A retired ambassador
I was in charge of the U.S. embassy in Freetown, Sierra Leone for
several weeks in August and September.
Following is some background on the rapidly changing situation there. I have been home now for more than twenty-one days and did return before the Ebola hysteria mushroomed in the U.S.
Last August in Sierra Leone the infection rate for Ebola was
doubling every week. Hundreds were already dead and a thousand more sick with
the deadly disease. The country was in
shock, the populace scared and apprehensive, the government confused and the international
community ill prepared to deal with the scourge. American authorities were slow in
understanding how quickly the malady was spreading and what its impact would
be. A crisis of this sort was not
something we diplomats trained for, but the first order of business was to put
our house - our embassy - in order and to re-focus on an appropriate
response. Accordingly, Peace Corps
Volunteers were sent home and embassy families were re-located to the U.S. We advised citizens not to travel to the
region and, if they were already there to leave if convenient. However, most of the approximately four
thousand Americans in Sierra Leone are dual nationals and many of them are
minors. The embassy declared an “emergency,” a formality that permitted USAID
to respond with disaster assistance funding.
At the chancery we began a series of educational discussions designed to
insure that all employees, both American and Sierra Leonean, knew what Ebola
was, how it was transmitted and how to avoid contamination. We stressed “don’t touch sick people, don’t
touch the dead.” We also trained a team
to wear protective gear and put into place visitor screenings and contingency
plans should a contact or an infected person enter the premises. We deemed that our consular operation where
dozens of folks applied for visas daily to be our most vulnerable point, but
judged it necessary to continue operations.
Even as we took these precautions at the chancery itself, embassy
personnel engaged intensely with Sierra Leonean authorities from the President
on down and the donor community with regard to strategies, policies and
mechanisms designed to curb the outbreak. Unfortunately, nobody really knew the dimensions
of the problem or how to deal with it on the scale required. Clearly human resources, i.e. health care
workers, the necessary equipment -
protective gear, gloves, body bags, laboratory supplies, disinfectants, etc. - and
sufficient beds in properly managed isolation and treatment centers were in
short supply.
By mid-August all were acutely aware that the situation was
spiraling out of control. The numbers of
sick and dead from the hard hit eastern regions were growing astronomically and
cases were beginning to popup in the densely populated capital. The international press publicized the
situation. African neighbors ostracized the three core countries. Most
international flights were cancelled. The
government adopted stringent measures. Chlorine
hand washing stations were required at all buildings. Public meetings, gatherings and sporting
events were banned. Schools closed indefinitely. Travel to and from the
interior was constrained. All illnesses
were to be reported to authorities, likewise all deaths. Traditional funerals and funeral rites were
banned. The dead were to be collected and buried by trained teams wearing
protective gear. A nation-wide campaign was undertaken to educate the populace
about the disease. In September there
was a nationwide stand down so that Ebola education teams could visit every
household. Meanwhile, the government and
the World Health Organization (WHO) in conjunction with international partners
invigorated the response mechanism with new leadership. Visits by UN Ebola czar David Nabarro and CDC
Director Tom Frieden underscored both the urgency of the crisis and the
commitment of the international community to be supportive. By September that support was beginning to
flow in a steady manner.
Fortunately, CDC was ahead of the curve and by early August already
had a number of epidemiologists and other experts, between 20 and 30, on site.
They were instrumental in helping to establish the first isolation and
treatment centers. Working with the national Emergency Operation Center they
helped to define policies and priorities.
They were hands on in establishing laboratories, reporting mechanisms
and statistical compilations. A CDC team
worked closely with airport authorities to ensure that screening for travelers
met the highest standards. A four person Disaster Assistance Response Team
(DART) from USAID soon arrived and began the process of ordering and
coordinating the delivery of quantities of necessary supplies. We were also successful in getting five
ambulances transferred to the Sierra Leonean army from the Department of State
controlled regional peacekeeping stockpile.
We also made arrangements for specialized training for Sierra Leonean
military personnel engaged in providing security in and around the isolation
and treatment centers in the quarantined zone. Subsequently
all of these undertakings have expanded.
Now, even the U.S. military is deploying personnel and resources to aid
in the response. American efforts have
been complimented by other donors, foremost the UN family led by the World
Health Organization (WHO) and the World Bank. Additionally, the U.K. Ireland,
China, the EU and others have all played a part. A number of health professionals from
elsewhere in Africa have also volunteered to serve. Yet the anti-Ebola effort remains mostly a Sierra
Leonean affair. At least ninety percent
of the crucial health care providers are locals and health care personnel have
borne the brunt of the casualties.
Virtually all of the contact tracers, ambulance personnel and burial
teams are local. More people are being recruited and trained for all of these
tasks. The number of treatment beds is
expanding. The population is acutely aware of the reality of Ebola. Hysteria and rumor that characterized earlier
times have subsided to be replaced by stoicism while waiting for an uncertain
future. So far, although we may be
gaining a little, it is still not enough. New infections continue to outpace
the response.
The cost to Sierra Leonean society is high. People no longer touch in greeting. No handshake is a ever present reminder of the crisis. How to reconcile the need to care for sick
family with the stricture of not to touch?
How to conform to the directive of don’t wash or bury the dead, when
traditional culture requires that? With
no schools families are hard pressed to monitor their children. Imagine the disruption this generates. Fear of Ebola has meant the collapse of the
non-Ebola health care system. Hospitals
and clinics have closed because staff have no preparation or equipment to deal
with feverish walk-ins. So malaria,
measles, flu are untreated not to mention heart attacks, injuries, and
maternity cases. Food is in short supply
in the cities as transportation links to rural areas degrade. Similarly, regional transportation throughout
West Africa is stalled, exports affected and the economy spirals downward. Lack of international personnel, business
travelers and visitors has hit the hospitality industry hard. Hotels and restaurants are empty. Banks have limited hours. All of this, but
especially the specter of the unknown - will I get infected? Will my family? Will
I have a job? How safe am I? - result in
great apprehension. Personal
relationships are suffering and discrimination against families with known
cases, survivors and even health care workers is evident. People feel
victimized by God, by the devil, by fate, by government, by politicians, by the international
community, and by neighbors. So a sense
of helplessness grows. So far this has
not yet resulted in social chaos, but it might.
One has to hope that the Sierra Leonean strength of character, tempered
as it has been by a terrible civil war, will prevail. However, at the end - when it comes, when
Ebola is conquered - a massive undertaking will be required to heal the
national psyche as well as to rebuild the economy.
