Open letter to President Ernest Koroma: The Ebola response in Sierra Leone

National response and control of the Ebola Virus Disease (EVD) 2014

From: Mohamed C. Bah

Date: 8/30/2014

Dear Mr. President,

This letter is in reference to the mid May, 2014 Ebola outbreak in Sierra Leone. As you are aware, I have, including, millions of citizens around the world solemnly pledged our unconditional support to your government’s effort in fighting this deadly Ebola virus. Many citizens have offered prayers, while others have contributed financially, donated resources and worked tirelessly to mitigate the intolerable loss of lives of more than 422 victims as of August 30, 2014 – to this nefarious disease.

We are, nonetheless, grateful to you and everyone in your administration who is relentlessly “soldering” on to such unprecedented challenges our nation has ever seen. As reported by the World Health Organization (WHO) recently, the aggregate case load of the Ebola Virus Disease (EVD) could exceed 20,000 over the course of this health emergency in the affected regions. This is ominous and we seem to have a long road ahead of us.

It is therefore appropriate for any patriotic citizen to be honest and forthright with you in sharing their resourceful ideas and insightful perspectives in tackling this tragic situation that could take an escalating level of infection with an unimaginable death toll of Ebola victims. In a culture where people around you may be hypnotized to telling you mostly what you want to hear and not what you need to know; it is morally and nationally expedient for me bound by a patriotic instinct to unequivocally and truthfully give you a realistic assessment of your government’s response to this emergency health situation.

While I believe you deeply share a genuine compassion to the unbearable plight of our people, many of us are becoming increasingly concern about your wait and see approach including the consistent slow and inadequate response to the Ebola pandemic over the past several months. Your government seems to believe that this crisis will go away and that there is little you can do without international intervention. Such perception will slow your response, weaken your ability to adopt the “take charge” approach and subsequently cost our nation more loss of human lives.

Mr. President, your government is not aggressively being proactive, to a larger dimension, in making the significant progress necessary to pursue the two main strategic objectives of prevention and control of the transmission of the Ebola virus across the nation. Many Sierra Leoneans in the medical community including donor partners and the International community have not seen a comprehensive Ebola Virus Disease outbreak response plan and the 6 to 9 months contingency plan to stop the virus from spreading in highly affected areas.

It is your constitutional and moral duty to develop a rapid response plan through the Ministry of Health and Sanitation with the support of the Ebola Task Force that will save more lives and control a disease that has created a psychological mayhem and unwanted fears to the imagination of our innocent citizens. Even though the cure is not yet available, but the disease itself is preventable and controllable as we know of its history in Congo, Uganda and Sudan over the past 40 years. It is doable and we can conquer this disease in one to two months time frame.

Mr. President, while I understand the enormous pressure you are facing and the difficulties it entails to governing a nation where people are apprehensive to strict regulations and laws, we cannot wait for the international community to lead the effort to fight against the deadliest disease in human history. You have a unique opportunity to lead our nation and you must show pro-active leadership NOW. I happen to share a different view about transporting blame to the international community for the inadequate response of the Ebola containment.

Indeed, you have an obligation to protect our citizens and the World Health Organization (WHO) and other partners can only play but a vital supportive role. We are affected by the plague of Ebola not them. It is our people that are dying from the wrath of this deadly virus not them. Only we (Sierra Leoneans)can come out of the wilderness of the Ebola crisis with some additional assistance from International partners. The Democratic Republic of Congo (DRC) and Uganda reminded us that we can do it and we must charter the way forward.

While reviewing the cost analyses of Ebola Response Road Map from the World Health Organization (WHO) on August 28, 2014 (page 22-27), I realized that if we show due diligence with a result oriented attitude about waging a defensive response against Ebola, we can develop an internal budget to pay for the cost of the intervention package, treatment centers and even the purchase of medical equipments including beds. This is both practical and something we can do without any financial struggles.

For example, according to the World Health Organization’s estimate, for a 50-bed treatment facility including an initial set up cost, it will run around $386,000 and monthly cost will be around $881,000.And for total cost within six months, it will be about $5,672.00. Do we not have that kind of money to cover such emergency expenses relatively in all the 12 districts in Sierra Leone? Are we unable to pay for such costs that are affordable and financially feasible? Or do we just prefer donors to do it? May be, Mr. President, no one told you about the ability of our government to fund these projects without international support.

Mr. President, you have already addressed my next suggestion about restructuring the Ministry of Health and Sanitation to manage and coordinate the Ebola crisis. Initially, Miatta Kargbo was performing her duties as expected from providing the door-to-door sensitization, the training of an additional 150 Ebola volunteers, coordinating the enforcement of the public health ordinance of 1960 with the Sierra Leone Police (SLP) and spear heading the effort to take on the Ebola virus with a ground invasion of preparation and rapid response strategy of containment and prevention.

Unfortunately, she apparently lost focus on the Ebola battlefield and could not handle her responsibilities well. A lot could have been done and perhaps we could have save more lives with a consistent response strategy of prevention, intervention and control in the highly affected areas like Kailahun and Kenema district. Was politics a hindrance to her competency or was it merely a performance problem? It is always wise to appoint people that have the academic background and work experiences related to their job functions in the event that such expertise are needed in contingency moments.

