After Ebola: Sillah’s Journey to EducAid

The World Bank identifies “orphans and vulnerable children” as a group requiring special consideration and intervention to protect them from a high likelihood of “negative outcomes.” These children “are more exposed to risks than their peers” and “most likely to fall through the cracks of regular programs.” These are the children that experience “loss of their education, morbidity, and malnutrition, at higher rates than do their peers.”

Sometimes, catastrophic events push large numbers of children very suddenly into this high-risk group. One such event was the 2014 Ebola outbreak in West Africa.

And Sillah was one of those children.

At the beginning of the 2014 summer holidays, Sillah made the hour and a half journey by road to return home from his school. He was looking forward to a pleasant summer with his family. But soon after he arrived, the Sierra Leonean government declared a three-day lockdown.

Sillah’s father, a pharmacist with a good career that enabled him to pay the school fees for his son’s education, was asked to volunteer. Eager to help, he agreed to be a “sensitization” volunteer – someone who would provide information about the virus and limiting the spread of disease to members of the local community.

When he arrived at the center to begin volunteering, it was immediately clear that manpower was urgently needed for a different, more difficult and dangerous job – burials. Wanting to help anywhere he could, Sillah’s father joined the burial team and was tasked with collecting and carrying bodies from their final resting place to the gravesites. Typical of early-response health services during the epidemic, he was not provided with adequate training. Nor was he given proper protective gear to use while handling infected bodies.

Almost inevitably, he fell ill within a few days.

Sillah took his father to the hospital and two days later the entire family was quarantined – Sillah, his mother, his 12 year-old brother, and his three sisters (16 years, 10 years, and 19 months old) were all restricted to their home for 21 days – the maximum window of time for incubation of the virus (http://www.who.int/mediacentre/factsheets/fs103/en/). If they were infected, they would show symptoms within those first 21 days and be transferred to a hospital for treatment. So they began to wait.

On the 17th day, the entire family began showing symptoms of the dreaded disease. They were taken to a hospital and crowded into an already over-taxed, under-resourced care center.

Only Sillah and his mother managed to survive.

Reeling from the loss of four siblings and one of his parents, Sillah was also worried about his future. Without his father’s income, he would not be able to continue his education. The disease, which had already taken so much from him, was going to take his future as well.

Fortunately, a journalist told Sillah about EducAid Sierra Leone, a system of schools run by World of Children Honoree Miriam Mason-Sesay. He pointed Sillah in the right direction and recommended he get in touch.

EducAid welcomed Sillah with open arms and he moved to the school in December. When he arrived, he was still very emotional, grieving his many losses. But he settled in as well as he could and began the process of resuming his studies.

Miriam immediately noted that, “he is generally amazingly cheerful and threw himself into being part of things: football, wood collecting, learning, cooking, whatever it was.” While it appeared that his previous school had provided poor mathematics lessons, he jumped into the subject and began tackling it with enthusiasm. “He has a quiet confidence,” Miriam said. “He will do well.”

Though a merciless epidemic caused Sillah unfathomable loss and thrust him into a “category” that made him likely to have negative future outcomes, EducAid was there to stop his falling through the cracks. This is truly what it means to protect children. World of Children Award is honored to support and stand with Miriam, EducAid, and all of their donors and community in protecting children – today by providing a safe place to stay and for the future, by providing the education they will need to survive and thrive.

Donate today to help protect more children worldwide: www.mydonate.bt.com/EducAidSL

Read more about Miriam’s 2015 World of Education Award: www.worldofchildren.org/honoree/miriam-mason-sesay

Learn more about EducAid by visiting their website: www.educaid.org.uk

This blog post is part of the World of Children Award Child Protection Blog Carnival. The Blog Carnival pulls together stories that represent the global breadth and depth of thinking and on-the-ground work that we and our fellow World of Children Award Honoree organizations are providing to protect children.

Visit the Blog Carnival to read stories from fellow Honoree programs protecting children from child-trafficking, abuse, neglect, and the vulnerabilities associated with being poor, orphaned, or disabled in countries as widespread as Colombia, Nepal, Sierra Leone, Mexico, India, Ukraine, and Haiti.

www.worldofchildren.org/blog/child-protection-blog-carnival

The Progress of the Vaccines

Back in January, I wrote a blog post about the on-going vaccine trials that were providing hopeful signs to find a permanent preventative drug against Ebola. We can all agree that this is the most permanent way for the global community to prevent another outbreak of this virus. As Ebola recedes, and Liberia is declared free from the virus, how have those vaccine trials that we laid so much hope and financial capital in ended up? According to the WHO, not as well as we had hoped.

Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation, said in a news briefing in Geneva: "The best news is we are going to zero cases, there is absolutely no doubt about that," she said.

“Two experimental Ebola vaccines - developed by GlaxoSmithKline and jointly by Merck and NewLink Genetics - being tested on volunteers may not yield sufficient data on efficacy as case numbers fall. It is not clear whether it will be possible to have even a hint of efficacy from these two vaccines," she said, noting that they already had been proven safe.

To have efficacy we must see if people are actually protected, as the number of cases is going down it is not clear whether there will be a strong robust answer to this question at the end of epidemic," Kieny said.

This is, fortunately, not the whole story. As you may remember, Bavarian Nordic, which struck a milestone deal with Johnson & Johnson in October for the development of their Ebola vaccine, was working on a 2-dose vaccination approach for Ebola using different vaccines for the first and second doses. This approach is known as heterologous prime-boost. The two vaccine candidates are known as Ad26-EBOV and MVA-EBOV. Bavarian Nordic, and Johnson & Johnson, have received a 50 million euro loan from the European Investment Bank (EIB) to help it develop a vaccine against Ebola.

This latter partnership has been collecting samples of the live virus in blood, urine and other bodily fluids in order to continue the testing. Considering the uncertainty surrounding the efficacy of these drugs, it is highly unlikely that we will see human trials of these drugs until absolutely necessary. However, the continued investment by the EIB shows a determined and long-term approach to creating a useable vaccine.

The continued investment and prevalence of live virus samples will enable these companies to do what they can to make sure that we are better prepared for the unfortunate situation when Ebola arises. Let’s hope, for all of sub-Saharan Africa that Ebola doesn’t become a major issue in the future, but at least big Pharma will be in a position of knowledge, rather than chasing ghosts as they were this time around. If you would like to read the full update on all of the antivirals, you can do so from the WHO website here.

There are many lessons that can be learnt from this Ebola outbreak, and the speedy preparation of antivirals is a major one.

Liberia declared Free from Ebola

Yesterday, Liberia became the first of the three countries at the centre of the Ebola outbreak to have been declared free from the virus, after 42 days of no new cases. In response to the WHO announcement, the government encouraged the country to have a day of celebration, as can be seen in the photos.

This is a truly landmark day for what has been the biggest outbreak of the virus ever. It’s important that we pay our respect to those that have suffered from the disease, and for those who have maintained their strength and composure in battling it. It’s a great day for Liberia, and we hope that the day will come for Sierra Leone very soon.

Unfortunately, that day is not yet here. Schools are back, and the reports are that attendance is picking up from their initial low numbers. At EducAid we were at 80% on our first day, and numbers have been steadily rising since. It’s been an incredibly busy time at EducAid, so we want to say thank you to all of the staff that have made this first few weeks as smooth as it has been.

Today, an Italian nurse operating in Sierra Leone has been confirmed - a severe warning that those still in the firing line of Ebola are still severely at risk.

On a positive note, numbers of new cases have not increased since the schools have opened. This would suggest that, not only have the schools been well-prepared for their re-opening, but also that the general population have learnt the all-important lessons of combatting Ebola on a local level. Those showing symptoms of the virus are being reported quickly, enabling rapid and efficient treatment and quarantine by the Ebola teams still combatting the spread of the virus.

We should draw a lot of hope from the announcement in Liberia – if nothing else, we know that it can be done. The combined effort from the government and NGOs, as well as from the population itself, has enabled the country to eradicate this pervasive and destructive virus. 

Sierra Leone is in a different situation: geographically, it sat in the centre of the three affected countries, and that certainly impeded the efforts to slow the outbreak. For now, we must be patient. We must continue to be cautious, and we must continue to work against the spread of Ebola.

Onwards and upwards for Sierra Leone – our day will come soon.

The Challenge of Getting Students back to School

Schools are open, but attendance is low. There are several things affecting the cautious and slow return to school for Sierra Leone’s youngsters. Roeland Monasch, Unicef’s Sierra Leone representative, who described the reopening of the country’s 8,000 schools as “a major step in the normalisation of life”, but Alison Schafer, World Vision’s mental health and psychosocial support specialist in Freetown says that “reopening schools is not just a one-off event. It’s going to be a months-long journey.”

Below we look at some of the reasons behind the slow return of students, and whether we can expect the numbers to return to normal.

