To travel to most of the Community Care Centres (CCCs), you need to drive for at least three hours inland from the coastal capital Freetown. I’d packed my bags with a mix of fear and excitement. But above all, I was really curious to meet the Ebola-affected communities in which we were working. How had people’s lives changed since Ebola arrived, and what were their attitudes to the CCCs in Tonkolili, Bombali and Kambia districts?
The CCC model has been a key part of the fight against Ebola in Sierra Leone and 46 out of 58 CCCs in the country were built for the Government by UNICEF with local partners, creating 404 Ebola beds (around a quarter of the overall national Ebola bed capacity).
As the name suggests, CCCs are built in communities with community buy-in. The whole process starts with extensive community meetings to get their views on how many CCCs they think are needed and where they should be built. Now that the CCCs have been open a couple of months, I led a team to carry out community focus group discussions with men, women and youth to get their verdicts on the facilities and the Ebola fight. The focus group discussions took place in five villages in the three districts with the Temne and Limba ethnic communities.
On a bright hot day I remember visiting one women’s group 15 miles down a dusty bumpy road. People crowded around the car to offer us coconuts and fresh bread. We found the women sitting around their huge cooking pots, while a radio blasted out music. They gathered around, with some smiling and laughing while others whispered to each other. It didn’t take long for them to open up.
Drawing together the conclusions from the various discussions I took part in, there were some broad themes. Initially people we spoke with said there had been a lot of fear as people started hearing about Ebola but didn’t have the information on how it was spread. As one woman said: “I was not even aware of Ebola in my community till someone died. Then I thought: this can kill!’’
All the women said they were concerned about their children’s health, and with the schools closed, the difficulties of keeping the children occupied. Girls have been helping their mothers with household chores or selling vegetables, while boys have mostly been playing.
The majority of the respondents in the groups said they now approved of the CCCs, but many said they did not initially understand their purpose. ‘’I have gone to the Ebola centre myself, when my child had fever. It’s not very far from home and the nurse was so helpful and kind, gave me all the information on Ebola and told me not to worry, they would provide treatment and protect my child,” said one focus group member.
Young people in the youth focus group seemed particularly positive about the CCCs: “I prefer the CCC and I believe that it gives us the treatment we need. You also get malaria tablets and fever tablets. It’s like a hospital: big and clean.” Another said: ‘’It’s in our community. My father was involved in the construction of the CCC. I am a mobiliser myself and I tell people to use the CCCs, sometimes, even take them there myself.’’
But for some in the groups they were initially scared when the CCCs were being set-up because of their direct association with Ebola. They told me in one women’s group that the traditional practice says, “We take care of sick at home and have always done that, our traditional practices are very effective. We never took the sick to the hospital, unless it was an emergency. We are trying to change that now.”
Now, we found high levels of trust and confidence in the CCCs in all groups. When we asked them about how perceptions had changed, it was clear that the communities had come a long way. Before, respondents said there was discrimination against people working in the CCCs. People didn’t believe Ebola was real, or they said that: ‘’Ebola killed you anyways, so why go to a hospital? Die at home and with dignity’’ and that “Whenever you would even walk by a CCC, people would think they have Ebola.’’ Another said ‘’People thought it was a place to draw blood and give you Ebola.”
Now they said they had “So much information on these centres and, on Ebola, you feel confident, to access and not shy.” Another said: “They are a good investment for the community.”
I came away with the clear impression that the communities we visited have benefited from the establishment of the CCCs, made possible by DFID funding. They have helped enable people to overcome the fear of Ebola; improve their health-seeking behaviour; and brought a sense of community ownership.
I travelled back to Freetown with a feeling of pride and happiness that the CCCs have had a positive impact on the lives of these people and have been so crucial in curbing the spread of the outbreak, which could have affected many more if the CCCs had not been there.
Aarunima Bhatnagar works as a Communication for Development Specialist working for UNICEF Sierra Leone.