Sierra Leone Conquered Ebola And Celebrated The Best Way Possible

Photo credit: CDC CDC disease detective Kari Yacisin went to Guinea to work with local teams doing contact tracing, the laborious job of finding all those who came into contact with an Ebola patient and checking them for symptoms every day for 21 days. It is slow, painstaking work, not made easier by hours of hiking jungle paths required to reach small villages and the people living in them. "I only knew we had reached the right place when my local colleagues said so. The dedication and knowledge of these local teams is a critical part of the Ebola response."

Photo credit: Emiko Petrosky/CDC This small settlement is near Wahru, a village in the Tonkolili District of Sierra Leone. Upon hearing of possible Ebola cases in the settlement, CDC staff and partners including disease detective Emiko Petrosky drove as close as they could get, then hiked three miles on a narrow dirt path through the jungle to reach their destination. They arrived to find four people sick. Their first challenge was getting these sick patients back to the road where an ambulance waited. Two were able to walk to the ambulance, but the others were too weak to make the journey on foot. One was taken by motorbike, sandwiched between two men who wore personal protective equipment to keep from getting infected. The last was strong enough to hold on, so he clung to a second motorbike driver who was also dressed in protective gear. “After getting the last patient to the ambulance, we stayed in the settlement to be sure the children of the sick villagers were cared for and to gather as much case information as we could. Then we walked three miles back in the hot sun and picked up our cars to drive to the District Health Management office and report on what we found. It took one full work day for us to help those in this one small community,” said Petrosky.

Photo credit: Justin Williams/CDC Sometimes the road to a village is not just a dirt path, but a log path as well. Here, a rutted dirt road is interrupted by a makeshift bridge made from a dam of fallen logs. CDC communications staff member Justin Williams took this photo when he was part of a convoy of seven vehicles headed to John Logan Town in Grand Bassa County, Liberia. “We were in the ‘dry’ season, but it was still very muddy and rained every afternoon. We were traveling in a logging area where deforestation contributes to the bad road conditions. We walked across this bridge while our drivers determined the best way to get the vehicles across.”

Photo credit: Jamaica Corker/WHO Where roads do exist, travel is not much easier. CDC epidemiologist Caitlin Worrell and her colleagues including Jamaica Corker of WHO traveled these roads daily as part of their work in Guinea. “It’s hard to capture in a photo how terrible and terrifying the roads can be. They are barely passable by motorbike where the driver can maneuver the bike through the extremely uneven terrain. But in a vehicle with four wheels, there’s no way to avoid the bumps and ruts. There were times when every wheel of our vehicle was on a different level. And as passengers we were tossed around like rag dolls. Your head would hit a window or the roof – there was no way to do anything during a two-and-a-half hour ride except hold on,” said Worrell.

Photo credit: Jamaica Corker/WHO Road conditions are so poor that it’s not unusual for vehicles to lose a part and require maintenance on the spot to get them back running. Here local driver Aruna Keita has pulled off the road to make a repair after a part fell off on the bumpy journey to Macenta, Guinea. "Even the most rugged vehicles will take a beating on this terrain. Frequent pit-stops for impromptu repairs are par for the course in Macenta, and all drivers must also be skilled mechanics, ready to improvise all kinds of emergency repairs on the side of the road. Though all vehicles are equipped with toolkits, sometimes extra creativity is needed. On one trip, our driver used a scarf I'd had on my head to secure a large piece of the underbelly of the truck that had come loose. You have to plan and prepare for these kinds of thing on any trip – and in some cases rely on the kindness of a stranger on a motorcycle to send word of your delay ahead," said Jamaica Corker of WHO.

