Sunday, March 29, 2015

The MSF Report: What Went Wrong – A Timeline

The Médecins Sans Frontières report, issued this week, gives us an insight in to the early stages of the Ebola outbreak. As the organisation that first flagged the scale of the Ebola health crisis, the MSF is in a strong position to critique the international and domestic response from the outset. The MSF acknowledges, “it is difficult to draw definitive conclusions whilst lacking the necessary distance for a thorough critical review. Here [they] put forward initial reflections on the past year”, however, the report does not pull any punches; it is firm and critical of those parties it perceives not to have responded quickly enough, in some cases itself included.

I have reviewed the 20 page document and summarised the findings in to the four main areas of interest in this report: what went wrong at the beginning; what must we do to eradicate Ebola; what will be the lasting impact of Ebola on West Africa; and what are the lessons learned for the future?

The report begins with an emotive reminder of the risks that healthcare staffhave faced during the fighting of the outbreak:

“The vulnerability of medical staff to Ebola is a double tragedy – the virus takes the lives of the very people meant to tackle it. Nearly 500 healthcare workers have died of Ebola in Guinea, Liberia and Sierra Leone to date.”

What mistakes were made at the beginning?

Denial of Facts by the WHO

Having investigated the ‘mysterious disease’ reported by the Ministry of Health in Guinea on the 14th March 2014, the MSF’s predictions of Ebola were confirmed by laboratory tests in Europe on the 21st of the same month. At this point the Ministry of Health in Guinea declared an Ebola outbreak in the country.

The detective work of the MSF epidemiologists revealed that contact had been made between the early victims of Ebola with family members, both within Guinea and in neighbouring Sierra Leone and Liberia. The scope of the outbreak was therefore potentially much larger, and unconfirmed cases were coming in from over the borders.

“It was dawning on us that the spread of the outbreak was something we’d never seen before. Just days after we arrived, an alert came in of suspected cases over the border in Foya, Liberia,” says Marie Christine Ferir, MSF emergency coordinator. “Then it went from bad to worse – a confirmed case showed up 650 km away from Guéckédou in Guinea’s capital, Conakry.”

On 31st March, MSF publicly declared the outbreak as ‘unprecedented’ due to the geographic spread of the cases. What now seems obvious was, at the time, considered exaggerated and alarmist by many. On 1st April, the World Health Organization (WHO), via its chief spokesperson in Geneva, was the first to call into question MSF’s declaration, objecting that the virus dynamics were not unlike those of past outbreaks, nor was the outbreak unprecedented. This was the first major mistake in the international response to the Ebola outbreak.

Undiscovered Outbreak in Sierra Leone

There was concern within MSF all along about the puzzling absence of confirmed cases over the border in Sierra Leone. From the onset of the epidemic, the US biotechnology company Metabiota and Tulane University, partners of Sierra Leone’s Kenema hospital, had the lead in supporting Sierra Leone’s Ministry of Health in investigating suspected cases. Their investigations came back Ebola negative, while their on-going surveillance activities seem to have missed the cases of Ebola that had emerged in the country.

In mid and late March, Ebola cases in Guinea were discovered that were reportedly coming from Sierra Leone. MSF immediately sent these alerts to the Ministry of Health and the WHO in Freetown to be followed up locally.

Then, on 26th May, the first confirmed case was declared in Sierra Leone and the Ministry of Health called on MSF to intervene.

Lack of Transparency and Information within Sierra Leone

After 26th May MSF’s priority became setting up an Ebola management centre in Kailahun, the epicentre at that time in Sierra Leone. With MSF’s teams already spread thin, and due to the high number of cases, MSF lacked the capacity to simultaneously manage essential outreach activities such as awareness raising and surveillance.

“When we set up operations in Kailahun, we realised we were already too late… The Ministry of Health and the partners of Kenema hospital refused to share data or lists of contacts with us, so we were working in the dark while cases just kept coming in.”

Lack of acknowledgement by the world

In late June, MSF teams counted that the virus was actively transmitting in more than 60 locations in Guinea, Liberia and Sierra Leone. Facing an exceptionally aggressive epidemic and unable to do everything, MSF teams focused on damage control and prioritised the majority of resources on running Ebola management centres. Critically, it was not possible to roll out the full range of containment activities in all locations.

“We raised the alarm publicly again on 21 June, declaring that the epidemic was out of control and that we could not respond to the large number of new cases and locations alone,” recalls Dr Bart Janssens, MSF director of operations. “We called for qualified medical staff to be deployed, for trainings to be organised, and for contact tracing and awareness-raising activities to be stepped up. But effectively none of these things followed our appeal for help. It was like shouting into a desert.”

Although the writing was on the wall, again MSF was accused of alarmism. Dr Janssens recalls, “In the end, we did not know what words to use that would make the world wake up and realise how out of control the outbreak had truly become.”

Political Reluctance

The governments of Guinea and Sierra Leone were initially very reluctant to recognise the severity of the outbreak, which obstructed the early response. This is far from unusual in outbreaks of Ebola – or indeed other dangerous infectious diseases; there is often little appetite to immediately sound the alarm for fear of causing public panic, disrupting the functioning of the country and driving away visitors and investors.

