.

The head of the MSF in Sierra Leone, Walter Lorenzi, in an interview revealed that the greatest obstacle against the fight to curtail the spread of the disease is contact tracing, and supports government's establishment of checkpoints in high-risk areas to check and determine the movemnet of people. He dismissed the widespread reports that the MSF team sent initially to respond to the outbreak in the Kailahun district was attacked by some members of the public, and blamed the media for propagating rumours. Since MSF's taking over the fight agains the disease in the Kailahun district the situation has stabilised there. The acquisition of a mobile laboratory from the World Health Organisation (WHO), he explained, has made their verification of potential victims faster and easier, compared to the initial phase, where blood samples had to be sent to Kenema for verification. To stop the chain of transmission MSF has set up pre-referral units, where suspected cases are screened.

On the way forward, Lorenzi stressed that the fight would be made much easier by intensifying public education and welcomed the introduction of the Ebola task force management team set up by government to offer a rapid response to the threat. The task force comprises experts from diverse fields such as doctors, nurses and other medical staff, social welfare workers, psychologists, etc. He stressed that public enlightenment is the key to succeed in fighting Ebola.

On the issue of taking over the running of the Kenema Ebola center as requested by the health workers in Kenema, Lorenzi explained that with the resources at its disposal, MSF does not envisage taking over the Kenema center.