Ebola in Sierra Leone | Epidemic of Blame

In this undated photo, Health Minister Miatta Kargbo speaks to the press
Some say the immediate Ebola crisis may be almost over, but others aren't so sure. As efforts continue apace to contain the outbreak in Sierra Leone, the nation’s Minister of Health and Sanitation, Miatta Kargbo, is facing the fallout.

This is Africa reports that Kargbo, on Monday, blamed those suspected to have died from Ebola fever responsible for their own deaths

The lash back came swiftly on social media but there was one editorial that stood out in its vehemence.

The New People Online,
which often runs strident criticism of government, accused Minister Kargbo of “ordering the kidnap and secret killing of dying Ebola virus patients.”

New People's Abdul Fonti also implied misjudgment when the ministry dismissed Sylvia Olayinka Blyden’s initial reports. Blyden, a medical school graduate turned publisher, currently serves as a special executive assistant to President Koroma. Fonti wrote that when Blyden first ‘reported’ the outbreak or prevalence of Ebola in Kissi Teng chiefdom, health ministry officials treated Blyden’s call with “reckless abandon.”

The health ministry were the ones, Fonti said, who “summoned a press conference in Freetown to dismiss a BBC report further raising alarm on the Ebola disease.”

Fonti also claimed that the Koindu community health center, which serves Kissi Teng, epicenter of the Ebola outbreak in Sierra Leone, shut down yesterday.

All the suspected Ebola cases are said to have been abandoned with patients left with no option but to return home, Fonti protested.

He went on.

“Sources have disclosed that the lady minister has secretly ‘ordered’ all Ebola patients to be kidnapped from Kissi Teng chiefdom and driven to Kenema on grounds of isolating the patients. Patients are said to have been dying in Kenema where they have been receiving little or no treatment at all,” Fonti exclaimed.

Kailahun, in the Eastern Province of Sierra Leone, was the epicenter of regional conflict for many years. The area also has a reputation as “the forgotten district” noted Katrina Manson in a recent travel guide.

Koindu, one of Kailahun’s largest towns, is a major diamond mining and market center with a population estimated at 16,751. Koindu lies approximately 63 miles from Kenema and about 230 miles south-east of Freetown, the capital of Sierra Leone. The population of Koindu is largely from the Kissi ethnic group.


Fonti also claimed that relatives of the patients reportedly attacked the medical team. Police, he said, responded by firing live rounds to disperse the crowd, which sent patients running to take shelter in the nearby woods.

“The doctor and the rest of the team sent by the minister are said to have escaped from the health center and sought police protection.

The kidnappers have also left the town with the Ebola patients left with no medical attention,” Fonti concluded.


Dr. Aiah A. Gbakima

"This sort of message does not help,” remarked Aiah A. Gbakima, a biologist and country director at Global Viral Testing. Dr. Gbakima, onetime vice chancellor and principal of the University of Sierra Leone and before that an associate professor in the Department of Biology at Morgan State University in Baltimore, Maryland, called Fonti’s story “misleading.” 


There has been vigorous preparation to stop this virus from entering Sierra Leone by the Ministry of Health and Sanitation, development partners, non-governmental organizations and many others, Gbakima asserted. There is no drug for treatment and no vaccine, he added.

On learning about the crisis Monday night from the team in Kenema, Gbakima said the health minister was kept informed as were a group of people from the Ministry of Health, who stayed up in meetings till 2:00 AM.

Because it was late, the specially adapted ambulance left Kenema by dawn for Kissi Teng, Gbakima said.

"Bear in mind, he explained, "Kenema is the only hospital in the country with a special isolation unit to handle all viral hemorrhagic fevers. The ambulance was to bring the confirmed case for hospitalization. Meanwhile, the contact of this patient (7-8 people) were identified and also put in health centers pending their samples being tested. When the ambulance and the health surveillance team got to Kissi Teng, the chief apparently refused to cooperate with the team and refused to allow the ambulance to take the patient to Kenema for admission, to be given supportive treatment and possibly save her life. They did not stop at this but forcibly removed all the contacts who were beginning to show signs of Ebola (vomiting, diarrhea, high fever, and body pains) and took them away and hid them.”

"Before this confirmed case, a lot of training had been done for most health workers and they were all given personal protective equipment’s, gloves, masks, etc. The border post health workers were trained and these Train the Trainers were also supported to train others in their areas. There was a lot of sensitization about Ebola. These programs were all presented and discussed at the National Task Force meetings every week and that was chaired by the Minister of Health and Sanitation herself. I am a member of this task Force. I do not see reason for the writer to say that there was lack of preparedness.

"On Monday, May 26th, there was a an emergency Task Force meeting to announce we have a confirmed case and that there were patients admitted with diarrhea and vomiting--4 (four) others were admitted later. There were four deaths. The minister did not hide anything from the Task Force and we all discussed the approach to this outbreak.


