Bumpy Road to Zero: Tackling Ebola in
Sierra Leone
John William Raine OBE
Presentation to Geographical Association
7th April 2016
Overview…
1.
2.
3.
4.
5.
6.
7.
8.
What is it?
Where did it happen?
How was it tackled?
Who took part?
Did it work?
Bring it all together – SellaKafta case study
Links to national curriculum
Conclusion
What?
The Ebola virus
First discovered in 1976 near the
Ebola River in the Democratic
Republic of the Congo.
The Ebola virus
Signs and symptoms
Where?
West Africa
Sierra Leone
Human Development Report 2015
The start of the journey
Cases of Ebola 2014
The start of the bumpy road
Humanitarian crisis or Public Health Emergency?
•
•
•
•
•
•
•
Control
Education – Social Mobilisation
Infection Prevention Control
Immunisation
Survivor Support
Prevent
National Ebola Response centre
District Ebola Response centres
MOHS V NERC
JIATF (MOD/DfID)
Funding
Actors
Logistics
Locate
•
•
•
•
•
•
•
Treat
Case Management
Isolation facilities
Treatment facilities
Interim Observation Centres
Laboratories
Ambulances
Psychosocial Support
Contain
•
•
•
•
•
•
117 – Emergency Line
Active Case Search
Community Event Based
surveillance
Social Mobilisation
Byelaws
Safe Dignified Burials
• swabbing
Quarantine
Contact Tracing
Security
Gene Sequencing
Livelihoods Support
Actors: international to local
Level 1
Level 2
Level 3
Level 4
Level 5
•International Donors
•DfID, USAid, Private Trusts
•UN Agencies
•WHO, WFP, UNICEF, World Bank, IOM, (IFRC)
•International NGOs
•Save the children, GOAL, ACF, MSF, World Vision, Concern, CAFOD
•Consortia
•SMAC, SMART, ERC
•Local NGOs
•Caritas Makeni, WESOFOD, Focus 100, Church organizations
Actors: International to local
Fuel paid for via Caritas,
funded by CAFOD, funded by
World Vision funded by DfID
Vehicle donated
by UNICEF using
DfID funding
Driver paid by MoHS
Risk pay paid for by World
Bank or DfID
Vehicle serviced by local
mechanics paid for by
World Vision
Food for driver
provided by
GOAL as part of
ERC funded by
DfID
DERC – The reality
1. Life Support – FOB and MRE
2. Day 1 - chaos
a. No systems or processes
b. Too few staff – not paid
c. Fleet beyond repair
d. No command and control
e. No communications
f. No computers/Wi-Fi
g. No strategy
3. RSLAF – Pillar Leads
4. Rapid procurement of vehicles
5. Rapid scale up of staffing
6. Emergency funding for salaries
7. Massive logistics operation
8. Commence build ETCs/CCCs
Port Loko DERC 01/11/2014
1. % live and dead body alerts resolved < 24hrs
Alerts
33
43
Alerts Processed
Genuine Alerts
Conversion Rate
33
30 (3F)
91%
43
42 (1F)
97%
2. % persons visited meeting case definition
Live Alerts
13
Visits
15
13
15
No’ meeting CD
Pending
Conversion Rate
10 (3F)
0
76%
14 (1F)
0
93%
3. % persons meeting case definition transferred to holding centre
Total No’
10
14
Transferred
Pending
Conversion Rate
10
0
100%
14
0
100%
5. % corpses buried < 24 hrs from notification
DB Alerts
No. Buried
Pending
Conversion Rate
20
20
0
100%
28
28
0
100%
4. % persons with +EVD blood test transferred to treatment centre
No of patients
Transferred
2
2
6
6
Pending
Conversion Rate
0
100%
0
100%
The Bumpy Road
Epi Curve by date of symptom onset
16 Feb, 2015
Confirmed
Probable
Suspect
ROTIFUNK (KB)
17- M
PLK: 500077
DATE ONSET: 31 Jan ‘15
DATE REPORT: 2 Feb ’15
NOTES:
LUNGI (KB)
29 years- M
PLK: 500093
DATE ONSET: unknown
DATE REPORT: 3 Feb ’15
NOTES:
30- M
PLK: 50084
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES:
1 mo. - M
PLK: 11502
STATUS: Dead – 5 Jan ‘15
DATE ONSET: 5 Jan ‘15
LAB RESULT: Positive
NOTES:
Relative
Survivor?
