Freetown, Sierra Leone: The dreaded Ebola virus came to the children’s hospital in the form of a 4-year-old boy.
His diagnosis became clear three days after he was admitted. The Ola During hospital — the nation’s only paediatric centre — was forced to close its steel gates. Fear swelled. The boy died. The 30 doctors and nurses who had contact with him were placed in quarantine, forced to nervously wait out the 21 days it can take for the virus to emerge. And remaining staff so far have refused to return to work. They, along with millions of others, are facing the worst Ebola outbreak in history. Already, the hardest-hit West African nations of Guinea, Liberia and Sierra Leone have reported more than 3,000 cases, including the infections of 240 health-care workers.
Ebola is now spreading from the remote provinces and into the teeming cities such as Freetown, where 1.2 million people jostle for space. Previous outbreaks had been limited to remote villages, where containment was aided by geography. The thought of Ebola taking hold in a major city such as Freetown or Monrovia, Liberia’s capital, is a virological nightmare. Last week, the World Health Organisation warned that the number of cases could hit 20,000 in West Africa.
“We have never had this kind of experience with Ebola before,” David Nabarro, coordinator of the new UN Ebola effort, said as he toured Freetown last week. “When it gets into the cities, then it takes on another dimension.”
The haemorrhagic fever has no cure. Odds of survival stand at about 50-50. Detection is difficult because early symptoms are hard to distinguish from those of malaria or typhoid, common ailments during the rainy season. While Ebola is not transmitted through the air like the flu, it does spread by close contact with bodily fluids such as blood, saliva and sweat — even something as innocent as a tainted tear.
Now it is headed to Freetown, where the streets hum with low-level panic. People long ago stopped shaking hands. Hugs are unheard of. Plastic buckets filled with a diluted chlorine solution are posted outside many businesses to encourage hand-washing. Some of these homemade solutions tingle and burn; others smell like aromatic cleansers. For a while, street peddlers, who normally sell peanuts or umbrellas from stacks balanced on their hands, sold surgical gloves, $1 each.
But the roads are still crammed with autos and people, stray dogs and wild chickens. Trucks with loudspeakers rumble down rutted roads. ”Wash your hands!” they announce in Krio. “Ebola is real!” shout banners strung throughout the city. Radio ads detail the virus’ symptoms: headache, fever, nausea and vomiting. The government of Sierra Leone has been running these messages in the capital for months, just in case.
Sierra Leone’s first case appeared in late May, in the distant Kailahun district. A month later, the country had 158 total cases. In late July, it was up to 533 cases. A national state of emergency was declared. Soldiers erected roadblocks to cordon off the rural epicentre, raising memories of the country’s brutal civil war, which ended in 2002. Residents were ordered to stay at home for one day of prayer and reflection. An evangelist texted tens of thousands of people before dawn one morning, telling them to douse themselves in saltwater for protection from Ebola. People rushed into the streets, singing and washing.
Laws to limit close contact
“It looked like panic,” said Killian Doherty, an Irish architect living in Freetown. “It’s the kind of thing that makes you lose your bearings.”
The government has passed laws to limit close contact, altering the city’s daily rhythms. Riders in the city’s many “Poda Poda” minibuses, usually packed shoulder to shoulder, are now curtailed to four people per row. “Okara” taxi motorbikes are restricted at night. Even banks have cut hours to limit time spent in their crowded lobbies. And large public gatherings have been outlawed. The small cinemas where patrons would pay to watch foreign soccer matches on TVs have been shuttered. The popular clubs along Freetown’s Atlantic Ocean beaches are now empty.
Recently, a group of 12 men sat on benches under palm trees along Lumley Beach. Technically, this was illegal. The men all knew about Ebola, even reciting how the virus got its name from a Congolese river near where the first outbreak was discovered in 1976. Still, they didn’t know what to think of this strange disease. This country, where doctors are few and over half the population lives in poverty, knows plenty about malaria and cholera and even Lassa fever, a more forgiving haemorrhagic fever spread by rats. But Ebola was new to Sierra Leone.
“I don’t believe 100 per cent that Ebola is real,” said Moses Sensie, 32, who works in security for a construction company. The movies he has seen about the virus show victims bleeding out in the disease’s last stages. He hasn’t heard about that happening now, and experts acknowledge haemorrhages in this outbreak have been rare. “I believe in Ebola maybe 60 per cent.”
But Anthony Jimmy, 30, was not taking chances. He times his commute to work on the Poda Podas so they are less crowded. He avoids people who look ill. But, he said, the worry was exhausting.
“People are fed up with the situation,” Jimmy said.
Many of the people who can afford to leave Freetown are gone — some on vacation, others to foreign countries to wait out the virus. But getting out has become harder as several airlines have stopped flying to Lungi International Airport. Air France, under orders from the French government, became the latest last week. The nation’s school year is supposed to begin on September 9, but few expect that date to hold.
At the Lighthouse Hotel, the usual executives from the mining, pharmaceutical and banking industries are absent. The hotel is running at 15 per cent occupancy, said general manager Andrew Damoah. He is barely able to cover the cost of gas for the hotel’s generator — a necessity in a country with a shaky power grid. Most of his guests now are the international doctors and nurses responding to the outbreak.
“We are all running empty hotels,” Damoah said.
The city’s hospitals are empty, too. People avoid them over worries about catching Ebola. They would rather suffer at home and hope that what they have is just a mild case of malaria. It is not an unreasonable concern. The Kenema government hospital in the provinces has seen 40 staff members die of Ebola.