Fear

Parents are, understandably, nervous and fearful of allowing their children back to schools to mix freely with other students. It’s a realistic concern, and one that we share to a certain extent ourselves.

The fear that parents are feeling was exemplified when we opened two of our schools; we had to have major community meetings with the Paramount Chief and Deputy Director of Education to convince parents that the drinks we were giving the students while they were taking their questionnaires and literacy tests we not a plan to give them Ebola. The paranoia that this invisible and indiscriminate killer has left is astounding.

School children across the country have been met at the gates with infrared temperature checks, chlorine washes, educational programmes to reinforce Ebola prevention techniques, and more stringent rules surrounding playing and touching one another.

Ebola is still in the country and, going against the previous announcement from the Ministry of Education, the schools have opened before the country has been declared Ebola free. We will be watching closely the news and figures surrounding new cases, and whether they are linked to the reopening of schools.

At EducAid, our staff have been actively engaged in fighting Ebola from the outset, so we have the facilities and training to minimise the threat of an Ebola outbreak. Having said that, the utmost caution and discipline will be taken at every step.

Family Economy

Due to the widespread destruction that Ebola has caused, more than 8,600 Sierra Leonean children lost one or both parents to the disease. Family finances and the general economy are at a desperate low, with many children forced to find work to support themselves and their families.

“It will be hard for struggling families to sacrifice even that small income and send their children back, especially girls,” said Alison Schafer.

Fortunately, EducAid does not charge any fees, nor do we require any of the potential financial barriers to education such as clothing or educational materials. As you may well be aware, our fees are: excellent attendance; excellent behaviour; and excellent effort.

In an article by The Guardian, Sylvester Meheux, a headteacher in Rokel, says that in many cases the students “have been trading and are now used to having a little bit of money.” This makes the challenge of bringing these students back to school that much more difficult, and bringing this new-found independence back in to the schooling environment.

This is a challenge that we will face on a student-by-student basis, and one that we are prepared for.

Birth Rates

Teenage pregnancy has been a huge problem, and one that we wrote about in two previous articles: Teen Pregnancy & Sexual Violence – Unseen Consequences of Ebola (Part 1 & Part 2). This group, girls that have already lost so much to this disease, will not be allowed back because the government has refused to lift the ban on pregnant girls attending school.

Fortunately, we will not have to abide by this ban if we find that some of our girls have fallen into this trap. The Ministry of Education is digging it’s heels in on this item for government schools though, and we know that many futures will be lost with this decision. In a country where women are already at such a disadvantage, they are being punished for actions for which they should either share responsibility or, unfortunately, share absolutely no responsibility or blame in. To read more about this, do read the blogs linked above.

Disengagement

Disengagement is potentially one of the biggest problems that we will have to encounter. Like child students across the world, a year out of education – under any circumstances – will make it incredibly difficult to return to the structure of school. Add to that the lost skills and investment in the school and examination system, these students will need so much support to get them back to their studies.

“Amid the relief and excitement of returning to school”, says Alison Schafer, “there would also be fear and anxiety – which was why World Vision had helped train more than 1,000 teachers in psychosocial support skills. Although children may be concerned about the possibility of catching Ebola in the classroom, they are more worried that they’ve forgotten everything they’ve learned,” she said. “They’re anxious about whether they can ever catch up.”




People in the country are quietly positive, however. Many people in Sierra Leone do recognise the importance for education, and it has become a something positive in the world since the civil war. Increasingly, children have better access through both government and NGO lead programmes.

“The turnout is small but we hope more will come by the end of the week,” said Sylvester Meheux, Rokel’s headteacher. “Some children have dropped out but the bulk will return.

The problem is, of course, the longer that they stay away from school, the harder it will be to get them back. With nearly a year out of school already, every day it gets more difficult.

The good news is that EducAid will be reopening our schools on the 27th April. We are a lifeline for so many children, it will be good to get back on to our mission. The excitement within the schools is palpable, and our staff have been busy preparing for the students return. Not long to go now!

Inside Ebola Junction: Dr. John Wright

Dr. John Wright is one of the first NHS volunteers who travelled to Sierra Leone to help fight Ebola. He was a part of the founding team at the Ebola Treatment Centre at Moyamba Junction. During his time in Sierra Leone, Dr. Wright recorded the events and experiences; in this article I have transcribed some of his thoughts.