While I applaud your good decision in appointing a medical doctor as the new Minister of Health and Sanitation in the person of Dr. Abubakar Fofanah, I still want to emphasis that we can locally finance most of our Ebola programs and prove to our International donor partners that we are determined and ready to control the transmission rate and robustly protect the health of our people. The newly appointed Minister of Health and Sanitation should be on the phone calling manufacturers of medical equipments/devices in the USA and Europe about the procurement of Personal Protective Equipment (PPE) and other medical supplies and not waiting for donations from Red Cross, Britain and China.

He should not be hold up in consultative meetings after meetings as he takes up these important responsibilities – rather he should be working with the Ministry of Finance to come up with an Ebola emergency response budget to pay for these critical programs that are needed across the country. The first challenge he must overcome is to provide the health care workers with basic medical supplies of latex gloves, gowns, goggles and hospital beds without depending solely on outside support and Non-governmental Organizations (NGO’S). Also, he must design an attractive payment package for doctors, nurses, the burial team and janitors to incentivize them to continue the fight against this deadly disease.

Mr. President, let me make a cost reference again to the Ebola Road Map response authored by the World Health Organization (WHO). My goal is to point out that we have the financial resources to fund the Ebola effort if only we change our thinking strategy and intervention approach. And if only we are serious and determine to address this health crisis. I want to directly quote the cost analysis report of World Health Organization: “The estimated cost for referral/isolation centers are based on an average center that can manage 80 people per month, which include an initial set up cost of $112,500 and monthly running cost of $181, 250, resulting in a total cost for six months of $ 1,200,000.”

So, it’s not about how much donations we received from businesses, organizations and other countries, it is clearly about how we manage and prioritize these resources to meet the growing threat of the Ebola virus. This is where, Mr. President you need to judiciously show a clear foresight with the strategic understanding that we can provide both collateral and cost based funding to encourage the donor community that we are leading the way. That we are problem solvers not blame game players, especially in crisis moments when we need to take charge of our deplorable situation.

Thus, we are suffering from a perception problem rather than a resource intervention capabilities. Sierra Leone, like many Sub Saharan countries, Mr. President, has a donor addiction disease that it cannot eradicate. The President of Gambia, Yahya Jammeh has recently demonstrated an impressive transformational leadership not only because of the donation of $500,000.00 to Sierra Leone, but the growing conceptual attitude that Africa can support its own member countries when they are in national emergencies. That we can help each other in a modest way without relying on the old traditional hand outs of the aid dependency culture.

I am, however, not a popular fan of President Jammeh, but I was deeply captivated by his exceptional contributions both financially and psychologically. Our problems need to be solved first by us and additionally getting whatever supports others can provide. We must be the drivers of our own destiny not someone else. We continue to let others dictate our future and we have not addressed the issue of proactive leadership because we rely on “outside” intervention as the solutions to our political, economical and social problems. President Jammeh has broken the glass ceiling that African countries can come together and address new threats collectively.

Furthermore, Mr. President, I think you should remove yourself from the Ebola Task force as the chairman and appoint the Minister of Health and Sanitation to lead that effort. While you are the primary decision maker, you need to allow people with the expertise to provide you the necessary advice to make informed decisions. The Health and Sanitation Chief should also appoint a six man medical team to investigate the reasons why doctors and health care workers are increasingly losing their lives to the Ebola virus as they care for sick Ebola patients.

The composition could be one CDC doctor (per your request), three certified Sierra Leonean doctors and two World Health Organization epidemiologists. Your government must create a renewed trust in the fight against Ebola. The foot soldiers like Doctors and Nurses need assurances that the health system is not compromised because of the lack of adequate training and insufficient protective gears (PPE) to perform their clinical jobs without contracting the Ebola Virus. Indeed, the recommendations of the six member team, Mr. President, should be set up immediately and the investigative report be provided to you as soon as possible.

The overall objectives for such hands-on recommendations are to design new protocol procedures to reduce the rate of infection of doctors and health care workers, to stop the transmission while achieving a full geographic coverage of response, proper Ebola intervention and improvement on preparedness of the medical Ebola team who are the first responders to such public health crisis. More effort should also be applied to finding out why the infection rate is rapidly spreading, identifying and tracing the sources and keeping accurate data records of infected patients for resource allocation and intervention purpose.

Also, it is critical, Mr. President, that you merger your Strategic Unit team and the Ebola Task force into one “command and control” center of operation at State House to evaluate, monitor and to make tactical or strategic decisions where necessary. And one strategic planning you should be embarking on is to stop the transmission in the capital city (Freetown) by mobilizing larger response and relief effort –rapidly detecting and responding to Ebola exposures. And don’t forget that our population is about six million and we do not want to lose many of our citizens needlessly to such preventable disease.

