Consequences of an epidemic

Geri Jeffery and I wait as the Facetime connection on her laptop once again reconnects. The sound and video of her friend on the other side of the screen, Patrick Sesay, is delayed by the more than 6,600 miles between Maple Valley and Makeni, Sierra Leone, as well as a tenuous satellite connection. Sesay’s bald head reappears, his smile and excitable response making Jeffery laugh. He is full of life, despite the somber subject at hand — the state of his country.

Families of Ebola infected patients are quarantined for 21 days.

The following is written by Covington reporter Eric Mandel:

Geri Jeffery and I wait as the Facetime connection on her laptop once again reconnects. The sound and video of her friend on the other side of the screen, Patrick Sesay, is delayed by the more than 6,600 miles between Maple Valley and Makeni, Sierra Leone, as well as a tenuous satellite connection. Sesay’s bald head reappears, his smile and excitable response making Jeffery laugh. He is full of life, despite the somber subject at hand — the state of his country.

I’m asking Sesay about the death of his friends and neighbors and optimism is decidedly scarce. The city’s confirmed deaths have risen to 547, the number of quarantines up 170 — 40 more than in September — and, yesterday, they ran out of chlorine, which is needed for both safety and continued education about necessary hygiene protocols.

From an iPad mounted inside Makeni’s Bridge of Hope compound, Sesay says the people of Makeni are desperate. Even more so than usual.“We are getting help and we need more help,” Sesay says. “In normal cases people are struggling. We have nothing to start with. We desperately need help.”

Even before the Ebola outbreak, which is estimated to have killed nearly 5,000 of the more than 13,500 infected West Africans in eight countries, the people of Makeni, and much of Sierra Leone, lived in hardship. The country was beginning to recover from a nearly 11-year long civil war that ended in 2002. On the best of days, the West African nation of six million suffers from immense healthcare issues that include HIV/AIDS, malaria, tuberculosis, Lassa fever and one of the highest maternal mortality rates in the world.

All of these issues still remain, which means while the people of Sierra Leone, Guinea and Liberia are currently just fighting to survive, there will be far reaching consequences to the Ebola epidemic beyond the final body count.

“Our normal effort is to help rebuild up after the wars they went through,” says Jeffery, Executive Director of The Bridge of Hope, a nonprofit organization in Maple Valley that has been providing aid in Sierra Leone since 2006. “Now it’s become just an effort of relief, educate and feed.”The Bridge of Hope is among the many non-governmental agencies around the country attempting to provide aid to the region from afar. Volunteers from the Maple Valley organization, which started with mission work, typically make three trips per year to Sierra Leone. The volunteers have helped build schools, provided micro-loans for businesses like bakeries and barber shops, have planted churches, and are building medical and dental programs.But, after the Ebola concerns mounted, the group cancelled its last scheduled trip in April.

“We are not equipped to be there,” Jeffery says. “We’re kind of just trying to see what happens; we may send a couple of our leaders early next year. We are trying to be wise… We don’t want to bring anything back to the states. We need to do the best we can from here.”

Despite the panic and concern, talking with “Mama Geri” seems to help Sesay, the accountant and a team lead for The Bridge of Hope in MaKeni. Even if just a little.

He knows it’s too dangerous for Jeffery and the other volunteers with The Bridge of Hope to come and visit, but realizes they are still making plans for aid. Heck, she brought a newspaper reporter: maybe he can get the word out.

“Life is not ok compared to what it looked like before,” Sesay tells me over Facetime. “It’s really ravaging our country. Things have come to a halt.”“People in Makeni desperately need help, please,” he adds, pleading.

A spreading problem

While health and aid workers from around the globe work to stop the epidemic at the source, the United States response to the spread of Ebola has been decidedly fickle, with politicians and a public pressure pushing for mandatory quarantines of returning health care workers who are not showing any symptoms of the virus, while the President has spoken out against automatic quarantines and denounced the media for “stirring up panic.”Dr. Elizabeth Wheeler, Chief Medical Officer for Tacoma General and Allenmore Hospitals said clinically mandatory quarantines for aid workers are not warranted.

“We know about the illness that we know it is not going to be spread unless someone is symptomatic,” Wheeler said. “Most people would say, ‘better safe than sorry’ and if I was a physician who went to Africa I probably would volunteer myself. But clinically, it’s not necessary.”Ebola is a provocative and, ultimately, terrifying disease with no known cure. While, from America, it may seem easy to consider cutting West Africa off from the rest of the world, Jeffery sees this is a worldwide problem, especially if the virus were to become endemic — e.g. like malaria that could always pop back up. Both Jeffery  and Wheeler said the silver lining to the media onslaught and public fear is that it woke people up to the problem.

“It’s too often that people look it at it is an African problem,” she said. “If we don’t stop it there, we will continue to risk here.”“Everyone is nervous, and rightfully so,” Wheeler said. “If the disease is not contained in West Africa, if it grows and spreads, we will probably see more cases here.”

Protocols set around King County

Ebola is not airborne and, therefore, extremely difficult to catch, especially in medically advanced countries like America.But, in the wake of the mishandling of an Ebola patient in Dallas, the Centers for Disease Control has recommended that every medical center in the country to update and prepare policies and procedures.