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“It’s Friday, and it’s our real opening day today. We are 4 days late from our original starting date, but it feels like 4 weeks. However, perfection continues to be the enemy of the good and our infection control team are still finding lots of fairly trivial things to sort out before they’re absolutely confident about accepting our first patient. We settle on another postponement from the morning until the afternoon. 3 Ebola positive patients have been reported, and they’re all clinically stable. So, this seems like a pretty good test for our opening. We can admit them straight away and start looking after them properly. There are still lots of other issues in the background: the security for the centre isn’t quite right; the kitchens aren’t working properly; but clinically - and from the infection control - we’re ready.

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After half an hour in my protective suit, I feel as though I’m in an out-of-control sauna. My goggles are fogging up, and my vision is starting to get impaired. After an hour I have a pounding headache, and sweat is literally pouring down my body filling my boots which squelch when I walk. I start putting up an IV line, but I’m thick-fingered with my double gloves. I can’t see very well out of my steamed-up windows, so I do the right thing and pass it over. However, this is just mid-morning, and I dread to think what the ward rounds are like in the middle of the African Heat. Eventually I stagger to the doffing area. The doffing monitors are the Kings of the Ebola centres; they have no qualifications, little literacy, but in the doffing station they have all the power. With their chlorine sprayers on their back, they are the ones who will de-contaminate me and get me safely through to the other side.

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Ebola really is a terrible disease: pain; fever; exhaustion; confusion; diarrhoea and vomiting; and bleeding. Safi, the older woman, has against expectations improved from her near-moribund state yesterday. Isatu, the younger woman, who was well on admission deteriorated yesterday, but after ramping up treatment she’s showing some signs of improvement. On this morning’s ward rounds she was really distressed: she says that she is not worried about her own life – about dying from Ebola – but she is worried about her children. Her 5-month old daughter died last month, but her other children are now abandoned at home with no one to support them. Meanwhile, Ibrahim, the one we were least worried about, has deteriorated rapidly. He is confused and almost catatonic, a zombie-like state of late-Ebola. During the first 36 hours since our Ebola Treatment Centre opened, these 3 patients were jostling for position on the critical list, but today it is Ibrahim that looks most likely to die.

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There is a maxim for Ebola hospitals, and that is to expect the unexpected. This afternoon we were taken by complete surprise when two ambulances turned up in quick succession. It is the second that causes the greatest problem. On the adult-sized stretcher lies a tiny 2-year old girl, silent with fear. There are now 7 of us in full personal protective equipment. I pick her up in my arms; I know there is a risk that she may pull at my goggles, but she is so small, so fragile, so afraid , that I cannot resist.

She clings to me with the reflex of a toddler, and the stoicism of an African child. She is beautiful. I asked the ambulance nurse about the child. We have no name, no parents, no record, no history. The nurse had been at the primary healthcare clinic when the child

The story is that her mother has Ebola. The story is that her mother is here in our hospital.

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On the afternoon ward round, I find Ibrahim unresponsive. It is difficult to feel a pulse with the double-gloving, and it is difficult to check his pupils with my fogged up goggles, but it doesn’t take long to conclude that he is dead: our first Ebola fatality. I stretch out his arms and his legs, and I cover him in a blanket. The chlorine sprayer is twitchy as she washes y hands, and she drops her sprayer. She knows that Ebola is most dangerous at death, and she is scared of the body. And after the close contact that I have had, she is fearful of me. A sudden sadness descends on the team. Ibrahim was young and fit, and almost symptomless on admission. Ebola is an unpredictable grim reaper.

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It’s my last morning in Moyamba, and I have just heard great news back from the laboratory: our first negative Ebola test from one of our patients. It’s Safi, a woman in her 60s who was very close to death when we admitted her. This means that we have our first survivor just one week after opening. The first of many I hope. How do you cure Ebola? One patient at a time. I couldn’t have wished for a better souvenir

‘Moyamba’ is Mende for ‘send for us’, which they did. We turned up far too late to the starting line for this life and death race, but we have arrived in time to make a contribution. Our Ebola hospital will isolate and care for the last patients on the bumpy tail of this epidemic, and our work with the community will help stop spread. The real heroes of this struggle are not the international community, but the health workers in the communities of Sierra Leone who have fought and died on the front-line of this terrible war. I leave full of admiration for their bravery; Sierra Leone: Lions on the Mountain”

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The radio piece was originally broadcast on Radio 4 on 24th February of this year, and is available here.

Thanks to the Dr. John Wright and the BBC for providing such a compelling listen.

Following this is a short aerial video of the Moyamba Ebola Treatment Centre where Dr. John Wright worked – it really shows the scale of the operation going on there. 

Curing Ebola, one patient at a time.

Click to view video here.