On 10th May, Guinean media reported the president of Guinea complaining that MSF was spreading panic in order to raise funds. In Sierra Leone, the government instructed the WHO to report only laboratory-confirmed deaths in June, reducing the death toll count in the country by excluding probable and suspected cases.

A Vacuum of Leadership

The WHO plays a leading role in protecting international public health, and it is well known that its expertise lies in its normative work and technical advice to countries worldwide.

There was little sharing of information between countries, with officials relying on the WHO to act as liaison between them. It was not until July that new leadership was brought into the WHO country offices and a regional operations centre was established in Conakry to oversee technical and operational support to the affected countries.

“When it became clear early on that it was not simply the number of cases that was creating concern, but indeed the epidemic’s spread, clear direction was needed and leadership should have been taken,” says Christopher Stokes, MSF general director. “The WHO should have been fighting the virus, not MSF.”

Lack of expertise

Given that Ebola outbreaks in the past occurred on a much smaller scale, the number of people with experience of the disease was limited within MSF; there were simply not enough experts worldwide to stem the tide of this epidemic

Exhausted national health workers bravely and tirelessly stepped up and continued to tackle the outbreak each day, while facing stigma and fear in their own communities. Some MSF locally-hired staff were abandoned by their partners, ejected from their homes, their children ostracised by playmates. Their dedication and extraordinary hard work over the past year is parallel to none.

Lack of Leadership in WHO

“I finished my presentation at the Global Alert and Outbreak Response Network (GOARN) meeting by saying that I was receiving nearly daily phone calls from the Ministry of Health in Liberia asking for support, and that MSF had no more experienced staff I could send to them,” recalls Marie-Christine Ferir.

“I remember emphasising that we had the chance to halt the epidemic in Liberia if help was sent now. It was early in the outbreak and there was still time. The call for help was heard but no action was taken.

Meetings happened. Action didn’t,” says Ferir.

Lack of Capacity

By the end of August MSF’s treatment centre in Monrovia, ELWA 3, the biggest in the world, could only be opened for 30 minutes each morning. Only a few patients could be admitted to fill beds made empty by those who had died overnight. People were dying on the gravel outside the gates. One father brought his daughter in the boot of his car, begging MSF to take her in so as to not infect his other children at home. He was turned away.

“We had to make the horrendous decision of who we could let into the centre,” says Rosa Crestani. “We had two choices – let those in who were earlier in the disease, or take in those were who dying and the most infectious. We went for a balance. We would take in the most we safely could and the sickest. But we kept our limits too –we refused to put more than one person in each bed. We could only offer very basic palliative care and there were so many patients and so few staff that the staff had on average only one minute per patient. It was an indescribable horror.”

In Summary

Global failures have been brutally exposed in this epidemic and thousands of people have paid for it with their lives. The world is more interconnected today than ever before and world leaders cannot turn their backs on health crises in the hope that they remain confined to poor countries far away. It is to everyone’s benefit that lessons be learned from this outbreak, from the weakness of health systems in developing countries, to the paralysis and sluggishness of international aid.

Friday, March 27, 2015

A Clear Picture of the Ebola Situation in Sierra Leone

Médecins Sans Frontières (MSF) released a report this week to coincide with the 1st anniversary of the Ebola outbreak. One year on from the first confirmed case in Guinea I wanted to give a brief update on the situation in Sierra Leone, and to outline the next steps for the quick and comprehensive eradication of the Ebola virus.

Let’s be clear: Sierra Leone is still in a situation of severe Ebola crisis. The MSF reports that “there is no room for mistakes or complacency; the number of new cases weekly is still higher than in any previous outbreak.”[1] The number of new Ebola cases has declined from its peak level but the number has spiked recently in Guinea and, as we are about to investigate, has stabilised but only slightly reduced since mid-January in Sierra Leone. The NERC and government agencies have been working hard with international assistance to contain the virus, but what we have learnt from previous outbreaks is that we are now entering the most difficult stages of eradicating the disease.

During the months leading up to December 2014 we saw a large spike in the number of Ebola cases nationwide.

During mid-December the number of new cases dropped to around 45 per day. In the period immediately after Christmas we saw these numbers swiftly falling to the 22nd January, at which point there was a relatively stable 12 new cases per day.

The graph below shows the daily new cases since the 22nd January

This period of general stability is accompanied by a slight decline in new Ebola cases, from 12 per day to 8 on average. This is a positive movement and one that would suggest the work being done by government agencies, NGOs and charities is helping to stem the spread of Ebola.

There are several reasons for the downward turn in the number of new cases, including: establishment of protocol and accepted standards of containment; provision of treatment and testing facilities; acquisition of ambulances and frontline care supplies; and the effectiveness of the information campaign. The country’s national infrastructure and the international aid community learnt many difficult lessons in the incredibly trying months leading up to Christmas, and it will need to take those lessons in to the near future in order to eradicate this disease.

Whilst clearly indicating a general downwards trend, the graphs do not give us the full picture. What we are actually seeing in Sierra Leone is an increased focus of the virus in certain areas. The Western Urban Area, which includes the capital, Freetown, is the single hardest hit region in the country; over the whole outbreak it has suffered 26% of all cases. Port Loko is the second most heavily hit region with 17% of all national cases. Despite the total number of new cases falling, both the Western Urban Area and Port Loko have seen a disproportionate increase in the share of new cases since 23rd January: the Western Urban area accounts for 37% of new cases during the period as opposed to 25% before 22nd January; and Port Loko accounts for 23% up from 16% in the previous period.

