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The Ebola threat in Sierra Leone: Initial lessons to be learnt

The Ebola threat in Sierra Leone: Initial lessons to be learnt

In a world of globalization when travelling across the world has become so fast and easy, disease transmission has correspondingly become much more rapid.  A few decades ago, disease transmission took much longer to occur from one place to another – not anymore, especially with the advent of air travel.  Even in less developed countries like Sierra Leone, where travel is predominantly, if not exclusively, by road (vehicular or otherwise), transmitting an infectious disease is almost instant because a vehicle with an infected person can travel from Freetown to Kenema (a little less than 200 miles) within a few hours. This means that those in Kenema previously unexposed to the disease are now no longer safe from infection.  (Photo: Mohamed Kanu, author)

Ebola is an infectious disease that is spread rapidly through direct contact with infected individuals. While many diseases like HIV/AIDS and TB are enduring problems in Sierra Leone, the Ebola epidemic is an emerging one that requires thinking “out of the box”.

It was in March of this year that news of the outbreak of the Ebola virus was first heard in the neighbouring country of Guinea. Many people, especially health professionals were worried that it could be only a matter of time before the threat reached Sierra Leone. Health officials in Sierra Leone paid keen attention to the emerging threat.

The disease was first reported in Sierra Leone after the virus was hosted by a woman returning from the funeral of an Ebola victim from neighboring Guinea.  To date, almost all the confirmed cases are clustered in the Eastern part of the country. As of the date of writing this article the death toll in Sierra Leone is approaching 100. This Ebola epidemic has been classified by the World Health Organization as the largest ever recorded although, thankfully, the impact of the disease in the third country of Liberia has been minimal, at least for now.

Given the mode of transmission of the disease it is obvious why it poses such a threat to a population that is steeped in its cultural traditions of engaging in communal activities, using bare hands to wash bodies of the deceased and taking part in collective religious activities, among others.

The current rampage of the Ebola virus in Sierra Leone teaches us many lessons. I will come back to that shortly. Many of the lessons we will have to learn from this unsavory experience are basic fundamentals in Public Health – the related concepts of surveillance and response.

Public health experts (epidemiologists) will tell you that for a disease to spread there are three basic components –the environment, the host, and the agent. Of course time is an important factor in dealing with the spread of any disease. In many developing countries such as ours, we have not been able to effectively handle all these components. This explains, among other reasons, why we have not been able to shift our focus from the treatment of infectious diseases to that of acute illnesses. Given our circumstances, it makes absolute sense to put greater emphasis on prevention. I am not suggesting that this must be done at the expense of treatment. The biomedical model of disease treatment has been and will always be there, but when resources are low, placing greater emphasis on prevention should be indispensable. This is more so when the illness does not yet have a cure.

The government and people of Sierra Leone have done remarkably well in trying to contain the spread of the disease. This is in spite of numerous challenges (inadequate resources) and the initial sabotage of a few people with potential ulterior motives. The mass mobilization of all sectors of the Sierra Leonean society and those outside of the country and other partners is laudable. One would wish that we had such a robust response in place at all times. This is one lesson we can learn from this outbreak, which is having a response framework that is proactive rather than reactive.

The second lesson is to do the best we can to improve our surveillance systems. Developed countries spend colossal sums of money doing just that. Activities of the various ministries in the public sector and entities in the private sector must be coordinated at all times whether or not there is an outbreak of disease. It is called “systems thinking,” that is when various components of the health system can interface with one another as well as other entities from outside of that system. When systems are effectively coordinated, providing a robust and timely response to any disease threat is less difficult and costly.

As the tragedy of the Ebola virus still unfolds, it is too early to know what the full ramifications of this sad episode will be, but it is important to remember the words of President Earnest Koroma in his recent statement to the nation that “Ebola is real.”

Dr. Mohamed Kanu is an Associate Professor of Public Health at Tennessee State University in the United States of America. His email address is Mkanu@tnstate.edu.

Mohamed Kanu, Ph.D.,
Associate Professor & Director, Master of Public Health Program,Department of Public Health, Health Administration & Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-415, Nashville, TN 37203, USA

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