Monday, March 23, 2015

The Working Environment: the 2014 OSAC Crime and Safety Report for Sierra Leone

 Source: OSAC:

Sierra Leone 2014 Crime and Safety Report

Travel Health and Safety; Transportation Security; Stolen items; Theft; Civil War; Disease
Outbreak; Cyber; Assault; Burglary; Hotels; Drug Trafficking; Financial Security; Oil & Energy;
Maritime; Bribery; Elections; Religious Terrorism; Riots/Civil Unrest; Floods; Landslides and
mudslides; Fraud; Information Security
Africa > Sierra Leone; Africa > Sierra Leone > Freetown
Overall Crime and Safety Situation
Sierra Leone presents an exceptionally challenging operating environment for business
investors, as it continues to struggle with pervasive corruption, rebuilding from the
decade-long civil war (1992-2002) and the consolidation of democratic procedures. One
lasting effect of the war is the lack of skilled and semi-skilled workers, making finding
competent and qualified employees difficult. The country ranks 180 of the 187 countries in the
U.N. Human Development Index, and poverty is endemic, as the GNI per capita is less than
U.S.$1 per day. Drug and alcohol use within the 20-40 year-old age range is high and
increasing. Hyperinflation, high unemployment rates, and low incomes associated with work in
the informal sector create conditions of gross economic hardship. Poor infrastructure,
unreliable communications and electricity, and the full range of tropical health risks -- including
endemic malaria -- deter many foreign investors and entrepreneurs.
There has been a steady proliferation in the number of gangs and cliques in Freetown over
the past five years. They present a potential threat to public order that has increased
criminality and encouraged anti-social behavior. Most often, these groups are comprised of
unemployed youth who align according to geographic or ethnic/tribal similarities or according
to pop music preferences (i.e. rival local hip-hop artists). Most gang activity is confined to
eastern Freetown and does not involve visitors or foreigners.
Freetown’s extremely limited infrastructure suffers from lack of maintenance and planning.
The absence of reliable power and water in most areas of the city, heavy wear and tear on
vehicles contending with poorly maintained or unpaved roads, long logistical lead times, and
licensing restrictions can be burdensome and costly for all businesses. Telephony is limited to
cellular phones, and there are no traditional “land line” telephone services. There are several
Internet service providers, however, bandwidth is limited, and service is extremely slow and
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expensive. The launch of fiber optic cable has improved some service. The 3G and 4G
networks are oversubscribed.
Crime Threats
The Department of State classifies Sierra Leone as Critical for crime. Nighttime robberies,
assaults, petty street crime, and home invasions are common. Expatriates are frequent
targets due to their perceived wealth. Theft and malfeasance is a problem for business
owners; employers should be prepared for substantial pilferage and internal losses.
The majority of crimes against Americans are non-violent confrontations characterized as
crimes of opportunity (i.e., pickpocketing, theft of unattended possessions in public places or
hotel rooms, bag snatching, and financial confidence scams). Pickpocketing is common, and
the perpetrators are very adept. Thieves often attempt to distract a victim by asking questions,
begging for money, bumping or jostling the individual, or offering to sell items. While the victim
is distracted, an accomplice may take a piece of luggage or pick the victim’s pocket or purse.
Occasionally, the nightclubs along Aberdeen Road and Lumley Beach Road are the scene of
incidents including theft, prostitution, drug sales, and bar fights.
The number of violent crimes is comparable to most other West African countries. Violent
crime and the use of weapons in the commission of crime is commonplace.
Most diplomats, expatriates, foreign businesses, and wealthy Sierra Leoneans rely on 24-hour
private security guards or armed SLP Operational Support Division officers to protect
residences and other property. Most residential break-ins at well protected compounds are
“inside jobs” and are typically non-violent. However, they can also be perpetrated by small
groups of well-organized, armed bandits equipped with tools and/or machetes or homemade
firearms. The preferred method of entry is using stealth techniques (during a rainstorm to
mask their movements, sneaking past a sleeping guard, cutting through roofs, or tunneling
under walls). Security plans should include layers of protection to make their property less
attractive for break-ins.
Americans have reported theft of money/property from locked hotel rooms. A majority of these
crimes were inside jobs by hotel employees and house-keeping staff. No hotel – even upscale
establishments -- is immune.
Sierra Leone is generally a cash economy, but U.S. dollars from 2006 are not accepted.
There are some ATMs that accept international Visa cards. Some businesses are beginning
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to accept credit cards, but only Visa can be used locally. Point of sale credit card terminals
exist in some major shops, hotels, and restaurants. An anti-money laundering law passed in
2005 prohibits importing more than $10,000 in cash except through a financial institution.
Travelers' checks are not usually accepted.
Members of the greater Sierra Leone Diaspora normally return to Freetown to visit
family/friends during the Christmas and New Year holidays. As a result, travelers are advised
that hotel rooms and international flights may be in short supply from November until
