H5N1

Ebola in Sierra Leone: Background on the sacking of Miatta Kargbo

Via Sheku Sheriff's Diary, some background on the politics of Sierra Leone: Miatta Kargbo Recalled to State House. Excerpt:

"Miatta Kargbo has been recalled to State House to serve in the Strategy and  Policy Unit until further notice" 

The above was the statement released in Sierra Leone last week, announcing the "sacking" or "recalling"of the most incompetent Health Minister in the history of post independence Africa. This sacking of course came only after mountains of pressure had been piled on Sierra Leone's President Ernest Bai Koroma.

He may finally have been convinced that his health minister was the very symbol of incompetence, both in how she prepared for and how how she responded to the Ebola crisis that is now battering the small West African nation. 

When Ebola entered the country from Guinea and Liberia, the health ministry was totally unprepared. There was no comprehensive strategy, the Ebola test kits that had been stockpiled were expired, the personal protective equipment -PPEs- used by the health workers were for standard precautions and totally inadequate for Ebola, and consequently the infection spread as quickly as wildfire in the harmattan. 

Miatta Kargbo's dilemma could be likened to a mediocre student who has prepared studiously for junior school exams being forced to take the final year exams of a university honors program with the expectations that she will pass with flying colors. It was never bound to happen. The computer experts have a term they call it;(GIGO)- garbage in, garbage out. 

Everybody, except President Koroma, knew that Miatta Kargbo was a walking disaster. How she managed to stay as Health Minister from May to August, the President will one day be forced to explain to the souls of the hundreds who have died due to the disastrous handling of the Ebola outbreak in the country. Many people, including those very close to the President have blamed the hapless minister for the poor response to the crisis.  

In my honest opinion, what many of her critics fail to comprehend is that this was truly a failure of presidential leadership. Miatta Kargbo's failure was the failure of President Koroma to see that square pegs are just not meant for round holes. If you have a round hole, you look for a round peg. 

President Koroma is the type of leader you need in a country which is completely disaster free, a country where the only role the ministers play is to praise the President and shower him with superficial platitudes. The only blessing that Sierra Leone has is that during country's protracted civil war, Ernest Bai Koroma was never voted for as President, as that would have been catastrophe of unimaginable proportions. 

In Periods of crisis, President Koroma has proven over the years that time and again, he simply cannot rise up to the challenge of good leadership. The President's major flaw, both as a leader and a human being, is his inability to make quick decisions and his affinity for meaningless platitudes. In periods of crisis, he has sometimes asked people to engage in periods of fasting. One irate lady once said that if she had wanted a President who encouraged her to fast, she would have voted for her pastor.

I have no insights whatsoever into Sierra Leonean politics, but I note that as soon as Kargbo was replaced by Dr. Abubakar Fofana, a very adequate ministry website appeared and the daily Ebola updates became much more detailed. 

WHO: Ugandan team brings Ebola experience to Liberia

Via WHO's Regional Office for Africa: Ugandan team brings Ebola experience to Liberia. Excerpt:

A team of Ugandan doctors and health workers are deployed by WHO to provide medical support for an Ebola treatment centre in Monrovia, Liberia. This team comes with vast experience in managing Ebola outbreaks, having faced many cases of this disease since 2000. They work shifts alongside their Liberian colleagues to provide around the clock care and to help maintain strict infection control measures. 

Madira Lefa, assistant physician at Kagadi Hospital in Uganda, cried when he read what was going on in Liberia, one of the three countries most seriously affected by the Ebola outbreak. Immediately he started thinking, “I have to help my colleagues”. Madira is one of 14 Ugandan medical doctors and health workers now working in the Ebola treatment centre in JFK Hospital in Monrovia, having been deployed by the World Health Organization (WHO). 

The Ugandan team comes with strong experience in Ebola outbreaks, having faced many cases of this disease in several outbreaks since the year 2000. 

“To deal with this epidemic, we need to have good case management of patients, an effective isolation area and community-based contact tracing,” says Ugandan Dr Atai Omoruto, who arrived in Liberia in July to train and support health workers and doctors in JFK´s Ebola treatment centre. 

Providing around the clock care 

Work continues in 3 shifts around the clock in the treatment centre. The Ugandan doctors and health workers work alongside their Liberian colleagues treating patients and helping to maintain the strict infection control measures that are necessary in the centre. 

