Direct Relief will establish and support Ebola survivor services in Bombali District, Sierra Leone. In partnership with the Medical Research Centre (MRC), a Sierra Leonean health NGO, the project will establish a static clinic in the city of Makeni that will accept any Ebola survivor from Bombali and other surrounding districts. The clinic will function at the level of a large Community Health Centre. It will include outpatient and observation wards and a referral system (ambulance) to respective specialized and higher level health services when needed. The clinic will be established in a rehabilitated building in close collaboration with the Ministry of Health and Sanitation (MOHS), local stakeholders, including city council, communities, and the Bombali EVD Survivor Association.
The clinic will work with partners in Sierra Leone to provide various services for Ebola survivors, including eye health, mental health and psychosocial services, food services, and education and awareness building.
Specifically, the Ministry of Health and Sanitation (MOHS) will provide medical staff for the clinic, including a supervising attending physician, eye care specialists, mental health specialists and other specialized healthcare providers. In addition to providing direct services, healthcare providers, a large portion of whom are female, will conduct community outreach. The MOHS will also provide a link to the National Mental Hospital in case of need for referrals. Military Health Services will share experiences running a Survivor Clinic in Freetown, including staff training to manage the clinic, advice on patient data collection and possible future research linked to the clinic.
Additional partners include: the canteen of the Midwifery School Makeni will provide prepared food for clinic healthcare workers, staff, and patients, with a focus on patients under observation; The University of Makeni (UNIMAK) will deploy psychiatric nurses; additional health NGOs will provide specialized or higher level health services; MRC will provide non-healthcare related, administrative staff training to employees of the clinic; and Bombali EVD Survivor Association will conduct outreach, including through radio dissemination.
Direct Relief will build on its extensive experience of providing supplies and equipment. MRC will contribute its wide experience of health project management and its strong collaboration links with MOHS and other health partners and communities in Bombali District and Sierra Leone. Potential challenges are the stability of the country (economy, etc.), the weather conditions (rainy season for outreach), and the weak health system.
This commitment expands upon work that has previously been done. MRC and Direct Relief have partnered to support the national Ebola Virus Disease outbreak response with several inputs in Sierra Leone, including for Bombali District. This commitment builds especially on the experience of the Military Health Services in Freetown that have been running an Ebola Survivor Clinic in Freetown (capital of Sierra Leone) for 9 months. They will therefore be involved for advice and training in this commitment. MRC's extensive network has been used to prepare for this commitment, ensuring collaboration arrangements with the Ministry of Health and Sanitation and other health partners in Sierra Leone for example for eye health services, mental health services and provision and staffing of the building. MRC regularly attends national Ebola coordination meetings as a key member. MRC is also attending meetings about health systems strengthening Post-Ebola.
The 2014 outbreak of Ebola affected the entire country of Sierra Leone, especially the already fragmented health system that had been slowly building capacity, service levels, and improved outcomes for several years but remained thinly funded, staffed, and overstretched on every level. The types of rapid detection and response efforts needed to avert or significantly lessen the outbreaks spread to epidemic levels simply were not available. Health facilities were ill-equipped to either diagnose Ebola or admit and treat confirmed cases, including for lack of basic protective equipment in facilities. At a time when better information and expanded services were needed, existing health services contracted. Many health workers fearing Ebola infection, both in Ebola treatment units (ETUs) and the existing health care system, refused to work without personal protective gear. Similarly, patients with injuries or other health conditions were reluctant to seek care at facilities for fear of potential Ebola infection. The diversion of limited existing health personal, facilities, and finances to combat Ebola was not sufficient to fully address the emerging crisis and left all other matters unattended.
The Ebola outbreak in Sierra Leone is gradually coming to an end, but the struggles facing survivors are not over. As of August 26, 2015, there were 8,547 confirmed cases of Ebola Virus Disease (EVD) of which 3,586 confirmed deaths, and thus a maximum of 5,111 survivors (EVD Situation Report GOSL/MOHS). EVD survivors continue to face serious health and social challenges. The health issues include eye problems, musculoskeletal problems, headaches, neurological problems, gastrointestinal problems and mental health and psychological challenges. The social challenges include stigma, rejection, multiple loss of family members, and loss of education opportunities and livelihood. Services for survivors are gradually emerging, but there is an urgent need to scale-up support. In the Northern Region, where Bombali District is located, there is only one survivor clinic in Port Loko district. Bombali District alone has maximum 659 survivors, many of whom live in remote rural areas.