In Sierra Leona, the tough stace of the government is accompanied by loose enforcement.
The house was supposed to be under strict quarantine. Meals were to be delivered by the health department. Nobody was to go in or out. But the enforcement of the government’s tough new measures to contain Ebola was light.
Two police officers hung about chatting, out of sight of the house. Visitors came and went, including family members and well-wishers who were not supposed to be there. On the front porch sat the Ebola victim’s father and mother, in whose arms the young woman had died.
They had handled her body, putting them at serious risk of infection. But days after the death of Saudatu Koroma, her mother, Anna Conté, left to fill her plastic teapot from the communal water tap used by dozens of others.
Her government minders seemed not to notice. Alarmed by the world’s worst outbreak of Ebola, West Africa leaders have declared extraordinary measures to fight the disease, including closing schools, authorizing house-to-house searches for infected people and, at least on paper, sometimes vowing to go beyond the standard international controls for halting the virus.
Here in Sierra Leone, the nation with the most cases of the disease, the government has decreed a broad state of emergency — telling families to stay at home on Monday for “reflection, education and prayers” — and has ordered strict new measures, like bans on many public gatherings and the quarantine edict.
“The very essence of our nation is at stake,” President Ernest Bai Koroma said in a televised speech Monday morning. But that tough stance is being accompanied by loose enforcement that is deeply worrying to doctors and health care workers trying to stem the rapid spread of the virus.
“Ebola doesn’t permit a halfway engagement,” said Walter Lorenzi, the chief of the Doctors Without Borders’ mission here. His group, which has been battling the disease on the front lines, declared the Ebola epidemic out of control in Sierra Leone and its West African neighbors.
Deadly spread
The outbreak was first identified in March in Guinea’s remote Forest Region. Since then, it has spread with a deadly swiftness, spilling over porous borders in one of the poorest parts of Africa.
The epidemic also leapfrogged by air after an American working in Liberia flew to Nigeria, Africa’s most populous nation, and died there last week. On Monday, Nigerian news media reported that a doctor who treated him had contracted the disease as well.
By Friday, 887 people in the region had died, according to the World Health Organization, easily the highest Ebola death toll ever. Hoping to stop the progression, Liberia has urged people to avoid “public amusement and entertainment centers,” Nigerian officials are screening passengers arriving by plane, and Sierra Leone is demanding that any death in the nation be reported before a body can be buried.
But the ability of countries at the bottom of global development rankings, with some of the world’s weakest health systems, to enforce sweeping policies to contain such a virulent disease is a major concern.
Only days after President Ellen Johnson Sirleaf of Liberia recommended cremating the bodies of Ebola victims, which are highly infectious, officials tried to bury dozens of corpses in a mass grave near where people lived, eliciting protests and subsequent complaints that some of the bodies were not properly covered with dirt.
On Monday, the World Bank said it would provide up to $200 million to help Guinea, Liberia and Sierra Leone fight the disease and cope with the economic impact. The announcement followed a warning by the WHO late last week that the virus was spreading faster than the efforts to curb it, a concern echoed by some of the local health workers tasked with containing the outbreak.
But the government-ordered isolation of victims and careful monitoring of those in their immediate orbit was not happening in the impoverished Kissi neighbourhood of this dense seaside capital.
At the unpainted cinder-block bungalow of Saudatu Koroma’s family, who are not related to the president, five members were supposed to be under government quarantine. But there were at least eight people Sunday afternoon on the tiny veranda overlooking a muddy slope leading to Cline Bay.
But the problem is not just with the government effort. In some quarters, the very existence of Ebola continues to be challenged by the population that the virus is afflicting. Just up the street from the Koroma household, a government warning poster on Ebola had been mostly ripped from the wall.
A few blocks away, a health ministry truck equipped with loudspeakers and plastered with graphic images of Ebola’s symptoms warned residents of the dangers. Nobody on the bustling street on Sunday paid any attention.