February. There is also an uptick in criminality during this period (i.e., petty theft, luggage
pilferage, pickpocketing, confidence scams, etc.) due to the presence of affluent visitors.
Sierra Leone does not have major problems with piracy within its territorial waters. With the
increase in oil exploration activities in littoral waters, piracy has become a security concern.
As such, lawmakers are attempting to develop specific laws to punish this crime; piracy is
currently prosecuted as “armed robbery.” Sierra Leone has also become a “flag of
convenience” in the international shipping industry. The government has certified a shipping
agency headquartered in Singapore to manage Sierra Leone registrations of vessels;
however, Sierra Leone’s registry of sea vessels remains poorly managed.
Overall Road Safety Situation
Road Safety and Road Conditions
Driving is a serious challenge. Motor vehicles are a major cause of death/injury. Visitors are
advised to exercise extreme caution when near any road or in motor vehicle traffic. Freetown's
downtown streets are narrow, crowded, and in a state of constant disrepair. The lack of street
lights, stop lights/signs, sidewalks, and guardrails, combined with steep hillside drop-offs,
potholes, and unpaved road surfaces, increase risk of injury/death for drivers and pedestrians.
Local drivers do not follow general road safety rules. Drinking and driving is a major concern
and poses a significant risk particularly after dark. Motorbikes, usually carry multiple
passengers, weave in/out of traffic, drive on any available surfaces or nearby sections of the
road, and adhere to no rules. Several major arterials are undergoing road widening, a positive
development for the city; however the long-term construction results in significant delays,
congestion, and an “anything goes” driving style (i.e., using the opposite lane for forward
movement, disregard for the proper flow of traffic in roundabouts, etc).
Roads outside of Freetown are unpaved, unlit, poorly maintained, and can be hazardous to
drive. For these reasons, U.S. Embassy personnel are counseled to not drive the roads
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outside of Freetown after dark. Fuel stations and police assistance are limited outside
Freetown, so motorists should plan accordingly.
During the rainy season, mud, deep puddles, flooding, glare from oncoming high-beam
headlights, and near-zero visibility present an even greater challenge for travelers. Several
hours of travel time may be added to a trip.
Pedestrians are a constant hazard and tend to walk on/near roads often only inches from
passing vehicles, frequently oblivious to motorists, and mindless of their own personal safety.
Be especially aware of pedestrians at night.
Taxi cabs, motorbikes (okadas), and the ubiquitous mini-van transports (poda-poda) present a
hazard because they are poorly maintained, crowded, and driven erratically. These
conveyances should be avoided when possible and are off-limits to U.S. Embassy personnel.
Other forms of public transportation are minimal. There are no railways or domestic flights and
only a very limited bus network.
Use of public transportation, including buses, taxis, and mopeds, is highly discouraged. Hiring
a dedicated car/driver from a trusted, reliable source is recommended. Keep doors locked and
windows rolled up at all times when inside your vehicle. Always park in secure, well-lit
locations. Do not hitchhike or pick up hitchhikers. If you are involved in a vehicular accident, a
large crowd may gather and could become hostile and aggressive. This may happen even if
you are not at fault. If you feel threatened or fear for your safety, go to the nearest police
Sierra Leone does not have major problems with banditry along its highways. However,
children and road repair crews often establish impromptu roadblocks using string, rocks, or
branches in order to exact money from passing motorists. These roadblocks are illegal, and
drivers should not feel compelled to stop.
The Freetown airport, located across the Sierra Leone River in Lungi, is serviced using ferries
and water taxis. There is no helicopter service to Freetown from the airport. There is no
convenient roadway to the airport, though one is under construction. The Embassy
recommends only using licensed taxis and ferries, not dhows or cheaper transport.
Theft from vehicles is common with criminals reaching through windows or opening unlocked
doors while cars sit in traffic. Several American citizens have been victimized in the evening
along Signal Hill Road near the former UN Compound in Western Area. Due to the poor road
condition, vehicles are forced to move slowly and negotiate through large potholes. Criminal
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gangs take advantage of unsuspecting motorists by throwing rocks (causing vehicles to stop)
or by simply opening doors and grabbing items through passenger side windows and then
running away through the heavy foliage.
Political, Economic, Religious, and Ethnic Violence
The threat of political violence against American interests in Sierra Leone is rated as medium.
There were no instances of political violence directed against Americans in 2012. Political
violence is sporadic and tends to increase during election periods.
Local, Regional, and International Terrorism Threats/Concerns
The government is sensitive to the threat of terrorism and is engaged with international
partners to combat it.
There is an element that is sympathetic to Hizballah’s political agenda and may provide
financial and moral support. There is no known organization targeting American citizens or
affiliated interests in Sierra Leone. Similarly, there is no evidence to indicate that terrorist
