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In Sierra Leone, Life and Health Systems Grind to a Halt as Ebola Rages On

A native of Sierra Leone, Mohamed Jallow now works as a grants officer in the finance division at IntraHealth International in Chapel Hill, North Carolina. But he grew up in Koidu, Kono District, Sierra Leone, in one of the regions now most affected by Ebola.

He sat down with VITAL to talk about the situation in Sierra Leone and the country’s progress so far.

VITAL: What was health care like in Sierra Leone when you were growing up?

MJ: Life in Sierra Leone was difficult, and anyone who grew up there knows that life was a constant struggle even before the arrival of Ebola. I still have memories of the ever-present malaria, the occasional outbreaks of cholera and Lassa fever, and the everyday travails of maternal and child health.

For years, Sierra Leone has been defined by the horrible civil war that took place there from 1991 to 2002. The war had a deep effect on all aspects of life, including the very important issue of health care and access to it.

As one of the poorest countries in the world, Sierra Leone has struggled to provide basic health care for its citizens. According to the WHO, the country’s health sector faces a shortage of health workers, poor skills mix in the health workers that do exist, a demotivated workforce, and a high attrition rate.

If you have something serious—then just prepare to die.

However, even with all this, the country was making progress in addressing the critical gaps in its health system—until the arrival of Ebola.

The current government has championed maternal and child health, and has invested considerable capital in making health care free for pregnant women and infants. But Ebola has turned the clock back. The country was unprepared for the monumental work of an outbreak. The already inadequate health infrastructure became overwhelmed in a matter of weeks.

VITAL: How did the health care system affect you personally? For example, did you get sick often?

MJ: All the time. Growing up, I had all the usual ailments common in low-income countries—malaria, dysentery, and cholera, to name a few. But I was one of the lucky ones. Almost one-fifth of all children in Sierra Leone die before they reach five years old.

My hometown, Koidu, had a population of over 250,000, but only one major hospital. The hospital was often crowded, with about a hundred beds and very rudimentary services. I mean, there was nothing there. When we got sick, we had to take our own paper for the doctors to write on. There were no medications. People often died—and still do—from simple things there.

This, added to destruction from the war, meant that only the basics were available. If you have something serious—then just prepare to die.

The hospitals became notorious as places for infection, so many people shy away from them. This legacy, as well as the lack of support for the national health system, contributed to the spread of Ebola when the outbreak started.

VITAL: How has that type of fear affected Sierra Leone’s Ebola response?

MJ: In the beginning, many people were reluctant to go to treatment centers if they had symptoms. Many not only distrusted the health workers, they distrusted the system.

In the beginning, some even accused health workers of giving them Ebola. That’s because health workers in Sierra Leone didn’t have proper protective gear and many did inadvertently transfer the disease. This fueled rumors about the hospitals and contributed to Ebola’s spread.

Now there's more information available and people understand. They’re saying, "Okay, health workers are not our enemies, they're trying to cure us, they're trying to take care of us."

When the system was crumbling, these people held it together.

But beyond that, there have been changes in Sierra Leoneans’ way of life, traditions, and of our relationship with the dead. It changed the routine of death itself, and the sacred burial rites common in that part of the world. Accepting these changes has been very difficult for a society that is steeped in tradition, religion, and superstition.V

ITAL: Do you know anyone who has been infected?

MJ: Luckily, none in my immediate family has been infected, but I know of people who have.

For example, Sierra Leone has probably fewer than 100 well-qualified doctors in the whole country. Therefore, those few doctors are household names. One called Dr. Willoughby died of Ebola this past December. Growing up, I heard his name all the time. It is disheartening to hear of these doctors dying.

VITAL: How has Ebola affected Sierra Leone’s health workforce?

MJ: Sierra Leone has lost hundreds of doctors, nurses, nursing assistants, and other health workers. When the system was crumbling, these people held it together. We dropped the ball when it comes to health workers on the front lines. I mean, we don’t even pay them enough for the risks they take every day. We want health workers to know that what they do is valued and that they will be protected on the job. IntraHealth’s CEO Pape Gaye, the Liberian president, and others spoke about this last month when they gave testimony before the US Congress.

VITAL: So are things now improving in Sierra Leone?                              

MJ: Things are slowly stabilizing, and the outbreak is slowly being brought under control. However, even a few weeks ago, the situation was very different.Now, more than 10,000 infections and over 3,000 fatalities later, the world is responding to the crisis as it should have in the first place, and new cases are finally subsiding.

One unfortunate side effect of the Ebola outbreak that did not make the news is the economic effects. In many communities, life has been brought to a standstill. People don't go to markets; children don't go to school because the schools are shut down. Routine medical checks don’t happen, and pregnant women don’t get health services. The response to and fear of Ebola have put all these issues on the back burner.

Ebola has shown us that you can never neglect the health sector in favor of economic development. 

VITAL: What does all this mean for Sierra Leone today and tomorrow?

MJ:  Ebola’s impact will extend beyond the obvious loss of life and effects on the health system. Before Ebola, Sierra Leone had one of the fastest-growing economies in the world. While the rest of the world hailed the country’s post-war development, it paid less attention to the precarious health situation there. Ebola has shown us that you can never neglect the health sector in favor of economic development. They go hand-in-hand.

Photo by Morgana Wingard for USAID.Also read: Special Coverage: Ebola in West Africa