2-M
PLK: 500081
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES:
1y 8mo. - F
PLK: 500080
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES
Kaffu Bullom
y
?-F
PLK: Unknown
DATE ONSET:
STAUS: Dead ~ 21 Jan ‘15 at LGH
DATE REPORT: Unknown
LAB RESULT: Not tested
NOTES: Secret Burial ? U
25 years- F
PLK: 500083
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ‘15
NOTES: Wet patient and
admitted with 2 child
PLK: 500329
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES:
30 - M
PLK: 50077
DATE ONSET: unknown
DATE REPORT: 2 Feb ’15
NOTES:
1y 8mo. PLK: 500082
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ‘15
NOTES:
Son
I
PLK: 500330
DATE ONSET: 31 Jan ‘15
DATE REPORT: 2 Feb ’15
NOTES:
F
-F
PLK: 500100
DATE ONSET: unknown
DATE REPORT: 3 Feb ’15
NOTES:
75 yearsPLK: 500076
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES:
25- F
PLK: 500328
DATE ONSET: 2 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES:
30 years- F
PLK: 500087
DATE ONSET: unknown
DATE REPORT: 3 Feb ’15
NOTES:
27 years- M
PLK: 500078
DATE ONSET: 1 Feb ‘15
DATE REPORT: 2 Feb ’15
NOTES:
y
3-F
PLK: 500332
DATE ONSET: 31 Jan
‘15
DATE REPORT: 2 Feb
’15
NOTES: CIF shows
Fever Yes – 36.4
23 - F
PLK: 500334
DATE ONSET: 30 Jan ‘15
DATE REPORT: 2 Feb ‘15
NOTES: Visited Lungi
General Hospital 1 Feb
‘15 – IV fluids and
discharged.
Alert pending
lab results
34 - M
PLK: 500352
DATE ONSET:
Unknown
DATE REPORT: 2 Feb
‘15
NOTES:
Positive case
Not tested
Draft as of 3 Feb 2015 – Several CIFs yet to be analyzed
Bringing it all together
National Ebola Response Centre (NERC)
KAMBIA DERC - EVENT STORYBOARD
Date of Update: 09 Sept 15
CP
Village – Sella-Kafta
Chiefdom – Tonko Limba
District – Kambia 005 – Update 11
Magburaka
Kambia
CP
Massessebe
Village
H/R QHH
VQF
CP
ICP
CP
1. Households in quarantine: 227 (amended after discussion IOT
keep Hse 1 on the list)
2. Individuals in quarantine: (Total 847)
a. 843 in Sella Kafta
i. 824 in Sella Kafta (including 36 HR contacts).
ii. 6 preg woman and 6 HR children in OICC.
iii. 1 in Kambia Gov Hosp. EVD Neg and being
monitored.
iv. 5 EVD+ and 1 contact in the ETC.
b. 1 in Kalamba,
c. 2 in Mile 14.
d. 1 in Kassirie Mathatoi
3. Missed Contact: Kadiatu Kamara (HR Contact)
Local responses
Question 1 – Salone has 1 new case of Ebola in Tonkolili. Do U
believe dis is a TRUE case or a FAKE case for other reasons?
Local responses
Question 2 – Please tell us the reason U think the case is Fake.
REPLY 1-Political conspiracy, 2-Financial conspiracy, 3-Other
reason.
