Les Roberts – “Oh what a difference 140 days makes!”

Les Roberts – Freetown, Sierra Leone – March 24, 2015

I got back here a few days ago after 3.5 months back home, and oh my gosh are things different! The posters and billboards from last September were all about, “Ebola is Real!” in an attempt to get people to believe that this outbreak was a “natural” disease and that the messages people were giving could save the lives of their families and them. By the time I left, most people believed that Ebola was real. Lots of huge social changes had happened, like people reducing their touching and kissing of bodies at funerals, and the messages popping up on posters were focused on key measures to prevent the disease: Know the Signs and Symptoms, Get treatment early, Call safe burial teams to bury a body… Now the new billboards are mostly about believing the government will function. The emergency Ebola call number is 117, so one popular poster says “117 Works!” meaning that after months of people calling that number with no one answering the phone or no meaningful response if they did pick up, now if you call 117 you will get help. Another one says, “Ambulances are clean and safe” to battle the perception that if you call for an ambulance and get in it you will probably die… which unfortunately is still true.  My favorite one says something like, “Hospital beds are available” with a picture of a nice bed and a European looking doctor in PPE. As I talked about before in the Day 54 posting, this past fall the lack of Ebola treatment beds available made it so that nothing in the interlinked response system worked. People viscerally knew that; now there are plenty of beds and now most everything works as it should. The idea that the fundamental messages have shifted from battling disbelief in the reality of Ebola to battling distrust in the functioning of government and relief community seems to me a big victory. People in the wealthy countries often don’t trust their government’s ability to function in a disaster… so at times of crisis when there will always be some disbelief and discontent, this might be as good as our species gets.

The fact that there are lots of beds, far fewer cases, and all the elements in the Ebola response (117 call-lines, ambulances that arrive, treatment and safe burial teams) have become sufficient has made for a radically different vibe! My peers have gone from a desperate state of 19 hours a day panic mode driven by fear and terror about where this outbreak is headed, to an upbeat “there are clear tasks that need to get done” mindset. Everyone now can see that what has been happening in terms of social dynamics and social messaging, and in terms of the services they have created, is making a difference. The fact that Liberia might be back to near baseline is very encouraging.

Most importantly, the vibe among the Sierra Leoneans has changed in the same way.  When I arrived, the receptionist at the hotel said “Welcome back. We are now winning!” The children on the streets who were friendly but physically distant before now run right up beside you and get physically close in their exuberance. They have some of the classes going again in school and kids are playing soccer together on the streets and in the fields which was not allowed before. The most humorous change for me are the gals on the street who rent their services. Before, they would sit in their chairs as men walked by and casually say, “Good evening.” Now, they get up and are much more aggressive in their friendliness clearly indicating that they are actively back in business. As a public health person, knowing that sperm can transmit the virus for over 90 days, I see this last social uptick as not completely positive.   There are only about five well described sexually transmitted cases from survivors here, but as we get to the end game, these lower population attributable risk routes of transmission are likely to be either more detectable and perhaps more important; especially cases associated with people crossing the border from Guinea. Thus, I fear while the forest fire called “Ebola” looks a lot smaller and people are soooo ready to celebrate, we are likely some months away from declaring the country Ebola free. All those 2015 graduates hoping to work on Ebola might just get their chance. Darn!

Cheers, Les

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