I have a vivid memory of the first time I heard predictions of a “bumpy road” to zero Ebola cases. It was December 2014 and I was up-country in the town of Kenema (south-east Sierra Leone) close to the place where Ebola was first recorded in the country. We were listening to the radio in a dusty hotel courtyard as we prepared for a day of filming with Ebola survivors and children affected by the epidemic. The country had just passed the height of the epidemic, though we were still seeing hundreds of new cases each week.
Skip forward more than a year, and despite the official end of the outbreak in Sierra Leone, we hit a bump. With unsettling timing, Sierra Leone confirmed a new Ebola case less than 24 hours after the outbreak had been declared over in Liberia. Sierra Leone was in heightened surveillance, and we’d seen from Liberia that new cases could emerge. But it felt like a set-back.
The positive swab from a deceased 22 year old woman led to contacts, including young children, being quarantined in three districts of the country. On 3 February 2016 most ended their isolation, and I was in Magburaka town, where the index case had died, to witness the discharges.
“I’m free! Ebola: Bye bye” shouted Mohamed S. Lakoh as he danced on a table placed at the barrier of the Voluntary Quarantine Facility in the ‘Old Town’ area. Behind him those about to step out across the orange plastic fence that had been their boundary for the past 21 days greeted family members and danced as the festivities got going. Those discharged benefited from mattresses, pillows and other household items from UNICEF, and a package of food provided by WFP and Plan International.
A day earlier, herbalist Shekha Kargbo had been discharged from quarantine and returned back home to a village not far from Magburaka. When I met him, he’d taken advantage of his liberty by testing his legs with a stroll from one end of the village to the other. “It’s good to walk and I’ve had no problems stretching out my legs,” he told me with a smile. He laughed at having spent 21 days in quarantine before being reunited with the 21 members of his family. He told me he’d been annoyed at first when he had been placed in quarantine, but that he then got used to it. As his children and grandchildren gathered around under the shade of a mature mango tree, he told them with an air of satisfaction about the three good meals a day he’d received over the past 21 days.
Just then his phone rang and it was his friends back in quarantine in the town: “Hey, save me some food” he shouted with a laugh, “I’m coming back!” I asked him if he’d known any of these friends before they had shared quarantine together and he replied no.
He said he’d been welcomed by everyone he’d met in the village so far, though WHO and UNICEF staff have been working with the village elders to make sure there are no issues of discrimination and stigma.
This has not been the most straight-forward set of new cases. While sick, the index case travelled across three districts putting at risk hundreds of contacts, including children, over a wide geographic area. In the subsequent days one of the contacts in quarantine tested positive for the virus. She was quickly referred to a treatment centre, and was recently discharged after having recovered.
Complicating factors in the new cases included discouragement at seeing Ebola again in Sierra Leone, and a subsequent high level of denial. “We were all happy, all enjoying our lives when all of a sudden we had this new case. It was really a problem. Everyone was really shocked,” the head of the Social Mobilization pillar in Tonkolili district, Aiah Sam, told me. “We went from house to house trying to convince people that this case is real. You can’t downplay these things. Otherwise by the time you finally accept you’ve got Ebola, it’s done a whole lot of damage. We didn’t want a repeat of what happened before with our very first cases in 2014, which ended up reaching all of Sierra Leone.”
When things got too tense, social mobilizers from a variety of organisations, including UNICEF, the Sierra Leone Red Cross, Restless Development and Real Woman for Action let matters cool, and returned the following day. The key was to spread safety information and ensure a cooperative environment so that health officials from the District Health Management Team, WHO, and CDC could continue monitoring those who were at risk of having been infected.
I finished off my tour of the town with a visit to the MSF-supported government hospital in Magburaka. In a cordoned off area, I met three Ebola contacts in good spirits who were close to being discharged. Two of them had walked for three days to get to the town for their quarantine, and were looking forward to the long trek home. There was relief that things were almost over, and that they hadn’t been infected. For my part, I hope the bumpy road to zero Ebola infections has come to an end.
John James is a UNICEF Communications Specialist with UNICEF Sierra Leone