Financial
Political
14%
49%
37%
Other
Conclusion
1. Ebola is a potentially fatal VHF – first appeared in West Africa December 2013
2. Unrecognised at first – allowed to secure a foothold in Sierra Leone, Guinea, Liberia
3. Spread through Sierra Leone facilitated by a mobile population, good roads
infrastructure and porous borders
4. Dealt with as a public health emergency – using conventional public health tools
5. Interventions hampered by indigenous customs and practices
6. Response evolved quickly – but the bumpy road to zero proved bumpier than most
imagined
7. Huge international ‘no regrets’ response provided scale with complexity – UK/WHO led
8. Proud to be part of such an immense team effort that saw the region declared free of
Ebola – but further outbreaks will occur
Bumpy Road to Zero: Tackling Ebola in
Sierra Leone
John William Raine OBE
Thank You - Questions
Reported v Expected
National Ebola Response Centre (NERC)
KAMBIA DERC - EVENT STORYBOARD
Date of Update: 09 Sept 15
Village – Sella-Kafta
Chiefdom – Tonko Limba
District – Kambia 005 – Update 11
Headlines:
- ST(8yo) has received an EVD Pos 2nd test.
- Now have 5 x EVD+ individuals within the ETC. They were all HR contacts.
Magburaka
Background: MK is a 50-60 yo female from Sella, Tonka Limba who was
discovered to be EVD+ on the 29 Aug 15. MK is a local businesswoman
(restaurant owner), who is known to have visited the Sumbaya Lumar ca. 13
Aug and attended a burial on the 17 Aug in Bayandi before falling ill on the 20
Aug. Over the following few days her condition deteriorated further before
developing wet symptoms ca. 23 Aug. Treatment was provided by the village
chief’s brother (herbalist) ca. 25 Aug. MK passed away on the 28 Aug when
her death alert was notified and the swab test was subsequently found to be
EVD+ late on 29 Aug.
Update: Soc Mob have continued to reinforce Byelaws, engage with schools
regarding hand washing and other general IPC measures. PSS have visited all
houses with no general complaints from villagers. They showed videos of the
OICC to family at House 6 and the sharing of video messages from their
children will continue this evening. No issues with OICC pregnant women. All
contacts seen less 2 of the 3 old women. A visual assessment completed for
one lady. A survivor is now being trained to contact trace IOT ensure their
temps are taken in future. The isolation facility being placed by the PHU within
Sella-Kafta (for use if required during silent hours) is almost complete, it is
expected to be available for use tomorrow evening. There is continued
engagement with the community through Active Surveillance, today they visited
yeleboya island (via boat) to meet with the ex-husband of Mayalie Turay
(EVD+). He has denied leaving the island. They also met with a boyfriend of
Kaiadtu who is being held under local citizen arrest. We are awaiting feedback
from the visit. A total of 48 mattresses have now been delivered to children who
require them. The livelihood work continues on the 199 farms, the breakdown is
as follows: 65 x Sella (30 WiP, 21 completed and 14 awaiting work), 131 x
Kafta (68 WiP, 35 completed and 28 awaiting work), 1 x Mile 14 – complete. 28
businesses will be paid for their loss of earnings. 4 x 2man (unarmed) RSLAF
patrols continuing today through village.
Recent Developments:. IOM have provided 6 monitors and 1 senior monitor to
assist the RSLAF on 3 x health screening checkpoints with temp testing and
general IPC.
Massessebe
Village
Location
Sella-Kafta
People
HR
Missed Tested Ongoing Died in
in Q contacts contacts EVD+ last EVD+
past 24
24 hrs
hrs
816
28
0
0
0
0
Final release
date from Q
19 Sept 15
S-Kafta Hse 1
0
0
1
0
0
0
19 Sept 15
S-Kafta Hse5&6
8
8
0
0
0
0
28 Sept 15
Kalangba
1
0
0
0
0
0
19 Sept 15
Mile 14
2
0
0
0
0
0
19 Sept 15
Kassirie Mathatoi
1
0
0
0
0
0
19 Sept 15
OICC
6
0
0
0
0
0
19 Sept 15
OICC (HR)
6
6
0
0
0
0
28 Sept 15
Kambia Hospital
1
0
0
0
0
0
19 Sept 15
ETC
6
0
0
1
4
0
N/A
Totals
847
42
1 (HR)
1
4
0
N/A
Next 24 hours: Temp tests, farming, PSS and Soc Mob engagement