The outbreak of Ebola virus disease in west Africa has seen a high proportion of infection in doctors, nurses and other health workers. This cooperation between countries is a good example of how experienced professionals can help to improve safety. 

“Health workers are at the heart of everything ,” says WHO Assistant Director-General, Health Security, Dr Keiji Fukuda. “They need to have the right training and the right environment to work safely. Their work is absolutely critical.” 

An opportunity to help another country 

"This is an opportunity to help another country," says Awilo Sarah Layo, a nurse from Mulago National Referral Hospital of Uganda. As the mother of 4 children, Awilo is in daily contact with them to make sure that they study and do their homework. 

“We are facing a lot of challenges. This outbreak is worse than the ones we faced in our country,” she says. “At first, people did not believe in Ebola. Now people are more aware but the cases are still increasing. If people get a fever, they must report it immediately,” says Awilo, who has worked as a nurse during all of Uganda’s recent Ebola outbreaks.

Ebola in Sierra Leone: August 31 update

Via the Facebook page of the Ministry of Health and Sanitation, Sierra Leone:

EBOLA OUTBREAK UPDATES---August 31, 2014 

DISCHARGED CASES 

• Total Survived and Released Patients = 244 

NEW CASES 

•New Confirmed cases = 44, as follows: 

Kailahun = 4, Kenema = 11, Kono = 0 

Bombali = 4, Kambia = 0 Koinadugu = 0, Port Loko = 8, Tonkolili = 2 

Bo = 6, Bonthe = 0, Moyamba = 0, Pujehun = 0 

Western Area Urban = 6, Western Area Rural = 3 

CUMULATIVE CASES 

• Cumulative confirmed deaths = 387 

•Cumulative confirmed cases = 1,077, as follows: 

Kailahun = 461, Kenema = 350, Kono =1 

Bombali =39, Kambia =1, Koinadugu =0, Port Loko =70, Tonkolili = 16 

Bo = 45, Bonthe = 1, Moyamba = 9, Pujehun = 7 

Western Urban = 49, Western Rural = 28 

• Probable cases = 37 

• Probable deaths = 37 

• Suspected cases = 76 • Suspected deaths = 11 

IMPORTANT NOTE! Koinadugu still remains the only district that has not registered confirmed cases of Ebola in Sierra Leone 

IMPORTANT NOTE: The EOC wishes the general public to know that the Call Centre has been upgraded with computers and call centre software for effective coordination and management of concerns from the public. 

The public is hereby informed that the operators at the centre are currently being trained on the use of this new software, which may result in the reduction of the number of calls received at the centre. The public is however, encouraged to call the 117 toll free line as it will continue to operate on the 24 hour basis despite the training and upgrade. 

The General Manager of Air France Jean-Raoul Tauzin has informed the EOC that Air France has suspended its operations in Sierra Leone until October 31st 2014. According to him, their decision to suspend the operations in the country is as a result of the decision taken by the Government of France, which demanded that Air France suspends all it flights into Sierra Leone and Liberia due to the Ebola outbreak in the two countries. Air France just a week ago assured the Government and people of Sierra Leone that it will continue its operations in Sierra Leone despite cancellations by other airlines, such as the Kenya and British Airways. 

The Ebola Emergency Account is audited by Chartered Accountants from the KPMG Accounting and Auditing Firm at the Emergency Operations Centre (EOC) All Cash Donations are deposited at the Ebola Emergency Account managed by the EOC, and kind donations (Medicines, Equipment, Supplies, etc.) are held at the Government Medical logistics stores, Freetown, by the Ebola Logistics team, for processing, storage and equitable distribution as required throughout the country. 

ISSUED BY: 

The Ebola Viral Situation Report, Ministry of Health and Sanitation

I am surprised and happy to report that Ministry of Health and Sanitation now has a proper website. I'm putting a link to it in the Ebola Resources list.

Ebola in Liberia: Government extends stay-home edict for non-essential staff

Via FrontPageAfrica, a September 1 report: Liberia Extends Stay-Home Orders for Non-Essential Staff. Excerpt:

President Ellen Johnson Sirleaf has extended, by the another month beginning Monday, September 1, 2014, the stay-home order imposed on all non-essential government employees who have been away since August 1st. 

