It seems that West Africa, and the world, have managed to free themselves from an overwhelming epidemic which has infected more than 28 thousand people and has surpassed the 11 thousand fatalities (1). Since in December 2013 the first ebola case in Guinea Conakry was reported, the virus quickly spread to the neighbouring countries seriously affecting Liberia and Sierra Leone among others. The pitiless virus advanced and the hasty increase of patients and deceased impelled the International Community, together with African Governments, International Organisations and NGOs, put in place an action plan to contain the epidemic. The need for qualified staff generated continuous appeals to the international population. The response and work of hundreds of volunteers have contributed significantly to mitigate the situation.
The case of Sierra Leone: arrival and virus spread.
Sierra Leone is the country with more reported cases of ebola patients (2) over 14 thousand people. The first two deceased had previously traveled to Guinea in March 2014. Therefore it is suspected that the virus was brought from the neighboring country. The first infection diagnosis was detected in a traditional healer that had treated patients affected by this disease, and could have transmitted it to other locals. After the healer´s death, in May, her funeral was held according to the tribal rite in which the corpse is washed, kissed and touched by the relatives. These rituals are an important source of contagion, and one of the causes for fast virus transmission.
During the following months the patients and fatalities number were increasing throughout the country. In October, they reached more than 120 deceased cases (3) by ebola in a single day. Authorities declared the state of emergency. They closed the borders and public places such as schools, cinemas, restaurants... A large campaign was undertaken through any available media that were informing about ebola symptoms, and health services. They settled quarantines periods which were overseen by Sierra Leone troops and surveillance community groups. Check points were set up throughout the country in order to control the temperature and health state of any passer-by. In the most critical moments, they established curfews in several parts of country, and even harsh actions (4) had to be taken at times such as the imprisonment of those who were not respecting the quarantine, were hiding or escaping whilst being suspected of contagion, were not informing of potential cases, or were burying the deceased without following the stipulated safety standards.
The collapse of health services and the lack of supplies were some of the major obstacles to contain the epidemic, in spite of the international aid received. Countries such as Canada, Cuba, and European Union members, together with United Nations, World Health Organization, other international organizations and NGOs, have contributed to slow down and smooth the drastic consequences of this outbreak. The European Union (5) has earmarked more than one billion euros, with funding from the members and the Commission. These funds have been used in diagnostics, treatments, facilities and medical supplies, qualified staff, and awareness-raising campaigns. Sierra Leone was assisted by Germany, Belgium, Denmark, Finland, Normandy and England in collaboration with other organizations and NGOs as Doctors without Borders, GOAL, International Medical Corps, or Save the Children.
The particular British contribution (6) to Sierra Leone included considerable resources: hospitals, transports and ambulances, laboratories, insolation units, specialized staff and volunteers among other aid. Public Health of England (PHE) carried out diverse appeals (7) in order to recruit volunteers with scientific knowledge to work in the diagnostic laboratories installed in Sierra Leone. Amor Alcaraz, PhD in Molecular Biology and resident in London, was one of those volunteers during the last months of the epidemic. "I decided to go because I want to use my scientific knowledge to mitigate human suffering, and this was an opportunity. I didn´t think too much, I applied in less than 24 hours”.
Testimony from a volunteer
Although there was an urgent need of staff, to be able to be part of the ebola diagnosis volunteer´s team, it was necessary to have certain requirements. Amor explains them to us, "You needed to have science or biology knowledge, as well as references and good health to be able to volunteer for the ebola diagnosis laboratory. Also you have to attend training and be assessed as competent. The next step depends on the host organization, in my case before traveling I had to pass a psychological resilience test, a medical assessment, and a travel nurse consultation where you get advice and your vaccines planed." The training is an essential part for carrying out this particular voluntary work. "The training prepared you thoroughly to work in the laboratories, they taught us all the work to be done in the lab, and also the general safety rules for our deployment time. People who had been there came to tell us about their experience too. We were given lots of information by PHE and by our host organisation before deploying, and this helped us a lot to reduce the stress of going to the unknown".
Amor travelled to one of the three hotspot districts in the north of the country, where she worked in an Ebola Treatment Centre. "My daily routine would start by donning the personal protection equipment first thing, analysing the samples that arrive from the Treatment Centre and the community, and diagnosing if they were positive or not, and further reporting the results to the appropriate party. Beside our lab team, there was great aid deployment: teams that warned of possible cases, different medical services, burial teams and a tremendous campaign with ads, posters... that informed people what they need to do if they find someone with ebola symptoms".
