Updates from Ebola-affected Sierra Leone – November / December 2014: Brian Starken C.S.Sp.

I Return to Sierra Leone – 11th November
II A very fine line between life and death – 18th November
III The Ebola Burial Ground – 24th November
IV Reflecting on Health in Sierra Leone in the wake of Ebola

Chapter IV  Reflecting on Health in Sierra Leone in the wake of Ebola

Photo for Ebola update

 Of all the factors that contributed to the spread of Ebola throughout Sierra Leone, lack of preparedness by government is surely top. Alarm bells should have rung when the first case was diagnosed in March just across the porous border with Guinea. When the first cases were diagnosed in Kailahun, there was still time to act by quarantining the infected people and the affected areas and by restricting the movement of people. Instead, panic was caused when suspected cases were moved to hospital in Kenema.  Fear and mistrust were soon rife.

The lack of any national information campaign allowed the rapid spread of mis-information such as ‘they are taking our people to the hospital to inject them and kill them’ and ‘the Ebola virus was imported so that health agencies and the government could make more money.’ Sick people would not go to hospital and in those early months of the outbreak, families removed relatives with Ebola from hospital making it extremely difficult for health workers to track down and control new infections. It also gave rise to very unsafe burials – a practice which may have caused up to 70% of new infections, as people who have died from Ebola are particularly contagious and must be buried without washing or touching the body.

The health system in Sierra Leone has always been very weak and it must be remembered that the civil war (1991-2002) had a further devastating effect, especially in rural areas. While a number of hospitals and clinics have been rehabilitated since the war they are still under- resourced, under-funded and under-staffed, and totally ill-equipped to deal with the current epidemic. Before the outbreak the country had just 180 doctors to serve a population of over five million people. At least ten of those doctors have since died from the virus. A four-month delay by government in introducing health checks and restrictions for people entering or leaving Kenema allowed the virus to spread easily to many other parts of the country while even health workers were unaware of the devastating effects of the virus or the precautions that were needed. 

The international response was also very slow in coming. Only Médecins Sans Frontières (MSF), which moved quickly in June to set up a field hospital serving the area first affected by the virus, had both previous experience of working with Ebola patients elsewhere in Africa and a long-standing presence on the ground in Sierra Leone. It has done a splendid job. (See

The International Federation of Red Cross and Red Crescent Societies (IFRC) came to Kenema in late August setting up its 60-bed facility. The IFRC too has made a real impact and the number of ‘new’ cases in Kenema has been reduced to almost zero. This shows that the outbreak can be contained. However, containment demands the co-operation of medical agencies, the government and the local population. 

One major fallout of the crisis is that people with other illnesses are now reluctant to go to hospital at all, including hospitals that are not designated for Ebola treatment, and people are even fearful of getting injections. 

Panguma Hospital, for example, is run by the Catholic Diocese of Kenema and is typical of those health facilities which, though not ‘Ebola-designated’, must be constantly on the alert for people infected by the virus. Suspected cases are immediately transferred to Kenema. The number of ‘regular’ patients at Panguma Hospital has decreased significantly. Expectant mothers will come for pre-natal checks and to receive their nutritional feeding supplements but, when it comes to delivery, they are unwilling to check-in to the hospital and opt to stay at home and call the Traditional Birth Attendants.

On the positive side, regular immunisation programmes are continuing, and patients who require regular medication and treatment for a range of diseases including diabetes, epilepsy HIV and TB are being catered for. Nutrition programmes continue to be administered by the hospital. 

Brian StarkenBrian Starken C.S.Sp. (pictured) was first appointed to Sierra Leone in 1975 and has spent a total of over 25 years there. Having returned to Ireland in December 2014, Fr. Brian takes up an appointment in pastoral ministry in a Dublin parish in early 2015.