From Ambassador John Hoover December 30, 2014 I’ve been in Sierra Leone almost three months now, so I’m still learning as I go. Needless to say, most of my time and energy have been spent on Ebola – meeting and coordinating with the Government of Sierra Leone, UN agencies, and other international partners, and trying to make sure that the U.S. Government’s efforts are fully in sync with the broader effort to turn the tide against the epidemic. Ebola continues to be an unfolding humanitarian crisis and a human tragedy. That’s sad and sobering. But I’m also cautiously optimistic that 2015 will be a much better year, a year in which we first start to slow the growth in the epidemic, and then push down the number of new cases to our ultimate goal: zero. It will take many more months of hard work and focus, but I sincerely believe it is achievable in 2015. I’m amazed and impressed by the collective efforts of so many different people and groups coming together to fight Ebola in Sierra Leone, and I’ve very proud of the work that the U.S. Government team is doing here to support that fight. Most of all, I’m blown away by the courage and resilience of everyday Sierra Leoneans, and especially by those who are on the front lines – the doctors, nurses, burial teams, surveillance teams, and contact tracers. They’re putting their lives on the line every day to make us safer. I’ve recently had opportunities to get away from Freetown and see how things are going upcountry, in the districts. Visits to Kono, Bo, Kambia, Port Loko, and parts of Western drove home an important truth: the war against Ebola will be won or lost in the districts. While the National Ebola Response Center in Freetown is an absolutely essential element in waging the war at the national level, it is at the district level, under district leadership, that the painstaking effort of breaking transmission and eradicating Ebola must be made. Outbreaks are by definition local; stopping them therefore requires local knowledge and local leadership. And it requires the national government and international partners like UN agencies and the United States to quickly get the right resources out to the districts so that local leaders can get the job done. How is it going? The picture is mixed. While much of the attention now is rightly focused on the Western Area Surge around Freetown, there are also very worrisome new outbreaks of Ebola occurring in several districts, including Kono and Kambia, which I visited a week ago with UK counterparts. In both places, District Ebola Response Centers, or DERCs, have been established with invaluable support from the UK. They are doing critically important work in getting the sick out of their communities and into isolation units and in collecting and burying corpses in a dignified manner within 24 hours. Contact tracing, which will become the most critical aspect of the response as the number of cases starts to come down, is weak, and that worries us very much. And in most cases, the DERCs still lack the basic tools – like vehicles, motorcycles, generators, and good cell phone coverage. In both Kono and Kambia, there are also still an insufficient number of safe isolation and treatment beds. In contrast, in Port Loko, which has been experiencing a surge in new cases for many weeks now, the response has had more time to gel. The DERC is a well-oiled machine and is efficiently managing cases that are phoned in from the rest of the district. Port Loko just got a lab for rapid turnaround of test results, and it now has ample, good quality isolation and treatment facilities. A final observation: I continue to scratch my head about new outbreaks of Ebola occurring in the places I visited and elsewhere. Why, seven months into the epidemic, are there new chains of transmission given that we know how to prevent Ebola’s spread? The answer for many is that “social mobilization” requires more work. Social mobilization is a catchphrase for community participation and leadership. I would boil it down to even simpler terms: it means taking personal responsibility and changing behavior. It doesn’t matter how much money and time we invest in defeating Ebola if at the end of the day ordinary Sierra Leoneans don’t take responsibility, own the problem, and alter their behavior. If people continue to defy all of the messaging on the airwaves and in the newspapers about not touching sick or dead people, if they continue to cling to traditional burial practices against all common sense, then we will not defeat Ebola. Personal responsibility translating into behavior change: This is the really important part of the effort that’s not fully in place. Once it is, I believe Ebola will be over quickly in Sierra Leone. We’re not there yet, but I’m encouraged that we’re making progress.
Posted on: Tue, 30 Dec 2014 12:26:14 +0000
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