One of the main influences of this increased focus is the high population density in these regions. Ebola, and contagious viruses in general, are much more persistent in urban environments with close living quarters and low levels of sanitation. Both of these regions in Sierra Leone have many people, often living in squalid conditions: the perfect environment for the virus to spread.

The past month, from 23rd February to 23rd March 2015, has shown further polarisation of newly reported cases: 8 regions show 0% of new cases whilst 1 region shows 1%. The remainder is broken down as follows (please note that the discrepancy between stated numbers and 100% is as a result of rounding):

Kambia is one of the situations that bares scrutiny, and one that demonstrates one of the potential risks in the path to recovery for the country. Kambia is located on the road between Freetown and Conakry, the capital Guinea, and has an estimated population of 40,000 people.[2] Lying on the transit road between two Ebola-suffering country capitals has fostered a breeding ground for Ebola in recent months.

Kambia accounted for only 2% of new national cases leading up to 22nd January, but between 23rd January and 23rd March it grew to 11%, and is at 10% in the most recent month. To put this localised outbreak in to perspective, Kambia still has one of the lowest total number of Ebola cases in the country, but it has suffered over 30% of it's cases since 23rd January and is clearly going through a localised period of infection. The risk of not recognising potential new outbreaks is captured perfectly in this MSF quote: “To declare an end to the outbreak, we must identify every last case, requiring a level of meticulous precision that is practically unique in medical humanitarian interventions in the field.”

The question begs: how do we stop Ebola? The accepted method is one that has been practiced throughout the outbreak: contact tracing. This simple but laborious process is to, one-by-one, identify all of those individuals that confirmed sufferers of Ebola may have come in to contact with. Hans Rosling, a consultant health statistician working in Liberia illustrates this process very succinctly with a current example in the video below. Please skip forward to 10:13 for the explanation of a localised outbreak and for the method and survival expectations of contact tracing

The challenge of declaring Western African countries free from Ebola is still a large task. It is easy for the government, health officials, NGOs, and the international community to become complacent when thinking about Ebola. The case of Kambia highlights just how important it is to retain focus on the situation in hand, and to re-allocate resources as is necessary.

Contact tracing is a laborious process, but these Ebola-stricken countries are much better equipped now to deal with the current levels of the outbreak. Contact tracing teams are experienced in how to effectively find the necessary information without imposing too greatly on the suffering victims or grieving families, and they will lead the country’s efforts to eradicating the virus. Simultaneously, the Ebola treatment centres are steadily improving their survival rates and have significantly increased capacity for sufferers of the virus.

Today, Sierra Leone has once again gone in to a 3 day lockdown. If ever there was a need to remind ourselves that Ebola is still having a serious affect on Sierra Leonean life, then this is it. People throughout the country will be unable to leave their homes throughout the weekend except for to pray. Please spare a thought for our staff and students in this difficult time, and for those Sierra Leoneans whose lives have been so disrupted and, in some cases, torn apart by death and grief. It is clear that we have much work to do. The continued effort by the government, international aid organisations, NGOs, and smaller charities like EducAid, will help to speed up the process of eradication. As many of you will be aware, we operate schools in both of the highest risk regions in the country, and so are very necessarily worried for the wellbeing of our students and staff.

We continue to need all of the support that we can gain in order to combat the effects of this virus. We hope that, once our schools are open again, we will be able to once again return to what we do best, and begin to educate and prepare the next generation of independent Sierra Leoneans.

We know that this will be a tough ask, so if you can spare anything to help towards our goal it will be much appreciated. If you would like to do so, you can donate here.

EducAid, fighting for a life #AfterEbola


Monday, March 23, 2015

Business in the Charity Sector

As a nation the UK has traditionally been very generous when it comes to donating money to help those in need, both domestically and internationally. According to a Charities Aid Foundation report on private donations, at 0.9% GDP the UK is second in charitable giving only to the U.S.A. Combine this figure with the amount that the government pledges with taxpayers money, you can begin to see the scale of the UK’s philanthropic commitment.

The connection between the charitable and private sector has always been strong. Aside from the CSR donations, the vast majority of donors are those employed within the private sector and from those running the business within it. Companies of all sizes, from the smallest businesses to the multinationals, are contributing through donations and resources all the time. This has been no better illustrated than in the recent drive for donation of clothes and educational materials covered in a recent blog post (available here); the contribution from individuals and business alike enabled a complex logistical challenge to be completed without a hitch. The positive business ethic that permeates throughout the country affords these business owners and their employees the ability to be generous, whilst the country’s social fabric commends and encourages it.

Sometimes, however, it is reasonable to wonder whether charities and businesses could collaborate in other ways. Very often, smaller charities suffer from a lack of knowledge in certain areas; for example: online communications, accounting, and reporting are all common struggles in early years. Later on in a charity’s life difficult decisions regarding strategy and growth will have to be made as well. For example: whether to open that new centre; whether to take on that new member of staff; or whether to invest in that software; these all are decisions that could either push the charity on to the next level of fundraising and impact, or could drastically set the charity back if improperly handled.

