Sierra Leone: The Kenema tent helps to prevent Ebola spread

October 2014

The 2 women on the veranda anxiously survey the gaggle of health workers, police officers, villagers and international aid workers firing questions from the other side of a small ditch. They insist their mother died of "natural causes".

Margaret Harris, WHO, is talking to a surveillance team in Kormende village, Sierra Leone 2014.
WHO/S. Gborie

”She was old, over 60,“ says one. “She never left the house.”

“Never? Didn’t she ever visit her neighbours?” asks a surveillance officer.

“Since we brought in the tents, we haven’t had another case in Mondema."

Dr Andrew Ramsay, field coordinator for WHO in Kenema, Sierra Leone

“Yes she did,” puts in a helpful villager, naming a nearby household with a confirmed Ebola case.

Although extensive information campaigns tell people to report Ebola symptoms immediately, fear of the consequences of reporting – quarantine - is outweighing concern about spreading the disease. The 2 women in Kormende village, near Kenema, Eastern Sierra Leone, are no exception.

Many households have more than 10 people living in a single room, sharing not just space but bedding. Thus, should any of them develop Ebola symptoms, it is impossible for that person to "self-isolate" while waiting for testing and transport to a treatment centre.

By the time the first case of Ebola is confirmed, many – if not all – members of the household will be infected.

Tents give people a little more space

However, in Kormende, more people are now accepting and tolerating quarantine because a new innovation, the "Kenema tent", is providing them with more space and allaying their fears of being trapped in an overcrowded, infected household.

“At a surveillance meeting we discussed these 2 very large unrelated households in Mondema who were at high risk of intra-household transmission – spreading Ebola within the family,” says Dr Andrew Ramsay, field coordinator for WHO in Kenema.

“We thought OK, we need to give them space: we could put up a tent. So we called the WHO office in Freetown and got a tent the next day.”

The WHO team advised that the tent should be used to allow people to distance themselves safely while in quarantine. If any family member developed symptoms, they should be isolated in one room while the rest of the family stayed in the tent.

“Since we brought in the tents, we haven’t had another case in Mondema and their quarantine is now over,” says Ramsay.

Image of a so called Kenema tent for fighting the spread of the Ebola virus, Sierra Leone 2014.
WHO/S. Gborie

Intra-household transmission

More tents have been supplied by the International Federation of Red Cross and Red Crescent (IFRC) and these are now being used wherever more space is needed for villagers in quarantine.

UNICEF has provided sleeping mats, bed nets and cooking equipment so people in quarantine do not have to share the same bedding. In Kormende, the tent has been pitched next to a primary school where several households have been quarantined.

“Although quarantining households stops the virus spreading from one household to another, you still get spread within the household when people are so crowded together,” says Ramsay.

“These are very poor overcrowded households living in conditions that make it impossible for people to keep a safe distance from each other, especially when children are sleeping 5 or 6 to a mattress. Unless you address this intra-household transmission you are never going to get rid of the disease. If you get 1 household affected, you will have 10 new cases.”