In March 2014, news of an Ebola outbreak in Guinea reached Sierra Leone. In response, the Ministry of Health and Sanitation (MOHS) mobilized the national Ebola Case Management Taskforce, and invited the King’s Sierra Leone Partnership (KSLP) to contribute. KSLP played a critical role in the Ebola response in Freetown, working within Connaught Hospital and with the Ministry of Health and Sanitation to curtail the outbreak. Although Ebola no longer makes the headlines, it is still very much felt by Sierra Leone and its people, and is still a part of our partnership’s collective memory, way of working, and strategic vision.
KSLP was a member of the Ebola Response Consortium (ERC), a coordinated NGO response in Sierra Leone to the largest Ebola outbreak in history. Utilising infectious disease experience within the in-country team, KSLP helped develop national guidelines for suspect case definition and developed safe isolation and testing protocols. Before the first case was confirmed in Freetown, KSLP supported the MOHS to establish an Ebola Holding Unit (EHU), the first of its kind in the country, at Connaught Hospital. As the outbreak spiralled out of control in August 2014, the unit at Connaught Hospital provided about half of all beds available in Freetown. The model for the EHUs was then replicated across five other government hospitals in the Western Area Urban, with direct support from KSLP. By January 2015, these units had isolated nearly 40% of all cases in the district.
By providing practical training and supervision and upholding standard operating procedures, KSLP volunteers were able to build confidence in local health workers and increase the overall number and competency of national staff. Enduring significant stigma and personal risk, these highly trained isolation unit staff managed over 1,125 suspected, and over 578 confirmed cases of Ebola in Connaught Hospital. In addition to providing essential training for a large number of healthcare workers, surveillance officers, and others involved in the outbreak, KSLP volunteers assisted the District Health Management Team (DHMT) for the Western Area to establish the Western Area Command Centre. With support from KSLP, the Command Centre managed key elements of the Ebola response such as coordinating ambulances, identifying cases in real-time, tracking beds in the area’s EHUs, coordinating burial teams, creating a central database for suspect EVD cases, and collecting and communicating laboratory results.
Despite a significant shortage in clinical capacity, the KSLP team worked with local partners to carefully record clinical information so that clinical features and management of EVD could be retrospectively analysed to generate evidence for best practice. The data from the collaborative research which was conducted will be invaluable in the response to any future EVD outbreaks.
Below is a video highlighting many of the organisations involved in the response:
About Ebola Virus Disease
Ebola virus disease (EVD) is a severe viral illness, with mortality rates of 60 – 90%. The virus is generally transmitted through bodily fluids, but also occasionally through contact with surfaces that a person with EVD has touched. Burial ceremonies that involve touching the body are also a transmission risk.
The early symptoms of EVD can often be confused with malaria or cholera, and can include: sudden fever, intense weakness, muscle pain, headaches and a sore throat. Vomiting and diarrhoea follow, increasing the chances of transmitting the virus, and there can be internal and external bleeding.
Patients are infectious once the symptoms begin to show: 2 to 21 days after they have contracted the virus. While vaccines are now being trialled, there was no vaccine or cure during the outbreak and treatment options were limited. Patients required intensive supportive care, with intravenous fluids or oral rehydration salts.
About Ebola Virus Disease in Sierra Leone
The virus first surfaced in Guinea in February 2014, but it was not until May that the first cases and deaths were confirmed in Sierra Leone. The disease spread quickly, and by July the number of cases was in excess of 1,000. Among the fallen was Sierra Leone’s most experienced haemorrhagic fever specialist, Dr Sheik Humarr Khan, who had been treating patients at Kenema Hospital in the eastern part of the country.
Having recently emerged from a brutal 11-year civil war, Sierra Leone’s weakened health systems struggled to contain the outbreak. A lack of supplies, a shortage of trained lab technicians, infectious disease specialists, and insufficient training in effective infection control practices were major challenges. While public health information from the government was consistent, fear of the disease spread and rumours circulated, further exacerbating the severity of the outbreak.
KSLP’s Role in the Response
The KSLP team remained in Freetown, supporting the Ebola response through advisory and clinical roles. We believed that the risks were manageable and that our support to partners had never been more vital. Read more about our role in preparing for the outbreak and working on the frontline.
The King’s Sierra Leone Partnership played a crucial role in curtailing the Ebola response in Sierra Leone. Working in collaboration with local partners we:
- Supported the management of more than 1125 suspected, and over 578 confirmed, cases of Ebola in Connaught Hospital
- Set up an isolation unit at Connaught Hospital and mobilised a team of 50 national staff to manage it. Connaught’s highly trained isolation unit staff managed over 1,100 suspected, and over 650 confirmed cases of Ebola in the hospital*
- Supported six hospitals across Freetown to set up Holding Units, which saw 2,571 suspected cases, 1,159 of which were positive*. These units are now fully managed by Sierra Leoneans, with training, mentorship and supportive visits from King’s Sierra Leone Partnership
- Provided training for a large number of healthcare workers, surveillance officers and others involved in the outbreak
- Set up the Western Area Command Centre, a key part of managing various elements of the response
- Supported Connaught Hospital and all other EHU-supported hospitals to stay open for normal medical services, and developed a system for those testing negative for Ebola to receive initial admission for free
- Worked closely with the Government of Sierra Leone and the British response to provide technical advice where required
- Piloted a psychological support programme by South London and Maudsley NHS Foundation Trust for healthcare workers
- Published the first field study of a rapid diagnostic test for EVD , designed a novel method of assessing environmental EVD contamination , and identified characteristics associated with a positive EVD diagnosis
- These papers, and others about various aspects of the outbreak and key findings for how best to respond to future outbreaks, were featured in Eurosurveillance, Lancet Infectious Diseases, and BMJ Global Health.
Additionally, a nationwide Infection Prevention & Control (IPC) programme was implemented to improve health workers’ capacity to prevent and manage infectious diseases. KSLP has since supported its colleagues at Connaught Hospital to train over 1500 health care workers in IPC practices and to build a new permanent Infectious Disease Unit to ensure Sierra Leone is better prepared to prevent and contain future outbreaks.
From Response to Recovery
On 7 November 2015, Sierra Leone reached the milestone of 42 days without an Ebola case. Known as 0+42, this is significant because it marks the passing of two incubation periods since the last case tested negative for EVD. Unfortunately another cluster of cases emerged in Sierra Leone in January 2016, restarting the countdown to 42 days. Transmission linked to these most recent cases was declared to have ended on 17 March 2016.
Although the Ebola outbreak has effectively ended, its legacy remains. The Ebola Holding Unit model was proven to be a flexible, effective and low-cost model of diagnosis, isolation, and treatment of EVD; KSLP-supported units provided initial treatment to over 10% of all Ebola patients in Sierra Leone for less than 0.5% of all UK expenditure during the outbreak. We continue to provide technical expertise in the management of suspected Ebola cases and we are also part of a consortium of NGOs working to support Connaught Hospital in its role as the tertiary referral centre for Ebola survivors.
The Ministry of Health and Sanitation (MOHS) has identified a number of key result areas in their post-Ebola recovery priorities including Infection Prevention and Control (IPC) and post-graduate training. We’re committed to supporting our partners in achieving these priorities and to finding long-term, sustainable solutions to ensure that Sierra Leone has a health system in place to prevent a similar outbreak in the future. To do this, we work in collaboration across four outward facing strategic areas: Workforce Development, Patient Care and Experience, Enabling Environment, and Innovation and Best Practice. You can read more about our work here.