The top priority for those of us working on the Ebola response in Sierra Leone is breaking the chain of transmission: stopping Ebola moving person to person as fast as we can. This means moving people with Ebola symptoms from their homes to holding facilities where they can be tested and given early treatment, burying the bodies of everybody who has died of Ebola in a safe medical burial, and ensuring the public knows the signs and symptoms. All of this while feeding the thousands of people who have been quarantined in their homes, tracing tens of thousands of contacts and look after orphans, widows and widowers of Ebola. It’s not easy but the Government of Sierra Leone is making real strides.
In the last month the focus has been on dignified burials. It takes time to build a treatment centre but you can bury a body immediately. And contact with dead bodies is the most common way people catch Ebola. The challenge faced here is that traditionally, people in Sierra Leone wash the bodies of their dead and organize a religious burial themselves but now this has had to change. Today Sierra Leoneans call 117 to notify the authorities that someone has died in their home or within the community – whether that person died from Ebola or not and a burial team arrives in full protective gear to conduct the burial.
Just over a month ago, hard-working burial teams in Freetown were struggling to keep up with the demands on them. Every morning, they were given a list of names and addresses, and went into the communities to find the bodies. Sometimes bodies were found in houses, sometimes left on the street. Communities were afraid because the new procedures went against West African traditions of how to care for people who were sick, dying or dead. The burials were conducted at the allotted cemetery but the teams weren’t operating efficiently: sometimes, arriving at a house to find another team had already picked up the body. All that has changed here in the Western Area District, home to the capital Freetown.
I have worked with the Republic of Sierra Leone Armed Forces (RSLAF) and partners to establish a Western Area Emergency Response Centre. It is already making a big difference. The Government, military and international partners have brought a new level of energy and discipline to the role and staff now receive prompt direction.
Setting up the centre involved four steps. The first step was to know where teams were needed and to keep them in one small area of the city, to reduce travel time and speed up the response. We worked with health officials and partners to ‘rezone’ the city and match the teams to the demand. We soon found that teams were waiting for hours for their vehicles to be decontaminated and refuelled, so we set a target that all teams should be in their vehicles and on the road by 8am every day and set up a vehicle management team to deliver that.
The second step was to put one officer in charge of dispatching teams for each zone. We set up a connection to the national call centre ‘117’, so that the officer could see new dead body alerts coming in, prioritize cases and dispatch teams to respond to them.
The third step was to make sure all dead bodies were swabbed and the samples sent to a lab, so they could confirm which of them had Ebola. This is essential, so that contact tracers can follow up with people who might have been in contact with an Ebola victim, and place them in quarantine if required.
The fourth step was to work with the international partners to improve the organisation of the cemetery so we had enough graves dug per day, and there was a process in place to bury the bodies, with a priest or imam present on request, and the families permitted to attend at a safe distance.
The Emergency Response Centre launched last month, starting with burials alerts. Captains and Majors from the Sierra Leone military manned their stations. They turned on their laptops, and alerts started coming onto their screen, routed directly from the 117 call centre. They mapped and planned how their teams should respond, and started calling teams with commands. As the phone calls came back, one by one, to inform the centre that burials had been completed, we saw the total number of burials rise beyond any previous day. Before launching the Emergency Response Centre, the percentage of bodies buried per day was too low. It rose rapidly to 80%, and kept rising. We’re now hitting 100% on a regular basis.
This system has now been expanded to other aspects of the response, managing alerts of suspected cases and getting them into beds as they become available, for example. Importantly, it is also being rolled out to other districts throughout the country, run by RSLAF officers, with support from British military mentors. The model is scalable: if we need to double the number of burial teams, we now have the data to predict and prepare for it. Every death, whether from Ebola or other causes, is a tragedy. But every body that is buried safely helps break the chain of transmission, and prevents further deaths.
Victoria Parkinson, Governance Advsor, Sierra Leone