These are the kinds of decisions that businesspeople make every day. As one of our partners, A Call to Business, writes on their website: “Business people are blessed with many gifts - risk taking, analytical capacity, vision, drive and the ability to manage many roles among them.” Early-stage charities are often philanthropy and vision-lead, and sometimes the more experienced and sanitised business approach can help a charity to prioritise it’s goals and identify exactly how to achieve them.

At EducAid, we are fortunate to have a board of trustees that are incredibly committed to the charity, and whose experience spans several directly relatable fields of industry. It is through their careful planning and strategy that the charity continues to grow in both size and impact. Charities can operate in many different ways, but our trustees work very closely with Miriam to ensure that the vision coming from Sierra Leone is matched by the resources and planning from the UK. If you would like to read a bit more about our trustees, you can do so here.

In EducAid’s field of operations, business can also perform several functions. A few weeks ago we wrote about the unseen importance of education in ‘Consciousness, Self-Awareness and Impact’, and in this we wrote that there are a multitude of other positive impacts to education that lay outside of literacy, analytical thought, and the employment prospects that go with those things. Alongside these elements of personal development are, of course, the improved professional credentials of an individual. One of our own trustees, Adrian Carr, has in fact been out to Sierra Leone to oversee a project that gave students and staff the chance to develop a business idea to which they would provide support and some financial backing. This level of professional guidance and interaction is rarely encountered by our students in Sierra Leone, and has proven to be extremely useful. Not only does it take education out of the conceptual sphere of personal development and root it in a practical application in the real world, it also has the capacity to yield great ideas. Many people have written of sub-saharan Africa as being full of energy, initiative and innovation, and it could be a wellspring of ideas that the whole world can use if nurtured and harnessed properly.

The skills that the business world provides are desperately needed in Sierra Leone. Empowering our students with the confidence to operate in a business environment are key to elevating them from the poverty from which they came, and in turn to help them pull Sierra Leone from it’s low position on the Development Index.

On 29th April, EducAid will be representing itself at the Resonate Connect event in Manchester Cathedral. This is an event that connects businesses and their employees with charities. It is in no way an exclusively beneficial arrangement for charities to take on talented business people in placements; employees that are tasked to go and solve problems for philanthropic organisations – encountering unique challenges in the process – often come back to the company with a new sense of perspective and a great sense of achievement. The organisers of the event are extremely vocal about how these arrangements are mutually beneficial, not from a CSR-related point of view, but from a position of genuine experience and development.

As previously mentioned EducAid has partnerships that encourage business development in Sierra Leone, but if you think you can work with us please do speak with one of our representatives at the event. At Resonate Connect we will also be there to invite interest from small, medium, and large businesses in to signing up for payroll giving. If you know of any business owners or professionals in the Manchester/North-Western area who might be interested in joining, please do forward them this post so that they can read a little more about the event from the link below. The evening should be a beautiful one: with a few short speeches from the charities involved; a keynote speech from the Chief Executive of the Manchester City Council; and a full wine bar and catering by Harvey Nichols, it’ll be good just to come and meet some of us from the charity – if nothing else!

Please do come down and show your support – there are so many ways that you and your companies can get involved. It’s amazing to think how much impact such a small amount of money can make when you coordinate a large number of people - this event hopes to facilitate some of that.

Event details can be found at the Resonate Connect website, here. Please register if you are interested and do let us know that you’re coming on facebook!

Let’s make it an #EthicalManchester on 29th April!

Thursday, March 12, 2015

An Unbelievable Contribution – RFA Argus

Over the past few months, the crew of the RFA Argus have been supporting EducAid in a variety of ways. The ship performs several functions but it’s main role is the Primary Casualty Receiving Ship for the Royal Navy; with state of the art medical facilities it is deployed to provide medical cover for all personnel deployed in Sierra Leone to tackle the Ebola outbreak. Although it is not designed to help with Ebola cases it does provide the peace of mind for all those working to stop Ebola.

The UK’s military has been in Sierra Leone as part of operation GRITROCK since October 2014, and is part of the wider humanitarian aid program led by the Department for International Development (DfID) and involving non-government organisations. The UK armed forces have so far played a pivotal role in providing support as they work with the government of Sierra Leone to tackle the crisis. Using British expertise and local building contractors, the UK has committed to support 800 new beds in Ebola treatment facilities. This package will further support the country’s stretched public health services in containing the disease by building and manning the medical faculties to care for nearly 8,800 patients over a 6-month period.

Over the past few weeks I have been talking with Petty Officer Diccon Griffith, the man responsible for establishing the connection between EducAid and the RFA Argus. I asked him a few questions about the general mission and how they came to be involved with EducAid.

For many of us, we have seen that the government pledges money and assistance from the British armed forces to fight the Ebola outbreak, but few know how that help actually plays out in real terms. Will you tell us a little about your deployment?

The ship sailed from Falmouth on the 17th October for what is expected to be a 6 month operational period. We have been providing advanced medical facilities for up to 1200 entitled military and civilian personnel who have been deployed to construct and man the 8 x 100 bed Ebola Treatment Centres that are being built in various key locations around Sierra Leone.

