DECEMBER 7, 2014: IN QUARANTINE
When we arrive at the school in the village of Tambiama, a few people stand in a dirt yard behind a strip of red and white quarantine tape.

Then, as a policeman and a soldier call to the rest, men, women, and children slowly file out—more than 40 people altogether. We’ve here, in northern Sierra Leone, to meet with the friends and neighbours of a woman from Tambiama who died from Ebola on November 14.

Today, when a local priest asks them how they feel, the villagers all say that they are fine; a few even break into a spontaneous dance to prove how healthy they are. If all goes well, they will be released from quarantine in a matter of days.

But for the moment, they have little to do. Asked how they feel about being in quarantine, the villagers murmur with dissatisfaction. James Koroma, a former teacher at the primary school, gestures to the village outside the quarantine tape, where people’s own houses are now off limits to them. Though I don’t speak his language, his meaning is clear: we don’t like being stuck in here.

Shekub Mansary, whose job is to trace contacts of people infected with Ebola, translates for Koroma: “They are not feeling good,” Mansary says. “They are not feeling good at all—there [is] no free movement for them.”

Quarantines have been a widely deployed tool in this outbreak, but they are a crude one, and it’s not clear how effective they have been.

Checkpoints line the road from the capital of Sierra Leone, Freetown, to Makeni, the big city near Tambiama. At every one, workers examine travellers for fevers.

Bombali district, which includes Tambiama, has been under quarantine since September. Only vehicles with special permissions can enter and leave. But there have been 877 Ebola cases reported here over the course of the outbreak, and one recent day—December 6—saw 11 new cases.

And though 1 million Sierra Leoneans now live in quarantined districts, that hasn’t stopped Ebola from traveling down roads and highways to infect new areas. People resent the quarantines, and sometimes resist them: residents of a village down the road from Tambiama fought off quarantine officers with machetes a few weeks ago.

Catherine Bolten, an anthropologist at the University of Notre Dame in Indiana, who has studied the ethnic history of the area, says it’s not hard to understand why people resist the quarantines—especially since there were problems early on guaranteeing that quarantined families got enough to eat.

“That’s a reasonable response under those conditions,” Bolten says. “You might or might not get Ebola, but you’d definitely know if you’re starving to death.”

Police patrol the quarantine line
Police help patrol the quarantine line in Tambiama, where a woman died of Ebola on November 14. Credit: Erika Check Hayden


DECEMBER 3, 2014: CLOSE TO HOME

Halima Shyllon
Halima Shyllon is the nurse matron of a new Ebola treatment center in Makeni. Credit: Erika Check Hayden


“From the back, from the back!” shouts Halima Shyllon, the nurse matron of a newly opened Ebola treatment center in Makeni. She and two workers are supervising doctor Moges Tadesse as he removes the hooded Tyvek suit that he’s been wearing to treat sick patients for the past hour.

Tadesse, standing in a bucket of bleach, pulls off the suit; his green scrubs underneath are drenched in sweat. Shyllon murmurs approval: “Good,” she says.

When it opened on November 24, this treatment center became the district’s first. Before, patients were sent elsewhere in the country, wherever there was a bed available. The prospect of being sent far away from their families—to cities such as Kenema, roughly 150 kilometers away—dissuaded people from reporting for treatment. The fear was well-founded: families often never saw or heard from such patients again, since many died in remote care facilities.

Now, families can follow the ambulance as it delivers the sick here. It’s hoped that this will convince more of those infected with Ebola to report for care earlier, while they have a better chance of surviving.

This center is run by the African Union and largely staffed by Africans: Shyllon works for Sierra Leone’s Ministry of Health, Tadesse is Ethiopian. There are Ugandan doctors on site and Nigerians arriving soon. There are 54 patients here today and room for 46 more.

One of those patients, Usman Fofanah, was so sick when he arrived here a few days ago that he doesn’t remember the journey from Port Loko, about 80 kilometres away. He had diarrhea, vomiting and pain in his feet and knees. He has lost his grandmother, an aunt and two sisters to Ebola. Still, today, Fofanah is smiling and feels much better—well enough to walk around the “dry” section of the treatment center. And yesterday, he was able to speak by phone to his mother, who had feared that he had died.

