7.3.a Ebola -Sierra Leone

Environmental

• Deforestation destroyed bat habitats and so they were forced to live closer to villages
• Bats lead to disease events as they can fly, easily migrate and can carry Ebola without the disease impacting the bat population

Human

• Lack of public spending led to underfunded hospitals, not enough doctors, damaged infrastructure and not enough medical equipment to deal with a large outbreak
• Cultural, tribal beliefs increased the spread due to lack of education, naivety without looking for professional, medical help
• There is a dense population within the villages
• Mis-information led to people being treated incorrectly as they were naive with poor communication
• No meetings or sharing of information
• Borders are extremely easy to cross with no fence or boundary (migration)

• $2.2 billion was lost in GDP of the 3 countries
• Loss in private sector growth, agricultural growth and cross-border trade
• Sierra Leone lost 7% of their healthcare workers
• Other diseases weren't given attention or treated such as HIV or malaria leading to an extra 10,600 deaths
• 20% of ebola was children under 15
• 17,300 children were orphaned
• Schools closed in 2014 losing 1,848 hours of education - 39 weeks of education
• A gap in vaccination programmes, decrease by 30%
• Response cost ACs $3.611 billion
• Screenings of 339,000 people - costs money and time
• Cost money to train up more healthcare workers

Contact tracing - direct

• 300 workers tracking ebola cases
• Tracking known cases to see who they have been in contact with
• Managed to find 2,500 contacts over 20 days
• Kailhun district - the region where most cases were

• Movement can be tracked
• Ensures early detection
• Allows immediate treatment
• Health workers were educated to protect themselves when going door-to-door

• There is a risk with going door-to-door with potentially infected people
• Difficult getting the ill to engage as they didn't want family and friends to be harrassed
• Only 39% of contacts had data on the addresses of those they have been in contact with due to poor infrastructure

WHO Radio - indirect

• Passed on key messages to the whole country
• Told to reduce traditional practices
• Encouraged the spread of the message to reach everyone

• Had a wide outreach
• Heard in workplaces for better sanitation practices
• Didn't risk contact with doctors risking their lives

• The message is easily changed when passed from person-to-person
• Many people didn't have radios - inequality
• Some were sceptical - especially the messages against traditional practices

117 Call Alert - indirect

• Phone alert system
• After the epidemic
• People could report deaths or suspicion if someone could be infected
• 350,000 calls over 2 years
• Calls could be geolocated to look at what areas needed the most help

• Allowed for reports without coming into contact with doctors
• Provided jobs for people receiving phone calls and geolocating them
• Quick to report and help

• Phone lines were very busy
• Required many workers
• Prank calls
• Not everyone has a phone - inequality

CDC (centre for disease control) - Infection Control - direct

• Aimed to train healthcare workers
• Created safeguarding techniques
• Checked 4 government hospitals for quality standards and their sanitation
• Trained 50 ministry of health staff

• Increased education on healthcare
• Increased professional response to the outbreak
• Checked and improved the healthcare already in place

• Very high cost
• Contact with potentially infected in hospitals which could've easily passed around the professionals
• Teaching wasn't always carried out correctly for everyone
• Very time consuming to train all the health care workers