People are checked for their temperature and other possible symptoms of Ebola at a checkpoint on a road just outside the town of Kenema, Sierra Leone. Guinea, Liberia and Sierra Leone have been struggling since March to stop what has become the largest Ebola outbreak ever recorded.Tommy Trenchard/The New York Times
There's a frantic feel palpable throughout downtown Freetown these days. A frenetic Ebola fanaticism has taken over, especially now that there are more than 40 confirmed cases within city limits. All talk is of Ebola, from street corner to office block, from cookery shops to bank queues.
Knowing your body temperature has become a fact of life in Freetown, where I've been living and working for the past five years since coming over from Canada.
I've had my temperature taken more times over these past three weeks than at any other time in my life. At almost every roadblock checkpoint, drivers and passengers are required to wash their hands and get their temperature taken before proceeding. I queried a guard recently at a UNICEF compound about the accuracy of the "point and click" laser temperature-taker that gets a reading from your forehead. "Don't worry," he said. "We only tell you to go to the hospital if the 'gun' makes a beeping noise."
Fear of hospitals
The Ebola outbreak in West Africa has taken 1,552 lives out of 3,069 known cases in four countries and "continues to accelerate", the World Health Organization (WHO) said on Thursday. More than 20,000 people could become affected, WHO said.
Like many Sierra Leoneans, I'm afraid of going to the hospitals here. Despite the attention of international donors and government programs, the country's health care hasn't developed much since the end of the civil war in 2002. And now, the fear of Ebola is stopping people from seeking treatment for other ailments, wreaking even greater havoc on a country already in the midst of a public-health disaster.
Mary Alberta Camara is among the many young people who are unemployed after finishing her secondary-school diploma. She's 25 years old and lives in a corrugated shelter in downtown Freetown. She recently had malaria but was afraid to go to the hospital, preferring to treat herself at home with over-the-counter anti-malaria medication.
"What if they mistake malaria for Ebola and send me to Kenema?," she said. "What if they test me for Ebola and I have it? What if someone else at the hospital has Ebola and I might catch it from them?"
These are all reasonable fears given the current hysteria over health care in the country. So people stay away from clinics and hospitals: pregnant women, ailing elderly, parents with small children, diabetics and even Ebola patients.
Connaught Hospital, in the central and oldest part of Freetown, is not known for its hygiene or level of health care. But it's usually full of nurses and patients, one of the busiest hospitals because of its downtown location and proximity to the morgue and nursing college.
This past weekend, when a high-level delegation from the United Nations and the WHO visited Connaught Hospital, only the pediatric ward housed any patients. The broken-down beds in other wards were eerily empty.
As the international officials crowded into the front entrance, nurses in starched uniforms clustered along the mouldy, poster-plastered walls. They explained they don't have medical equipment, training or personal protective equipment and many of them are afraid to come to work for fear of contracting the Ebola virus.
For the nurses, death and disease are part of their jobs. But their jobs and circumstances have changed dramatically and now include the monster of the Ebola virus. The WHO officials appeared stoic but one could tell they were cringing inside as nurses related horror stories from the wards. The nurses were visibly afraid and spoke quickly and nervously.
Almost straight across the country from Freetown, close to the eastern border of Sierra Leone and close to Liberia, lie the Kenema and Kailahun districts. These are the quarantined areas and the epicentres of the Ebola outbreak in Sierra Leone. For now, Kenema and Kailahun house the only medical facilities dedicated to fighting Ebola.
Others are planned but this is the region of the country where Ebola is most prevalent.
In Kailahun, the headquarter town in the district, the Ebola treatment centre of Médecins sans frontières (Doctors Without Borders) was literally carved out of the jungle. It sits atop a small rise about five kilometres outside the small town and is surrounded by dense, green, rolling countryside.
To get to the centre, you have to travel along a muddy, rutted road that often disappears under the flooding waters of heavy rains. The gleaming white tents and blue tarpaulins of the centre pop out of the green vegetation. It's a long drive from Freetown and the final stretch of road into Kailahun is a dangerous, muddy trek over bumpy roads and through small streams.
The MSF compound is an intricate network of fenced paths leading to and from a series of designated tents. The gravel courtyard that separates patients from doctors and nurses is as immaculate as one can expect in a jungle. The atmosphere is cautious and meticulously organized.
It's a far cry from the environment at the Kenema Government Hospital, four hours to the west. The Kenema hospital is where more than 30 health-care workers have become infected with Ebola and died. Contrast that to only one confirmed case of Ebola among staff at the Kailahun treatment centre. The British volunteer nurse, William Pooley, who was recently evacuated to London, was based in the Kenema hospital.
Frenzy of daily life
On Monday, a bank employee of the Sierra Leone Commercial Bank became the 41st confirmed case of Ebola in Freetown. She'd attended her mother's funeral several days before and probably contracted the disease during the burial rites. Apparently, the family did not suspect Ebola and went ahead with the traditional rites of washing and anointing.
Word quickly spread around the city and ramped up the paranoia. The bank was closed and there was a rush of rumours about other banks withholding money, running out of money and closing for good.
The relatively regal facade of the Commercial Bank sits opposite the colonial law courts building in downtown Freetown. Both buildings are majestic in their own way. Steel-barred gates now block the bank's entrance. Siaka Stevens Street, normally bustling with beggars, street sellers and bank customers, is strangely clear. Even the disabled guy, Alimamy, who sells pens from his wooden cart, is not at his regular post.
Two weeks ago, the Association of Bankers decided to reduce banking hours from seven hours a day to four. This, they said, was "to reduce the congestion in banking halls and prevent the transmission of the disease." According to the public notice put out by the bankers, all customers are now required to wash their hands in chlorine and water, have their temperature taken and wait outside before entering the banks.
These new entry procedures and reduced hours have severely disturbed the typical organized chaos of most banking transactions.
I tried to get into the Ecobank on Tuesday. Outside, where overhead awnings have been temporarily installed to ward off the seasonal rains, waiting bank customers were furious. The street hawker's din was overwhelmed by angry shouting.
More than 75 people were crowded together, held momentarily in place by an armed, fatigue-wearing guard of the Criminal Investigation Division of the Sierra Leone Police. And in Freetown, where there's shouting and jostling, a crowd of onlookers quickly forms.
The arrival of a large, blue police vehicle bristling with machine guns soon quieted the surging crowd. The diminutive bank official, wearing plastic gloves and firmly planted in the entryway, looked relieved.
There was an occasional outburst of protest as one of Sierra Leone's so-called "big men" – a member of the social and political elite – strolled to the bank's doors and entered. Without washing his hands.
For the next three hours, the crowd remained relatively calm and we sweated together under the midday heat. My temperature as I entered the bank was 36.4 degrees and after failing to retrieve my money, ("dollars don don," which means the bank had no U.S. currency in their tills) my temperature was 33.5 degrees. I'm not sure how I managed to lose body heat in these conditions, but the official forehead-laser-reading woman looked nonplussed.
The fear of Ebola has spread around the globe. It has been the top story on CNN, Fox, Sky. And thanks, in part, to this media frenzy, many countries now sport travel advisories suggesting, "essential travel only" to the countries affected.
Airlines, including regional flights and many international ones have been cancelled in or out of Sierra Leone, Guinea and Liberia. On Tuesday, the UN and WHO issued a strong statement urging airlines to continue flying into and over this region. They cautioned against flight restrictions, saying such limitations were preventing the transport of critically needed health workers and supplies, as well as contributing to economic and diplomatic isolation of the region."
Special to the Globe and Mail
With a report from Reuters