Lockdown Begins in Sierra Leone to Battle Ebola
New York Times-4 hours ago
FREETOWN, Sierra Leone — The most ambitious and aggressive government campaign against the Ebola epidemic gripping parts of West ...
Sierra Leone’s Aggressive Attack on Ebola
CreditSamuel Aranda for The New York Times
FREETOWN,
Sierra Leone — The most ambitious and aggressive government campaign
against the Ebola epidemic gripping parts of West Africa began on Friday
when Sierra Leone ordered everyone in the country to remain indoors for
three days, suspending commerce, emptying the streets and halting this
beleaguered nation in its tracks in an attempt stop the disease from
spreading.
Calling
the struggle against Ebola a matter of life or death, the government
mustered police officers, soldiers and nearly 30,000 volunteers to go
house to house, hoping to educate the country about the dangers of Ebola
and identify people who might pass the disease to those around them.
“Some
of the things we are asking you to do are difficult, but life is better
than these difficulties,” President Ernest Bai Koroma said in an
extraordinary radio address on Thursday night explaining the national
lockdown.
From
the start, the limits of the government campaign were evident. The
warnings, mobilization and exhortations quickly clashed with the reality
that cases here are surging and the infrastructure to deal with them
hardly exists.
Kroo Bay
Sierra Leone
River
Freetown
GUINEA
SIERRA
LEONE
SIERRA LEONE
Freetown
Atlantic
Ocean
LIBERIA
2 Miles
There
is no large-scale treatment center for Ebola patients in the capital,
Freetown, so many patients have to be placed in a holding center until
they can be transported to a facility hours away — that is, if an
ambulance can be found to pick them up and if those packed facilities
have room.
The
countrywide lockdown showed the desperation among West African
governments — particularly in the three hardest-hit countries, Guinea,
Liberia and Sierra Leone — as they grapple with an epidemic that has
already killed more than 2,600 people and shows no signs of slowing
down.
While
governments in the region have already cordoned off large swaths of
territory in hopes of containing the outbreak, none have attempted
anything on the scale of what is being tried here. The government says
it wants to visit every residence in this country of about 6 million,
with the aim of instructing people in how to stop the disease from being
transmitted and to find out who is harboring sick people, with
potentially deadly consequences.
“We
have been sending lifesaving messages through radio, TV and print, but
it’s not enough,” said Roeland Monasch, a representative for Unicef,
which supported the government effort, providing money, advice and
information materials. “We need to take information to where people
are.”
In
the streets of the capital on Friday, one woman lay curled in a fetal
position, eyes shut, precariously balanced on cardboard sheets next to
an open gutter in front of locked storefronts. From a wary distance, the
anti-Ebola volunteers said she had high fever. Hours of calls had
produced no ambulance.
A
small crowd, including the police, soldiers brandishing guns,
presidential advisers and spectators taking cellphone pictures of the
immobile woman, milled about. A medical worker said two more bodies in
the vicinity needed attention. But still there was no ambulance.
“They are not responding; they say they have lots of cases now,” said a volunteer, Alhassan Kamara.
Finally,
a rickety ambulance pulled up, more than five hours after the initial
calls, the volunteers said. But the loosely outfitted attendants refused
to pick up the sick woman: they had no chlorine spray and said it was
not their job. A loud anti-Ebola jingle played on a car radio. It took a
second ambulance, and the president of a moped club who quickly suited
up in protective gear, to get the sick woman bundled off to uncertain
care.
On
nearby streets, other volunteers were going house to house to warn
people of the disease’s dangers. Normally clogged streets in the capital
were empty, stores were shut down tight, and pedestrians were rare on
the main thoroughfares.
The
senior United Nations envoy appointed to work on the Ebola crisis, Dr.
David Nabarro, said he was struck by the yawning gap between the spread
of the disease and the ability to fight it. The world needed to increase
the efforts on the ground many times over, he said.
That
would include “the capacity to treat between 9,000 and 10,000 people
within the countries at any time,” he said. “To get there, we need to
get extra people and cash into the countries, obviously, but also we
need fantastic organization and logistics that are second to none.”
Dr.