According to an Executive Mansion release, this measure remains necessary to decongest government work places as efforts continue to contain the spread of the Ebola virus disease which is having devastating consequences on the country. The Liberian leader has assured government employees affected by the stay-home orders that they will continue to receive their salaries during the period of their absence from work. 

On Wednesday, July 30, President Sirleaf, in a Special Statement to the Nation on additional measures in the fight against the Ebola virus disease, announced that all non-essential staff begin a 30-day compulsory leave; noting the strategy was to contain the spread, care for the afflicted with the goal of “No New Cases.” 

In another development, President Ellen Johnson Sirleaf, on Friday, August 29, held talks with officials of the Alliance for Peace and Democracy (APD) at her Foreign Ministry office in Monrovia. The APD requested the meeting to discuss how they could be of help in the national fight against the spread of the deadly Ebola virus disease. 

The APD officials proposed a “Strategy for Rapid Tracing and Tracking of Individuals,” similar to that used during civil war for the distribution of relief materials to various communities by the Special Emergency Life Food Program. As a way forward, the APD recommended that the Chair of the National Task Force mandates the Ministry of Health and Social Welfare (MOH&SW) to consider the integration of community enumeration and structure numbering strategy into the Ebola virus transmission tracking and tracing mechanism to enhance and support ongoing efforts.

What’s missing in the Ebola fight in West Africa

Via The Washington Post, an opinion piece by Partners in Health co-founders Jim Yong Kim of the World Bank and Paul Farmer of Harvard: What’s missing in the Ebola fight in West Africa . Excerpt:

The take-no-action argument has been used over the years as an excuse not to mount an effort to control drug-resistant tuberculosis, malaria and many other diseases that afflict primarily the poor. 

But the reality is this: The Ebola crisis today is a reflection of long-standing and growing inequalities of access to basic health care. Guinea, Liberia and Sierra Leone do not have the staff, stuff and systems required to halt the outbreak on their own. According to its ministry of health, before the outbreak Liberia had just 50 doctors working in public health facilities serving a population of 4.3 million. 

To halt this epidemic, we need an emergency response that is equal to the challenge. We need international organizations and wealthy countries that possess the required resources and knowledge to step forward and partner with West African governments to mount a serious, coordinated response as laid out in the World Health Organization’s Ebola response roadmap. 

 Many are dying needlessly. Historically, in the absence of effective care, common acute infections have been characterized by high mortality rates. What’s happening with Ebola in Africa has been no different. 

A 1967 outbreak in Germany and Yugoslavia of Marburg hemorrhagic fever — a disease similar to Ebola — had a 23 percent fatality rate. Compare that with an 86 percent rate for cases across sub-Saharan Africa in the years since. The difference is that Germany and Yugoslavia had functioning health systems and the resources to treat patients effectively. The West African countries coping with Ebola today have neither. 

With a strong public health response led by the United Nations, the World Health Organization, the United States, Britain, France and other wealthy nations, the virus could be contained and the fatality rate — which, based on the most conservative estimates, exceeds 50 percent in the present outbreak — would drop dramatically, perhaps to below 20 percent. 

We are at a dangerous moment in these three West African countries, all fragile states that have had strong economic growth in recent years after decades of wars and poor governance. It would be scandalous to let this crisis escalate further when we have the knowledge, tools and resources to stop it. Tens of thousands of lives, the future of the region and hard-won economic and health gains for millions hang in the balance.

Liberia: Ebola survivors lack clothes

Thanks to Lucie Lecomte for sending the link to this report. Via allAfrica.com, a New Dawn story: Liberia: Ebola Survivors Lack Clothes. Excerpt:

Health authorities at the Eternal Love Wins Africa or (ELWA) Hospital have disclosed that Ebola survivors leaving the treatment center do not have clothes to wear. Medical Director Dr. Jerry Brown, said nurses usually dress survivors in veils as they leave the hospital compound due to lack of clothes. 

Dr. Brown made the disclosure when the Citizens Organized for Transparency and Accountability (COPTA) presented items valued over US$5,000 to the ELWA Isolation Unit 2. 