organizations have operational capacity or are actively targeting Western interests in Sierra
Sierra Leone’s participation in the United Nations peacekeeping efforts in Somalia has caused
concerns that terrorists may turn their sites on Sierra Leone. The government is keenly aware
and actively monitoring against this. Anti-American sentiment is rare; however, visitors are
cautioned to avoid large public gatherings (i.e., concerts, sports matches) that could be
attractive targets for terrorists.
Civil Unrest
Although political demonstrations and rallies are normally peaceful, spontaneous rioting and
attacks on individuals can occur. Over the past year, there have been violent confrontations in
Freetown, Kono, and Kenema. Participants at political rallies are often intoxicated and may
use weapons of opportunity, including sticks and rocks. SLP Crowd Control Units have been
mobilized, and tear gas was deployed to control politically-based conflict. Crowds of students
have been known to become destructive and vandalize buildings and vehicles in Freetown
after soccer matches between rival schools. Political demonstrations also can become
dangerous, with rival factions becoming aggressive toward one another and the police. Police
often respond in kind, exacerbating already tense situations. The large, loosely affiliated union
of commercial motorbike riders (okadas) is quick to mobilize and has caused several public
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order problems across the country. Similarly, strikes and demonstrations by employees in the
mineral extraction industry and teachers/lecturers, based upon salary grievances and
conditions of employment, are a perennial issue and often cause widespread disturbances.
Religious or Ethnic Violence
Religious violence is rare, and Sierra Leonean society overall is religiously tolerant, with a
mixture of religions serving throughout the government and living side by side.
Tensions do run high between tribal groups, and there is evidence of favoritism between
regional tribes and their political representatives.
Post-specific Concerns
Environmental Hazards
Freetown lacks the drainage infrastructure to accommodate storm water runoff. As a result,
low-lying parts of the city and major vehicle thoroughfares flood during the rainy season
(June-October). Torrential rains also challenge Freetown’s often poorly-constructed hillside
structures. Mudslides and building collapses result in several deaths every rainy season.
Visitors should familiarize themselves with flood-prone areas and consider travel in a
high-clearance 4x4 vehicle.
Drug-related Crimes
Narco-trafficking represents a growing threat to stability and security in the region. The
increase in narcotics trafficking through Sierra Leone, with links to international organized
crime syndicates, is a disturbing trend. Porous borders, endemic poverty, and relative
geographic proximity to South American and European markets make Sierra Leone
vulnerable to organized criminal elements. The considerable wealth associated with the drug
trade, channeled through corruption and complicit officials could have a destabilizing impact
on the country. Illicit drugs are readily available in Freetown and are often offered for sale in
bars and nightclubs. Transiting drugs are commonly found on the local market, adding
cocaine and methamphetamines to the more traditional drug of choice, marijuana.
Police Response
The Sierra Leone Police (SLP) have problems addressing crime elements. It suffers from
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limited resources and training. Public perception of the police is poor.
Police response is often slow and unreliable, and the quality of service declines as one travels
farther from Freetown. Receiving police assistance can be especially difficult for Americans
- local police stations do not have working landline telephones. Most police officers rely on
private cell phones, and these numbers are not publicized.
- officers answering the telephone often do not understand English. It is the official language,
but Krio is the lingua franca.
- the police frequently lack transportation to respond to the scene of the incident.
- when transportation is available, fuel often is not.
Some American citizens who have gone to a police station to report crime claim that police
officers requested money in order to purchase paper/pens before the officer could take a
statement or write a report. There is a fee to make a police report; for foreigners the cost is
300,000 Leones, (about $70) and 50,000 Leones for citizens. Payment is made at the bank,
not at the police station. It is not recommended to pay bribes, comply with requests for a “gift,”
or pay on-the-spot fines. Instead, obtain the officer’s name and badge number and politely ask
to speak with a supervisor and/or request to be taken to police headquarters for further
Police and immigration checkpoints can be found throughout Sierra Leone. These
checkpoints are official and require all vehicles to stop so that passengers and materials can
be searched and/or passports/entry visas can be confirmed. They are staffed with SLP
officers in uniform and normally feature a “Police” sign or SLP logo.
How to Handle Incidents of Police Detention or Harassment
SLP are required to notify the U.S. Embassy when an American citizen has been arrested;
however, it consistently fails to do so. If arrested, be certain to assert this right and demand to
speak with a representative from the U.S. Embassy by calling (076) 515-000 or, if after normal
business hours, (076) 912-708.
Where to Turn to for Assistance if you Become a Victim of Crime
Travelers requiring police assistance are advised to contact the police through the Joint
Communications Center (076) 319-978 or Control Room (076) 771-721, which are the best