Sierra Leone suffers from a particularly poor transport network meaning that getting around the country is very slow going. In addition to the medical facilities that the ship is able to provide, we have 3 highly versatile Merlin Mk 2 helicopters from 820 Naval Air Squadron which are being used in the crucial support role to transport key personnel, equipment, and more recently food and medical supplies around the country. The ship also has an amphibious inshore capability thanks to the Royal Marines from 42 Commando and 539 Assault Squadron. There are currently 350 Naval Service personnel embarked in RFA ARGUS.

You are clearly doing very positive work already, what made you want to raise money for charities as well?

Looking into Freetown and the surrounding areas that have been badly affected by the Ebola virus I realised in the very first week that there was much more we could do to help. It was after one particular sortie where we flew into one of the worst affected towns, Port Loko, with some of the UK media that got me thinking about a charitable effort. I had the privilege of speaking to many of the children and capture some powerful images using the squadron camera. Each and every face I saw seemed so happy that we were there, many of them quoting the slogan that is seen stickered on many of the UK and UN vehicles out here “Togeder, we de fet Ebola [Together, we will fight Ebola]”. It was this slogan and the definition of “Together” that really got me thinking; that word could extend to everyone at home and needn’t be limited to the 800 or so military personnel working in Sierra Leone. 

How did you first come to hear about EducAid?

I began researching children’s charities in the country, but it was actually a pilot that put me on to EducAid after hearing a radio interview with Miriam during a trip back to the UK. 41% of Sierra Leones population is under the age of 16, so we wanted to find a charity that would help this vulnerable age group. After looking around their website we knew straight away that we had found a very suitable charity; reading about their vision and approach to improving the future of under privileged children – many of whom were badly affected first by years of civil war, and now Ebola - fit what we were looking for perfectly. We organised a visit to meet Miriam Mason-Sesay, the EducAid Country Director, and looked around two of her schools in Port Loko. We met some amazing children, and heard about the challenges that are being faced by the charity to provide these students with an education that they deserve. I have had the privilege of visiting one of their primary schools on several occasions, and each time I have been overwhelmed by the sense of community and the positive attitude of everyone that I have met at this difficult and testing time.

What fundraising initiatives have you started on-board?

Falmouth – Freetown Row
The crew on board have successfully rowed the distance from Falmouth to Freetown (4461km) during the month of December and the theme of buying a kilometre for £1 was well received by service families and the general UK public who were keen to get involved with the fundraising. The £4461 was raised extremely quickly and was used by EducAid to purchase a reliable heavy-duty generator. This generator will allow for up-to-date electronic teaching methods to be used at secondary school level, and to facilitate the vital 24-hour Ebola medical screening checks to take place.

Reindeer Racing Night
A festive evening on the flight deck was another successful fundraiser that took place on Christmas Eve. The event itself involves large dice and big board game type layout, and is a regular Royal Navy favourite for entertaining the whole ship but this time with a Christmas twist. We raised £940 from this event.

Donation of 1 x Days Sea Pay
Deployments that involve a significant period away from our families bring with it a bit of extra pay, (averaging £12 - £15 per day depending on how long you previously spent at sea during your career). Many of the embarked personnel have happily donated 1 day of extra pay to go towards helping the charity. £1100 cash has been raised so far from just one department on board.

Run, Cycle, Row 1 mile for every victim of Ebola
The 13 members of the Royal Marines Band service on board have undertaken a physical challenge to run, row or cycle one mile for every person who had died of Ebola up until the end of 2014. They did this challenge from the 15th January until the 10th March. So far this challenge has raised £1,670.

How do you think the proceeds of these initiatives are helping?

I have seen first-hand the impact of the items that have been kindly donated by friends and family of embarked service men and women. On a visit to the school in Maronka I met two children that tragically lost both parents to the Ebola Virus and were recently taken in by EducAid. When Miriam went to pick them up from their village their entire life possessions fitted inside two plastic carrier bags! It is as a direct result of the generosity of our friends, families, and supporters that over 1.5 tons of donated clothes and educational materials have been donated. Personnel from 820 Squadron had the opportunity to deliver some of the donated clothes and toys just before Christmas. A truly magical day was had by all and it was inspiring to hear the stories of EducAid staff (all former EducAid students) that had successfully completed their teacher training and were now working with the next generation of children. Whilst these two youngsters have tragically lost their family, some solace can be taken that they at least have a safe environment to grow up in with an education as part of the EducAid family. The response from everyone at home to this appeal has been phenomenal and better than we ever could have imagined. The current fundraising total to the charity stands at £10,900, plus an awful lot of physical donations. The RFA Argus has also been instrumental in connecting EducAid with BandAid; this relationship has lead to a huge contribution towards EducAid’s efforts in Sierra Leone.

On behalf of the crew of RFA Argus, EducAid, and the Charity Committee on board I would like to say a huge thank you to everyone that has been involved with the appeal. I would like to say thanks again for all the donated items. They really are making a huge difference to the lives of so many.

Visit the RFA Argus Educaid ‘Orphans of Ebola’ Appeal facebook page here to find more information and photographs from their work in Sierra Leone.

At EducAid we continue to fight Ebola, and to prepare for a life after the outbreak has ended. If you would like to contribute to our work, you can do so here.

Tuesday, March 3, 2015

Teen Pregnancies and Sexual Violence – Unseen Consequences of Ebola (Part 2)

Yesterday’s post detailed many of the instances that women are subjected to increased risks of teenage pregnancy. Whilst the geographical isolation imposed by restricted movement contributed to an increased promiscuity in the youth, women were also subject to increased levels of rape from both within the community and their households.

