The first cases were in Guinea, then Liberia, and the Ebola outbreak finally hit Sierra Leone in May 2014. To respond to this new crisis, EMERGENCY already had its Surgical and Paediatric Centre in Goderich – the traumatology centre of reference for West Africa for many years – reorganised and ready by more or less the beginning of the year.
All staff were specifically trained in new procedures for containing the spread of the disease and preventing infection. The hospital was completely reorganised: a new triage area was set up to limit contact between waiting patients and prevent suspected Ebola cases from entering the hospital; patients with possible Ebola symptoms were isolated in two separate tents while waiting for laboratory results to confirm the diagnosis; visits from family members were stopped and new procedures were implemented to monitor the health conditions of all staff. This was all done to prevent Ebola entering the confines of the hospital. This was a considerable undertaking, since the most of the 100 children arriving every morning at the clinic had symptoms very similar to Ebola: nausea, diarrhoea and high temperature. Meanwhile, the disease, initially only in northern districts, spread to the rest of the country.
By mid- September 1,600 Sierra Leoneans were ill, 100 of these in the capital, Freetown. The overcrowding in the city’s shanty towns and the terrible hygienic conditions multiplied the number of cases. More than 20 people a day were contracting a virus that is potentially fatal in up to 90% of cases in the absence of adequate healthcare facilities. Sierra Leone, just 13 years after a civil war, was totally unprepared for the epidemic. Local staff had no knowledge of protection systems and often didn’t even have adequate protective materials, so a large number of the personnel in public hospitals fell ill.
As soon as we started diagnosing the first cases of Ebola in the patients in isolation in our hospital, we came up against the total inadequacy of Sierra Leone’s health system. We tried many times to find beds to transfer the patients for treatment, but the few, poorly equipped available facilities were unable to cope with the outbreak. Faced with an emergency that was becoming more and more evident each day, in response to requests from the Sierra Leone Ministry of Health and President, we started work on a new project: an Ebola treatment centre. In a race against time, we opened our first centre on 18 September in Lakka, a short way from the capital. This gave us 12 isolation beds and 10 care beds, 22 in all. The main purpose of the centres set up at that time was to isolate infected patients. EMERGENCY decided to take the further necessary step – despite doubts about its achievability amongst those working to contain the epidemic – of curing the patients. With the virus spreading rapidly at the rate of 100 new illnesses every day, the Lakka Centre beds were always full, so we began planning a 100-bed Ebola treatment centre.
The Goderich Centre, constructed in just 6 weeks and funded by the British Government’s Department for International Development (DFID), was opened on 13 December. In just a few weeks, we set up an intensive care unit for Ebola patients – the only one of its kind in Sierra Leone – equipped to the standard of hospitals in western nations, with ventilators, dialysis machines, infusion pumps and monitors, allowing us to provide patients with the best possible care. At the Centre, we set up a polymerase chain reaction (PCR) test laboratory, working together with the “Lazzaro Spallanzani” National Institute of Infectious Diseases to test patient blood samples as positive or negative for the Ebola virus. The laboratory has made it possible to reduce the time lost between testing and diagnosis, thus ensuring speedier treatment for patients.
As well as treating patients, we’ve also been working to prevent the spread of the infection. To do this, at the beginning of December we opened a First aid post at Waterloo, a refugee camp where 22,000 people are crammed into overcrowded, makeshift shelters. The camp, like many other parts of the capital, had no healthcare facilities capable of providing a quick response to suspected infection cases. We had four nurses working at Waterloo using triage for suspected cases and transferring them to the Treatment Centre if necessary. To stop the spread of the virus, we involved the entire community. We trained 90 healthcare operators to identify the people in the camp that had come into contact with Ebola patients and monitor them daily. Our Paediatric and Surgical Centre worked ceaselessly throughout the Ebola emergency. While hospitals everywhere were closing due to lack of doctors and nurses, the EMERGENCY centre was the only surgical and paediatric centre in the entire country to remain open. For many months, the population was left to its own devices: malaria, typhoid, infections and surgical emergencies continued to be daily problems that could no longer be dealt with by public health facilities. The Ebola emergency further exacerbated the endemic lack of doctors and nurses that has so hindered the development of the health system in this country. The Ebola virus cost Sierra Leonean healthcare workers dearly.