Stopping Ebola: It takes collaboration to care for a village
In late August 2015, as Sierra Leone anxiously counted each day that passed with no new confirmed Ebola cases, a woman fell ill with fever, then diarrhoea and vomiting in Sella Kafta village, Tonko Limba chiefdom, Kambia. Her family cared for her at home and, though her symptoms got worse, no one called the Ebola hotline. She was not tested for Ebola virus until after she died, when the Safe and Dignified Burial team were called to bury her and, following surveillance protocols, took a swab. That swab tested positive for Ebola virus disease, bitterly disappointing a country hoping to see an end of Ebola transmission and triggering a rapid response by WHO and partners.
Teams of contact tracers, surveillance experts and community engagement specialists were on standby, ready to go to wherever they were needed to stop any further transmission. The district authorities decided to quarantine the entire village of close to 1000 people for 21 days. Different organizations provided food, water, supplies, social support, educational support for children, even solar powered telephones and assistance with farms so that crops were not left to rot during the growing season. Confirmation of this new case has also set in motion the first "ring vaccination" use of the experimental Ebola vaccine in Sierra Leone.
Here in pictures are a few examples of what it takes to close down Ebola virus transmission.
Knowing who has been in contact with someone infected and who has symptoms that may be those of Ebola virus disease is crucial for understanding where the virus is spreading. Here WHO contact tracing mentors visit the homes of people known to have been in contact with the woman confirmed to have died from Ebola virus disease. The day before this picture was taken one such "contact" said she was feeling very unwell and 'was scared'. She was tested and confirmed to be the second person with Ebola virus disease in the flare-up.
In 2 tents set up in the middle of the village, people eligible for the ring Ebola vaccine trial are being vaccinated after having the trial and its purpose fully explained and giving written consent. The "ring vaccination" strategy involves vaccinating all contacts - the people known to have come into contact with a person confirmed to have been infected with Ebola (a 'case') - and contacts of contacts.
Care of pregnant women
Among those quarantined in Sella Kafta are at least 15 pregnant women. Several of these women are close to full-term so they have been taken to a health centre where they can give birth safely. Here 3 members of the GOAL (Irish nongovernmental organization) reproductive health team are making their daily visit to the expectant mothers quarantined in this village.
People in quarantined homes can not get to wells and bore pumps to fetch household water. UNICEF is providing water and hygiene kits to every home, along with educational materials for children, who are missing 3 weeks of school as they stay in quarantine.
People in quarantined homes have many concerns and questions, and want information about what is going on. Here local officials are visiting a family to ask whether all their needs are being met and list any actions that should be taken to improve their welfare.
Listening to what people understand and fear about the illness and providing information about what they can do to protect themselves is crucial for improving willingness to take action to stop Ebola. Here a team from the local nongovernmental organization Rest Less Development and Focus 1000 are visiting each home to provide more information about Ebola and what people need to do to prevent it.
Mobile phones to quarantined homes
Helping people to stay in touch with friends and family outside the quarantined village lessens anxiety and resentment. Here, DFID (through community volunteers) is distributing mobile phones with solar-powered chargers to all heads of households in quarantined homes in Sella Kafta.
Sella Kafta is in rich agricultural land and most of the villagers are rice and millet farmers. The 3-week quarantine is keeping them from their fields in the middle of the growing season. A local NGO funded by DFID is working with farmers, providing people able to tend the crops from neighbouring villages and ensure families do not lose a year’s food supply because of the quarantine.