These factors are largely born from a degradation of social morals exacerbated by Ebola, rather than by virtue of a situation directly caused by Ebola. Today’s post covers this latter point. There are several consequences of Ebola that have left women powerless, and increasingly dependent upon the men in their families and communities. With a lack of alternative options many women are being forced to seek another method of earning money; often this is prostitution. In many cases, this route further compounds the problem of a lower perception of women and female dependence on men. Today we look at what drives the increasing levels of prostitution, and the ramifications that mothers who bear children under these circumstances face. Once again we will look closely at the report by Plan International and other contributory sources surrounding its findings.

Decline of Agriculture Leads to Increased Dependency

The Plan International report bases much of its research in neighbouring Liberia, but many of its findings are applicable across countries in West Africa. It notes that the regional quarantines and self-imposed community isolation has decimated the agricultural sector in West Africa. The reduction of agricultural produce and stemming of trade has caused wide unemployment and a loss of household income. The report writes:

“Women are disproportionately active in the food sector and informal economy and so are hit hardest by the economic impacts of Ebola. Their ability to work and provide food or income is further compromised by the additional childcare responsibilities imposed by the closure of schools.

This convergence of factors leads to women being more and more dependent on their husbands and male members of family, with their economic situation getting worse as the Ebola outbreak matures. Unemployment and loss of household income are widespread: salaried employment and self-employment have been dramatically reduced, and most households are finding it difficult to afford food, medicines, agricultural materials and other essentials due to lower incomes and higher prices.

The extent of food shortages and hunger is a striking finding from the research. Isolation, abandonment, quarantine and stigmatisation deny children and adults access to basic needs, including food. Undernourishment is also widespread. Protein intake is limited by the ban on bushmeat and the limited availability or affordability of alternatives (e.g. fish and chicken).”

These spiralling food prices – rice is reported to have increased by around 50% during Ebola – means the weight of women’s dependency is even greater on their husbands, boyfriends, or male family members. Unfortunately, this serves to further exacerbate the already pronounced perception of woman’s inferiority in Sierra Leone.

Oftentimes in these situations, women are increasingly dependent on men, and are being forced in to more and more drastic means of earning money: prostitution among young girls is reported to have increased significantly during the Ebola outbreak. With ever-increasing cost of living in a worsening economy, this is often the only realistic route to making money. Matthew Dalling, UNICEF’s head of child protection in Sierra Leone, pointed out that transactional sex — exchanging sex for a favour or goods — is driving up teen pregnancy. Increased incidences of transactional sex are thought to be tied to harsh living conditions that are worsened by the Ebola outbreak. In an Al Jazeera blog post, a young girl called Marie Koroma from Sierra Leone told her story that illustrates this:

“My boyfriend was a big, important man, and nothing goes for nothing. I was seeing him because he was helping me and my mum by giving me money. My mother was crying when she found out [that I was pregnant], because I was the only daughter in school, and now there is no hope.”

Koroma said that the baby's father told her he would give her some money while she is pregnant but she would be on her own after the baby is born.[1]

Dependency and Abuse

From reading the report it is evident that cases such as Marie Koroma’s are widespread throughout the affected West African countries. There is, however, an even more disheartening phenomenon that is prevalent throughout the region, and one which relates to the Ebola survivors mentioned above. In some areas, the report found, men are harassing female Ebola survivors for sex despite the risk of infection. If women do not consent, the men turn to rape. Doctors advise Ebola survivors to abstain from sex or use condoms to avoid infecting others for at least three months but, according to the women interviewed for the report, men are still harassing them for sex. Because many women have lost their husbands and other male family members to Ebola, men may view them as vulnerable targets for sexual violence, the report said. In a post by the Public Health Watch, two women who lost their husbands to Ebola told their stories of being drugged by men and becoming victims of attempted rape.

“We are being harassed every day,” said Ariana. “Men see us as vulnerable and think because our husbands are not here any more, they can do whatever they want.”[2]

An Increase in Sexual Violence

An Al Jazeera post writes that “according to a police report obtained from national human rights organization Humanist Watch Salone, there were 2,201 sexual assaults reported in 2014 — up from 1,485 in 2013. Christopher Braima, the national coordinator for Humanist Watch Salone, said it estimates that sexual violence cases have increased 40 per cent since the Ebola outbreak began over a year ago.” Braima goes on to say that “some of the girls who came to our clinics say they were sexually assaulted when they went out to work in markets because they were alone and were not going to school. The more girls are out of school, the more they are vulnerable. A lot of these girls have lost their childhood for good.”[3]

Compounding the problem, the Ebola epidemic also shut down many health and judicial services for survivors of sexual violence. Many hospitals and clinics turned their attention to fighting the virus or shut down.

The Plan International report notes that the closure of schools also removes an important location for child protection. When schools close, children are no longer spending days with peers and teachers in an environment that can provide a level of child protection. The shutdown of wider government services and restrictions on movement (including for international aid workers) in the earlier stages of the outbreak meant that child-protection programmes, where they existed, were no longer providing care to vulnerable children. Often, this lack of child protection leads to teenage protection.

What are the Long-Term Implications of Ebola?

