One of the great advantages of living and working in this kind of setting is that you get the best of both worlds. The Academy has a daily routine that helps the days away from friends and family to fly by but also life out here is always full of surprises to keep you on your toes and stop you getting bored.
At the moment one of those surprises is the confirmation of the spread of the deadly Ebola virus within Sierra Leone. It was only a matter of time before it arrived really, the border between Sierra Leone and Guinea (where the outbreak initially started in March) is regularly crossed for trade reasons, and to visit relatives displaced in the civil war.
Whilst the confirmed cases continue to be mainly in the East of the country on the border with Guinea and Liberia, it has made sense for us to put some precautions in place here at the Academy. The boys were less than impressed to miss the recent Leone Stars match at the national stadium but we just don't have access to that amount of hand sanitiser when in contact with thousands of people! One of the measures is to speed up an existing part of the plan for the medical side of the academy by organising a sick bay at the Academy. A sick bay has always been part of the plan here but up until this term we didn't have the room. The boys sleep in two large dormitories and aside from not being able to rest effectively when surrounding by 29 of your classmates, it has also meant general viruses spread really easily and are difficult to contain - creating more poorly boys for me to look after. By having sick boys away from the others it means they can recover quickly without exposing the other boys to their germs. In respect to the Ebola outbreak it also gives us an isolation area should we need it.
I'm not going to lie, the word 'Ebola' is absolutely terrifying, no matter how pragmatic you try to be. The virus itself is billed as one of mans most deadly. The outbreaks are hard to contain and the fatality rate is up to 90%. With no vaccine or cure, a virus like this can wipe out hundreds of people very quickly. With people contagious from the onset of symptoms (usually a non-visual symptom like a fever presents first) the virus is easily spread to several people before you realise how sick you really are.
It's extremely contagious with people picking it up in a number of ways:- contact with a victim/victims bodily fluids (either dead or alive.. ewwwww!) contact with contaminated services or by eating infected meat.. In a country where the basic hygiene levels are drastically reduced from the UK, it's not a pleasant thought.. plus there's the fact that to greet someone in Sierra Leone generally involves a prolonged hand shake and occasionally a back grab.. How do I not come across as a rude white girl if I refuse to shake hands, or if I cringe when I have no other option - it's an actual dilemma!
To get rid of it Ebola literally has to die with its victim; by isolating cases and providing no other hosts for it to spread, the virus is exterminated either by it's final victims recovering or by dying without spreading it to anyone else.
Ebola Facts:
- First appeared in 1976 in 2 simultaneous outbreaks in Sudan and Democratic Republic of Congo
- There are 5 different strains of the virus
- Fatality rate of up to 90% generally
- Fruit bats are a natural host for the virus
- There is no vaccine or cure
Symptoms-
- Begin 2 days - 3 weeks after contact with virus
- Initial - fever, headache, sore throat, muscle ache, fatigue
- Secondary - nausea, vomiting, diarrhoea
- Tertiary - internal and external bleeding, seizures, confusion, agitation
Transmission-
- contact with an infected animal including monkeys and bats
- contact with an infected persons bodily fluids (stools, vomit, sweat, blood) either directly or indirectly
- direct contact with a deceased victims body at a burial ceremony
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| Billboards around Freetown give people advice |
Sadly the health care workers probably contracted the virus before they were aware Ebola was around to contract and I would imagine infection control procedures have been increased across the country since then. Most fatalities in Sierra Leone have been recorded in the Kailahun area near the border. The main concern for the spread of the virus is the 'persistent reluctance among the infected to go to hospital' Doctors Without Borders has reported. I can imagine the fear is pretty strong and to present yourself at a hospital knowing you are going to be put into isolation is a pretty big thing. Plus the culture here is such that most people are kept at home and looked after by family members, sometimes even turning to local healers instead of doctors or healthcare clinics. The myths around Ebola are insane, the governments in Sierra Leone has had to issue official guidance confirming Ebola is not a curse and that ginger, honey, garlic, onion and vinegar mixtures do not cure it!