This Ebola Treatment Centre, managed by the GOAL NGOs (8) in collaboration with the Sierra Leone Ministry of Health, and staff from Public Health of England, has 3 work areas. The red area is organized for receiving the ambulances with patients, and assisting and diagnosing them by a medical team. Depending on the disease stage, they are accommodated in different facilities separated one from the other. In the green area the disinfection section is found, the laundry, the control center where they organize patient admissions and discharges, the meeting point for patients and doctors which is protected by a fence to avoid contagion, and the laboratory. In the white area are the pharmacy, the dining room, the store, and the offices.
There are other work teams in addition to the Treatment Center staff. Amor speaks about this. "There were teams that went out to the community to inform and detect cases. Burial teams, qualified workers that bury the corpses of people who had died from ebola in a safe way. Support teams that helped the community when they were in quarantine and could not cultivate their lands, these teams would take care of their livelihood”.
Even many of the traditional healers, who initially were an obstacle to contain the epidemic, joined the fight (9). "I learnt from a conference podcast of the American microbiology association (10) that to convince people for not going to the healer was quite complicated because it is part of their culture and beliefs. What they did was to speak to the healer; they gave to him something like an ID card, and they asked him for giving this ID card to people with ebola symptoms, and referred them to a clinic or a hospital. Then some healers received a certain amount of money for each patient that came with the card. The healer was not losing customers and patients were treated”.
Consequences of the struggle
At the end of 2015 the ebola epidemic seemed to be under control. Two months after Liberia was declared ebola free, Sierra Leone began his countdown followed by Guinea. When the countdown started Amor was still doing her volunteer work. "I was there when the first day of the countdown began. They need to accomplish 42 days without any new cases, 2 periods of 21 days which are the incubation period. If you don't have symptoms by the end of 21 days, that means you are not infected. The results have been positive in the sense that we have managed to contain the epidemic".
On the other hand, the economic crisis (11), the job losses, and the decrease of health services for the treatment of other diseases such as malaria, have been some of the serious consequences of the fight against ebola. "The worst was to see the misery, see how people´s life had to change because of the outbreak, see how the country was isolated, devastated. There were just us, international workers, scarcity and poverty. And in spite of everything people were smiling and fighting. But the impact has been devastating, the economic impact has been extremely harsh" says Amor.
However it is not only the economic situation. In the cases of the ebola survivors, they may also have to deal with being rejected by the community. But they are not alone; they have each other and their "Rescue Team" (12), an association that they have founded for helping their reintegration into the community, and the fight against ebola. The surviving children also suffer the consequences. Amor tells us how the EducAid (13) orphanage school is trying to deal with this problem. "In the district where I was there is an orphanage that accommodates children who are orphans and have problems to return to their homes because of the ebola. It may be difficult for the community to accept children who have survived the ebola. The orphanage also offers educational services and vocational training in order to provide the children with a future. This orphanage is doing a great job. I visited it and I could see what they were doing there. We tried to help them by donating clothes, shoes, schooling material, first aid kits, and all we had there, but they need much help. That is why now I am organizing a race to raise funds (14) for EducAid".
Amor is organizing this fundraiser together with other volunteers she met in Sierra Leone. The fact of having shared moments of intense collaboration for a mutual purpose with other volunteers has been an essential part of Amor´s experience. "Being surrounded by all kinds of people with very different backgrounds and stories, not just my team mates but also all the other volunteers, and feel that we were a team, that we were there working for the same goal, it was magical. This is a wonderful memory. There was lots of sense of humor, warm fellowship, sense of community... within a circumstance like this. This was very helpful in a situation as stressful as an epidemic".
This cooperation and effort at the individual, national and international level is what has allowed to contain this virulent epidemic and to help its victims. It is further proof that the human being is also able to join and contribute towards a common goal, survival. "Through this experience I've learned how an international response works in an epidemic crisis, and I was very nicely surprised by how they have in consideration not only medical issues but also the local lifestyle and culture. You can´t see all of this from the outside, you have to be there. There is much that we don't know and that is so positive".
 El Mundo
 El Pais
 Ebola Deeply
 Goal Global
 Banco Mundial