Dan Lucey, an American who volunteered in an Ebola holding center at a
Freetown hospital, described the situation as horrific. “There were not
enough beds, space,” he said. “When you first see this, you say this is
totally intolerable. It can’t be this bad,” he said after returning
home. “It was an incredible, searing experience not like anything I’ve
ever seen.”
Graphic: What You Need to Know About the Ebola Outbreak
Without
treatment units in the capital, he said, patients who tested positive
for Ebola had to be driven at least four hours away. Those who tested
negative could be exposed to Ebola while they waited. When Dr. Lucey
volunteered, there was just one other doctor present. Patients were
housed together in open wards with a plastic curtain between beds,
awaiting their test results. At the foot of each bed were three buckets —
one for urine, one for stool, one for vomit.
“There
were body fluids everywhere,” he said. Fuel for the ambulances could be
hard to come by. “It’s beyond belief until you see it day after day,”
he said.
Dr.
Oliver Johnson, a British physician currently working at the hospital
with King’s Health Partners, said Friday that the 18-bed unit had
received 10 patients during the first day of the lockdown and now had
four physicians. He said two other isolation units had opened in the
Freetown area in the past several days. “We’re starting to see more
beds, more supplies. More staff are coming to work,” he said.
Sierra
Leonean health workers, who he said have worked bravely, are now being
offered hazard pay. “Things are improving,” he said, but “the real
question is whether we can get ahead of the curve. We’ve been seeing
more new patients than we’ve been able to build new beds.”
The
United States is planning to build as many as 17 Ebola treatment
centers in Liberia, with about 1,700 treatment beds, while the United
Nations is planning an expanded mission in the region, based in Accra,
Ghana, according to Anthony Banbury, the United Nation’s Ebola operation
crisis manager. It is intended to be more nimble than the United
Nations’ notoriously bureaucratic operations, bringing in as many as 500
trucks and jeeps from other missions in Africa, possibly paying teams
in one country to speed up safe burials, buying fuel for monitoring
teams in another country, or offering helicopters to transport health
workers where they are needed.
But
even with the promises of help, international health officials are
worried by what they describe as a rapid growth of cases here in Sierra
Leone’s capital — a dense urban environment where containment is
difficult and the ability to respond is limited.
“The
situation in Freetown is very worrisome as cases increase,” said
Michael Goldfarb, a spokesman for Doctors Without Borders. “Without an
immediate, massive, and effective response, there could be an explosion
of cases as has been witnessed in Monrovia,” he added, referring to the
capital of Liberia.
Whether
Sierra Leone’s lockdown will constitute an effective response is open
to question. Despite the mobilization, the volunteers hardly appeared to
be thick on the ground. In some neighborhoods, residents said they were
yet to see any of the green-vested young men and women who had
volunteered.
In
other neighborhoods, the volunteers — many of them students, all
working for no pay — complained that there was no response to their
knocks at most houses. If they arrived without supplies like soap or
chlorine, residents were not interested in speaking with them, the
volunteers said.
Where
there was a response, it was often followed by cursory admonitions to
residents to wash their hands, report on neighbors suspected of illness
and wear long-sleeve shirts at the market.
At
one house, several volunteers talked loudly at once about hand washing,
leaving the residents visibly dazed. At another, they were amazed to
discover residents who were supposed to be under quarantine because of
their suspected exposure to Ebola, but were actually unguarded and free
to roam about. At still another, one gave out questionable information
about the Ebola virus — seeming to contradict some basic precautions.
Well
into the morning, the house-to-house visits had yet to begin in Kroo
Bay, a densely populated neighborhood of iron-roof shanties where
roughly 14,000 people live, despite officials saying they would start at
dawn. The police cruised into Kroo Bay on a pickup truck, yelling at
residents to go indoors and warning of imprisonment. People simply
stared at the officers and continued lingering as the police drove off.
“The
policeman is doing his thing, and I am doing my thing,” said Kerfala
Koroma, 22, a building contractor. “We can’t even afford something to
eat on a normal day. How can we get something now?”
Sheri Fink contributed reporting from New York, and Somini Sengupta from the United Nations.
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