Photo credit: Justin Williams/CDC Where bridges exist, they are often makeshift affairs, and some structures aren’t safe for anything heavier than a person on a motorbike. In October, a CDC team encountered this bridge almost five hours out of Monrovia as they headed to the community of Manbili-ta in western Bong County, Liberia. Scott Laney (left) and David Blackley walked the bridge to see if it would be safe for their vehicle. “Less than a mile beyond this bridge was the end of the road. We parked the SUV and the team continued on foot for two more hours to conduct assessments in several isolated villages,” said Blackley. “In October when this picture was taken it was critical for us to reach remote villages to get community members to treatment facilities as soon as possible. Now, in February, I am returning from a grueling road trip to remote villages along the border of Ivory Coast. I am happy to report that we found no evidence of ongoing transmission in these villages. It is critical to go the hardest to reach areas to make sure Ebola is not lurking there. Ebola doesn't respect borders or rough roads and sketchy bridges. We will chase it to the ends of the earth,” said Laney.

Photo credit: Justin Williams/CDC Sometimes teams get to a bridge only to find that it’s under construction or being repaired. Earlier on the day this photo was taken, the CDC team had traveled this road and crossed a log bridge on their way to John Logan Town, Liberia. This is a logging area and bridge builders make frequent use of large trees as a way to span a waterway. Returning to Monrovia later that day, the team discovered the bridge had been taken down and a new one was being erected. There was no choice but to park their vehicles and wait while new logs were fitted into place. “At the end of a very long, hot day, it was discouraging to come to a complete stop. But the bridge was being replaced and so we had to wait. They had just laid the first log when we arrived,” says CDC staffer Justin Williams.

Photo credit: Justin Williams/CDC It was after dark before the bridge repair was completed and the CDC team could finish their journey back to Monrovia. “Because traveling from place to place can take so long, on a typical day we were on the road by 5:30 a.m. The day we had to wait for the bridge to be replaced, we didn’t get back to where we were staying until 9 p.m.,” said Williams.

Photo credit: Kelsey Mirkovic/CDCIn this part of West Africa, travel is done by water as much as it is by land. The countryside is crisscrossed by hundreds of rivers, creeks, and streams, with no bridges at all across many of the wider waterways. Here, at the border of Guinea and Sierra Leone, canoes that serve as water taxis stand ready to ferry passengers between the two countries. “Travel by boat is a daily occurrence for many people living at the intersection of the three countries, where the outbreak is thought to have originated. Many people live and work on opposite sides of the river and use these water taxis to ferry across. The most common type of boat is displayed in the photo, and a long stick is used to push the water taxi from one side to the other. Once across, people travel by foot or motor taxi to reach their destination as there are almost no cars found in this area,” said CDC disease detective Kelsey Mirkovic.

Photo credit: Angela Dunn/CDC CDC disease detective Angela Dunn accompanied a burial team as they traveled to a small nomadic settlement in Sierra Leone. One of the country’s most successful efforts has been the Ministry of Health’s programs to ensure safe burials. Burial teams respond to every death, burying each body safely within 24 hours of hearing that someone has died. The day this photo was taken, eight burial team members had driven two hours from Magburaka, the capital of Tonkolili district, to the end of the road. From there, they hiked a mile to the river where they took dugout canoes to make the crossing. They then hiked almost four more miles to the settlement, which regularly shifted locations as the community moved its cows to graze in new areas. A guide helped the team find their way.“The team dug a grave while the entire family watched and grieved. The team was quiet and respectful of the families and the bodies, and once the burial was done, they went to another village to repeat the process. They do this several times a day and then return to Magburaka to their quarters at the hospital there. They do this day after day, not returning to their families, but doing a very necessary task. They are some of the true heroes of this epidemic,” said Dunn.

