Ebola blog: Inside a care community centre
Today I visited four of our Community Care Centres (CCCs) in Port Loko: Lunsar, Foredugu, Kamasondo and Kagbantama.
Plan International runs five CCCs in Port Loko, and also supports a holding centre and the government-run hospital. Our role is to manage the centres, ensure delivery of medical and non-medical supplies, and provide meals to both staff and patients. Other partners contribute in areas such as staffing, construction and by providing specialist clinical knowledge.
Community Care Centres in action
The first centre I saw was in Lunsar, where I met Alfred, the centre supervisor. He explained how it all works. Usually patients suspected of having Ebola arrive by ambulance and enter triage, which has two areas – one where patients enter and one for them to be assessed. These are separated by a 1.5m buffer zone to ensure a safe distance is maintained.
Alfred tells me that when people arrive, they’re often very scared – sometimes in tears. He says their first task is to reassure patients. Many people who arrive here will have malaria or another illness which is initially suspected of being Ebola because of the similarity of symptoms – typically, fever and vomiting.
In triage, patients are asked a series of questions to establish if they are indeed a suspected case or not. If Ebola is suspected, they enter the centre, are tested for Ebola and given initial treatment. A test result now comes back fairly quickly: within 1 to 2 days. If the test comes back positive, the patient is moved to a confirmed case section of the centre. Because there are now a reasonable number of ambulances, confirmed cases are then usually transferred to a full treatment centre in about 24 hours. Previously this process could take 3 to 7 days or even longer.
Green and red zones
The centres are divided into green and red zones, which are separated by a 1.5m buffer. The red zone is where patients enter. No staff are permitted except in a full PPE suit. On leaving the red zone, staff are sprayed down with chlorine before removing their suits, which are then destroyed.
The green zone is where the staff usually spend their time and where medical and other supplies are stored – and this is the area that I’m able to enter to take a look around.
It’s a common set-up, although each centre that I visit is different. At Lunsar, an existing concrete building is in use, with two rooms (one for suspected cases and one for confirmed cases) and the relevant barriers and green zone built around it. At another, Foredugu, the whole site is a temporary tented structure. Wooden fences have been erected and covered in plastic sheeting to demarcate the walkways in the green and red zones and create the buffer zone that separates them.
The situation on the ground in our CCCs mirrors the trend across Sierra Leone: cases of Ebola appear to be dramatically dropping. One centre has not had a patient admitted for six days, two for three days, and one in Kagbantama currently has just a single patient, who was admitted last night and is awaiting test results.
Cases have diminished rapidly, and many people are now talking about transitioning out of the crisis. This is sensible – we need to be planning for what comes next, given the severe impacts this crisis has had on health, education and livelihoods. But we can’t expect Ebola just to burn itself out – it’s the work we’ve been doing which has produced this downward trend.
The situation in Kagbantama shows why we can’t be complacent. No patients had been admitted for about 10 days. Then, staff tell me, a few days ago there were five patients – all of whom tested positive and were transferred to a full treatment centre. Now they have another patient, and they were expecting two more via ambulance any moment – I passed the ambulance as I left the centre.
Conditions for staff
When I visited Foredugu, accompanied by Aminata, who works for Plan International in Port Loko, the centre had no patients. This gave me the opportunity to speak to staff from across the centre, including nurses, sprayers, cleaners and the stock-keeper. They told me about their concerns – what if they get ill? Who will treat them? Aminata reassured them that the government has now made provision for their care.
It's not just Ebola that concerns them. Saidu, one of the nurses, speaks up, and there is a palpable sense of distress in his voice. He says that they haven’t had a day off since 12 November and they fear for their health. There are three teams at each centre who work in three daily shifts. The work is hard – time in PPE suits is limited to a maximum of 45 minutes at a time, because it becomes so hot. Things have got quieter, but the work has, understandably, taken both a physical and a mental toll.
Another of the nurses, Edna, tells me they haven’t been paid since 10 November. Most of the medical staff we work with are on government payroll, and Edna’s experience is typical of many.
Fears in the community
As if this wasn’t hard enough, many of the staff can’t return home at night because of the stigma they face. Mohamed, who is one of the cleaners, tells me he was kicked out by his landlord and is now sleeping in the stock area. He says passionately: “Plan International was here before, supporting the community. When things broke down [because of Ebola], Plan International was the first to come. I want Plan International now to do something [to tackle the stigma and isolation]”. The other staff members agree with him.
Their concerns extend beyond conditions in the centres. A nurse called Gladys asks me, “What will happen to the Ebola orphans?”
Life after Ebola
They are all also extremely worried about what happens after the Ebola crisis. Will they still have jobs? Finding a job in Sierra Leone is not easy, and future prospects look bleak.
I really admire the people I met at the centres – and hope that something will be done by Plan International and others to repay them for their dedication. In many cases, they are working without pay, without a day off in months, facing stigma, isolated from family and friends, and have little job security. Yet they continue to work and to care for patients that come to the CCCs; all this in spite of the heightened risk they face. Without their efforts, I doubt we would be seeing the vast improvement we’ve seen in the numbers of new cases.
‘We need some joy’
As I leave, Brima, a contact tracer comes into the centre. When there is a confirmed case of Ebola, his job is to identify who that person has been in contact with recently, so that they can be placed under quarantine for 21 days.
He tells me how hard things have been and that after all this, and as the situation hopefully continues to be brought under control, “we need some joy, some time to celebrate and be happy”.
I hope that times of joy and happiness will return to Sierra Leone soon – but that will only be possible if we can beat Ebola.
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