Today, November 7, after the loss
of considerably in excess of 3,500 Sierra Leonean lives to Ebola, and
with the heroic efforts of many within Sierra Leone and around the
world, the WHO has declared Sierra Leone free of Ebola. In a ceremony in Freetown this
morning, the WHO's country representative, Anders Nordstrom, made the
formal announcement, the
country having gone 42 days, equivalent to twice the disease's
incubation period, without reporting any new cases. Mr. Nordstrom,
stated that the country would now
enter a ninety-day period of enhanced surveillance, to prevent a
recurrence of the outbreak.
A big, big thank-you goes to all who helped in this effort. A huge
thank-you to the Cuban and Chinese governments, the
very first countries to step into the disaster, with moneyand
medics directly involved in treatment of Sierra Leoneans. Truly,
ideology and principle have never been more positively demonstrated
than in their response. A big thank-you to all the other governments,
big and small, who contributed. A big, big thank-you to the Sierra
Leonean doctors and nurses, many of whom paid the ultimate price, to
the other hospital staff, the burial workers, ambulance drivers and all
other Sierra Leoneans who courageously played a part in battling the
scourge of Ebola. A big thank-you to the research scientists all over
the world, even including normally profit-seeking multinationals, who
toiled round the clock, with some success, for a vaccine and/or therapy
for Ebola. A huge thank-you to MSF, a private organization, with us
heroically in the thick of the battle, from the first to the last. When
we first reported an Ebola crisis in Sierra Leone in June last
year, very few people were taking the matter seriously. Certainly not
the Government of Sierra Leone, which at best was ignoring the
outbreak, at worst was doing all it could to conceal the problem.
Indeed, President Ernest Bai Koroma had in May all
but declared the Ebola outbreak in the region over. As late as
August, 2014, he had to be persuaded that his country was indeed in a
crisis and this was not the time to be going on a jaunt
to the US for the US_Africa summit.
TheSierra
Leone Ministry of Health was unable to perform simple statistical
calculations relating to the outbreak. Meanwhile, the reflex
reaction of the lunatic elements within ruling party supporters was to
label the bearers of the bad news “detractors” and “saboteurs”. Among
others not taking the crisis seriously at the time was the World Health
Organisation, WHO, which spent many weeks ignoring
all the indications that there was a very serious, unexplained viral
haemorrhagic outbreak in Eastern Sierra Leone at exactly the same
time as Ebola had been confirmed in neighbouring Guinea and Liberia.
Credit goes to Osmond Hanciles, who, by some margin, was the very first
writer we found to warn of the dangers to Sierra Leone of the impending
crisis. Credit also to Sylvia Blyden, also early to spot the danger.
Credit, too, to Yahya Jammeh, President of Gambia. Whatever other
criticisms one might have of him, he was the earliest of all the West
African leaders to understand the threat Ebola posed to his country and
others in the region.
Our assessment of the defeat of Ebola, based not on
scientific analysis but on close observation of day to day events, is
that the advice of the medical experts was correct from the start:
Ebola spreads through close contact with symptomatic patients and
corpses. Focus on this and the disease can be defeated. Ignore this, or
focus elsewhere and the disease will spread. Our assessment, again
based not on scientific analysis but on close observation of events, is
that many of the preventive measures put in place, to the extent that
they diverted focus away from the dominant mode of transmission, were
not helpful in the fight. The state of emergency, mass quarantining (as
opposed to quarantining of identified high-risk locations) and
lockdowns (which we at one point supported) in the end, in our layman’s
view, probably did not contribute much to the defeat of Ebola. All the
restrictions on economic activities and public gatherings, in the
end, in our layman’s view, probably did not contribute much to the
defeat of Ebola, especially when one considers that the income and
energy lost in these measures could have been utilized in more precise
Ebola-specific measures. We heard of not a single instance of Ebola
being contracted in public transport or in a crowd (and despite Ebola,
crowds were
congregating in markets
every day). The origin of the disease in almost all specific cases we
heard about could be readily traced to one or other of the dominant
modes of transmission. Handwashing and improved personal hygiene have
other health benefits, but in our layman’s view, the ubiquitous
handwashing buckets did not contribute much to the defeat of Ebola. Liberia
ended its Ebola outbreak remarkably early even though it had long
lifted its state of emergency, whereas Sierra Leone's state of
emergency still exists today.
From our layman’s perspective improved testing, infection control
procedures in medical facilities, medical surveillance, contact
tracing, targeted quarantining, public education, social mobilisation
and monitoring of deaths and burials were some of the key factors in
the defeat of Ebola. This was actually more or less what experts who
had faced down Ebola previously had told us from the beginning.
Sometimes, in the face of an enemy that inspires mass terror and with
infected corpses rotting in the streets, it is easy to ignore the
advice of experts. Overcoming distrust of the government health
authorities and their message was also a key part of the problem.
It was a terrifying time for Sierra Leone, a country that has had its
share of terrifying times. At the height of the epidemic, it looked
from here on the inside as though we would not escape. We hope, but are
by no means confident, that lessons have been learnt from it, that we
now understand as a nation the need to be globally and/or regionally
competitive in all things. In health care, in education, in
agriculture, in our environment, in income generation, in
infrastructure. In all areas of serious human activity Sierra Leone at
the very least should be competitive with its neighbours. The tendency
to fall behind even the relatively low standards of the West African
region is a sure road to national disaster. We simply cannot afford to
continue to ignore global best practice, brush aside serious criticism,
and downplay all the negative developmental indicators revealed by
global bodies. There is much work to be done to ensure Sierra Leone
never again faces these terrifying times.