equipped offices to assist international travelers.
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Other Police Contacts:
Central Police Station: (076) 607-742
Eastern Police Station: (078) 319-984
Lumley Police Station: (076) 561-065
Congo Cross Police Station: (078) 137-348
Goderich Police Station: (088) 208-910
Malima Police Station: (076) 921-765
Various Police/Security Agencies
The Sierra Leone Police (SLP) Force is a national police force administered from Freetown.
Of the approximately 12,000 members of the Sierra Leonean Police force, there are about
3,000 officers assigned to the Operational Support Division (OSD). OSD officers are armed
with shoulder weapons and usually staff roadside checkpoints, serve on emergency response
patrol teams, and are assigned to protect foreign missions. Accusations of excessive force by
the OSD has caused protests and rioting in recent months.
There are also traffic police, a Criminal Investigation Division, and regular police.
Medical Emergencies
Medical facilities fall critically short of U.S and European standards. There are no 911
equivalent ambulance services in Sierra Leone. Trauma care is extremely limited, and local
hospitals should only be used in the event of an extreme medical emergency. Blood
transfusions can be life-threatening due to lack of screening and poor quality control. Many
primary health care workers, especially in rural areas, lack adequate professional training.
Medicines are in short supply, and due to inadequate diagnostic equipment, lack of medical
resources, and limited medical specialty personnel, complex diagnoses and treatments are
Visitors with serious health concerns (e.g., diabetes, heart disease, asthma, or who are on
blood thinners (with the exception of aspirin)) are discouraged from traveling to Sierra Leone.
Visitors should bring their own supply of medications, as the quality of medications is
inconsistent, and counterfeit drugs remain a problem.
Patients are required to pay up front, before being admitted to a hospital or provided
treatment. All travelers are advised to purchase insurance to cover medical evacuation in
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case of a serious accident, injury, or illness. Medical evacuation can cost thousands of dollars,
depending on the severity of the situation, so all travelers should ensure their policies provide
sufficient coverage.
Contact Information for Recommended Local Hospitals and Clinics
The Consular Section maintains a more complete list of medical contacts at
Medical Facilities
Choithram Memorial Hospital: (076) 623-483
Emergency Hospital Goderich: (076) 611-386
Davidson Nicol Medical Centre: (076) 977-028
Cardiology: Dr. Russell, 3 Liverpool Street, (076) 412-442
OB-GYN: Dr. Frazer, 60 Wellington Street, (076) 225-539
Pediatrician: Dr. Robin-Coker, 12 Main Motor Road, (076) 230-374
Recommended Air Ambulance Services
Emergency Transport: Western African Rescue Association, (078) 666-111 (provides
helicopter and ground ambulance service from anywhere in the country to local hospitals in
Freetown or neighboring countries).
CDC Country-specific Vaccination and Health Guidance
Malaria is a major cause of death/injury in Sierra Leone. Malaria is endemic, and prophylaxis
is a necessity. Expatriates have died from cerebral malaria in the last year. Visitors are
advised to take properly prescribed anti-malarial medication. Prior to arrival, all visitors should
have current vaccinations, including, but not limited to: tetanus, yellow fever, polio, meningitis,
typhoid, hepatitis A and B, and rabies. Lassa Fever is endemic in Eastern Province, and
yearly cholera outbreaks are common, but the cholera vaccine is not required.
Since sanitary conditions are poor, and refrigeration is unreliable, use caution when eating
uncooked vegetables, salads, seafood, or meats at restaurants and hotels. Only bottled water
should be consumed.
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Information on vaccinations and other health precautions, such as safe food and water
precautions and insect bite protection, may be obtained from the Centers for Disease Control
and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747)
or via the CDC’s website. For information about outbreaks of infectious diseases abroad,
consult the infectious diseases section of the World Health Organization’s (WHO) website.
The WHO website also contains additional health information for travelers, including detailed
country-specific health information.
Tips on How to Avoid Becoming a Victim
In recent years, American citizens have been victimized by confidence scams involving the
purchase of gold and diamonds. Individuals have been defrauded of thousands of dollars by
local nationals claiming to be affiliated with gold dealerships, government ministries, the
Government Gold and Diamond Office (GGDO), customs, and police. American citizens
considering purchasing gold or diamonds need to complete their due diligence before entering
into deals. Offers to sell diamonds and other gems should be ignored. These items are highly
regulated and must be purchased through licensed brokers. Any offer made on the street is
illegal, illegitimate, and likely involves fake gems. Do not purchase diamonds, gold, or other
gems/minerals from an unlicensed source. Many diamond distributors are unlicensed and
produce fraudulent gem certificates.
Foreign businesses are often the target of other scams, among them claiming false ownership
of land and charges for electrical use purportedly by the National Power Authority. Similarly,
businesses should be cautious when choosing legal representation, as local attorneys are
often at the center of criminal scams. Prospective American business owners should be
