Rapid response to new Ebola infection in Bombali, Sierra Leone

September 2015

WHO is helping Sierra Leone to mobilize all its experience and partners to ensure that any new cases of Ebola are investigated and transmission of the disease stopped as rapidly as possible. Sad news that a 16-year old girl had died from Ebola in Bombali district, a part of the country that had a large outbreak 5 months ago, sparked an immediate inter-agency rapid response. Partners sent people with the skills and equipment needed to stop further infection in Bombali.

Ebola contact tracing team at work in the quarantined village, Bombali district, Sierra Leone.
Ebola contact tracing team at work in the quarantined village, Bombali district, Sierra Leone.
WHO/S. Gborie

Pa Kprr Thullah, a ceremonial chief in Robuya village, Bombali, is worried and angry. He and 20 members of his family are now quarantined in their home after his 16-year-old niece died of Ebola on Sunday, 13 September 2015, sparking fears of a new flare-up in the district.

Ebola and quarantine are not new to this village but everyone had hoped the epidemic which raged through Bombali district 5 months ago was gone for good. Not only did Pa Kprr Thullah hope the worst was over, he also never thought the virus would hit his own household.

"Ebola is clearly still a problem and the fact that I’m speaking to you from behind this barrier, is proof that this sickness is not done with Salone (Sierra Leone) until we all, everywhere, stop thinking that it won't come back." he said.

As we talked, an ambulance drove up and parked behind us. It had come to pick up a man in the house next door, who had developed symptoms typical of Ebola. Like Pa Kprr Thullah's house, this neighbouring house is ringed by distinctive orange plastic sheeting used to fence off quarantined households categorized as "high-risk".

All members of quarantined households are monitored 3 times a day to ensure they stay free of any suspected Ebola symptoms. Those who show any suspected symptoms are quickly removed to"‘voluntary quarantine facilities" where their condition is monitored more closely until they are either discharged or have tested positive for Ebola virus and then moved to an Ebola treatment centre for Ebola care.

Pa Kprr Thullah, a ceremonial chief in Robuya village, Sierra Leone
Pa Kprr Thullah, a ceremonial chief in Robuya village, Sierra Leone
WHO/S. Gborie

Nineteen of the 750 people currently in quarantine in Robuya village have been identified as "high risk". These are people known to have come into direct contact with the girl who died of Ebola. Another 170 people have been identified as "low risk contacts".

Partners playing different roles

We met up with Mohammed Bangura, a food monitor with PLAN (a child rights organization) who was doing a final check of numbers in each quarantined household ahead of the first food distribution of food and non-food items. Once a week during the 21 days that families are confined, they receive rice, sardines, batteries for their radios, beans, plates, spoons, cups, meat, tea leaves, sugar, butter, baby food, charcoal to cook with, mosquito coils, water, onions, tomatoes, toothpaste, sanitary pads for women and palm oil.

As the food distribution was being organized, UNICEF was readying to distribute household water tanks, soap, buckets and the Ministry of Water Resources came to replenish the giant water tanks in front of the village centre.

Meanwhile, teams of epidemiologists were working with the community - piecing together the story surrounding the illness of the teenage girl who died - to try to establish the source of this new Bombali infection.

"Ebola is clearly still a problem and the fact that I’m speaking to you from behind this barrier, is proof that this sickness is not done until we all, everywhere, stop thinking that it won't come back".

Pa Kprr Thullah, a ceremonial chief in Robuya village, Sierra Leone

Experience makes a big difference

All this is part of the inter-agency rapid response led by WHO to support Sierra Leone’s efforts to stop Ebola transmission in Bombali district. Experience from previous rapid response activities in Tonkolili was evident. All partners were on-site with the right people and the right skills and equipment to take all actions needed to stop further infection in Bombali.

Dr Emmanuel Konteh, a policy specialist by training is the District Coordinator for Bombali and is leading the government response to Ebola in the district. "The fact that we have been able to classify all the high-risk contacts by just the second day proves that this has been a well-coordinated response with our partners," Dr Konteh explained.

"There are teams consisting of contact tracers, surveillance and psycho-social officers that serve 10 households each to ensure that all the 70 quarantined houses have a dedicated team monitoring their health and wellbeing. Furthermore, the perimeters to the village have been sealed, and food distribution to the quarantined households is about to take place, as you can see", he said.