On November 7, 2015, 42 days after the last patient with Ebola was confirmed to test negative for the disease, the World Health Organization declared the end of the Ebola outbreak in Sierra Leone. Forty-two days is double the maximum incubation period for the disease. During the epidemic, more than 14,000 people in Sierra Leone contracted Ebola and 3,955 people died. The outbreak in Liberia ended on September 3, 2015. Guinea still has several active cases.
The outbreak was stopped in Sierra Leone thanks in part to Handicap International, which manages the only centralized ambulance service for transporting suspected Ebola patients and disinfecting their contaminated homes in Sierra Leone’s Western district, which includes Freetown. Before Handicap International started this program in December 2014, only a handful of ambulances were available to safely transport Ebola patients in the Western area.
Handicap International’s team of 250 ambulance and decontamination staff have transported more than 3,700 patients showing symptoms of Ebola to treatment centers and disinfected nearly 1,800 homes. Operating in the country’s Western district, which includes the capital of Freetown, the project manages a fleet of 30 ambulances and 15 decontamination vehicles (24 ambulances and 9 decontamination vehicles since June) out of two bases, Hastings, a large base and decontamination site east of Freetown, and Fire Station, a small base located in downtown Freetown.
“I think this ambulance service played a big part in breaking the Ebola transmission chain,” says Pauline Lavirotte, the Ambulance Fleet Project Manager. “In responding to the Ebola crisis there are two main parts—there is the treatment, the taking care of patients, and then there is containing the epidemic and we are part of the containment.”
For Handicap International, mobilizing its logistic know-how within such context was a real challenge. “Our organization is seasoned in the implementation of large logistical projects and the running of vehicle fleets, explains Pauline Lavirotte, but in order to be able to work in the context of this epidemic, we had to recruit experts in infection prevention and control, to help us set up the right protocols”
“I think now we can be proud of the quality of our work,” says Lavirotte. “We have learned a lot and I think we’ve reached a high level of expertise. We’ve faced huge challenges, but we’ve managed to find technical solutions that work.”
During the peak of the outbreak, Handicap International teams responded to dozens of cases per day. Each ambulance staff member might be dispatched four or five times per day for interventions that take at least two hours to complete.
“Every day the staff come to work, they wait for the calls that they know will come, and when the call comes, they know it’s going to be dangerous,” says Mike Denny. “They put on PPEs (Personal Protective Equipment) in 35C degree temperature and 100% humidity. They navigate treacherous roads and narrow alleys between dwellings where they need to intervene, they enter an unknown dwelling with sometimes sharp objects, potentially contaminated fluids and suspected Ebola patients. They help the patient reach the ambulance, they bring the contaminated material out and treat it, they decontaminate our vehicles by once again putting on PPEs. They’ll do this four times, five times, and they’re exhausted but they don’t complain. They get up and do this.”
While there have been no active Ebola cases in Sierra Leone for weeks, the ambulance project has continued to operate and will run at least through the end of the year. Chances are likely the disease could return to Sierra Leone. The outbreak in Liberia was first declared over in May 2015, but the disease reemerged.
“It’s nearly impossible to tell the difference between an Ebola patient and somebody suffering from malaria, cholera; symptoms are so similar,” says Mike Denny, Infection Prevention & Control Manager for the program. “Therefore, until the epidemic is over, every patient who has a fever, and three other symptoms like muscles pain, vomiting, and diarrhea, needs to be treated as a suspected Ebola case.”
“Ebola will come back,” says Denny. “No one knows how long the Ebola virus stays in the body fluids after being cured. People who survived Ebola can sometimes still pass it on through fluids, such as semen. The probable reservoir, the fruit bats, can still infect wild life and people. People will still come into contact with wildlife. And as of today cases are still being identified in neighboring Guinea. That is why we must not let our guard down.”