One year on and we are there again.
Kaffu Bullom, a Chiefdom of Port Loko district.
A wonderful Chiefdom on the peninsular, surrounded by the sea, home to the airport and numerous ferries and boat crossings to Freetown. If it were in England I would describe it as wooded but here we say it is covered in bush – high palm trees and huge cotton trees that monopolise the sky and the land.
The majority of the Chiefdom is bush but there are a few very populated areas around the airport and the ferry points and now, sneaking in to those crowded areas, Ebola.
More than one year after the first case was confirmed in Sierra Leone it feels like we are back to the beginning.
15th May 2015. A 60 year old woman in Kaffu Bullum received a telephone call from her daughter in Kambia – a district in the north of the country, 2 hours away. Her daughter said she was sick. She didn’t want to call for an ambulance but instead she wanted to return home for her mother to look after her.
Her mother obliged, travelling in a taxi to Kambia to collect her daughter and her 3 year old granddaughter. They travelled together by taxi all the way to Kaffu Bullum.
This marked the opening of a new frontier in the outbreak.
The daughter died not long after she returned home. When the Paramount Chief of Kaffu Bullom found out about the death in his community, he called the Ebola response teams to do a swab on the dead body.
The body was positive for Ebola.
By this time so many people in the house had touched, stroked, washed and cared for that lady – including a woman eight months pregnant. Soon after the first death this pregnant lady started experience labour pains and started to give birth in the house.
She bled to death during the labour. She too was positive for Ebola. Very few pregnant women ever survive. They tend to bleed out. Somehow the baby managed to survive and the other women in the house started to care for the young baby.
Hold the baby, feed the baby, wash the baby, as any normal person would.
By this time the whole compound was quarantined. The idea is to quarantine the houses to isolate the families and don’t allow Ebola to spread. Stop the spread, that’s always the aim.
The family took exception to this. They did not believe that Ebola is real and they do not believe that it is Ebola that is killing them but witchcraft – witchcraft from the white man. The belief is that the spell or the curse is in people’s eyes – because every time they examine someone they say they have “Ebola” and then that person dies.
As this is one of the last mini outbreaks in the country everyone is watching! Liberia is Ebola Free, Guinea is secretive but Sierra Leone feels like it has failed slightly. So now everyone from Freetown rushes to Kaffu Bullom to come and see. People go to the quarantined house to try and talk to the people. White people, black people, Asian people, you name it – everyone goes there – and the people are even more afraid, even more convinced of the witchcraft coming to get them.
Nine days after the first death and six days after the woman died in labour the young new born baby starts to show signs of Ebola. The newborn baby that everyone in the house has held and washed and loved.
Very few babies survive Ebola, in fact I don’t think anyone under 5 years old has survived.
The feeling is that we can’t let the baby die in the house as that will expose even more people. We must get the baby out. However, the family feel differently. They want to keep the family in and they do not want that baby to be taken away. Especially the grandmother – the same woman that originally received a phonecall from her sick daughter in Kambia to come and collect her.
The baby dies in the house.
Two days later and now the grandmother looks sick. She has red eyes and is hiccupping, a sure sign of Ebola. She does not want to come to the ETC (Ebola treatment centre) as she does not want to leave her other granddaughter, the four-year-old daughter of the original patient from Kambia. The only way we can get her to come out is if we let this girl come with the grandmother – so we do. We take them both. Within 26 hours in the ETC both are confirmed Ebola positive. A few hours later another sister of the woman who died in labour arrives at the ETC and she, too, is positive.
On the 31st May 2015 the sister dies of Ebola in the confirmed ward at the Lunsar IMC ETC and then, on the 1st Of June 2015 at 06:48, the four year old granddaughter dies of Ebola at the Lunsar IMC ETC.
The grandmother, age 60, is still alive – in fact by now she is being given ZMapp. After a whole year of battling Ebola finally, as the cases start to drop, the authorities have got ZMapp ready – and they are practically begging for positive cases to test it out.
Today I took a video of the Grandmother talking to camera and even running around to prove to her family that she is not dead and we did not kill her!
We had to have her explain on the camera that the reason her granddaughter died was Ebola and not, as they believe, because a chlorine tap burst and chlorine flooded into the ETC and suffocated the young girl!
She had to tell them that we are not killing her and we are not eating the bodies of those that die here.
On the 1st June 2015 another 4-year-old girl from the same family tested positive for Ebola at 14:56. We were with the father this morning as part of a multidisciplinary team of people: one from the WHO, one psychosocial person (from my team) and one medical person. As the case numbers fall, and there is less work for all of these organisations to do, we find we have to try to stop too many NGOs and too many expats just turning up at these houses.
It sometimes seems as though they just come to look at these people in distress. Endless queues of people branded in different T-shirts with different logos, a parade of aid workers, each believing that they know best and they can save Africa. Each thinking that they have the answer to everything. But each failing to recognise that fundamentally the problem is still that people do not believe that Ebola exists.
How do you reason with someone when you are speaking a different language?
Two days later 5 more people have been confirmed with Ebola. Slowly we have been dragging them out of the house. Some we have managed to slowly coax out. Some others are released to us by the adults in the home. They let us take the ones who are sickest and look like they have the least chance of surviving. By the time we can reach them there is often little that we can do. We know that still others in the house are sick, but they say that they are fine and we can’t have them.
Each time they release one of these very sick people into our care – beyond the point at which we can help – and they die, it serves only to confirm their suspicions of us.
Rumours are that we are drawing their blood and keeping it in huge containers onsite – no idea what we are supposed to do with the blood except use it in Europe somehow.
On Thursday 4th June another lady in the same house died. When they tested her body she was positive for Ebola.
Of the remaining 19 people in that house all 19 touched, washed, dressed, ate with and cared for that woman when she was alive and when she was dead.
Since then we have been trying to convince the adults to let the kids come to a safe Observational Care Unit where they will receive immediate help and support if anything happens.
The man of the house says yes and then no, yes and then no. Yes I will think about it – then we organise for things to happen – and then he changes his mind and the answer is no.
Saturday the 6th June in the morning. He agrees to let 10 children come to the OICC to be looked after by the first survivor we have from that house.
Ebola is so capricious that this 60 year old woman – the one who went to collect the original sick woman, bringing Ebola into their home – survives while the young children perish.
She is due to be released today. We agreed with the family that she would stay with the children in the OICC so they could be observed and cared for if they became sick. The family seemed happy with this, so we have put everything into place.
Then we hear from the man of the house again. He’s changed his mind. The children will stay with him.