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The United Methodist Response to Ebola

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UNITED METHODIST RESPONSE TO EBOLA

The Impact

News of Ebola outbreak in Sierra Leone was first reported in May 2014. From May to date, the disease has spread with such devastating consequences that it is now found in every political district in the country. It is estimated that over 491 people of have died of Ebola in the country.

On the average, 20 people are being infected by Ebola every day with an average death rate of 5 people per day. It is reported that in Kenema, about 45 people died of the disease in one week in one settlement alone, and it is now true that the capital city Freetown and its eviron (Western urban and Western Rural) are the second hot spot for the disease next to Kailahun.

The disease has caused such devastating social and economic consequences that today everyone lives in a state of fear and intimidation. Two of my personnel have been so intimidated by the disease that they are afraid to travel out of the country for fear of the harassment that may be meted out to them. The fact is that these days, once you travel out and people come to know that you are from Sierra Leone, they move away from you. Sierra Leoneans now live in a state of shame and embarrassment, loss, pain, grief, panic, suspicion and superstitions. In Port Loko, it is said that the high rate of infection is due to a witch craft air plane that crashed in the town causing many people to die.

We live with accusations and counteraccusations. Our economy has been seriously affected as prices of essential items continue to hike every day. Some of our people are losing their jobs and institutions close down. Others are receiving less working hours and therefore less salaries.  Some have already been asked to stay home without salary.

Our educational system has been affected. There is a nationwide deferment of exams and forceful closure of schools. The end of the first week in September is the usual time for the new school year to start but up to this time, no one knows when schools and colleges will reopen. This places our children’s education at risk.

Ebola has also made serious negative impacts on religious activities – no pilgrimage to holy lands and ban on public gatherings such as cinemas, weddings etc.

In the United Methodist Church, the children’s camps and the Pastors’ retreat which events normally take place in August have been suspended.  District conferences which were scheduled to begin this month have been temporarily put on hold. At the UMC House, we have temporarily scaled down operations by sending on leave some of our staff including the most vulnerable workers who use “poda poda” (public transport) to come to work each day in order to reduce the risk of contracting the disease.

The Conference Health Board was temporarily shut down four of the most vulnerable health facilities in the rural communities in order to protect our health workers from infection from unsuspected Ebola patients who may seek treatment at these facilities.

On the government front, Ebola isolation units are being overwhelmed with the influx of Ebola patients and with inadequate care and food supply, patients escape from these isolation units and go in search of food thereby mingling with the population and compounding the situation even more. The limited availability of ambulances and acute shortage of government Ebola response teams have further worsened the situation. Many calls from homes to pick up Ebola patients has remained unanswered. Sometimes by the time the Ebola response team actually comes in, the patient has died.

Several health facilities have closed down across the country. In some of the few remaining facilities, health workers actually refuse to touch patients because they fear risking contracting the disease. In Freetown, a young woman died of appendicitis because she was taken to two separate hospitals and no doctor was willing to touch her. Her appendix eventually ruptured and she died. This means that it is no longer Ebola alone that is killing people. People are now dying of very common diseases that can easily be treated.

But perhaps the most scary of it all is the alarming rate of health workers who are dying of the Ebola Virus Disease. When an army commander dies in battle, the entire army is thrown into disarray. This is now the situation that Sierra Leoneans find themselves. We are in total disarray. President Ernest Bai Koroma, in his meeting with Religious Leaders on Monday September 15 informed the group that since May 2014, a total of 463 people have died of Ebola including 49 health workers (4 Doctors and 45 Nurses). In a nation with acute shortage of trained health workers, this presents a hopeless situation. Yes indeed, it is hopeless.

WHO, MSF, the U.S. CDC, and other international health organizations who are on the “front lines” of the Ebola epidemic are in agreement that the situation is out of control, and without major engagement from the international community, the situation will only get worse. The Sierra health infrastructure has completely collapsed and the country no longer has the capacity to handle the situation. Every attempt to curb the virus including, isolation of patients, isolation of whole regions, suspension of international flights etc. have yielded very little result. The virus is traveling effortlessly within and across borders by plane, car, motorcycle, bicycle and foot, across mountain tops, valleys, forests, villages and cities. Border closures, flight bans and mass quarantines have been ineffective. “Everything we do is too small and too late,” said an international Ebola expert. “We’re always running after the epidemic. Ebola has been able to follow its own course because West Africa lacks the health care workers it needs to monitor potential carriers and train communities in how to avoid catching the disease. People in contact with the sick have evaded surveillance, moving at will and hiding their illnesses until they infect others in turn. Whole villages, stricken by fear, have repeatedly shut themselves off for days or weeks, giving the virus more opportunities to whip around and skip to other places”. WHO is now estimating it will take 6-9 months to get the situation under control (in the BEST of circumstances), and that by that time they would be looking at something like 20,000 fatalities.