Mr. President, another change in operational strategy you should adopt is to spend more time with the Strategic Unit Team, Ebola Task Force, International experts from WHO and other participating NGO’S. All companies, organizations and individuals wishing to donate against the fight of the EVD should deposit their checks to the new Ebola Contingency Account set up by the Ministry of Finance and Economic Development. You need to re-evaluate what coordinating roles each Ministries, Departments and Agencies in government can perform to bolster the strong response to the Ebola outbreak.

The Ministry of Information and Communications should forward all donor names/organizations to bebroadcast by the Sierra Leone Broadcasting Corporation (SLBC) with an acknowledgement letter from the Office of the President. The donor list should be published and transparently provided to the general public including both the disbursement and expense analysis. By doing so, Mr. President, you create accountability standards that are fundamental to the principles of good governance and one that will develop trust and confidence in the ability of government to operate effectively.

Another grave concern by many citizens is the lack of food program to support quarantined victims in Kenema and Kailahun districts – the epic centers of this deadly disease. Exposure to the Ebola Virus Disease (EVD) is not a crime and quarantined victims should not go to bed hungry while battling the psychological trauma associated with such epidemic disease. The Ministry of Health and Sanitation with the Ebola task force should develop nutritional and food programs to support quarantined victims. It is morally wrong to ignore the hardship of defenseless citizens, who to no fault of their own have become victims of circumstances.

It is inhumane to abandon quarantined victims without providing them the care and medical attention that they deserve as citizens. The Minister of Health and Sanitation should immediately address this problem as he works to repair the credibility issues that his Ministry has suffered recently. Other related Ministries should also plan on how to prepare for acute food security, water and sanitation and hygiene support, secondary health care and education as well as the long term recovery effort that will be needed. There should also be a plan to address the complex social consequences of this emergency, such as the increasing number of children who have been orphaned.

Mr. President, let me remind you that Ebola was first identified on August 26, 1976 in Yambuku, a small village in the Democratic Republic of Congo (DRC). It reoccurred again in 1995, 2003, and 2007 and recently in August 21, 2014 in Congo. The next major outbreak occurred in Uganda in 2000 where more than 224 people lost their lives. Another Ebola exposure happened again in Uganda on November 30, 2007 in the Bundibugyo District in Western Uganda. Infact, Sudan had an outbreak of Ebola case in 1979 as well.

Mr. President, these previously affected countries were able to contain the virus by using proper full-body personal protective equipments and disinfectants, suspecting and diagnosing the disease early and using standard precaution, isolation and quarantine measures to people exposed to the virus, sterilizing equipments and wearing protective clothing including mask, gloves, gowns and goggles. What your government can do: is to make these field resources like medical supplies and equipments available to them. That is the basic solution to this ordeal. The wheel has already been invented – we don’t have to think harder to find out the solutions to the problems.

While I am willing to share my fighting solutions to you about the best way to defeat the Ebola virus through your Presidential leadership, I want to mention to you the countless citizens who have died from this disease and national heroes like: Dr. Sheik Humarr Khan, the leading expert in Hemorrhagic fever and the chief Ebola doctor in Sierra Leone. Dr. Khan’s life on this earth reveals us that we can be a blessing to others by doing extraordinary things. He left an indelible message of human compassion, a unique character of self-sacrifice and why it was necessary to serve humanity even though he lost the battle against the Ebola disease.

There are other Sierra Leoneans worth remembering like Mbalu Fonnie, the nursing supervisor at the Laser Fever ward at the Kenema government hospital who worked there for over 30 years, Alex Moigboi, a registered nurse at Keneman Hospital, Alice Kovoma, a nurse with 6 years of experience at Kenema Hospital, Mohamed Fullah, a lab technician in Kenema hospital, Doctor Modupeh Cole at Connaught Hospital and recently Dr. Sahr Rogers at Kenema hospital including the 422 (as of August 30, 2014) victims that perished to this disease. But they did not die in vain because they epitomized the best that Sierra Leone can be. We are better today as a nation because of their blood and sacrifice.

Mr. President, the act of courage and selflessness that these citizens have exemplified should inspire you to lead not from behind or succumb to the illusion that the World Health Organization will do everything for Sierra Leone. The voices of these souls and the numerous ones that will fall victim to Ebola are looking up to you to change the situation and stop the senseless Ebola carnage in Sierra Leone. God will be with you when you think about the people of Sierra Leone every step of the way. We have confidence that you will stand up to the challenge but you must act NOW.

The only way forward is to change the thinking strategy, regroup the team, appropriate the necessary resources and follow the basic rules of survival. Congo, Uganda and Sudan have overcome this problem and Sierra Leone will do the same. Ebola will be history and the state of normalcy will emerge again. We will defeat Ebola in the end.   But Ebola will surely define your Presidency. You have a choice today to seize the moment and let posterity judge you kindly.

May God guide you in this perilous time; give you the strength and wisdom to lead. May God save our people from this costly epidemic. May God give you the steady hands to continue to move Sierra Leone into an Ebola free nation, where our people live together in peace and harmony.

And may God continue to bless our great Republic.

Warmest Regards,

Mohamed Chernor Bah

Former National Democratic Alliance (NDA) Presidential aspirant

The author can be reached @ the following email address – mcbah60@gmail.com

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