If Fofanah continues to improve, Shyllon and her staff will test his blood to find out whether it is free of Ebola virus; only then will Fofanah know if he’s been cured.

Moges Tadesse
Moges Tadesse is a doctor at the Ebola treatment center in Makeni. Credit: Erika Check Hayden


DECEMBER 2, 2014: THE TREATMENT GAP
In some ways life goes on as usual in northern Sierra Leone, despite the Ebola crisis. People in roadside villages between Freetown and Makeni, two current focal points of the epidemic, continue to gather around village water pumps, braid each other’s hair, wash their clothes in the river and hang them out to dry in front of mud-walled houses.

But it’s impossible to avoid the fact of the outbreak for long. Every few miles police or soldiers stop traffic at checkpoints and take each traveller’s temperature. People file out of minibuses, line up for officials wielding thermometers, and reboard their vehicles on the other side of the cordon. Posters describing the signs and symptoms of Ebola are pasted up on buildings and houses; schools are empty, their gates closed and classes cancelled.

Ebola survivor Abie Kanu prepares to leave a treatment center in Kerry Town, Sierra Leone. Credit: Erika Check Hayden


Then there are the clusters of white tents that rise at certain points along the road. Some, surrounded by mud walls, are community care centers—holding places for those suspected of having Ebola. Others, set farther apart from the villages, along large gravel roads, are treatment centers enclosed by chain-link fences.

One treatment facility, outside the city of Lunsar, sits near a fork in the road; the western branch leads to Port Loko, where Ebola transmission “remains persistent and intense,” the World Health Organization said on November 26. (Seventy-two new Ebola cases were reported in Port Loko during the week ending on November 23, according to the WHO.)

An Ebola treatment center near Lunsar opened two days ago,
but Sierra Leone still has more infected patients than beds.
Credit: Erika Check Hayden

The treatment center near Lunsar is run by the International Medical Corps and opened just two days ago; yesterday, six patients arrived. But there still are not enough treatment facilities for everyone who needs them in Sierra Leone. Although foreign governments, including the United Kingdom and China, have committed to construct new treatment centers in the country, progress is slow. Just 11 of the 700 additional treatment beds pledged by the United Kingdom in September were operational as of November 27, the charity Médecins Sans Frontières reported today.

Tomorrow, I’ll be visiting a town hit hard by Ebola to see how communities are coping with this lack of resources.

DECEMBER 1, 2014: MIXED SIGNALS
Arriving at an Ebola treatment center outside Sierra Leone’s capital, Freetown, I heard celebratory voices singing and clapping: three survivors of the disease were preparing to leave. Staff at the center in Kerry Town, which is run by the non-profit group Save the Children, presented the survivors with laminated certificates documenting their Ebola-free status. The patients looked wearied by their fight with Ebola, but they were going home.

As the ongoing Ebola outbreak approaches the one-year mark, there are signs of hope—such as these survivors. And the epidemic, which has claimed upwards of 5,600 lives, is finally stabilizing in Guinea, Liberia and parts of Sierra Leone, according to the World Health Organization. Health officials are congratulating themselves: “The global response has successfully turned this crisis around,” Anthony Banbury, head of the United Nations Mission for Emergency Ebola Response, told a press conference in Freetown today.

This map shows the distribution of new and probable Ebola cases reported by the World Health Organization on November 26. Credit: Erika Check Hayden


But the number of cases is still rising in some areas in Sierra Leone, including Freetown, and there are still not enough treatment beds for everyone who needs them in this country. Sierra Leone is still seeing hundreds of new cases a week; 385 were reported in the week ending November 23, WHO says. And although the three survivors left the treatment center in Kerry Town today, 20 Ebola patients stayed behind.

There’s no one reason why the epidemic is still growing in parts of Sierra Leone, but a contributing factor is the difficulty of convincing people who have never experienced the disease to change the way that they live their lives, care for the sick and bury the dead.

I’ve traveled to Sierra Leone to see how these factors are playing out on the ground—and what that means for the broader Ebola response.

Workers at the center prepare to don personal protective equipment. Credit: Erika Check Hayden

 

Smoke from an incinerator rises above Ebola wards in Kerry Town. To prevent the spread of the virus, the treatment center here burns its trash. Credit: Erika Check Hayden


This article is reproduced with permission and was first published on December 2, 2014.