The situation in Sierra Leone is far from improving. Rather, it is getting worse each day with escalating new infections and death. There is a huge scarcity of Personal Protective Equipment (PPEs) in the country to protect health workers who are on the front line of the fight against Ebola. Ambulances are in short supply. The same ambulances that carry Ebola patients from one place to the other are the same ambulances that carry “normal” patients. It is reported that public transportations (Poda Poda) are being used to convey Ebola patients from Freetown to Kenema. On their return journey, the drivers take onboard healthy passengers thereby helping to spread the virus. Body bags to bury Ebola victims are not available in the country.  At the only major Ebola testing and treatment center in Kenema, bodies are buried in rice bags which often leak and expose the burial teams to further risks. This is one of the reasons accounting for the loss of life amongst health workers. As a result most of our doctors and nurses have downed tools thereby compounding the situation. The few that do go to work refuse to touch patients for fear of contracting Ebola.

Some hospitals across the country have already closed down because health workers are not going to work for fear of risking contracting Ebola. Two weeks ago, nurses in the largest government operated health facility in the country, Connaught Hospital, went on strike demanding government to provide them with PPE’s or they would not go to work. This week, health workers in the only Ebola testing and treatment center in Kenema have gone on strike demanding for protection equipment and other needs.

Until very recently, there was only one Ebola testing center in the country. Patients and blood samples from suspected Ebola patients are moved across the country to this one testing Center in Kenema each day. The limited number of trained and skilled testing staff at Kenema have become overwhelmed with the magnitude of tests they have to do each day. As a result, patients have to wait for days for them to know their status. This period of waiting could be agonizing and the fear of a positive result often cause the patients to escape the rather loose “isolation units”.

The Ebola isolation units have run out of space. Patients are congested in the limited spaces available thereby spreading the virus amongst infected and non-infected suspects. Food and basic supplies to isolated patients are grossly inadequate and with patients far removed from their families, care for them remains largely inadequate.

Another psycho-social impact of the Ebola Virus Disease is that once patients are tested positive, their social status immediately changes. They are more or less treated like mere criminals. In the vast majority of cases, relatives of suspected patients hardly ever set eyes on their loved ones from the day they are taken into isolation until their death and burial, most often in mass graves where family members will never know.

These are the hard realities we live with in the country.

Challenges

Ebola broke out in the country when no one was prepared for it. In their attempt to respond to the outbreak, government health officials inadvertently sent out conflicting and often counterproductive information at the initial stages of the outbreak. Some of the information that was passed on to the people in the media created fear, panic and an atmosphere of hopelessness and denial among the people. In Kailahun, the epicenter of the disease where whole families were being wiped out, there was a massive loss of trust in the government health personnel and the police whom they thought were more of a threat to their lives than the disease itself. Others fearing force arrest fled into the forests. In its Accelerated Ebola Virus Response plan, the government recently presented several reasons why the virus has continued to spread with such alarming speed:

Inadequate understanding within the communities of the EVD as this is the first major outbreak reported in Sierra Leone.

Lack of experience among healthcare workers and limited capacities for rapid response.

High exposure to Ebola virus in the communities through household care and customary burial procedures. This has resulted in a high level of community deaths leading to panic and anxiety.

Denial, mistrust and rejection of proposed public health interventions arising from misinterpretation of the cause of the new disease.

Fear of the disease by frontline health workers leading to either suboptimal care for patients or substandard implementation of protective measures.

Close community ties and movement within and across borders has lead to difficulties in tracing and following up of contacts for the three countries.

This outbreak poses serious challenges in terms of human capacity, financial, operational and logistics requirements and threatens national and international health.

What we have done

Through the United Methodist Church Ebola Response Initiative funded by the United Methodist Committee on Relief (UMCOR), an interfaith response – the Religious Leaders Task Force on Ebola was initiated to curb out Ebola.

Since its formation, the Religious Leaders Task Force had intentionally focused on adopting a “quick impact response” that has had a wider and more positive impact on the nation. In fact, the United Methodist Church, through the Religious Leaders Task Force was the first faith based organization that actually rang the alarm bell signaling the seriousness of the EVD.

The work of the Religious Leaders Task Force include:

Aggressive and intentional media coverage

Intentional radio and TV programs aimed at creating awareness, sensitization and education of all Sierra Leoneans on the causes, symptoms and prevention of Ebola. These have been done through panel discussions, announcements, songs and jingles in many major radio stations in the country

Recorded messages on Ebola prevention for dissemination to all district headquarters and major towns and villages throughout the country on CDs. Engage volunteer young people and provide them with T-shirts bearing the slogan “Ebola can be prevented” vehicles with CD players, microphones and loud speakers.