The report’s conclusion writes it most succinctly:

“When asked how long it will take for the community to return to normal after Ebola is stopped, most talk in terms of years. Children tend to see a quicker recovery, thinking about when schools will reopen and when it will be possible to mix with friends, although some also mention deep and long-lasting changes. Community members use the language of war when describing the impact of Ebola. For people with recent experience of civil war and atrocities it is easy to see how the reappearance of widespread deaths, orphans, checkpoints, curfews, movement restrictions, armed troops, surveillance, house-to-house searches and divided communities is a fearful step backwards. Those young people who are forced from education into work or early marriage express feelings of having their future taken out of their hands. To ensure survival, most other needs and rights have been pushed aside.”

This report has put in to focus the importance of the work that we are doing for the Orphans of Ebola, both during the outbreak and the preparations that we are making for after Ebola. Roger Yates, the head of Disaster Response for Plan International, summarises the impact of Ebola like this:

“Illiteracy, unemployment and poverty could escalate at frightening rates in the short term and long term future if children do not go back to school. Before the Ebola outbreak, these West African countries had started to progress in terms of education, with girls in particular benefiting from programmes to get them into school. The long term impact of having so many children missing school for such a prolonged period will be extremely serious, creating another generation of children who lose out on those crucial years of education, who turn into adults who lack the means to get employment and break the poverty cycle. Effectively, we go right back to the beginning again. This is turn will have a massive long-term impact of socio-economic development in the region”

Unfortunately, this is a very real concern that we share. As mentioned above, schools provide a point of child protection that has more or less disappeared for children throughout Sierra Leone and other West African countries. Those of you that know EducAid will know that the provision of child support and protection is a fundamental part of our vision: by creating a stable and safe environment for children - who would be otherwise at risk - we can create the platform for our students to achieve academically and socially. Unfortunately we will have lost some students to the chaos of Ebola, both through childbirth and through the disappearance of their formal education. It is now for us to prepare and provide for the new generation of children who have been born during this period so that we can avoid the bleak future represented in the reports conclusion. Our brave and dedicated staff have done their best to continue the education of those that are not presently on EducAid sites, and we hope that we will be able to bring as many of them back in to our schools as possible. However, we know that we are facing a whole new scale of humanitarian crisis once the Ebola outbreak is declared over.

This impending problem is something that we had identified very early in the outbreak – our #AfterEbola campaign was put together to prepare for this period precisely. Over the past 5 months we have been working tirelessly to prepare for the challenges that we will face when the virus is contained. Now that time is approaching the hardest work begins. Just because Ebola no longer dominates the headlines, by no stretch of the imagination does it mean that the situation has improved. Although people’s lives are no longer directly at risk from this deadly virus, unless we act swiftly and comprehensively, several thousands will be feeling the direct impact of its legacy for decades to come. We are in a great position to directly benefit many of these young people in order to create a better life for them after Ebola.

We are in a situation where the fabric of an already strained society will be stretched to its very limits. Only through support and education will we be able to combat the long-lasting effects of Ebola. It is a job that will stretch long in to the future, but we are in it for the long haul.

If you are in a position to help, in any way you can, please do. Our post last week showed how members of our community organised themselves to send a package of clothing and educational resources to Sierra Leone. There are many examples of how you can raise money for EducAid on our Fundraising page. Or, if you are in a position to help us financially, you can do so by clicking here.

Everything that you donate will go directly to Sierra Leone. No admin fees, no trustee salaries, no nonsense. It’s hard to think how your money could help anyone more in need more cost-efficiently. Please consider donating today.


Monday, March 2, 2015

Teen Pregnancies and Sexual Violence – Unseen Consequences of Ebola (Part 1)

If you have been following the blog closely for the past few months, you will have noticed a continuing theme that runs through all of the accounts coming from Sierra Leone. Every individual that we have interviewed in our ‘Living with Ebola’ series has raised teenage pregnancy as one of the major concerns in the aftermath of Ebola. There have been several suggestions as to the root cause of this phenomenon but, until Plan International released their report on the subject, it has been difficult to comprehend the gravity of the issue and the many – often malicious - forces driving these rising levels.

We have already reported that, as the primary caregivers, women are disproportionately at risk from Ebola. Tending to the sick has put women on the frontline of the fight against Ebola and, as the many instances of doctors and health workers contracting the disease shows, even with training and proper medical facilities it can be extremely difficult to avoid contracting the virus. More often than not women in both urban and rural communities are the first to respond to the sick and the lack of practical information and basic medical supplies have caused the virus to cut those caregivers down prematurely. Although this has been of serious concern during the outbreak, it is important for us to recognise how else women are being disproportionately affected by the outbreak so that we can try to help them with the greatest efficacy. In this post, the first of two halves, we look at some of the driving factors that are influencing these increased rates of teenage pregnancy in Sierra Loene.

Increased Promiscuity

Some situational factors that have lead to the increase in teenage pregnancy are paralyses of commerce, education, and movement. The closure of schools, geographic isolation, and reduced employment opportunities have lead to young people having little variety by way of things to occupy their time. This is accompanied by a general lack of social structure. Blog posts by the Thomson Reuters foundation illuminate this matter by telling a number of Ebola mothers’ stories:

““I heard of 15 girls in this village who have become pregnant because they’re not going to school and have nothing to do,” says Abibatu, 16, who before the schools closed due to Ebola was head girl at a school in Moyamba. “Some of them are as young as 13 or 14,” she adds.

