With the death toll in the current Ebola outbreak having gone beyond 130 people with over 400 cases, there are increasing concerns over the spread of the virus, whether or not it is out of control, an emergency or simply: how it is being pursued. Umaru Fofana spoke with the Minister of Health, Miatta Kargbo as she was literally on her way to holding meetings in the provinces on ways to curb the spread of the virus.
Umaru: Madam Minister how is the fight going against Ebola and are you pleased with the way things are?
Miatta Kargbo: Well as the Ministry of Health and Sanitation, working with the partners and as a government we are actually intensifying our response to the Ebola outbreak. We believe it is most important for us to focus on contact-tracing and infection-control to reduce the footprint of the virus and stop the transmission. So at this material point in time there is a lot we are doing around contact-tracing and infection-control. In fact one of the outcomes the Accra meeting [of health ministers called by ECOWAS and the WHO] that my deputy minister attended...there were a few decisions that were made for us to have a regional plan...where nations will begin to look at the national plan and cascade that down into the district plans, but coming from the region to the sub-region, national and the district plans. So what we have done in the ministry of health and sanitation, as a government working with our partners, we have created an emergency operation centre which will respond in a more definitive way, anticipating and going ahead of the curve. We will be shifting resources rapidly and intensifying actions across the nation so that we will be able to reduce the footprint we have. So this emergency operations centre will have daily meetings which will be chaired by myself and co-chaired by the WHO representative...
The emergency operations centre will also be that central receiving and distribution centre for information pertaining to the epidemic so that we could have rapid information coming in from the district on a daily basis. [There will also be] mandatory reporting [which] we are asking that all district medical officers do now. And this daily mandatory reporting will include what are some of the issues, what are some of the challenges, so that we could rapidly shift resources from human resource to vehicles [and] financial resources so that we could have effective coordination both in government and with donor support that is coming in.
So this daily leadership decisions and directions will be communicated out in the field as soon as possible. The emergency operations centre will be manned almost 24 hours so we could get information going. And this is the new decision and new direction we are going as a nation, sub-region and region; so that we could combat this disease.
Umaru: I will talk to you about the regional response momentarily, but in terms of Sierra Leone do you think that the virus is out of control?
Miatta Kargbo: We are at a serious point but I will not say it is out of control. That is why we are intensifying the issue about contact-tracing and infection-control because if we get that right then we will be able to minimise the footprint because what we see happening is that suspected cases and even some of the confirmed cases are leaving their various points and moving to other locations in the country which is not helping the fight because what we need to do is contain; and by containing we need all suspected cases and all those who are under surveillance to stay in their locations so we could stop the transmission. We also need individuals who are showing signs and symptoms of Ebola to go to the nearest health facility and seek treatment early. What we are seeing is that those who are suspects and who have come in contact with Ebola cases and have been exposed to the virus don’t get medical attention in time, go to the health facilities very late and some of them die in their homes and communities. So this is a problem for us and it is a serious issue that we are trying to tackle. We are working through all the mediums that we do have currently so that we could pass the message on. We could ensure that the local authorities including the chiefs, the tribal heads continue to intensify sensitisation within their communities so we could get this right.
Umaru: Now if suspected and even confirmed cases are moving all about the country which you say is a very serious issue - and the fact that WHO figures [two week ago] showed that Sierra Leone was the worst hit in the region [in that week] doesn’t that give one the impression that you don’t seem to be able to control the rise?
Miatta Kargbo: I would not say individuals or suspects are moving all across the nation.
Umaru: Well the cases that have been traced to like in the south, and in the north and even in the Western Area have been cases that have come in from the east of the country.
Miatta Kargbo: It is a gradual progression that you could see where the direction from the epicentre coming into Kenema, coming into Bo, and the most logical point for some of these cases to come to seek treatment is in the capital city where we have most of the facilities. We have not seen the cases in other parts of the country in other regions because the capital city Freetown as you know most people will come into the capital city because that’s where you have the best hospitals and those who could afford and do have the financial support to come into the capital city would seek treatment in the capital city. So that is why you see the most recent cases coming in about three cases in Freetown.
Umaru: But even the figures, WHO figures say that [in one week alone two weeks ago] about 50 people died and almost twice that number of new cases. That, surely, sounds grim?
Miatta Kargbo: We have 118 deaths and the 118 deaths have been a gradual process through from May 27that we started identifying confirmed cases of Ebola and it has been gradual process. I would not know where the information, I am not privy to the information that you are quoting now that WHO says just [in one week alone two weeks ago] 50...
Umaru Fofana: But even by your own figures [in one week alone two weeks ago] 30 people died. That's by your own figures - the highest since the outbreak.
Miatta Kargbo: It is for that reason we are asking and pleading to our fellow Sierra Leoneans to come to the health facilities on time because there is something to celebrate as we talk about Ebola cases across the nation. There's something we need to celebrate - and that is the survival rate that we have had. We have the best survival rate so far in this epidemic. We have 60 patients that have been discharged Ebola-free and are in there communities. So even as we talk about deaths there is something to celebrate. Sierra Leone has the best case of fatality rate. We have about 60 survivors given the numbers that we have that have been infected. So this is something we need to celebrate. Yes we have people who are dying and we are asking everyone to seek medical treatment on time at the government health facilities that are certified to treat Ebola and not private facilities that do not have the capacity to treat Ebola. So those stories, the success stories, we also want to celebrate and showcase them so that individuals who have the signs and symptoms could seek the treatment, come to our facilities and add to those numbers. We don’t want to see people dying that is not our goal. Our goal as a nation, as a government is to treat our people. See more survival rate so that we could move on with the development that we so desire and need in Sierra Leone.
