Koinadugu is one of the northern districts in northern Sierra Leone bordering with Guinea. It is no surprise that strategies put in place by the Koindugueans have greatly contributed to the very slow outbreak of Ebola in their district.
When Kailahun in the eastern region started reporting Ebola cases, the politicians that haled from Koinadugu immediately, visited the district. These included Koinadugu Parliamentarians alongside the Minister of Finance, Dr Keifala Marah, Minister of Tourism and Culture, Mr. Peter Bayuku Kont and the Deputy Minister of Youth Affairs, Miss Feremusu Konte. These politicians held consultative meetings with key stakeholders,including one-on-one and group meetings to discuss how best everyone could put their hands on deck to prevent Ebola from invading the district.
These meetings brought out a lot of thoughts which were put into action, and are described below.
Establishing an Ebola Task force and Emergency Operation Centre (EOC)
A district Ebola task force was formed early on in the country’s epidemic in May 2014, with a good mix of community representatives ranging from traditional leaders, politicians, government ministries, NGOs, CBOs, DHMT, Hospital, radio to Mamaye Activists. The task force is chaired by a renowned health professional Dr. Faseneh Samura who is known to be a “no joke” person. The EOC is the technical body at the district level as it is being technically headed by the District Medial Officer and of late a Coordinator has been identified for EOC who also doubles for the chairman of the Task force.
Engagement with traditional healers
Koinadugu is known for having people with Black magic ‘skills’ commonly known as “JuJu men”. Among one of the first cases known in Sierra Leone was a traditional healer in Kailahun district in a small community at the Guinea/Sierra Leone border. Here, Ebola patients from Guinea came to receive her healing powers but instead brought Ebola into Sierra Leone were hundreds of lives have been lost.
Reflecting on how this traditional healer contributed to transmitting Ebola by passing it on through her clients, the first group that the Ebola taskforce engaged were the traditional healers.In Koinadugu the traditional healers were well sensitized about the disease and they were strictly warned to cease from healing people until such a time. The task force advised that they would inform them when they could recommence their consultations. It is also important to note that this is the only means these traditional healers could make their livelihoods. A seed of money was donated to these healers so that they could engage themselves in other profitable livelihood engagement rather than healing people. This was well appreciated by the healers and made a strong promise that they would cease from healing people at this point in time. The healers served as ambassadors who further went back to their communities and led Ebola sensitizations.
Requiring travellers obtain a ‘visa’ to enter the district
In addition, entering Koinadugu district requires a visa which is called “a pass”. Travelling to Koinadugu district is no more an unplanned event, as citizens also living in the district are permitted and given a pass to travel out of the district. This restriction is really effective in Kabala township but one would want to ask how well this is being replicated for other outlets in the district e.g the Guinea and Kono axis.
What is involved when you want to travel into and out of Koinadugu district?Travelling plans are being communicated to the task force and seeing the relevance, the task force chairman will fill in the “pass” template and sign and this is given to the passenger to board a vehicle leaving Kabala. For passengers travelling into Kabala like in our case, Mamaye in collaboration with the Office of the First Lady shared a concept note with the District Medical Officer and district Health Sister highlighting the purpose of the planned activity in Kabala, level of engagement with Key stake holders and the key messages.
The forum was to rebuild the confidence and trust of pregnant women to access health facilities even in the Ebola outbreak, since this have created fear in both health workers and patients of contracting the Ebola virus in health facilities. You might not have restrictions if your programme is already operating in Koinadugu district as it was the case for Mamaye, but mind you, your activity should have an Ebola flavour before it is urgently approved by the task force. The District health management team upon their approval of the activity sent the names of passengers on board the vehicles and vehicle numbers to the task force chairperson and this “pass” was signed and sent to the check point which is approximately 40 kilometers away from Kabala. If this pass is not received at this check point the vehicle is not allowed to proceed into the district.
Restricting movement of people into Koinadugu district
The district Ebola task force has also succeeded in monitoring the entering of all vehicles and people into Koinadugu district. Only essential vehicles are allowed to enter in the district which might be a known vehicle with food stuff or an identified NGO vehicle on duty. Days are designated for marketing vehicles to leave and come into Kabala. Traders already identified leave Kabala two days a week and the same passengers would return come with other goods and food stuff to address scarcity of goods and food stuff. The control of the movement of business people in Kabala have prevented entering of other business people from other districts.
Similarly NGO residing and operating in Koinadugu district have their vehicle numbers already communicated to the checkpoints. At each of the Koinadugu check points, the temperatures of all vehicle passengers are taken. The flow of vehicles into Koinadugu district has drastically reduced as vehicles from the Makeni high way stop at the first checkpoint which is about 4 kilometers to Fadugu. Passengers work from the first checkpoint to Fadugu where there is the second check point. So vehicles reaching Kabala picks up passengers from the second check point to Kabala. Passengers have been struggling with their luggage from this first check point to the second to join other vehicles.
Chiefdom level sensitization
Despite the rough terrains in Koinadugu district, the task force members undertook Ebola sensitization meetings in all the eleven chiefdoms, some of which are more than 100 miles from the district headquarters and in rough terrain. This was to ensure that communities are aware of the Ebola signs and symptoms and preventive measures. Community actions in the fight against Ebola included the reporting of persons presenting signs and symptoms as that of Ebola.
Neighbourhood watch
Neighbourhood watch is a strategy put in place for neighbours to report any suspected sick person and an unannounced travelling visitors that might be hiding in homes. This strategy is really effective in Koinadugu district as the District Health Management team in their Ebola sensitizations included the dissemination of Phone numbers of health professionals (District Medical Officer, District Health Sister, the Surveillance Officer) who could be immediately called. There were two incidence were neighbours reported suspected sick persons from Portloko and Kailahun districts in homes and these are Ebola hotspots and Guaranteed districts. These sick people were repatriated to their districts by the surveillance team.
The Koinadugu stakeholders are well prepared in case of an Ebola case in the district which has now materialised as of yesterday, October 15th 2014. The District medical Officer in collaboration with NGO partners have constructed an isolation centre within the hospital compound that would host suspected cases until they are being tested positive and would be taken to treatment centre.