He appealed to well-meaning Liberians and NGOs to assist the unit with clothes for survivors to wear when leaving the hospital. But a non-governmental organization, Smile Liberia International, has promised to provide clothes for survivors returning home. An executive of the group, Ms. Fasiah Harris, said Smile Liberia in collaboration with COPTA will continue to provide needed services for Liberians. 

COPTA is a local partner to Smile Liberia International and some Liberians working with the UN peacekeeping mission in the DRC. The project coordinator Christine Brooks-Jarrett said COPTA is an organization working to ensure a better Liberia in which leaders can be held accountable to the people in the discharge of their services. 

Madam Brooks-Jarrett said as part of their effort to complement initiatives of the international partners and government, COPTA has received two separate donations from two organizations, some Liberians working with the UN peacekeeping mission in the DRC, who have their hearts tied to the wellbeing of Liberia and have decided to join the fight against Ebola.

Leadership and calm are urged in Ebola outbreak

Apologies for missing this excellent August 29 article in The New York Times: Leadership and Calm Are Urged in Ebola Outbreak. Excerpt:

With the SARS outbreak in 2003, Taiwan’s news media was so alarmist that the government finally ordered every television channel to devote two minutes, three times a day, to a calm presentation of facts by Dr. Lee Ming-liang, a retired health minister in charge of the task force dealing with the disease. 

“Dr. Lee is nice, old, intellectual — very respected,” said Dr. Steve Kuo, who coordinated Taiwan’s SARS task force. “And he speaks an authentic Taiwanese dialect. Whatever channel you turned to, there he was. That was very useful.” 

Unusual tactics and inventive thinking will be needed to beat West Africa’s Ebola outbreak, according to some of the world’s top experts in disease eradication. About 3,000 Africans have been infected and about half of those have died. The World Health Organization has warned that infections could rise to 20,000, and Senegal on Friday announced its first case, a Guinean who entered a hospital in the capital, Dakar, seeking treatment.   

Leadership must be imposed, the experts said, perhaps with a West African in charge. Donors must commit at least $500 million. And a new strategy is needed, with the first priority being to stop the panic caused by imprisoning residents of the affected countries behind barbed wire and roadblocks.  

The outbreak will not end, they argued, until average citizens calm down and help their infected neighbors instead of fleeing from them. 

“Liberians are not going to be saved by internationals coming in,” said Dr. Bruce Aylward, one of the leaders of the drive to eliminate polio and an author of the health organization’s Ebola-fighting plan introduced this week. “They’re going to be saved by Liberians.” 

The New York Times asked 10 leaders of the fights against smallpox, polio, SARS, rinderpest, Guinea worm and other diseases — some of them legends in their fields — for their views on how best to fight the outbreak. 

All offered suggestions, but several asked not to be quoted by name for fear of appearing to undercut W.H.O. and United Nations leadership. 

Most agreed on many basic principles. All, for example, were sure the outbreak could be stopped without experimental drugs or vaccines. None expected it to take less than six months. 

All said that Western countries needed to help generously, especially those with long ties to affected nations: the United States to Liberia, Britain to Sierra Leone and France to Guinea. Their militaries may be useful, as long as they only deliver supplies, set up field hospitals, provide electricity and communications — and avoid anything that involves brandishing weapons, including enforcing quarantines. 

The experts were universally appalled at the sight of rural areas hemmed by roadblocks and a slum in the Liberian capital, Monrovia, with barbed wire that made residents believe they were being locked in to die; they were even more appalled that soldiers used truncheons and bullets during what was supposed to be a public health effort. On Friday, the government said the quarantine of the slum, West Point, would be lifted on Saturday morning.

Ebola in Nigeria: Diplomat may face manslaughter charges for fleeing to Port Harcourt

Thanks to Lucie Lecomte for the link to this story in 24/7 News Nigeria: Ebola: Diplomat to face manslaughter charges for fleeing to Port Harcourt.

The Nigerian diplomat attached to the Economic Community of West African States (ECOWAS), Olubukun Koye who escaped from quarantine in Lagos after testing positive to Ebola virus and travelled to Port Harcourt for treatment, an action that resulted in the death of the doctor who treated him (Iyke Enemuo) may face manslaughter charges. 

This is coming on the heels of reports that the number of persons under surveillance in the state for Ebola Virus Disease has increased from 100 to 160. 