aware that the vetting process of employee candidates is extremely challenging and
unreliable because the police do not have an electronic computer database and the
destruction of most hard copy criminal records during the war. Similarly, there is no formal
way to vet potential business partners.
Advance-fee fraud schemes typically associated with Nigeria are prevalent throughout West
Africa and pose a danger of grave financial loss. These scams begin with unsolicited
communication (usually e-mails) from strangers who promise quick financial gain, often by
transferring large sums of money or valuables out of the country, but then require a series of
"advance fees," such as for legal documents or taxes. The final payoff does not exist; the
purpose of the scam is to collect the advance fees. A common variation is the scammer’s
claim to be a refugee or émigré of a prominent West African family or a relative of a present or
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former political leader who needs assistance in transferring large sums of cash. Still other
variations appear to be legitimate business deals that require advance payments on contracts.
Sometimes victims are convinced to provide bank account and/or credit card information and
financial authorization that is used to drain their accounts, incur large debts against their
credit, and take their life savings. The best way to avoid becoming a victim of advance-fee
fraud is common sense: if a proposition looks too good to be true, it probably is. Any
unsolicited business proposal should be thoroughly researched before committing any funds,
providing any goods or services, or undertaking any travel. It is virtually impossible to recover
money lost through these scams.
Areas to be Avoided
Do not walk on the beach, including Lumley Beach, at night.
Best Situational Awareness Practices
All American citizens are advised to follow common sense guidelines to avoid becoming
victims of crime.
Maintain control of your personal items when in public areas and move away from anyone
who you believe is acting suspiciously. Do not carry valuables in excess of immediate needs
and keep what you need in a secure place on your person. Never carry anything that you are
not willing to relinquish in a confrontation with a thief. In the event an armed criminal confronts
you, immediately hand over the desired property to avoid escalation or injury.
Do not leave anything of value unlocked in your unoccupied hotel room. Even the safes
provided by the hotel are vulnerable and should not be trusted.
Do not invite strangers into your quarters. Supervise/escort all workers in your quarters.
Travelers are advised to use credit cards cautiously because very few facilities accept them.
Credit cards are generally not accepted at most stores, restaurants, and hotels. If you do use
a credit/debit card, do not relinquish it to a server or clerk. Credit card machines operate over
the cell phone system, so the machine should be brought to you. There is a serious risk that
using a card will lead to the number being stolen for use in fraudulent transactions. Currency
exchanges should be handled through a bank or established foreign exchange bureau.
Exchanging money with street vendors is dangerous because criminals may "mark"
individuals for future attack, and there is also the risk of receiving counterfeit currency.
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Carefully protect all financial and personal information, as incidents of financial fraud and
identity theft are increasing.
Be alert to any unusual surveillance or activity near the places you frequent. Vary your routes
and times so that others cannot predict your schedule. Keep valuable items out of sight.
Practice good operational security if you are transporting valuable items into and around
Sierra Leone. Some reported robberies committed against expatriates appear to have been
carried out by persons with inside information regarding the victims.
Always ask permission before taking a photograph. Local citizens may request a small fee for
taking a picture of them or their surroundings. Do not photograph government buildings,
embassies, military installations, airports, harbors, or other locations/items of a possible
security or intelligence interest. Cameras can be confiscated.
U.S. Embassy Location and Contact Information
Embassy Address and Hours of Operation
The U.S. Embassy is located at Leicester Square, off Regent Road, in the hills above the city.
Embassy hours: Monday – Thursday 8:00am – 5:15pm and Friday 08:00am – 1pm
Embassy Contact Numbers
Embassy switchboard: (232-76) 515-000 from overseas or (076) 515-000 if dialing locally.
After hours: (076) 515-160
After hours Embassy Duty Officer: (076) 912-708
RSO email:
Consular Section, non-emergency e-mail:
Visitors are encouraged to register with the U.S. Embassy Consular Section online or in
person. American citizens should register with the Consular Section’s American Citizen
Services on-line at prior to travelling or at the Consular
Section upon arrival. U.S. citizens wishing to conduct business in Sierra Leone should consult
the Embassy Freetown Economic Section website for advice and words of caution:
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OSAC Country Council Information
Embassy Freetown does not have a formal OSAC Country Council due to the limited number
of American-owned or -operated business interests. The nearest OSAC Country Council is in
Dakar, Senegal. Embassy Freetown has supported the establishment of an American
Chamber of Commerce in Sierra Leone. The RSO provides country briefings for
representatives of American businesses, non-governmental organizations, academia, and
faith-based organizations as requested.

