The impact of the Ebola crisis on Sierra Leone’s health system

More than 3,000 Sierra Leoneans have lost their lives to the Ebola virus which broke out in the country on May 25, last year when the first confirmed Ebola case was reported in Kailahun District in the Eastern Region of Sierra Leone.

The outbreak was at a time when the country’s health officers were unprepared for the Ebola battle. The unpreparedness of government to face such a battle was clearly manifested by the few ambulances allocated to referral hospitals in the ???district headquarters towns???.

Although some districts have gone for months without recording any case of Ebola, new cases are still being recorded within the Western Area in which the capital city is situated, as well as Portloko and Kambia North of the country. These new infections add daily to the existing Ebola case statistics.

The drop in Ebola cases was viewed by many Sierra Leoneans as the end of Ebola in the country. This is evidenced by the much talked about Post Ebola Recovery Plan for Sierra Leone.

As the country gears up for Zero Infection, this article clearly examines how the country has been affected by the Ebola crisis with a particular focus on the human resource component of the health sector, as well as the loss of confidence of the people to go to hospitals for medical care.

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William Sao Lamin, the Programmes Officer of ‘Health Alert’, a civil society organisation specialising mainly in health advocacy, monitoring and education, told Politico Press that the country’s health sector had a staff strength of 6,000, and the number of peripheral health units stood at ???1,2000???, with19 referral hospitals countrywide.

Out of the number of health officials, more than 150 succumbed to the Ebola virus. Mr Lamin further explained that prior to the Ebola outbreak, the health sector was known for its acute shortage of trained and qualified personnel and that the Ebola outbreak compounded the situation by taking a toll on the country’s health staff. “The volunteers in the hospitals cannot be relied upon as they are untrained and unpaid,” Sao Lamin explained.

The messages from health officials that the virus had no cure reinforced the peoples’ reluctance to go to hospitals even when the government later came out with another message of ‘supportive Ebola treatment’. The situation badly affected access to health facilities as there was a drastic drop in the number of people visiting hospitals.

“Since government says there is no cure for any Ebola victim, why should we go to hospitals for treatment?” This question became the most frequently asked at the most dangerous stage of the Ebola epidemic. Consequently, people hid in their homes and resorted to self medication.

The fear of being diagnosed with the Ebola virus even when one suffered from another ailment was prominent among the public. Connaught Hospital, the oldest in the country situated at the City Centre of Freetown, was filled with hundreds of patients daily during the pre-Ebola days. Today, visits to the hospital is at an all time low. A situation that is replicated in hospitals and community health centres at the provinces.

Effects

The Ebola outbreak has also affected the ‘Free Health Care’ system in the country, a government initiative started on April 27, 2010 to stem the tide of maternal and infant mortality rate in the country. The beneficiaries - under five children, pregnant women and lactating mothers - hardly go to hospitals for ante-natal and post-natal medical services.

The apprehension to visit the hospitals was linked to the fear of any health complication being mistaken for Ebola. As a result, pregnant women were delivering in their homes with the help of traditional birth attendants. Health alert is yet to release any figure regarding the upsurge of maternal and child deaths, as the organisation is monitoring the situation.

Private hospitals and pharmacies which used to complement government’s health system were closed down following the proclamation of a state of emergency in July last year when the contagion was at an alarming proportion. The closure of the private health facilities was justified on the basis that they were secretly treating suspected Ebola patients, a situation that frightened government. It resulted in many health workers becoming jobless as private hospitals dispensed with their services. Even though these hospitals have resumed operations, the effect of their closure still looms.

The Communications Officer of the country’s Ministry of Health and Sanitation (MoHS), Jonathan Abass Kamara, disclosed that the country had lost 12 medical doctors, including Dr Shek Umar Khan, the only virologist in the country attached to the Lassa fever unit in the Kenema Government Hospital.

Dr Khan was central and, therefore, a dominant figure in the struggle against the virus. He was instrumental in the treatment of the Ebola virus.

Mr Kamara also put the number of nurses who had died at 152 and other health support staff, including porters, cleaners, nursing aides, laboratory technicians and pharmacists, who had succumbed to the virus at 396.

The replacement of these health workers would cost the government several millions of dollars. “It takes seven years to train a doctor. When one graduates from the college, he has to be in a period of housemanship for two years before he is granted a licence by the Medical and Dental Council Association,” Mr Kamara explained.

Related effects

Belgian scientist Professor Peter Piot who claimed to have discovered the Ebola virus in 1976 in the then Congo Zaire, a Central African nation, while he was on a scientific research, visited Sierra Leone in December last year. During his visit, he held a public lecture at the Miatta Conference Hall, Youyi Building in Freetown on the origin and nature of the Ebola virus. When Liberia was declared free of the Ebola virus a month ago by the World Health Organisation (WHO), Prof. Piot warned that there would be future Ebola outbreaks and that governments should work towards an Ebola vaccine.

The routine immunisations of children for the prevention of childhood diseases, including poliomyelitis, whooping cough, measles, etc. have been brought to a sudden halt. Almost all government funds are now directed to the fight against the Ebola. Again, community people have an apathy to the immunisation of their children as they refer to the vaccination as ‘Ebola vaccines’.

The Ebola outbreak has impacted not only on the campaign against childhood diseases, but has also impacted campaigns on HIV. Lansana Koram, a senior official at the HIV/AIDS Secretariat, told Politico Press that funds for the HIV campaign were available but they were not utilised for any HIV-related campaign until WHO declared the country free of Ebola.

Dr Sarian Kamara said in a press briefing held at the Sierra Leone Association of Non-Governmental Organisations (SLANGO) that the Ministry of Health and Sanitation had recorded a 100 per cent drop in condom use at the initial stage of the Ebola outbreak. This has, therefore, led to an increase in the spread of sexually transmitted infections (STIs).

Conclusion

Doctors and nurses who are the frontline warriors in the fight against the Ebola virus have faced their greatest ordeal than at any other time in the country’s history. These health workers have been thrown out of their houses which they rented before the Ebola outbreak owing to the misconception that they were vectors of the Ebola virus. Most of them are still grappling with accommodation problems. It is no gainsay that this has adversely impacted the health sector.

From the above, it is apparent that the health sector is being haunted by the impact of Ebola. It is only a coordinated effort by both national governments of the Mano River Basin and the international community that can create a turnaround.