The
figures put out by the Sierra Leone Ministry of Health and Sanitation,
MoHS require some
explanation, and perhaps with the new task force in place and the new
emergency plan announced by the President last week additional
explanation will be forthcoming. From
the start of the outbreak the health ministry figures have been
different from those coming from the WHO; this has been the case
whether you look at the comfirmed, probable or suspect numbers, all of
which WHO release. However, a further potentially more serious problem
has emerged in recent weeks.
The
MoHS started to release figures for survivors some weeks ago. Now
if
we look at the confirmed cases and subtract the confirmed deaths and
the survivors this should give us a figure for confirmed cases who are
still patients, ie they have neither died nor been certified to have
survived. The numbers differ from WHO to MoHS and, naturally, from day
to day; a few days ago the President on television reported 500
confirmed cases, 129 survivors and 167 dead. This is approximately in
agreement with the WHO and MoHS figures, and it leads to a figure of
204
current patients (ie 500-129-167). Now MSF reports on its website that
its Ebola facility in Kailahun has 65 beds. The Ebola treatment
facility in Kailahun is nonfunctional following the infection and
subsequent death of the leadership of the facility. These are the only
specialist Ebola treatment centers that have been reported in Sierra
Leone. So if we assume MSF's 65 beds are all occupied by Ebola patients
(The Ministry of Health's July 23 Facebook page reported 65 patients at
the two facilities) we still have 139 patients (not counting those
confirmed positive in
the last few days) that are not in a functional Ebola treatment center.
Where are these patients? It seems beyond belief that they would be in
a general hospital or clinic. When one Ebola patient showed up at a
regular hospital in Freetown, panic ensued, and the hospital had to be
closed and then disinfected. So where are the 139 Ebola patients? Is it
possible they are somewhere out in the community? Is it possible no one
knows where they are? Do some of them remain at the Kenema treatment
center even though this is no longer functioning? Would the Ministry of
Health please explain? What is happening to newly confirmed Ebola
patients? Where are they being sent?
What is the procedure for handling and tracking suspected cases whose
blood samples are sent for testing? It is a matter of public record
that in some cases these patients have 'escaped' whilst awaiting their
test results. Some might have 'escaped' or left hospital even after
confirmation of their cases. We wonder what happened to the patients at
Kenema after the collapse of services there. We have been told by the
experts that the key to containing the outbreak is tracing all known
contacts of Ebola patients. Now if we can't trace the patients
themselves, it becomes impossible to trace their contacts! God help us
all!
Which leads us to ask, what is the plan for the future? Where will new
confirmed Ebola patients be sent? We understand a facility for
them is being constructed at Lakka in the Western Area. This is very
much in place and should probably be replicated in all the districts,
to avoid the problems of moving Ebola patients out of district. As
there is the possibility that sufficient health
workers may not be available and willing to look after these patients,
some plan could be considered by which immediate family members could
be trained to care for Ebola patients. One thinks of a mother and
infected child. Or a husband and wife. These are extremely difficult
choices at a societal and individual level, but they are choices that
have to be made. All the indications are that at this point in time we
do not have sufficient specialist Ebola care available to handle the
situation. We can not sufficiently protect the care givers, who
themselves become infected and infect others. Telling patients with
symptoms to report at a health facility is one thing, but from there,
what happens to them? The vast majority of health facilities in the
country are grossly unprepared to handle Ebola patients.
Dozens of
unaccounted Ebola patients
If we
accept the hard fact that we probably have dozens of Ebola
patients whose whereabouts are now unknown, how do we move forward? Our
Ministry of Health must
come clean and institute thorough, rigorous documentation of all
new cases. This is absolutely vital if we are to win this battle. The
President announced the involvement of the police and military and they
must be used where necessary to ensure that every
Ebola suspect that comes to the attention of health authorities is
tracked until final determination of his/her case.
This is no
time for Sierra Leonean sloppiness.
This is no
time for Sierra Leonean deception and cynicism.
Every
single patient whose blood sample is sent for testing must be
meticulously monitored until final determination of his/her case. The
records must be scrupulously compiled. If our Ministry of Health is
incapable of this then the international community should speedily step
in and take over the job. This is potentially an international
disaster, so there should be no scruples about this. One unaccounted
Ebola patient can ignite or reignite an epidemic.
The
reporting of all deaths is another important measure announced by the
President and involving the recordkeeping of the MoHS. The ministry has
to date in this outbreak ignored all deaths from other than laboratory
confirmed patients. This has led to an underestimation of the extent of
the outbreak. Going forward, a good-faith, honest attempt must be made
to include all deaths that are probably as a result of Ebola. This
would give a much better picture of the progression of the disease and
assist greatly in contact tracing and identifying areas for
quarantining.
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