At this year’s Geographical Association Conference it was our pleasure to sponsor the public lecture, where John Raine (OBE) presented a thought-provoking and absorbing lecture about tackling Ebola in Sierra Leone. John’s Ebola talk was a fascinating and thought provoking journey through the complexities of the bumpy road to zero and an interesting first-hand account of dealing with this virus. 

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Realities on the ground

From a background in the police, John Raine went to Sierra Leone to head up an Ebola command centre. Sierra Leone is one of the most impoverished countries in the world, ranked 181 on the Human Development Index. It does, however, have a reasonable road network due to international donations. The Ebola Virus Disease (EVD), as it’s officially known, John explained spread through ‘porous borders’ and is infectious at the point of ‘wet contact’ e.g. any bodily fluids (semen, breast milk, blood, etc.). As Ebola started as a zoonotic disease, from animals, namely monkeys, bush meat has been eaten far less so monkey populations have been thriving.

One of the first jobs John did with a team of people was to establish a grave yard and bury the dead. The command centre started to gather data on a daily basis to give an ongoing picture about the virus. Where there were dead bodies (with a high viral load) it was critical to get the family out of the home and into an isolation facility to be tested, if their blood test was positive they were moved to a treatment facility. The treatment facilities of course needed to be set up and hospitals were literally built from scratch as existing centres were unable to cope and facilities too basic.

Changed perceptions

With Ebola, there was discussion about whether this would declared a public health emergency or humanitarian crisis, if it was a humanitarian crisis this would trigger support from the UN and public funding. However, it was declared a public health emergency and this did not work. A national response centre was set up to try and contain the virus and this had a military flavour.

Humanitarian aid/International response

There was a no regrets approach to aid where well intentioned aid was given. However, there was not a joined up approach. Survivors of Ebola were given gifts such as mattresses, cooking equipment and / or food. However, with things such as mattresses how people would get them home without any transport was not considered. On a larger scale vehicles and ambulances were provided but with little / no expertise in how to maintain them.

Getting to zero

John and his team understood the sickness in terms of its geography however to get down to zero (no one with the Ebola virus) it meant John and his team had to isolate any Ebola reports down to individual families. For this they needed to work out who was sick, isolate / quarantine them, sometimes whole families and this was for 21 days. If a family member had died and the body was dressed then a number of people could potentially have become infected. For example, in a place called Sella Kafta, pregnant women and children were removed first and quarantined. It could be one positive case of Ebola and this can spiral so it was looking at the most effective way to contain the virus.