Six months after Ebola appeared, Sierra Leone

still lacks beds for patients

The lack of beds for infected patients has led to the rapid spread of the disease.

Nov. 19, 2014A member of the burial team struggles to regain his footing as the body of Alie
Fonnah is lowered into a grave at King Tom Cemetery in Freetown, Sierra Leone. Nikki
Kahn/The Washington Post

By Kevin Sief November 20 at 3:30 AM

FREETOWN, Sierra Leone Outside Connaught

Hospital, the woman with the glassy eyes and raging fever had been waiting all day,
hoping that a doctor might be able to answer her questions: Did she have Ebola?
Could someone treat her?
But five months and 24 days since the first case of the disease was confirmed in
Sierra Leone, there was no bed available for Aminata Dowhertoi. She sat with other
would-be patients in a plastic tent, where people often died waiting for treatment.

Theres still no space, said her husband, Salifa Konu Conteh. After so much time,

still no space.

Its a scene that recalled the earliest days of the outbreak before hundreds of
millions of dollars were committed to the fight against Ebola, before volunteers
arrived from around the world, before the number of cases in neighboring
Liberia began to decline.
But while resources were committed and progress occurred in some parts of West
Africa, the disease crept toward Sierra Leones largest city. New hospitals didnt
open on time. Makeshift holding centers filled up.

VIEW GRAPHIC

Time-lapse of the Ebola epidemic

We take as many people as we can. The rest we have to send back to their

communities, where they continue infecting their neighbors. What else can we do?
said Yusuf Koroma, the coordinator of Freetowns Macaulay Street holding unit.
On Tuesday, 40 people in Freetown and the surrounding area called the
governments emergency response number asking for transport to treatment
centers. Eleven of them were left at home because there was no space.
Holding units, like Macaulay, were intended as a stopgap measure a place for

patients to be tested and isolated until room became available in a treatment

center. But the holding units quickly filled up. And many of the patients admitted
never make it to treatment centers. In his blue logbook, Koroma has noted that
more than a quarter of the people admitted to Macaulay died before receiving
proper treatment.
In July, as Ebola ravaged Sierra Leones eastern districts, like Kenema, doctors in
the capital started to worry that it could spread to Freetown and wreak havoc on a
dense, urban population of 1.2 million people.
We saw Monrovia explode, and we thought, OK, theres no reason thats not going

to happen here, said Dr. Oliver Johnson, a program director at Britain-based

Kings Health Partners, which helps oversee Connaught Hospital.

But while bed space expanded in Liberias capital, it did not here. Pledges were
made to build new treatment centers, but many of them were delayed sometimes
because of logistical challenges. Some aid groups canceled their plans altogether,
unable to deliver on their commitments. The closest treatment center with
consistently available beds is eight hours from Freetown.
We thought we would have all these beds coming on line, but it didnt happen

when we needed them, said Winnie Romeril, a spokeswoman for the World Health
Organization. Everyone knew the problem here was going to get bigger.
Early intervention
In Liberia, where the Ebola caseload
appears to be declining, health workers say
the improvement is due largely to th

A boy rides his bike through the Monkey Bush neighborhood of Waterloo, Sierra Leone.
(Nikki Kahn/The Washington Post)

Early intervention
In Liberia, where the Ebola caseload appears to be declining, health workers say the
improvement is due largely to the increase in treatment centers, particularly in
Monrovia. When infectious people are taken from their communities to health
facilities, it serves a dual purpose: They no longer infect their friends and relatives,
and they receive earlier care, which is more effective.
There were 1,197 new confirmed Ebola cases in Sierra Leone in the 21 days prior to
Nov. 12, according to the WHO. There were 335 confirmed cases in Liberia during
that same period.
British officials who have been charged with leading the international Ebola
response in Sierra Leone say their timeline reflects the evolution of the outbreak.
Were where Liberia was three weeks ago, not because we were complacent but

just because it didnt kick off as early as Liberia, said Donal Brown, head of the UK
Ebola Task Force. Were not a month behind because we were sitting on our
hands. Were a month behind because of the way the disease has played out.
But others say that approach implies a reactive response, rather than one that
prepares for inevitable outbreaks in urban centers such as Freetown.
There was no effort at all here. If there had been more smaller treatment units,

there would have been a huge impact, said Monique Nagelkerke, the head of
mission in Sierra Leone for Doctors Without Borders, one of the aid groups most
involved in responding to the Ebola crisis.
An accelerated disease
Over the next few weeks, a number of facilities will open their doors, or increase
their bed space. The British government has completed construction of a 92-bed
treatment center in Kerry Town, about 30 miles south of Freetown. But only a
fraction of those beds are available while the center trains staff and gets its safety
protocols in place.
The British government has promised to build enough treatment units to house a
total of 700 Ebola patients. So far, 140 of the new beds have been made available.
The point at which, as in Monrovia, we have enough beds, I think were going to

see a decrease in caseload, said Johnson, of Connaught Hospital.

When those facilities open, were going to see a sea change, said Paolo Conteh, the

head of Sierra Leones National Ebola Response Center.

But at the moment, the disease is growing much faster in and around Freetown
than the medical infrastructure.
Experts agree that adding bed space must be accompanied by other efforts such
as campaigns to encourage safer burials in which infectious corpses are not
touched, and contact tracing to monitor and isolate possible victims.
In Freetown, such efforts are underway. The government and international groups
are also providing lessons and materials that will help families care for the sick.
Its now a necessity to teach people how to take care of the sick at home, because

theres nowhere else to put them, said Romeril, the WHO spokeswoman.

After her 11-hour wait, Aminata Dowhertoi was eventually loaded into an
ambulance that would take her to a holding unit. Her husband slipped her a bottle
of water through the window. She leaned back, exhausted.
While she had waited, more of the sick had gathered outside the tent, some lying on
pieces of cardboard, others holding their heads in their hands.
A doctor learned that another rare bed had become available at the holding center.
He opened the door of the ambulance where Dowhertoi was resting and looked at
the crowd.
OK, he said, which of you has been waiting the longest?

Kevin Sief has been The Posts bureau chief in Nairobi since 2014. He served
previously as the bureau chief in Kabul and had covered the U.S. -Mexico border.