Wheeler said she is confident about the new screening process, which involves three key questions related to a patient’s symptoms, travel history and whether he or she has been in contact with an Ebola patient – or contact with a person who has had contact with a patient.

Two out of three affirmative automatically triggers a call to incident command and isolation of the patient.

Wheeler said all front line staff — doctors, nurses and front desk staff —in every urgent care, emergency department and primary care office in the Multicare system have been or are being trained in the protocols, which have been directly modeled after Atlanta’s Emory Hospital infectious disease unit.

Wheeler said everyone was able to learn from the mistakes at Texas Presbyterian.

“Texas, unfortunately, it’s terrible that that happened,” she said. “A couple months ago that could have been any hospital in the United States, honestly.”

Wheeler said drills are being prepared for physicians and ICU nurses. Wheeler acknowledged that the Ebola craze is taking a lot of time, but, much like was the case during the HIV outbreak in the ‘80s, good standard protocols are being formed.

“It’s a useful exercise even if we never have to utilize it,” she said. “We’re learning something. That’s good.”

In early October, Harborview Medical Center announced that it would voluntarily accept American Ebola patients who are airlifted from West Africa.Wheeler said Tacoma General is one of several hospitals across the state establishing a treatment center on site.

Each clinic is to have identified an isolation room and is trained to use Personal Protective Equipment (PPE). The county has identified specific EMS rigs that would transfer the patient to the Tacoma General campus. Wheeler said the governor’s long-term plan is to establish six to seven hospitals across the state that could care for a patient with this kind of infectious disease.

East Pierce Fire and Rescue officials sent a press release saying they are prepared on multiple fronts to ensure that the department can properly respond to potential Ebola-infected patients.

“The complexity of dealing with Ebola, magnified by public fear, requires that we address the issue at the county and regional level,” said Assistant Chief Russ McCallion in the release.

But McCallion warns people against fearing Ebola in the US. He recommends that the public take precautions to protect themselves from the more common threat of the seasonal flu.

“So far, one person in the U.S. has died of Ebola, while flu-related complications kill thousands of Americans every season,” he said.

Emotional Cost

It’s difficult for Jeffery to keep from crying when discussing the rising death toll related to those she knows and cares for. If Sesay and the others were truly her kids, she would want someone else to care.

“They’re living through hell right now,” she said. “It wasn’t good to begin with.”

Jeffery speaks with her African team over Facetime a couple times each month and almost daily via email. Makeni, which has a population of 112,000, making it one of Sierra Leone’s largest cities, is a sparsely educated area that was quickly decimated in a fashion becoming common in the region.According to a New York Times article, Bombali, the district that includes Makeni, went from one confirmed case on Aug. 15 to more than 190 by Oct. 1.Sesay said sick individuals from neighboring cities of Kenema and Kailahun brought the disease.

With a culture based on eating off one plate, sharing spoons and cups, the virus quickly and quietly wipes out families and circulates through the city.

Officials banned public gatherings and closed the marketplaces. The city is isolated, with food coming in, but nobody going out.Those with infected family members are quarantined to their house. When released, these people have nothing left to eat and no place to work.Livelihood is secondary to survival.

Sesay said another of Makeni’s health care workers became infected with Ebola over the weekend. Four have already died. He couldn’t say how many doctors and nurses were in the city, but said medical teams from England are helping contain the situation.On top of the dire health needs, border closures and travel bans have stifled trade possibilities and investors in West Africa, with major potential hits to the country’s agriculture and mining operations.

Besides an impending food crisis for its residents, cocoa production is another major area of concern, as 70 percent of the world’s global cocoa supply comes from West Africa — 60 percent from Ghana and The Ivory Coast, which could be threatened if the virus continues to spread. The International Monetary Fund has reduced growth projections for the region. The World Bank has estimated that the outbreak has already cost each of the three countries upwards of $100 million and could cost the West African economy between $1.6 and $32 billion in 2015, depending on how successfully the virus is contained.

Tourism in Africa is also being decimated, with hotel bookings reportedly down 65 percent in Gambia, a nation near Sengal’s border with Guinea.Sesay said, even in a best-case scenario, the country will not soon see its version of normalcy. For those who survive, the fix will be gradual.“It will not happen automatically,” he said.

How to Help

Sesay said many in his city did not trust health care workers and didn’t believe in Ebola until they started seeing the death firsthand. Since then, he sees some positive signs: with people learning to follow basic hygiene protocols and changing the ritual for burying the dead — a practice that has led to countless infections around the region.

“The real problem now is to implement what has been told,” Sesay said.

The Bridge of Hope is involved in a “Rice Bucket Challenge” fundraising, with 100 percent of the profits going toward food, water, gasoline, medical supplies and vehicles that can be used in the relief effort. The organization plans to send a shipping container that includes a donated aid vehicle by the end of the year.

Jeffery said the ability to get and pay for food is devastating, fearing thousands will die from starvation and malnutrition.

And, once the camera’s turn away to the next disaster, those who love West Africa will be the only ones left to pick up the pieces.

“This is just going to bring them way back again,” Jeffery said.


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