Photo credit: Loren Rodgers/CDC Guinea, Liberia, and Sierra Leone, which all border the Atlantic Ocean, have many seaside cities, towns, and villages. The people of Kassa and Tamara (Fotoba), islands off the coast of Guinea’s capital of Conakry, make their living from the sea, primarily as fishermen and ferrymen for locals and foreigners alike. In November, CDC diseases detectives Richard Franka and Loren Rodgers, together with local public health physicians Hamidou Diallo, Barry Mamadou Billo Aye, and Oularé Bakary, visited Kassa and Fotoba to conduct and evaluate contact tracing, the essential process of finding and keeping up with the health of all those who came in contact with someone with Ebola. Here Franka is pulling in the pirogue, a small handmade boat that brought them to the islands.“Infectious diseases know no boundaries and spread rapidly through countries, oceans, and continents. To contain an outbreak and prevent disease from spreading, public health servants often have to go where ailing people and pathogens are. Cities, villages, islands, deserts or forests. There are no limits. Sometimes it means riding long hours in the car on bumpy and muddy roads, other times walking or riding a bike, wading across the river, flying in a small airplane or helicopter or taking a boat, kayak or other floating devices. And that’s what we have been doing in West Africa to prevent Ebola from spreading. All those field trips have one thing in common, however. At the end there is an enormous gratification from meeting wonderful people, helping those in need and saving lives – sometimes dozens or hundreds at a time,” said Franka.

Photo credit: David Blackley/CDCSometimes the only way to get where you need to go with everything you need to bring with you is by air.While in Liberia in October, CDC disease detective David Blackley was part of a RITE (Rapid Isolation and Treatment for Ebola) team headed to rural Gbarpolu County. The RITE teams, which are the creation of the Liberian Ministry of Health and Social Welfare, CDC, WHO, and UNICEF, move quickly into communities where active Ebola transmission is suspected. They have been instrumental in rapidly extinguishing outbreaks in remote areas of Liberia. “We took this U.S. Army Blackhawk helicopter because it would allow us to bring the necessary equipment, and get us there in about 40 minutes. We brought in important infection prevention supplies such as personal protective equipment, chlorine mix, hand pumps, plenty of water, food, and tents. We could never have walked all that in. When we left after three days, we had to hike four hours back to the St. Paul River, cross the river in a dugout canoe, and then meet our Peace Corps driver for the four hour trip back to Monrovia.”

Photo credit: Rebecca Hall/CDC Rebecca Hall took this photo from the window of a UN helicopter as she and fellow CDC disease detective Laura Eloyan and CDC medical officer David Blaney traveled from Monrovia to Yekepa in northern Nimba County, Liberia. The helicopter turned the 10-hour land journey in into a two-hour trip by air, and provided the opportunity to appreciate the rolling hills and beautiful landscape of this part of Africa. Hall says the billowing smoke on the left of the view is typical of Africa, where fires are common. In fact, many remark on Africa’s pervasive background fragrance of smoke and burning, particularly in rural areas. While the smoke seen in the photo may be coming from an agricultural burn or a fire set to clear an area within a forest, within villages charcoal fires are used for cooking and burning trash is the primary method of waste disposal. Hall and Eloyan were traveling to help the community of Yekepa and the mining company based there make plans to help the contacts of a young girl who had Ebola and had been brought from Guinea to Yekepa for health care. “One of the reasons people cross borders is that the closest health care or Ebola treatment unit may be across the border in another country,” said Hall.

Photo credit: eHealth Africa Early in the Ebola response we recognized that transportation would be a challenge. That’s why I am so grateful for the CDC Foundation and their quick work to help solve the problem. This photo was taken in Guinea as I stood surrounded by 325 motorcycles purchased thanks to the generosity of Foundation donors. In addition to the motorcycles, 206 four-wheel drive vehicles being used in Guinea, Liberia and Sierra Leone were purchased with the help of a donation by Facebook Founder and CEO Mark Zuckerberg and his wife Dr. Priscilla Chan. The vehicles are serving many purposes including transporting patients, the bodies of the deceased, lab samples, staff, and supplies and equipment throughout the region. With so many critical and urgent needs in West Africa, these vehicles are going a long way to speed us along on the road to stopping this epidemic and protecting the people of the world.