Sixteen year-old Ngadie got pregnant in September, at the height of the outbreak. She says she knew the father, but being out of school gave them more time to play around.

“I knew the father for a year before I got pregnant. I would meet him after school at his house. I don’t know how old he is, about 25. We were in love. I don’t feel good because schooling has stopped. My friends will go back to school whereas I will have to stay at home to take care of the baby.””[1]

Promiscuity is a rather predictable outcome of forced isolation in one’s community, but the consequences of that promiscuity lay much heavier on the woman. Without the sexual education or contraceptive methods that are available in the UK, pregnancy is often the outcome of sex. Regularly, if a child is conceived out of wedlock, the mother is left to fend for the child and herself with little or no input from the absent father. Whilst the lack of daily structure and movement has lead to greater levels of youth promiscuity, there are several more sinister consequences of this forced isolation.

Rape in the Community and in the Home

Throughout the region there are reports coming to the authorities that girls are being raped while they are in the home. During the idleness induced by Ebola, family members and community members succumb to the temptation of sex, ignoring the lack of consent from their victims. Regrettably, the lack of education and respect for human dignity is causing women to pay a severe price during the Ebola outbreak. Rape is not only occurring within communities; in a blog post by Al Jazeera’s Nina Devries, the reporter writes that the International Rescue Committee (IRC) reports that marital rape is also on the rise as a result of the Ebola outbreak. A member of the IRC said he was told of a case in which a male Ebola survivor raped his wife before the three-month waiting period ended. She caught the virus and died.

Marital rape, while illegal in Sierra Leone, is common and rarely reported according to women’s rights advocates. Tania Sheriff, the executive director of a local organization called the Rainbow Initiative said “there is a stigma, a shame for these women. Many are told to keep it quiet and within the family because they are so financially dependent on their husbands.”[2]

The consequences of the geographical isolation under Ebola are multifaceted, and invariably women suffer greatly at the hands of the communities in which they live. Rape within the community and within the family is becoming more common as general discontent with the Ebola situation grows. What’s worse is that, along with the physical and psychological trauma of the event itself, the shame perceived by communities means that rapists are seldom brought to justice. It is only imaginable what the lack of prosecution - or even recognition – of the rape must do to the sense of self-worth of the victim.

Ebola Stigmatisation

The women most vulnerable to the disease – those that have had their parents or breadwinners killed by Ebola – face even greater stigma. Stigmatisation of Ebola survivors and carers, even if those who have displayed no signs of the virus, has been widespread, making it even more difficult for those women who desperately need care and support to survive. The Plan International report notes, “Those stigmatised by Ebola find they cannot buy food even if they have the money.” As primary caregivers in the typical Sierra Leonean home, the responsibility will often fall on young women to care for a family who has lost its parents and traditional breadwinners.

Interviews with young women and girls in the Plan International report exemplify this. There are great concerns, the report said, that these girls will never return to complete their education, putting them at higher risk of exploitation in the future. One young girl in the town of Ganta told the interviewer, “I am used to being cared for as a child, but I am caring for my young siblings and even for my father, as a mother, since I lost my mother to Ebola.”

Not only are these young women often grieving over the loss of their loved ones, but they are being given more responsibility over their siblings than ever. Compound that grief and responsibility with the banishment from their home communities, these girls are being left with fewer and fewer options to provide for their dependents.

Unfortunately, many of these young girls are being driven to prostitution as a the only way to make a living for their young families. Girls as young as 12 and 13 have been reported to have engaged in some sort of transactional sex in order to provide for their dependents. As a result, the stigmatisation of Ebola survivors and orphans is also directly contributing to the increase in teenage pregnancy. This is a driving factor that we will investigate in much greater detail in tomorrow’s post. First, we should understand why teenage pregnancy is so harmful both to the individual, and to the society at large.

The Consequences and Dangers of Teenage Pregnancy

In this post we have looked at some of the influencing forces behind the increasing rate of teenage pregnancies. It is important to recognise why this is such a risk for the wellbeing of the future mother as well as the child. Teenage pregnancy totally disempowers the mother; it takes away the already limited options of education, a career, and an independent life away from, and it is also poses a huge health risk.

According to WHO, adolescents aged under 16 years face four times the risk of maternal death than women in their 20s. The death rate of their babies is about 50% higher. Miscarriages and stillbirths are on the rise, and charities in the UK’s Disasters Emergency Committee (DEC) estimate that one in seven women in countries hit by the Ebola epidemic could die in pregnancy or childbirth because hospital services are overwhelmed.

With fistula, prolonged labour and other complications all notable symptoms of teenage pregnancy, the lack of sufficient care during pregnancy and at birth is of particular concern. Aside from the dangers of teen childbirth, Sierra Leone lacks the medical facilities to handle these cases. With the medical facilities dedicated to the removal of Ebola in the country, many of these women are being denied healthcare services when they most need it.

It is clear that we need to address this upward trend in teen pregnancies and to help limit the damage that it does to these young mothers. There are several ways that we can do this; providing support and an education for their children so that we can avoid an endlessly repeating cycle of low education is a start.