According to Thisday, sources said that the issue of Koye (a primary contact of the index case, late Liberian Partick Sawyer) who defied instruction and left Lagos after being placed in the isolation unit, was discussed at the Federal Executive Committee meeting on Wednesday and that the Minister of Justice and Attorney General of the Federation was directed to look into the Nigerian laws and see how he could be sanctioned for his action that resulted in the death of Enemuo.

Suspected case of Ebola in Sweden

Thanks to Lucie Lecomte for spotting this report in Aftonbladet: Suspected case of Ebola in Sweden. Excerpt from the Google translation:

A suspected case of Ebola infection have been discovered in Sweden. 

A person who visited one of the countries risk has fallen ill with fever - and cared for now at the infectious diseases clinic at Karolinska Hospital. 

"The risk is minimal that it is Ebola, but we are extremely strict in management," says Åke Örtqvist, Director of Disease Control in Stockholm County. 

At 17:30 o'clock on Sunday sent a specially equipped ambulance to Solna to pick a man with Sweden's first suspected cases of Ebola. 

The man had fallen ill with a fever. He had recently visited one of the countries where the risk of the epidemic struck. Healthcare acted then, according to the action plan that the National Board has developed and the man has been transferred to the infectious diseases clinic at Karolinska University Hospital in Huddinge. 

"The Action Plan we write that a suspected case is whether a person who has visited an area where the epidemic occurs and becomes ill within 21 days with a fever higher than 38 degrees, it's the definition of a suspected case," says Åke Örtqvist to Aftonbladet. 

Risk is small 

He emphasizes that the risk of the man hit by Ebola is extremely small, but that the circumstances and that Ebola is a serious disease that makes safety increased. 

"You have put it on the level that we can rule out a case slips between your fingers. The man is now being treated in infectious disease unit had himself visited a local emergency on Sunday. 

"What I was told is that he himself stated that he had not had contact with any Ebola patient, but we do not know, and it is not sure that he knows that either." 

Samples were taken 

To rule out that the man is infected with Ebola has been sampled that as soon as possible, analyzed by the Public Health Agency P4 laboratory in Solna. 

The bunker where the sample analyzed is one of the most well-protected places in the country and equipped with several locks, where the air is sterilized. 

According to Ake Örtqvist should be within one day have an answer to whether the man suffered from Ebola or not.

This will be a very easy case for ECDC to check out; someone just has to walk down Tomtebodavägen from ECDC headquarters, cross Solnavägen, and then go up Karolinskavägen a couple of blocks to the hospital.

Ebola in Nigeria: 39 foreigners arrested in Lagos hotels

Via The Nation: Ebola: 39 foreigners arrested in Lagos hotels. The whole bizarre report:

Officers of the Nigeria Police, the   Nigerian Immigration Services and health officials at the weekend collaborated to arrest 39 foreigners in two hotels on Lagos Island. 

The arrest of the foreigners, it was gathered, was to prevent possible spread of the Ebola Virus Disease (EVD). 

The foreigners, 35 from the Democratic Republic of Congo (formerly Zaire) and four Senegalese were arrested by security agents at Benin Hotel and Guest House on Atere Street in Lagos Island. 

Eye witnesses said the arrest followed a tip-off by some residents of the area to Area A Command, Lion Building, Lagos. 

The residents were said to have expressed fears that the activities of the foreigners, mostly cohabiting together, could lead to the spread of EVD in the area. 

On receiving the report, the Area Commander and Assistant Commissioner of Police (ACP), Imohimi Edgal, reportedly contacted immigration and health officials who stormed the hotel where the foreigners were placed under arrest. 

A police source who spoke to newsmen said the immigration officials will determine if the suspects are legally residing in the country. The source said the health officials will determine their health status to know if they actually have the dreaded disease or not. 

Following the arrest, all hotels in the area have been placed under close surveillance while the residents were told to report any suspicious persons or activities to the police. 

Speaking to newsmen, a resident of the area, Femi Ajasa, said they became suspicious and alerted the police following the mass movements of the foreigners into the hotels since the outbreak of the Ebola virus. 

While commending the Area A Command for their swift response, which led to the arrest of the suspects, he said the residents suspected that some persons were receiving treatment in the hotels rooms, a development which made them alert authorities.