Work with Paramount Chiefs and other community leaders to propagate Ebola prevention message throughout their chiefdoms

Printing and distribution of T-shirts, banners, stickers with Ebola prevention messages in all 14 political district headquarter towns targeting the literate population so they in turn can teach the illiterate members of their communities

Aggressive training of religious leaders and health workers of faith based health facilities

We organized two nationwide regional trainings on Ebola awareness, sensitization and education. First training session was held in Bo July 16th & 17th for 100 religious leaders and health workers from Faith based health institutions in the South and Eastern Regions. The second leg of training took place in Freetown August 5th & 6th for 120 religious leaders and health workers in faith based health institutions in the West region.

We engaged in intentional advocacy and networking programs with other stake holders to urge government to:

Develop a nationally coordinated, accurate, credible, consistent and effective approach in responding to the threat posed by Ebola.

Intensify training of religious leaders and health staff on Ebola and provide adequate protective gear for vulnerable health workers throughout the country.

Expand Ebola testing centers to all district headquarter towns and provide adequate infrastructure such as ambulances to facilitate the free and expeditious movement of suspected cases to the nearest testing/treatment centers

Declare Ebola an emergency in the country so the international community could come in and help the country develop a more robust response to the epidemic.

Momentarily restrict free movement of people from infected to non-infected areas and vice versa.

Our work focused on increasing community awareness and education from the grass roots to our government. Our goal is to do everything possible to teach our people not to come in contact with infected and suspected infected individuals.

Finally, we lobbied with government health officials to make provisions for families, Imams and pastors of persons infected with Ebola to visit and pray with their loved ones as well as to ensure “last respect” burial of persons who die of Ebola.

A new strategy – Prayer, Preventions and Care

After two months of effective nationwide interfaith engagement in the fight to eradicate the disease, we have now shifted our attention to a new strategy which focuses on training of our United Methodist health workers across the conference and providing them with the needed protective equipment. As more hospitals close within our country, we want our UMC health facilities to remain open and be there for the people. As more and more health workers refuse to go to work, we want our United Methodist Health workers to keep the doors of our health facilities open to the public. And as more government health workers die, we want to protect our health workers from being infected with the disease. In pursuance of these goals, the United Methodist Ebola Response Team (UMERT) organized two conference wide trainings of our health workers.

On Friday August 29th, at Leader Memorial Church in Bo, the second largest city in the country, we organized a training workshop for a total of 91 health workers in the Southern region including Rotifunk Hospital, Taiama Health Centre, Mercy Hospital, and Manjama Health Centre. On Friday September 5th at Brown Memorial Church, Freetown, the capital city of Sierra Leone, we organized the second training for health workers in the East, West and North including Jaiama Health Centre, Kissy General Hospital, Lowel and Ruth Gess Eye Hospital, Doris Octon Health Centre Manonko and Yonibana Health Centre.

The training focused on strengthening infection prevention and control practices in all United Methodist health facilities including:

Discussions regarding the establishment of holding centers and efficient ambulance service systems in three of our major health facilities to convey Ebola patients to established government treatment centers.

Providing all our health workers with the best quality and adequate PPE’s, drugs and other basic health care consumables.

Training our health workers in the proper use and disposal of PPE’s and other body piercing instruments.

Training our health workers to be able to diagnose and handle Ebola infected patients without risk of being infected.

Two day training sessions on Ebola awareness, education and prevention for all Child Rescue Centre residential children and staff, Forster children and post-secondary children and their parents and care-givers in Bo.

Distribution of 800 sets of Personal Protection Equipment including garments, boots, shoe covers, head gears, gloves, goggles, facial masks etc. We also distributed quantities of Chlorine and other essential health drugs.

Episcopal conference wide visit and preaching to encourage members and give them hope in the midst of fear and grief and panic that has gripped the nation as a result of the EVD.

What next

The Ebola response team is developing a detail proposal for the next steps forward including:

Establishing holding centers and effective ambulance service in three of our major health facilities– UMC General Hospital Kissy, Freetown, Mercy Hospital, Bo, and Rotifunk Hospital.

Developing a comprehensive psycho-social care program for Ebola patients in holding centers and isolation units and survivors and surviving families of Ebola victims

Putting in place a surveillance team that will conduct periodic site visits to ensure that protective kits are actually being used by health workers.

Developing an integrated Ebola/Malaria response program that aims at addressing the escalating Malaria situation in the country that has now been swallowed up by the Ebola epidemic.

Continue with our interfaith response programs and collaborating with other organizations such as the Religious Leaders Task Force on Ebola, World Vision, Catholic Relief Services (CRS) etc. through resource sharing, networking and other advocacy programs.

The following are photos from the training sessions and distribution of the PPE’s to various health facilities.

Bishop John K Yambasu

 

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