All of this adds up to the occasional moment of full-on paranoia for me, I'm not ashamed to admit. If any of the boys were to contract the virus I, and the physio would be well in the firing range as the person taking their temperature initially and looking after them while they are sick! My infection control standards are usually pretty good but I'm not sure if it's Ebola proof!
Add these moments of paranoia to my recently newly ingested source of Larium and it's literally nightmare central.. I've dreamt of some of the boys vomiting blood all over me (a delightful last stage of the Ebola virus prior to death) in minute detail, even down to organising for the transport to the nearest infection control centre and thinking of how to make the academy safe behind me. I've also dreamt I'm being chased by a particularly enthusiastic (read crazy) lady from Tombo who decided I was her new best friend the other week, or lover - I'm not entirely sure what she was so enthusiastic about but I do know it involved a lot of touching grabbing and kissing and resulted in me taking a pit stop at the nearest health clinic to thoroughly disinfect myself (Tom still made me pour pineapple flavoured vodka over me when we got to the beach - what a waste!!)
Of course the likelihood of anyone here contracting it is minuscule but with things like Ebola you never can be too careful. The risk is extremely low but the consequences would be devastating. Up to 90% of all confirmed cases of Ebola are fatal.
It really could not be worse timing for an Ebola outbreak in West Africa. With the onset of the rains the mosquitos are out in force (I can count 4 in my apartment as I write this) and high numbers of people will currently be falling victim to another african killer - Malaria. Malaria is of course highly treatable and in all areas of Salone I have visited tablets are easily available(no such thing as prescription pharmacies here, you can buy Malaria medicine from street-side stalls)
Both Malaria and Ebola start with similar symptoms which could lead to Ebola victims underestimating their condition until it's too late and they've spread the virus far and wide. Both start with a fever, headache, flu like aches and pains, nausea.. really until you are vomiting blood, have blood in your stools or are bleeding from orifices (eyes, nose, ears, mouth, etc... ) you can't really tell the difference or so I'm told.
So how do you know?! A Malaria test is really simple to do, a pinprick of blood will tell you (99% of the time - I've had several negative malaria tests despite having a raging infection of P.Falciparum - the nurse said sometimes a really high level of parasite will give a false negative, which is reassuring..!)and I regularly carry these out here.
But here's where it gets really tricky, if it's not malaria and it's Ebola you now have a potentially lethal blood sample on your hands (hopefully not literally as you should be wearing gloves at least!) From the sounds of things the hospitals are looking to rule out Ebola before they continue with other treatment which I guess could mean you find yourself in a really scary isolation ward with everyone in hazmat style gear for a few hours/days before being told not to worry you only have malaria and you can go home or being unfortunate enough to get really sick while waiting for them to rule out Ebola before they discover what is actually wrong with you.
You can sit here and go back and forth over the statistics, the risks, the concerns and drive yourself completely crazy - should we be in full lockdown mode? am I overreacting? should I still be here? The biggest concern for me initially was the lack of communication, the whispers and the rumours. having never come into contact with anything like this before it's pretty hard to make sure you don't get completely overwhelmed and lose all sense of perspective. What really it comes down to taking acceptable measures to make yourself feel safe and that's down to everyone as an individual. I plan on being extra careful with my own hygiene standards and making sure I am careful when dealing with sick boys - I had just started not worrying about taking hand sanitiser with me everywhere I go as well. At the moment I am not too concerned about heading into Freetown or out of the Academy as a) the virus hasn't been found nearby yet and b) I really don't intend on getting up close and personal with any sickly looking characters!
We aren't also going to get Ebola here at the Academy. I can pretty much guarantee that at the moment. The spread of the virus is by close contact, mainly amongst family members and we are so isolated out here the chances are practically non-existent. We would be pretty stupid not to take an outbreak of the virus seriously however and put in place simple measures to protect ourselves and the boys such as regular hand washing, no unnecessary trips to other regions, careful health monitoring etc. Of course getting 30 teenage boys to observe these new measures is going to be the true test of my patience!
So for the next few weeks/months you will find me gloved up, shakily monitoring boys temperatures and gingerly taking blood samples for malaria tests in the desperate hope that no one has a temperature of over 38.5 for three days or more with a negative malaria test result.. because then I'm really in the shit!
