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Looking back and looking forward: After Ebola in Sierra Leone

11th November 2015

Until last weekend I had only ever counted down to midnight on New Year’s Eve, but as AGI colleagues and I joined President Koroma at Sierra Leone’s National Ebola Response Centre on Friday night that changed.[1] The outbreak of joy that began then continued throughout a weekend of celebration and remembrance across the country as Sierra Leone heaved a sigh of relief that the Ebola outbreak was finally over. We could have cases in future, surveillance and testing of potential cases must and will continue, but for now the worst is over.

Amongst the celebrations, like people right across Sierra Leone, I’ve been reflecting on all that happened here with the Ebola response. Although it has taken 18 months to reach zero Ebola, I can’t help but dwell on those first months of the AGI team’s involvement in the response from August 2014. At several points, we really thought we might lose the fight against Ebola. We thought we could be evacuated. We had no idea what might become of Sierra Leone. The uncertainty really wore on all of us and as Acting Country Head it was my job to provide some sense of direction and stability. It was the most daunting and most important task of my career.

The situation was frightening in the early part of the Ebola epidemic in Sierra Leone. There was no grasp on the real scale of transmission, inadequate resources and poor coordination. It cost lives.

AGI had decided in July to investigate how we could help with the Ebola response. I remember, with shame, my own scepticism. We weren’t a humanitarian agency. We didn’t work on health. Would we just contribute to distracting the government from their much-needed development agenda? Would we fail? Thankfully, as the crisis intensified, more visionary minds brought us back to the values of our organisation, values which compelled us to ask our Government of Sierra Leone partners what they wanted us to do. We pride ourselves on being government-led, independent, bold and focused on impact, on supporting our partner governments to pursue the highest priorities for their country. If supporting the Government’s Ebola emergency response didn’t meet these criteria, nothing would.  They wanted us involved. We were in.

I was tasked in late-August with working out how we could help. We knew that poor information and a lack of coordination to channel resources quickly meant decision makers didn’t know what they were dealing with and couldn’t organise a response. We did three things: we helped set up the 117 hotline to provide a mechanism for both the public to report potential cases and deaths and for the government to get more information about the real scale of the crisis. We worked on developing a national response, considering what functions and skills were required, and how it should all be structured for success. And finally, recognising the threat an outbreak in Sierra Leone’s densely populated capital posed to the whole country, the wider region and possibly the rest of the world, we supported the district-level response in the Western Area, which contains Freetown and its surrounds.

There were only three of us in the team in Freetown for most of September, by far the most chaotic and frankly scary period in the response. It was clear my most important task was supporting my colleagues, Victoria Parkinson and Emily Stanger Sfeile to do the best they could and to keep sane. We spoke all throughout the day. We caught up late at night. They cried. They shouted. Why weren’t people moving faster? Where were the beds we so desperately needed? On one occasion I remember Victoria telling me about the whiteboard they had for the Western Area which listed the known possible cases in Freetown needing a bed. There were around ten beds at the time I think, and many, many more names on that board. A bed had come free – should they send the 6 month old baby or the pregnant woman? Who should get the bed? Sadly, it often didn’t matter. By the time people were on the board it was usually too late.

Thankfully we were able to make a difference. Like everyone I have my own lessons to apply. The AGI role is unique and we can have tremendous impact with very few people, so I plan to be bolder and recognise we can achieve huge impact for Sierra Leone with a small team.

 

As several of our senior government partners have told me since Saturday, now we have to get back to work. Delivery of the recovery plan needs to be accelerated and the Government needs to articulate an agenda for the remaining two years of its term. The people of Sierra Leone have withstood this crisis, but now they want better healthcare. They need electricity and water. Businesses need to get back on their feet and create jobs. Right now we are reflecting with the government leadership on what lessons and capacity can be translated from the Ebola response systems to accelerate development progress. We want to capture the energy, urgency and focus that led the country from those panicked months of late 2014 to the celebrations this weekend and help the government channel it to reduce poverty by delivering improved healthcare, electricity, water and jobs in Sierra Leone.

[1] And not just because we actually counted up, which was another first for me that didn’t feel quite as dramatic as counting down!

All photo credits on this page are to Aurelie Marrier D'Unienville