Tuesday, February 17, 2015

Debriding a large tropical ulcer

At 14 years old, patient did not qualify for free govt care.  As with many of our patients, he was not able to afford treatment and a small medical issue turned into a threat to life and limb, due to lack of care.

Ebola and other medical care work update

Working on Ebola surveillance/treatment/decon, and have transformed a basic maternity/infant care clinic into a full-service free primary care/ER/maternity clinic in the mountains of E Sierra Leone. Starting to see patients who have walked all day to get to us. Malnourished kids, typhoid, ebola, infectious diseases, impressive fungal infections, tropical ulcers, and gangrene.  Compound tib-fib yesterday (fortunately there was a well-known local bone-setting herbalist available to work with), great debate over whether to amputate a big toe if govt surgeons are not avail due to Ebola... Just freed a 7 yr old from having 3 seizures/wk with a $2/month script.

Sunday, February 1, 2015

Ebola: Dispelling Myths

Last night our expat team joined some local folks for beers at a friend’s place.  We sat outside until late at night, sipping cold Guinness, with Freetown’s mix of thrumming generators, blaring horns, and tropical bird calls filling the warm night air.  In an effort to halt the spread of Ebola, the Sierra Leone government has imposed a curfew on motorbike taxis and shops (with the exception of pharmacies): no business after 1800 on weekdays, or 1200 on Saturdays.  So the former patrons of small beer stands along the streets have shifted to smaller home-based night-time gatherings.
This was a worldly bunch, and we swapped tales of shenanigans in places ranging from Kenya, to India, from Afghanistan to Antarctica.  Most present had traveled extensively for work or military service. 
Eventually, as it often seems to do here, the talk turned to corruption and exploitation.  The people of Sierra Leone, a small country of 6 million, rich in diamond-bearing kimberlite, iron ore, uranium ore, and other mineral resources, should enjoy a relatively comfortable and prosperous existence.  Instead, the vast majority of Sierra Leone’s wealth is funneled out of the country by international firms, or is sucked up by a small, corrupt local elite class.  Sierra Leone’s living standard is often contrasted by people here  with conditions in South Africa and Botswana.  In spite of many decades of intensive mineral harvesting, Sierra Leone remains one of the world’s poorest, least developed countries.  Many rural areas have no road access, no healthcare, and almost no government support.  In the decade since Sierra Leone’s incredibly brutal, diamond-fueled civil war, millions of dollars worth of international developmental efforts has done little to change this.  It was in this context that Ebola spread so rapidly once it entered Sierra Leone.
On a positive note, Sierra Leone has wealth that goes far beyond what lies under its soil.  Having read about the terrible things that happened during the war here, for many years I have subconsciously  pictured Sierra Leone as a dark, angry, cruel place.  My last personal experience of a (still somewhat active, low-level) recovering conflict zone was Bougainville and the mainland of PNG.  While I met many friendly, good, and kind people in PNG, in most towns and cities an oppressively dark, angry mood hung in the air.  Smaller islands and villages were often peaceful and pleasant, but in towns things always seemed just about to erupt into violence.  And several times they did.  
So, subconsciously, I expected a similar mood of repressed violence in Sierra Leone.  So far, that expectation has been very mistaken.  In spite of what, to me, seem like constant and unforgettable reminders of the war… a generation that missed schooling, the very common sight of people (often beggars) who have had one or both hands amputated by RUF or other military forces- Sierra Leoneans universally assert that people have generally gotten over the war and moved on.  While people are often willing to talk about their experiences, reference events of the war, and relate items such as Foday Sankoh’s imprisonment and death (with a bit of justifiable relish), on an emotional level this really does seem to be true- the people I’ve spoken with in Freetown have gotten over the war and the anger is gone.  Far from gloomy and dangerous, Freetown has one of the safest and friendliest atmospheres I’ve encountered in a developing world city.  There is certainly anger here, but it seems to be mostly directed in potentially constructive directions, such as against the slowness of the EVD response, government corruption, and the funneling of resources out of the country. 
One of the best, most promising things about Sierra Leone society is its religious tolerance.  At a time when religious-based violence seems to be erupting in the rest of the world, in Sierra Leone Muslim and Christian communities intermingle in harmony.  While the radio news talks about IS, Boko Haram, AQ, Yemen, Charlie Hebdo, and anti-Muslim protests in Europe, in Sierra Leone Christians greet Muslim friends and neighbors with “Salaam Alaykam”, and Muslims thank Christians with “God Bless”.  In the evening Muslims and Christians mingle freely over coffee or drinks, and In the newspapers Muslim and Christian advice columns run side-by-side.  Local friends note proudly that even during the war, vicious as it was, attempts to divide communities based on religious affiliations were not successful. 
Part of the reason for this religious tolerance is that Islam and Christianity in Sierra Leone are overlain onto an older set of indigenous beliefs and very intact social power structures, such as secret societies.  Nearly every man and woman in Sierra Leone is initiated during adolescence into a secret society – “Poro” for men, “Bundu” for women.  These societies are a powerful force in Sierra Leone.  Upcounty (in rural areas), where government presence is thin, the Poro and Bundu provide key community services such as cleaning and maintenance of communal lands and buildings, and civil defense during the war. 