Umaru: It’s gonna be difficult to celebrate that good news story if the deaths or the number of cases keep going up. And it is really going up. When do you think it'll really peak ?
Miatta Kargbo: It is not difficult to celebrate success story because it is by celebrating the success story of the 60 discharged and giving the hope to all Sierra Leoneans that there is hope, because hope is the last thing that extinguishes from a person’s heart so if they don’t have that hope they will not go to the health facilities. So I think we need to celebrate the survivors because it will allow us for more people to go in which will thereby help us to stop the transmission, stop infection - continued infection - reduce the footprint of the virus so at certain point we need to keep talking about the success, we need to continue talking about the survivors that we have so people could know that this is not a death sentence. You could come to the health facility and if you come on time you could come out a victor and survive and go back into your community and be a productive citizen.
Umaru: When will these numbers start falling down?
Miatta Kargbo: We are seeing good news so far. We are seeing people going to the health facilities - the cases of death in our health facilities are as a result of people going in late. So we hope that more people will see that there is light at the end of the tunnel and come to our health facilities so that they could be treated. And until such time it is a battle that we will continue to fight and we will continue to fight it with intensifying sensitisation for people to understand that these are the action you need to take and refrain from those actions that will not yield the results that we need to be realised in this fight against Ebola.
Umaru: And the regional crisis meeting in Accra called by ECOWAS and the UN World Health Organisation, what do you think is the outcome of that meeting. How has it impacted your fight here against the disease?
Miatta Kargbo: The meeting was attended by my deputy minister 1, Dr. Abubakarr Fofana and the feedback we received from the team that went from Sierra Leone including members from the ministry - the Chief Medical Officer, other Directors - and the WHO [is] that it was a successful meeting. And as a matter of fact some of the outcome of that meeting is what we are implementing now at the national level which goes back and feeds into the sub-region and the regional level.
Umaru: And how much of a difference has that made?
Miatta Kargbo: Countries are just implementing now so in the next couple of weeks we will begin to see the impact of the recommendations of the Accra meeting
Umaru: And what are these recommendations, specifically?
Miatta Kargbo: But already what we are seeing now in terms of coming in and consolidating national plans into sub regional and regional plans and also looking at the emergency operation centres within nations that will go back into the sub-region and region in the past couple of days. Since Monday we have started some of these changes, we are beginning to see great progress where the mandatory reporting and some of the key challenges, the shifting of resources at a rapid rate, the realisation from government and all the partners that a coordinated and consolidated effort and bringing all resources together whether it is government or partner. I think we are beginning to just see the improvement in that area and it is going to be an open trajectory from now in terms of the progress being made for us to be able to address the epidemic in Sierra Leone, in the sub-region and in Africa as a whole.
Umaru: Finally, some Civil Society Organisations has suggested that [Ebola] should be declared a public health emergency just so that more resources could be put into the fight by the central government. Is this a sentiment you share as a minister of Health yourself?
Miatta Kargbo: The Ebola virus in Sierra Leone is a serious matter. We have not got to the point where there is a crisis as the WHO representative...the deputy assistant director general mentioned last week as he…
Umaru: It is not a crisis? That sounds a bit strange!
Miatta Kargbo: Well...it is not at the point of the emergency that the Civil Society representatives have been propagating at this point. It is serious, it is a matter of serious and urgent concern to government and all partners. We are addressing it. It is not out of control at this point as it has been propagated. We are working our best to address the situation and we hope that everybody will come on board for us to address the problem that we have. It is very serious.
Umaru: Madam Minister how many more people must die before this becomes a public health emergency?
Miatta Kargbo: I would want to say we are going to take this issue as we have been dealing with it now as an emergency, and we are putting all of our resources both human resource and financial resource so we can address this even as a government. We have made this a priority - the budgetary allocation we have done we have put to the Ebola disease has been like none other. So you could see the seriousness to which government has taken this. His Excellency the president Dr. Ernest Bai Koroma has made this a priority on his agenda. He has instructed all parties and stakeholders including the Ministry of Finance that this is the number one priority in the country. So it tells you the seriousness to which His Excellency the President, the government of Sierra Leone and the Partners have put to it. So we would not want anyone or organisation to trivialise the effort that government has put into the fight against Ebola. It is serious, our people are dying, our brothers and sisters are dying, mothers and fathers are dying. It is one Sierra Leone that we do have and we need to fight this together. We need to come together and fight this disease, we need to educate our people and address the issues that we have in our communities that are in fact hindering some of the progress that needs to be made. So that is the message that we want out, so that is the key important message that we want out. Government has not taken it lightly we are serious about it; we are dealing with it as an emergency.
Umaru: And you say the president takes it very seriously and he is doing everything he could, but he's come under some flak that he has still not been to the region affected by this?
Miatta Kargbo: His Excellency the President has taken all the necessary measures that need to be done as a Head of State, and he is taking this seriously... I, as a Minister of Health and Sanitation, by even being in the region is representing His Excellency and the government in all parts of the country - in the epicentre, in other districts that have not been hit as yet, that is what is important. By giving the declaration that this is important all funds that need to go to Ebola, tells you the seriousness that His Excellency has put to this and every day the update that he receives the interest that he puts into it is very important. That is what is important.
Umaru: Thank you very much. Safe journey and good luck.
(C) Politico 22/07/14
