Officials ‘two steps behind’ epidemic in Sierra Leone’s devastated Ebola zone

The signs of a deadly struggle remain: scattered around the houses of the Ebola dead lie empty pill packages, their plastic casings punched through. Nearby in the mud are used packets of oral rehydration salts. The pills did not work and the hurried trip to the hospital, if there was one, came too late.

Inside house after house, Ebola has claimed its victims: Here, 10 people died; over there, four, including three children. A few metres away an old man lives alone, his wife now dead. In another, seven people are dead, the village teacher said. In a long, low house nearby, 16 died, all from the same family. Outside yet another, two tiny girls, one aged six and her sister aged seven, sit pensively, their parents gone.

And there are more. “So many,” said Sheku Jaya, the 35- year-old village teacher, clutching his little daughter’s hand. “We lost too many people.”

Here in Sierra Leone, the nation most afflicted by Ebola, in the hardest-hit part of the country, this may well be the most devastated village, local and international officials say. Some 61 people have died here, out of a population of perhaps 500. Njala Ngiema, a mud-brick community of rice and cassava farmers deep in the forest, is quiet now.

“We wanted to abandon this village,” Jaya said. There are still people here but the village appears frozen. Inside the darkened houses the scant belongings of the victims – ragged clothing, sandals, a rare radio – sit untouched weeks later. No new cases have surfaced here in nearly a month, but the fear that the deadly virus still lurks has kept everything in place. Nothing appears to have moved since the deadly tide swept through.

Quarantine

The government, desperate to contain an epidemic that has claimed about 300 lives in this nation alone, has effectively cordoned off this part of the country, deploying troops and setting up roadblocks in the hardest-hit areas. Two districts here in the east – an area with about a million people – were put under quarantine by the government late last week, shutting down much of the traffic on the muddy road cutting through the Ebola zone.

Now, a region roughly the size of Jamaica has been cut off from the rest of the country because of the roadblocks, warned a local leader, paramount chief David Keili-Coomber – raising worries that if the epidemic does not decimate the region a subsequent shortage of food, trade and supplies will.

“Our fear now is that closing these roads risks having more people die of malnutrition and even starvation than by Ebola,” Keili-Coomber said by email.

The sweeping quarantine, much like the one imposed on parts of Liberia across the border, underscores a basic reality in the battle against the epidemic: neither the government nor the international health organisations on the front lines seem able to stop it from spreading through the afflicted areas. So many villages have been struck, with so few health workers and other resources to try to halt the advance, that governments have resorted to closing off entire regions in hopes of containing the damage.

‘It is a disaster’

“Every week we get one or two new villages with infections,” said Anja Wolz, the Médecins Sans Frontières (MSF) doctor who was running the organisation’s treatment centre outside the town of Kailahun last week. “It is a disaster.”

The government quarantine comes too late for Njala Ngiema, where the scourge’s mark is everywhere along the wide muddy road that runs through the village. In front of a house where five people died hangs a pair of blue trousers, untouched since Ebola passed through. Inside a house where two older women lived, a plastic bag labelled “See the world” and packed with clothes, sits on a bed for a trip to the hospital that never happened.

Towels, trousers and underclothes still hang from the rafters in another house where Foday Joko lived with his wife and daughter. All three died.

At the back of Alhaji Abbah’s house, where 16 people died, the stained and torn farming clothes he wore – jeans and T-shirts – hang from a line. Nobody has dared remove them.

“People are afraid; we asked them to burn them,” said James Baion, a teacher from the area who is helping to organise an Ebola response on behalf of local officials.

So many of the farmers have died that the residents said this year’s planting season is not likely to occur.

“This farming season, we can’t do any work,” said Jaya, the teacher. “We have lost too many people.”

Villages all around here have been routed, and life has ground to a halt. Schools are closed, soccer matches called off, and food prices have shot up. In Bonbom, 24 are dead, along with 12 in Bendima, and 61 in Daru, a town of about 6,000 up the road from here, said the paramount chief in Daru, Musa Ngombu-kla Kallon II, ticking off the towns where his subjects have died.

Kallon lost his wife and daughter. His wife, taking care of the town’s initial case, an infected nurse, told her husband: “Don’t worry. Keep cool.”

At the nurse’s burial everybody wanted to “touch in abundance” the corpse, Kallon said, even dressing the deceased’s hair. Infected corpses are highly infectious, presenting a common risk of infection. Even at the MSF treatment centre outside Kailahun the doctors say they are not keeping pace with the epidemic, despite a staff of more than 300, 10 tents, more than 2,000 protective suits and a layout designed to reduce the risk of infection.

Two steps behind

“I think we are two steps behind,” said Wolz. “We are still discovering villages” where Ebola victims are dying at home, rather than in isolation, risking new infections. There have been up to 140 new cases at the treatment centre in the last three weeks, she said.

The standard protocols for containing the disease – isolating each patient, tracking the people they came in contact with and monitoring all of those for weeks to see if they develop symptoms – seems an almost insurmountable task across the four West African nations that have reported about 1,800 cases so far: Sierra Leone, Guinea, Liberia and Nigeria.

International officials have said there were at least 500 contacts to trace just from the city in Guinea where the outbreak was first identified in March, and the World Health Organisation has said it will need to send hundreds of additional health workers to the region to try to contain the epidemic.

At the MSF centre a medical assistant flipped cans of sardines to grateful Ebola patients behind a barrier, several of whom were eager to demonstrate their healthiness. But one patient, struggling to his feet, held his head in his hands. “Hurting, hurting, hurting,” said Mamou Samba, a 43-year- old mason, groaning and demanding painkillers.

Behind the tents the morgue is full. A body arrived – a young man, his arm hanging limply from the stretcher, who appeared to have been in his prime. Most of the patients are breadwinners for their families, as one staff member put it. A team of five in full protective gear disinfected the corpse with a potent chlorine spray solution. Behind the morgue rose smoke from the latest incineration of protective gear, which is discarded after a single use.

Wolz said the outbreak would not end this year. "Everybody sends experts," she said. "They sit in offices and go to meetings. We need people to go into the field." – (New York Times service)