An email from an NGO staffer in Sierra Leone who prefers to be anonymous:
It is an incredibly fast moving and changing situation, both with increases in cases, quarantined households and hotspots, and with the variety of responses being mounted by medical and non-medical actors. My impression from the past three days, attending meetings at WHO of the variety of actors, is that the case management is both uncoordinated and totally inadequate for the scale of the outbreak.
There are several teams of varying scale coming in from different countries over the next few weeks, some to staff existing centers (like the 165 Cubans) and some to develop full treatment centers (like the South Africans, in Freetown), but these will not be operational for several weeks at least.
Today I heard that the much-hailed 60-bed treatment center out in Kerry Town (in Western Area Rural) which is being built by DFID will not be ready for 6-8 weeks, and Save the Children has not made their final decision on whether they will run it or not. The treatment center at Connaught, in central Freetown, has 13 beds and is always full. There are small treatment centers for example at Macauley Street in central Freetown (6 beds) and out in Newton in Western Area Rural.
But due to lack of beds, there is a growing list of houses which are quarantined, with one person sick but 15+ people living in that house also quarantined.
Cases from Freetown are not being sent to Kailahun anymore. I am not an expert in infectious disease, but I do not see how the response can possibly control the outbreak unless there is a serious shift in the scale and the way things are coordinated.
Several days ago I heard one medical-NGO representative say they were anticipating surges of cases this week, and with the 3-day sensitization campaign taking place Friday - Sunday, and they anticipate their treatment center being overwhelmed. MOHS has stated they expect a 15% increase in identified cases due the campaign, though I don't know what that estimate is based on.
Preparations for this 3-day campaign seem confused and uncoordinated. NGOs were asked to submit lists of Community Health Workers they work with on Tuesday, but today we learned that the DHMT is not using these lists, and will instead select/have selected (again, unclear) from amongst the youth (which are 18 - 35 yo in SL).
CHWs, who have been trained both on basic health danger signs and specifically on Ebola signs by NGOs, are disgruntled and some are blaming NGOs for not putting their names forward. There is an incentive of Le 20,000/day which obviously people want, alongside the status of being chosen .
It remains unclear who will make up the 7,136 teams of four people, and if they will have been trained. Local staff told me that out in Waterloo they observed the training going on, but supposed participants still being registered outside.
Local staff also tell me of fear in their communities about the 3-day campaign, "even from reputable, educated people". There are rumors of the teams bringing poison medicine, of the soap they distribute being poison, and of the water from Guma Valley being poisoned. There are also rumors that the food WFP brings to quarantined houses is poisoned, and a local staff member told me of a quarantined household near her which is refusing to take the WFP food. My thought was that I was amazed WFP was actually bringing food!
This is in Freetown - who knows what kinds of rumors have taken hold upcountry.
Local staff tell me there is concern amongst people about prisons becoming a site of further cases, as, with a rising crime rate, more prisoners are being put into central prisons, and there is no isolation facilities in the prisons.
Local staff have told me that in the rural areas people run away as soon as they hear a car, afraid that someone will come and take their blood, remove them to a treatment facility, give them poison, etc. They run especially if they see a white person in the car. Hopefully these concerns are being taken into account for the 3 day campaign.
With all that said, life continues on as normal here, and I feel no threat to my safety or security. ... But local people are subdued, serious, and scared, no one is shaking hands and people wash their hands and get their temperature taken before entering most places.
I do not know if this 3-day stay-at-home campaign will change things, what they will do with the cases they find, or what the teams will do when they find whole villages empty because people are hiding in the bush.
I look forward to more such emails.