One topic that we all spent a long time discussing last night was Ebola rumors.  Some of these may seem pretty far-fetched to Westerners.  Upcountry, western medicine is often unavailable.  When available, basic medical services may be offered by a competent practitioner.  Or they may be offered by a traveling profiteer, with minimal training, who passes off placebos as antibiotics, or worse.  Government presence in such places is often minimal, and the main contact with foreigners is with those involved in reaping the country’s natural resources, with minimal resultant gain for local people. So naturally, people may have limited faith in westerners and western medicine, and instead tend to rely on local spiritual/natural healers who have established reputations in the community.  Often, illnesses and deaths are ascribed to some sort of transgression on the part of the sufferer, or to witchcraft.  Part of the upcountry Mende beliefs is the existence of a nocturnal, technologically advanced world of witches.  One persistent upcountry rumor blames Ebola on the overflight or crash of several witch airplanes into the remote forests of northern Sierra Leone, resulting in the curse of Ebola spreading there.  
The plane rumor is generally disparaged by educated people in Freetown.  But Freetown has its own Ebola rumors.   Like some people in the US, some people in Freetown wonder whether Ebola is airborne.  This rumor is pretty easy to dispel by going into the nature of PPE used for Ebola, and contrasting Ebola’s spread with the spread rate of diseases that are actually airborne, such as flu, TB, SARS, etc. 
Others rumors are trickier.  And the more you think about them, the more you realize some could be pretty easily to rationally wonder about, if you were coming from a Sierra Leonean background.  For example, we were asked if Ebola could have been created in a lab, as a weapon, and released here accidentally, or as a test.  This may seem highly implausible to the average American, but imagine that you live in Freetown. 
You live in a country that should be the Switzerland of West Africa.  Instead, most of the wealth is funneled out of the country by forces you can’t control.  How far-fetched would one more form of exploitation seem to you in that situation?
You have a fairly free press and BBC radio, but limited access to the internet.  Much of the real news in the country is spread through acquaintance networks.  Much of real business in your country, and real actions of the government, go on behind the scenes.  You tend to trust information from acquaintances more than the official line.  Perhaps you have a trusted acquaintance or two that believes Ebola is airborne, or made in a lab, and they make convincing arguments to support their theory.  You don’t have a computer sitting in your living room or a mental database of trustworthy online scientific information resources to consult on the pathology of the virus, so it’s up to you to evaluate the soundness of the arguments your friend is making.  Your country lacks the sort of large, powerful, trusted civil society and legal rights organizations that can help to provide power checks on government in, say, the US.  Sometimes bad things happen, and there isn’t always accountability afterwards.
You know that biological weapons accidents have occurred in the past, for example in the Soviet Union, and that there were attempted cover-ups.
Your friends are asking why the US military is putting so much money into the Ebola response in Liberia. 
Unlike in recent US history, unbelievably terrible things have happened on a large scale in recent Sierra Leone history.  This stretches the boundaries of plausibility a bit.
You are told that this is not a new virus, that it’s the same one that’s been studied for decades in central Africa.  But you know that it has never spread as a large-scale epidemic before.  Why now?
You are told not to eat bush meat, but you know bush meat animals in West Africa have been linked to central Africa by a corridor of rainforest for centuries.  Bush meat has been eaten for centuries, why has Ebola migrated to Western Africa only now?
You see your country’s top doctors, CEOs of banks, and other powerful people dying.  The death rate of infected in your country is 60-70% even with treatment.  Yet, when westerners are infected, they are transported overseas and, mysteriously, they all survive (except 2 elderly Spanish missionaries).  This could easily be misinterpreted as proof of a secret cure.  Now, to me, this is simple racism and selfishness.  But it is not necessarily that easy to convince a Sierra Leonean person that no, there is no secret, proven cure, and yes, the world is just simply too selfish to treat non-citizen Ebola patients in developed-world medical facilities.  The world is spending massive amounts of money on fighting Ebola, but the facilities that actually save lives are almost all standing by, empty, in the developed world.  Sierra Leone is a country that absolutely can’t afford to lose medical personnel.  For example, it only has lost 20% of its surgeons to Ebola; leaving 8 surviving surgeons to treat a country of 6 million.  Only one of these is under 60 years of age.  The doctor I’m staying with is nearly 80, and would like to retire, but is delaying retirement because he is so badly needed.  Sierra Leone docs who risk themselves to treat patients should be guaranteed a quick evac to Emory et al, for best possible treatment.  Its hard to sit down with people who are taking terrible risks to help their countrymen and explain why that hasn’t happened.

