The French charity, Medecins Sans Frontiers says it will be long before Sierra Leone is declared Ebola-free. The head of MSF Spain, Marcus Bachmann would not put a precise time to when he thinks the country will achieve that feat saying “It is going to be a very painful work I fear. It’s gonna test, it’s going to challenge the patience of all of us”. In an exclusive interview with Politico marking one year to the day Ebola was officially declared in the country , he said: “I think given that we maintain a comprehensive, coordinated, complete response it still, I fear, will keep us busy for another couple of months before we would start doing the countdown of the last 42 days.” Here is the full interview:
Interview: MSF Spain’s country chief on a year of Ebola
This week Sierra Leone marked one year to the day the UN World Health Organisation declared Ebola in the country. One of the agencies involved in the fight almost from the get go was the French charity, Medecins Sans Frontieres (MSF). Umaru Fofana spoke the head of MSF Spain, Marcus Bachmann about his reflections.
Marcus Bachmann: From the perspective of the population thinking that it’s now lasting one year and it’s still going on and not over, I can feel the stress, I can feel the tiredness, I can feel the frustration. And that’s my main impression when I look at the state of the country and look at the state of mind of my Sierra Leone colleagues I am working with.
Umaru Fofana: MSF sounded the alarm bell right from the get go and it seemed as if you weren’t listened to.
Marcus Bachmann: I think it was very frustrating for us because the outbreak in neighbouring Guinea was confirmed five months ahead of Sierra Leone. Looking at the population movement patterns, looking at the vulnerability of the trade routes of this area, it was very foreseeable that it was gonna spread out in the region to Liberia and Sierra Leone. There were no precautions; there was no preparedness at all levels. And MSF was the only one beating the drums and asking for preparedness. Once the first case was confirmed on the 25 May – a year ago now – there was very little response. We felt very lonesome responding in Kailahun, in Kenema, in Bo at the beginning of the outbreak. It took a painfully long time that it was declared an international health emergency. I think this is the most mislabeled crises because at this stage when this happened in when the WHO declared the health emergency it was no longer a health emergency, it was a humanitarian emergency and it would have required a much broader, better coordinated and much much more comprehensive response right from the beginning.
Umaru Fofana: Where are we right now? What does it take to get to that magic zero 42 days?
Marcus Bachmann: I think the lost opportunity at the beginning of the outbreak when the number of patients, when the number of transmission chains was more limited this was lost. Now we see the consequences, the population is paying the price because there has been a massive loss of lives and a massive amount of suffering in Sierra Leone and it is so widespread to follow up on the transmission chains to break the chains of transmission. It is going to be a very painful work I fear. It’s gonna test, it’s going to challenge the patience of all of us. But I think given that we maintain a comprehensive, coordinated, complete response it still, I fear, will keep us busy for another couple of months before we would start doing the countdown of the last 42 days.
Umaru Fofana: And, in that case when do you think this country will be declared Ebola-free?
Marcus Bachmann: I think this is speculation. The tail end of an outbreak can take painfully long. My appeal is to stay very, very tuned at all levels to maintain the level of outbreak response as we see now and not to relax. Also the population is extremely important to maintain the level of alertness and vigilance as before.
Umaru Fofana: You reckon that end would be in the third or the last quarter of this year?
Marcus Bachmann: Again, I do not want to speculate about time. In best case if all the efforts remain at a very high level and the commitment of all the actors involved stays at these levels, it’s going to take months before we can really hope to see the end of the declaration of the outbreak.
Umaru Fofana: And, would you say that Sierra Leone’s health system – or the weakness thereof – helped Ebola to thrive?
Marcus Bachmann: I think one of the key elements not to forget this is an outbreak situation it’s an infectious disease, a functioning surveillance system, alert system is critical to detect outbreaks. And talking now about the fact that we are now facing the tail end of Ebola, but there are other infectious diseases in this country with the potential of an outbreak. I think the surveillance system needs to be strengthened; the alert system must be much much more sensitive and much earlier to respond. But also outbreak coordination and response must be much faster. And I think one of the major lessons of Ebola is to have a flexible and adaptable outbreak response, you cannot base your outbreak response activities on assessment and on the reality of which is three months outdated as we have seen in Ebola. I think that is a strong message that we need to help flexibilize and to adapt the outbreak responses [with] all the actors involved.
Umaru Fofana: When MSF was sounding that alarm that there was a health emergency in Sierra Leone, did you feel isolated; did you feel that somebody thought you were just being alarmist?
Marcus Bachmann: Alarmist was what we were blamed for. This was the widespread reactions we received. I felt enormous frustrations, we felt very very lonesome. It took us...emm…we really put all means into the situation to really raise the alarm bells because the combination of Ebola virus which is new to this region and the fragility of the health care system around made it very very very foreseeable that the dimension of the disaster the impact on the population will be very traumatic. And I can just repeat that the level of frustration and the loneliness that we felt at this stage I will never forget.
Umaru Fofana: I am curious to know this Marcus, is it true that MSF was approached by the British to run the Kerry Town Treatment Centre and MSF did not take on the challenge?
Marcus Bachmann: Well, there is very many talks on all levels happening and I want to very clearly state when we MSF decided to intervene and where we based it always on our own genuine needs assessment and we strongly felt that there was a cluster of treatment centres in the rural area of the Western Area in the east of the peninsula. MSF had set up a very big treatment centre at Kingtom in the west of Western Area and based on that we logically tried to set up a treatment center in the high density east of Freetown in Kissy.
Umaru Fofana: Meaning you didn’t take up that because you had other commitments in the Western Area?
Marcus Bachmann: We saw the priorities in terms of needs, mapping out the incidence at that time…we intervened once in the West of Freetown and one in the high density badly affected east of Freetown in Kissy.
© Politico 28/05/15
