Editors’ Note: The World Health Organization (WHO) reports that more than 7,500 people have died from Ebola, nearly all of them in the West African countries of Liberia, Sierra Leone and Guinea, and a small number in Nigeria.
Dr. Dan Kelly (Courtesy of Global Action Foundation)
The situation is so dire that Sierra Leone has banned public celebrations of Christmas and the new year due to the crisis.
Recently, the WHO dispatched a response team to Kono District, a remote diamond-mining area in the Eastern Province of Sierra Leone. There, it found dozens of bodies.
Dan Kelly, M.D., a 2008 Einstein alum and co-founder and chief strategy officer of Wellbody Alliance, is on the front lines in Kono, trying to stem the spread of this deadly virus. We reached out to him to better understand what’s happening there.
1. Dan, we understand that authorities have placed Kono District—an area with 350,000 residents—in lockdown. Where are you situated? What is happening on the ground where you are?
Yes, Kono District, like other hot spots, is under quarantine. This means that people are allowed to travel around the district during the day, but movement outside the district and at nighttime is restricted. The first case of Ebola in Kono occurred in August, and since then, I have witnessed a gradual but steady rise in cases until Ebola surged in late November. Until that time, I had been more focused on building community-based Ebola programs to identify and refer patients into care. I shifted into a clinical role during the surge because of the incredible need and the lack of any other expatriate support.
2. As recently as two weeks ago, the WHO was reporting a grim scene of arriving in Kono and finding bodies piling up. Why hasn’t a response come sooner to this area?
Although I never saw any piles of dead bodies at the Koidu Government Hospital, I think this incident was metaphorically equivalent to the severe and uncontrolled nature of the Ebola surge in Kono.
As we were trying to have all Ebola patients moved to Kenema, a patient entered an ambulance that contained a confirmed patient. Despite our explaining his risk and begging that he go to another ambulance with other suspects, he would not budge. He was scared of being sent back into the hospital even with reassurance and said he would rather sit next to a confirmed Ebola patient than return to the hospital’s holding area. We let examples like this one happen because of our reactive approach to the Ebola epidemic.
We knew Kono had Ebola but it lacked many of the clinical services, such as Ebola diagnostic and treatment centers, made available to high-transmission areas. Ebola fighters are stretched and resources are still limited. We’ve had to work from the ground floor up and infuse intensive resources into hot zones over a six-month period to curb high transmission rates. Assuming we as an international community had more bandwidth to absorb the need, we could take a proactive approach to ending Ebola.
I think our capacity-building work around community-based Ebola programs contributed to epidemiological awareness of the situation in Kono. Bearing witness to the deplorable condition of the Ebola holding area and documenting and disseminating an assessment report led to a rapid assessment team from the WHO, the Centers for Disease Control (CDC), the UNMEER (U.N. Mission for Ebola Emergency Response) and the ministry of health. We briefed the team and assisted in development of presentation materials to the national coordinating body and within days, we had these international groups willing to deploy intensive resources to support the response.
I was impressed to see such a rapid response that there will be strengthening of all services throughout the district. Now an Ebola treatment center and community care centers are under construction. While deployment of a mobile lab is planned, the U.N. is sending blood samples to the CDC lab in the Sierra Leone city of Bo, about six hours away. The U.K. military is supporting and building capacity at an operational and logistical command center while the nonprofit community implements most of the on-the-ground work in collaboration with the ministry of health.
Given the robust nature of this response, I’m optimistic that we will see this intensive influx of resources with continued support from all partners result in the opening of an Ebola treatment center and community care centers within a month’s time. Fortunately, our momentum in Kono should prevent needless deaths as we resolve this Ebola surge.
3. What challenges does Kono face that other areas of Sierra Leone do not?
Kono District is notorious for being the blood-diamond-mining district during the decade-long civil war. Afterward, the government limited the presence of nonprofits in the district. In 2006, we started providing medical services to amputated civilians in Kono and grew our health services to strengthen broader health systems.
When Ebola hit Kono, the fragile health system had few partners and very limited resources to respond to the crisis. With most resources directed at high-transmission areas and the remote geographic nature of the district, we were only partially prepared for the surge in cases.
4. What, specifically, are you and your team doing to stop the spread?
We are working with the ministry of health to fill gaps to create a comprehensive Ebola care system. Specifically, community health-worker programs, community care centers, a maternal Ebola care center, a diagnostic center and an integrated data-management system are all initiatives of ours. We absolutely need continued health-provider support. and people interested in becoming involved in the Ebola response can register to volunteer through the Partners in Health website to initiate a recruitment process.
Health providers may be sent to work in Kono District, Portloko District or the maternity hospital in connection with the clinical-care efforts supported by Partners in Health in Sierra Leone. Feel free to contact me with any questions: dan@wellbodyalliance.org
5. There’s a tremendous amount of international aid pouring into Sierra Leone. From your vantage point, how long do you think it will take for Kono to get Ebola under control?
Based on lessons we have learned from other districts, it took about six months of focused Ebola care with ample access to control and treatment measures before we were able to curb high-transmission areas to the point where only scattered flares continued to occur.
6. What is the most important message you want to convey about the situation in Kono and the Ebola response in general?
The rapid response in Kono serves as a positive example of our efforts in the Ebola response, and of lessons we have learned over the course of this epidemic. We are, however, at the beginning of a many-month control-and-care effort there. We need health providers to respond to this call to action and realize that even after Ebola has ended in Kono we will need to build the health system so that future outbreaks are detected and controlled quickly.
We will also have to work hard to restore the gains we had recently achieved in maternal and child health and other areas of health.
This Ebola epidemic has been a defining moment in public-health history. I believe we as the international community will never allow an Ebola outbreak to grow into an emerging pandemic of this proportion again because we will make a stand and support capacity-building efforts for fragile health systems all around the world.