To my mind, the best way to dispel such myths is to sit down, share views, and have a respectful, open discussion with those individuals who the community looks to for wisdom and information.  Some of what I feel are our most effective arguments against Ebola rumors:
Describing the virus itself in layman’s terms helps people understand how to avoid it, i.e. it’s a bunch of genetic code (like the letters in a book) wrapped in a rather thin layer of fat… a virus’s only job is to inject that book of code into a human cell, so that the cell is forced to copy it and make more viruses… the Ebola virus’s layer of enveloping fat can be destroyed by thorough washing with soap, bleach, or alcohol hand cleaner, and the genetic code that’s left over falls apart.  Shred a book and try to read it… you can’t.  Ebola doesn’t persist in air or in the environment because it can’t hang in the air like TB does, and on a surface sunlight and air destroys it within 15 min- to a few hours, depending on amount of contamination and environmental conditions.  Those who are ill with Ebola don’t tend to shed large amounts of virus until they are visibly very ill, with limited mobility, or deceased.
Explaining the oldness and relative genetic stability of the Ebola virus (in layman’s terms)
Ebola’s inefficacy as a weapon (not readily dispersable as an aerosol, doesn’t survive transport, doesn’t endure in the environment, the fact that there is no cure, etc)
Human decency - The EVD epidemic has been so bad (21,000/+ infected) that if it was intentionally caused, at least one of the people involved in such a project would probably have been guilt-stricken enough to come forward with concrete evidence.  That kind of revelation would be a NYTimes front page piece, not a National Enquirer piece.  Same story if there was actually a large stock of a proven cure available.
Describing central African cultural traditions which have limited the scale of Ebola outbreaks there, versus some West African traditions which have served to spread it here
Thoroughly describing treatment procedures in the US and the fact that even those treated in the US get terribly ill before recovering
Describing the limitations of potential cures under development
Sharing the fact that the first vaccine test groups were American volunteers in the DC area (which a couple of our team members offered themselves as volunteers for), and Canadian volunteers in Canada.  Describe vaccine testing process and projected available doses.  With encouraging test results and millions of doses already produced, the vaccine (probably the ultimate large-scale EVD solution) seems to be a much less prominent part of local discussions than are potential cures (not going to be a large-scale solution for West Africans- especially in remote areas- any time soon, if ever).

2006-2008 USAMRID/Kenema Study Finds EVD Antibodies in 8% of Sierra Leone blood samples in test pool

Thatch temporary isolation unit outside of the clinic

Saturday, January 31, 2015

Buying infant formula for a malnourished 4 month-old

Elizabeth has been actively working as a nurse/local primary rural healthcare head in Kono, for the duration of the Ebola epidemic.  One of her chief tasks is delivering babies.  Her salary has not been paid in 18 months.

Friday, January 30, 2015

The Road to Kono

Finally on the road upcountry!  An Italian firm has a big contract to pave the road out to Kono.  Up until Magburaka the road it nice smooth new blacktop.  After that it's war- and time-potholed remnants of dirt and tar road all the way to Koidu- a very rough and dusty surface.

Screening patients for Ebola outside of the clinic

Thursday, January 29, 2015

Rough Roads

Rough roads in Sierra Leone - tire wear after a few days' driving, protecting the battery from shorting out against the side of the truck on bumps, frequent string alignments

Wednesday, January 28, 2015

Cape Community School, Freetown, Sierra Leone

Old pics courtesy of Gabriel Scott.  Cape Community School is a free primary school, founded by Mr Scott in 1999 during the Sierra Leone Civil war.  The school has received assistance from UK and US government partners, as well as from NGOs.
For those from the Iron Duke et al who were involved in construction: the school is still going strong.  It has turned out several students who went on to go to college, become teachers, etc.  It will re-open in coming months, after the epidemic ends.  While the school has been closed down due to Ebola, founder Gabriel Scott has put his energies into creating an orphanage for Freetown street kids. 
A few old pics of construction of new school facilities after the end of the war: