In Sierra Leone, A Lockdown ... Or A Time To Reflect?
Starting just after midnight, residents of Sierra Leone will be confined to their homes for a three-day lockdown.
It's the latest government plan meant to stem the tide of Ebola cases, which exceeded 1,500 last week in Sierra Leone.
But the plan has not won the support of the international medical community — and is causing concern among Sierra Leoneans as well.
"Everyone is rushing to the markets and stores to stock up on food to get ready for these three days, when they're not going to be allowed to leave their houses," says NPR's Anders Kelto, reporting from Freetown, the capital city.
Stephen Gaojia, head of the Ebola Emergency Operations Center in Sierra Leone, bristles at the word "lockdown." He says 28,000 volunteers have been recruited and trained to go door-to-door throughout the country, educating families about Ebola.
Earlier this month, the government's health ministry said it would actively seek out Ebola patients, but now it says it won't. "This process is not a lockdown, neither is it a shutdown, neither is it a root-out exercise," Gaojia told All Things Considered Wednesday. "This is more a psycho-educational exercise."
Shoppers in Freetown stock up on supplies before a countrywide lockdown starts on Friday.
Instead, Gaojia says, it's a time for people to "stay together to do some reflection, engage in prayer, generate some kind of family discussion about Ebola."
A press release from the Emergency Operations Center called it a "house-to-house Ebola talk," or "Ose to Ose Ebola Tok" in Krio, a local language.
"We want to help rebuild public confidence and trust in the public health care system," Gaojia says.
International medical professionals think the plan could backfire.
"Large scale coercive measures like forced quarantines and lockdowns are driving people underground and jeopardizing the trust between people and health providers," Doctors Without Borders said in a statement earlier this month, when the government first announced its plans. "This is leading to the concealment of cases and is pushing the sick away from health systems."
In response to such criticism, Gaojia says, "The risk of doing nothing far outweighs the risk of doing something."
But a quarantine in a Liberian slum neighborhood in August led to violence and riots.
And, says Doctors Without Borders in their statement: "Without enough beds to treat patients who have Ebola we will fail to stop it spreading even further. What Sierra Leone and Liberia urgently need are more beds in case management centers, and they need them now."
Gaojia says the Emergency Operations Center estimates the country will see a "surge of about 15 to 20 percent of the cases that we have had ... anywhere between 200 or more nationwide."
But even with a new Red Cross facility in Kenema, the country's third largest city, there aren't enough beds at treatment centers. Instead, there are holding centers, which many people view as places where suspected Ebola patients go to die alone.
"These holding centers are very bare bones," says Kelto. "They don't have IVs, they don't have saline solution to keep people hydrated, they don't have medicine to treat diarrhea or to stop vomiting. So essentially it's no different than just lying at home in your own bed."
In the meantime, the prospect of a lockdown has caused a spike in food prices in Freetown. "Everything is so expensive, double the price," says Miriam Kallom, a shopper in Freetown. That's a problem in one of the world's poorest countries, where many live on day-to-day wages.
The health ministry plans to send over 7,000 teams of four people each to go door-to-door throughout Sierra Leone "to disseminate information on Ebola virus and enlist family and community support to participate in the response process." Gaojia says. Each team will include a healthcare worker, community volunteer "and possibly a youth within the community."
Gaojia says that they will be "using an encouragement approach," telling people who may be ill or who have ill family members to call a hotline so a rapid response team can transport them to a holding center, where they can be tested for Ebola.
"Military people, police and soldiers are not the face of this campaign at all," says Gaojia. "Of course, the police and military will be in readiness in the event of any lawlessness."
The volunteer teams are set to work between 7 a.m. and 6 p.m. In the evening, people will be able to move three to four doors from their homes. Vehicular movement will still be restricted.
"We don't expect [Sierra Leoneans] to refuse," Sidie Yahya Tunis, communications director for the health ministry of Sierra Leone, told the BBC earlier this month. "You follow or else you'll be breaking the law. If you disobey then you are disobeying the president."
Initially, the plan was for the volunteer teams to reach every single house in the country of 6 million. Now, their aim is to visit 1.5 million households, each of which will get a bar of soap.
The only protective equipment the volunteers will carry, Gaojia says, is rain gear.
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Transcript
ROBERT SIEGEL, HOST:
Sierra Leone has decreed that starting tomorrow, residents of the entire country will be told to stay in their homes for three days. Teams of health workers and community volunteers will go door to door to educate people and identify those infected with the Ebola virus. The nongovernmental organization Doctors Without Borders has raised concerns. They say this plan might cause mistrust of health workers. But the head of Sierra Leone's Ebola Emergency Operation Center, Stephen Gaojia, dismissed those concerns. He described the next three days to me as a psycho-educational exercise.
STEPHEN GAOJIA: This process is not a lockdown, neither is it a shutdown - neither is it a root-out exercise.
SIEGEL: But - you say it's not a lockdown or a shutdown, but aren't people, in fact, told to stay indoors, with police and soldiers enforcing that instruction?
GAOJIA: Of course, the police and the military will be in readiness in the event of any lawlessness. But this is by no means an exercise by the police or the military or the (inaudible) sector to root out people. That is by no means an exercise.
SIEGEL: Yeah.
GAOJIA: Yes, go ahead.
SIEGEL: Yes. So even if I'm visited first thing in the morning on Friday, I should still stay in through Sunday, is what you're saying.
GAOJIA: Well, of course because the simple reason is that the families have to stay together to do some reflection, engage in prayer and generate a kind of family discussion about Ebola.
SIEGEL: So that's what Sierra Leone's government says it hopes will happen in the next three days - prayer, reflection and discussion. I asked Stephen Gaojia, what will happen if health care workers discover suspected Ebola victims in the homes they visit? And he said patients will be encouraged to call an ambulance to go to a treatment center. NPR reporter Anders Kelto is on the line now from the capital of Sierra Leone, Freetown, to talk about treatment options. And Stephen Gaojia talked about holding centers the government has created all over the country. He said patients can begin receiving therapy there while awaiting transfer to a treatment center. What do you know about these holding centers?
ANDERS KELTO, BYLINE: Well, I'm hearing something a little different here on the ground. These holding centers are very bare-bones. They're basically beds where people can go and sort of lie there and be sick, just like they would at home. They don't have IDs. They don't have saline solution to keep people hydrated. They don't have medicine to treat diarrhea or to stop vomiting. So essentially, it's no different than just lying at home in your own bed.
SIEGEL: Anders, tell us how people are preparing for these next three days in Sierra Leone, when they're supposed to stay at home.
KELTO: Yeah, well, we actually just got back to our hotel after sitting in gridlock traffic for over an hour. Everyone is rushing to the markets and the stores to stock up on foods, to get ready for these three days when they're not going to be allowed to leave their houses. But in the sort of bustling heart of the city - we went down to a market, an open-air market. That was absolutely jam-packed, people everywhere. And I spoke with a woman named Miriam Kalom (ph) who told me she was really upset that this lockdown was leading to pretty severe price inflation.
MIRIAM KALOM: Everything is so expensive
KELTO: It's, like, a lot more expensive than usual.
KALOM: Yes, everything expensive today, then double, double, double the price.
KELTO: And she was also concerned that with all these people in the market, where they're sweating and packed closely together, that Ebola might actually be spread around there. And she was scared to go in and buy the food that she needed for the next few days. So to her, it felt like this whole lockdown strategy might even be making the situation worse.
SIEGEL: Her fears are obviously real. Are they, in fact, justified? Can one contract Ebola that way?
KELTO: It's very unlikely that she would contract Ebola that way. But I think the lesson here is that this lockdown is creating even more confusion. People are told not to go into crowded areas, not to have physical contact with other people. And yet, here in this crowded market, that's exactly what was happening.
SIEGEL: Anders, thank you.
KELTO: Thanks, Robert. Transcript provided by NPR, Copyright NPR.
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