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Shaken by Ebola setback, Sierra Leone probes health system's readiness

Building a better path to progress

The World Health Organization confirmed a new case of Ebola in Sierra Leone Thursday, the second since West Africa celebrated the end of the epidemic last week.

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    A woman has her temperature taken as part of Ebola prevention, prior to entering the Macauley government hospital in Freetown, Sierra Leone, Thursday, Jan. 21, 2016. A second case of Ebola emerged in Sierra Leone after health officials thought the epidemic was over, with a close relative of the first victim testing positive for the virus that has killed more than 11,000 people, authorities said Thursday.
    Aurelie Marrier d'Unienville/AP
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The story of Marie Jalloh’s death weeks ago sounds like it was plucked straight from the earliest days of Sierra Leone’s 2014 Ebola outbreak. In early January, family members brought the young woman to the government hospital in the northern town of Magburaka. A nurse without protective clothing took a blood sample, and later, Ms. Jalloh was discharged.

Only days later, after her death and traditional burial, did health officials confirm: she had died of Ebola, and in the course of her sickness had put dozens of others at grave risk.

More than 100 people were quickly quarantined, and on Thursday – exactly a week after the global health community triumphantly declared an end to West Africa’s Ebola outbreak – health officials announced that Jalloh’s aunt, who had cared for and helped bury her niece, had tested positive as well.

The sudden resurgence of Ebola in Sierra Leone has rekindled concerns here that, despite promises to the contrary, the public health care system remains vastly underprepared to safely manage new flare-ups of the virus, which public health experts say are likely to continue for at least several months. Shortly after Jalloh’s death was announced last week, a group of young people stormed the hospital where she was treated, demanding the doctors and nurses be held accountable for their negligence.

But the tragedy has also prompted an important question of the global health community. Why, after two years of intense international scrutiny and aid, does Sierra Leone’s health care system still remain seemingly unable to stand on its own to fight Ebola?

The answer, in part, lies in the strategies the world initially employed and the decline of international attention that left Sierra Leone to struggle on its own. 

“If we were able to stop this epidemic, it was not because we rebuilt the public health systems in West Africa,” wrote Nahid Bhadelia, director of Infection Control at National Emerging Infectious Diseases Laboratory, in a recent post on NPR’s Goats & Soda blog, “but because massive resources were poured into immediate response and heightened surveillance, with an immense amount of education and policies that echoed wartime precautions, like roadblocks that restricted the movement of entire countries.” 

The world steps in

As the Ebola outbreak picked up momentum in mid-2014, international health charities like Doctors Without Borders, the Red Cross, and others were welcomed gratefully into Sierra Leone to supplement a health system hobbled by decades of neglect during the country’s civil war and its aftermath.

Almost overnight, these groups began to construct massive complexes of tarp and tin across the country – vast, temporary treatment facilities.

“The outbreak of Ebola actually drew the attention of the international community in terms of [the need for] strengthening or building the health sector in this country,” says Yusuf Kabba, president of the Sierra Leone Association of Ebola Survivors. Among the major gains, he says, were ambulances to carry patients, which most hospitals in the country had lacked.

Meanwhile, as the epidemic neared its apparent end last year, many of the temporary treatment centers and checkpoints around the country abruptly closed, leaving Sierra Leoneans – among them Ebola survivors facing ongoing health problems – once again reliant on the overtaxed public system for care. Mr. Kabba says it quickly became apparent that local hospitals and clinics were still not equipped to handle the burden.

'Something like this could happen again'

Today, Sierra Leone’s Ministry of Health admits the winding down of international attention has left his country struggling to shoulder the responsibility of keeping the outbreak from re-emerging. Sidie Yahya Tunis, director of communications for the ministry, says the response to the latest cases had been a “bit slow.”

At the same time, the ministry has significant resources at its disposal that were nearly unthinkable at the beginning of the epidemic two years ago. Earlier this week, for instance, health officials announced that they had begun, with some difficulty, a vaccination campaign for all those who came into contact with Jalloh before her death. The officials used a a Canadian vaccine, VSV-EBOV, that proved largely successful in trials last year.

Still, the ongoing challenges to Sierra Leone’s health care system is a canary in the coal mine for the global public health community, says Axelle Ronsse, an Ebola emergency response coordinator for Doctors Without Borders.

“People are more sensitized now," she says. "But I’m afraid if we don’t strengthen the health system, something like this could happen again – in West Africa or somewhere else with the same level of facilities."

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