The Ebola epidemic has been acknowledged as a serious international threat, but the efficacy of measures required to contain the outbreak remains debatable. This is due to the lack of resources in the most affected West African countries: Sierra Leone, Guinea and Liberia.
In a drastic attempt to stem the outbreak and limit the spread of the virus, the Sierra Leone government, headed by President Ernest Bai Koroma, initiated a three-day national lockdown from Sept. 19 to Sept. 21, during which a population of six million people was ordered to stay indoors. Commercial activity was suspended and the streets were mostly empty. During this three-day period, police officers, soldiers and nearly 30,000 volunteers were mobilized to disseminate life-saving messages and to discern unreported cases of Ebola victims in every residence they encountered.
Authorities declared the lockdown a success, based on the discovery of 130 new cases in this unprecedented effort to conduct nationwide reconnaissance. The results of the survey proved to be alarming, prompting Koroma to declare an extensive quarantine over more than a quarter of the country on Sept. 25. As of now, almost all of the country’s 14 districts have been placed under complete or partial quarantine. To minimize the further spread of the virus, the Sierra Leone government has also restricted travel through quarantined areas from nine a.m. to five p.m., ordering passengers to remain in their vehicles during their transit.
The Sierra Leone government is determined to quarantine large swaths of the country for an undetermined period of time. Yet, the effectiveness of quarantine on a scale as large has been exercised in Sierra Leone is disputable. During the three-day national lockdown, volunteers, going from door to door to provide residents with information about the virus, were amazed to find individuals, supposedly under quarantine, unguarded and free to leave the designated area.
The breach of quarantine may be simply attributed to negligence, and its lax enforcement may be ascribed to the lack of infrastructure in the Sierra Leone government’s efforts to vanquish the virus. International aid in the form of military troops may end up being the solution to the insufficient enforcement of quarantine. However, Clementine Fu, a doctoral student in epidemiology at the Bloomberg School of Public Health, is doubtful that the use of soldiers is the answer.
“A ‘successful’ quarantine necessitates individual adherence to guidelines, which comes with behavior change not military force,” Fu wrote in an email to The News-Letter.
Fu was one of two doctoral students at the Bloomberg School to conduct an evaluative study of the response to the Ebola public health crisis. From July 19 to Aug. 1, commissioned by the International Federation of Red Cross and Red Crescent Societies (IFRC), they investigated the social mobilization movements at Conakry, Guinea and Guéckédou, the outbreak’s initial epicenter. Their interviews with community members and keyresentatives of various health organizations allowed them to divine the cruciality of community-centered behavioral change in the efforts to stem the Ebola outbreak.
“A quarantine,” Fu wrote, “may have clinical outcomes which appear immediately successful on the surface, but incur social consequences to the detriment of the long-term response.” Instead of relying on the promised presence of foreign groups on the ground to enforce quarantine, West African governments would be able to far more effectively curtail the virus by promoting social mobilization (SM) and behavior change communication (BCC) activities in both affected and unaffected communities.
The deficiency in resources, particularly the lack of treatment centers devoted to Ebola patients, must be immediately addressed. “There simply aren’t enough financial or human resources available to maintain this type of comprehensive coverage,” Fu wrote, so it is of the greatest importance that the transmission be hampered by outreach to communities ahead of the disease.
In July, as Fu reports, the Croix-Rouge Guinéenne (Guinean Red Cross) expanded its outreach operations to unaffected communities, educating the community through SM activities and building rapport with community leaders to establish trust.
The implementation of similar proceedings in Sierra Leone and other countries struggling with the Ebola outbreak would offer an alternative strategy that may yield a better outcome than to simply play catch-up. According to the recent report by World Health Organization on September 25, at least 2,909 people have succumbed to Ebola in Sierra Leone, Guinea, and Liberia, with an additional 6,242 reported cases of Ebola overall. A stratagem concentrated on the construction of trust and communication with communities may help reduce the impact of the Ebola outbreak.