"The Index case was a lady and all those who attended the funeral and the 40th day ceremony were requested to be seen by trained surveillance officers and to possibly take a blood sample from each if there was a need to do so. The idea was to eliminate those who were positive from those who were not at that point in time.

"When the Minister was told of the removal of  the patients from the Hospital/clinic in Kissi Teng chiefdom, she alerted the stakeholders and summoned another Task Force meeting today, Tuesday May 27th.  Before that meeting, she met with all Members of Parliament from Kailahun District and other stakeholders from that district to solicit their assistance in identifying these patients and to stop the spread of this deadly virus.

The teams from Kailahun, Kenema and Kono depart tomorrow morning (Wednesday, May 28) to have meetings with their chiefs and people in these border districts.

"As far as I know, and I was at both Task Force meetings on Monday and Tuesday, at no time did the Minister of Health say or even suggest that these patients should be kidnapped and brought to Kenema to die. In fact, it was decided by the Task Force that we should set up an isolation unit in Koindu to stop people being transported to Kenema for the distance.

"In addition, all samples will be sent to the mobile lab in Gbakedu on the border to be tested instead of Kenema due to distance. Tents have been donated by MSF (Medecins Sans Frontieres or Doctors without Borders) to set the isolation Unit in Koindu and to expand the ward in Kenema in case we are overwhelmed. The health workers in all the border districts were trained on how to set up an isolation unit during the three weeks of training preparedness response.

Let me tell you why these patients were taken away by their relatives.

"They live very close to Guinea and most use the Guinean currency, they buy from and sell in Guinea and have relatives in Guinea. During the outbreak in Guinea, the news going around was that when they take
one's relatives to take blood, they never come back. This created fear that if they take their relatives to either take samples or take them to Kenema for treatment, they will not come back.

There are no patients dying in Kenema. In fact, there was no Ebola patient in Kenema on Monday, but three of those who disappeared from Kissi Teng came by themselves to the Kenema Government Hospital for treatment for diarrhea and vomiting. Because of the alertness of staff there, they were immediately referred to the isolation ward and we now have three patients confirmed for Ebola; admitted and they are all alive.

The World Health Organization is sending expert physicians and anthropologists to help educate people on Ebola. The posting of Abdul Fonti is really false and very unfortunate. The minister and her team have been working very hard to contain this outbreak. I am sure you will hear from them," Gbakima said

TIMELINE of A Crisis


On Wednesday, April 2, 2014, The British Independent reported that the Ebola virus had spread to Sierra Leone.

The same day, Awoko, a leading newspaper in Sierra Leone, said senior officials and health professionals in the Ministry of Health and Sanitation paid a visit to Gbalamuya on the Sierra Leone- Guinea border to update border authorities on Ebola.

Awoko also said that Minister of Health and Sanitation Miatta Kargbo told immigration authorities and security personnel about the Koroma administration’s commitment, and that of its partners, to fight the disease, noting that Ebola in Guinea means Sierra Leone is in a serious threat.

According to Awoko, before leaving Gbalamuya, Sierra Leone’s Director of Disease, Prevention and Control Dr. Amara Jambai, gace the ministry’s questionnaire to port health authorities and asked them to be vigilant over transportation of corpses for burial into Sierra Leone.

Jambai also said there would be updates from District Health Management through the District Medical Office on a daily basis.

The same week, Dr. Gbakima denounced news reports saying that the virus has spread to Sierra Leone.

It “is wrong for now. The two people that died and that every news house is referring to died in Guinea and their bodies were transported to Sierra Leone and buried there due to the closeness of the villages.

"Our teams have gone there and identified the graves of both deceased persons. We were also able to find 15 contacts and we took blood specimens from all of them and tested them for Ebola. They were all negative Ebola and for all other hemorrhagic fevers. We are following all leads any information of suspected cases country. We do not at this time have any positive case of Ebola in Sierra Leone, thank God. If we do find even one case, we will inform you.”

Early on Saturday, May 24, an active blogger on Facebook, who regularly posts comments from Sierra Leone, broke the news of Ebola in eastern Sierra Leone.


“I will like you all to help me pray for our people in Kissi Teng chiefdom, Kailahun, near Guinea border. The news from there, if confirmed to be what is suspected, is very distressing. May the soul of Nurse Messie Konneh who passed away last night in Daru, as she was being rushed to Kenema from Koindu and all the other victims so far (two of whom are being buried right now as I type), rest in perfect peace.

Let us also pray for Traditional Birth Attendant Yawa Korseh who is in critical condition and being transferred from Koindu even as I type this message. The medical team have taken samples for tests. Please, let us pray.

“If this specter of last 48 hours continues, we are going to need all hands on deck. Nine deaths so far according to Koindu Town Chief, Moses Foryoh.”


Transmission


Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Among workers in contact with monkeys or pigs infected with Reston Ebola virus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

Signs and symptoms

EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

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