FEEDBACK – A story of deployment in Sierra Leone by Jean-Baptiste Richardier | February 5, 2016
A few months ago, Jean-Baptiste Richardier, one of Handicap International’s founders and Handicap International Foundation’s Executive Director, visited Sierra Leone to meet Handicap International staff and attest to the quality of the association’s work. Here is not only the account of his stay, but the story of those who had to cope with the virus, […]
A few months ago, Jean-Baptiste Richardier, one of Handicap International’s founders and Handicap International Foundation’s Executive Director, visited Sierra Leone to meet Handicap International staff and attest to the quality of the association’s work. Here is not only the account of his stay, but the story of those who had to cope with the virus, victims and HI staff members alike.
“At the moment the convoy of three ambulances halted at the height of the tiny dirt street of this west side neighbourhood of Freetown, I crossed her worried and defiant glance. Louisa, a well dressed teen-ager, was standing straight, in front of the door of the family house, her fists on her hips, her school girl rucksack still on her shoulder. Her closed face expressed certain hostility towards those who were coming to take away her mother Agnes and her little sister, reported to the Command Centre with symptoms of the terrible epidemic.
For the observer that I was, Louisa’s anguished gaze will remain the very first contact with the reality of the threat that the Ebola virus represented for the population over so many months. Agnes brings up her five children alone; pregnant with a sixth, handicapped by a paralysed arm, she was waiting sitting down, prostrate, with a lost gaze… Only one attentive neighbour stayed obstinately close by, encouraging her with a soft voice and trying to reassure her by her simple presence. Distraught and silent, Louisa was standing aside, not understanding why a lost form obliged us to wait for an authorisation to take her mother away; an endless wait, uncomfortable and oppressing for all, that nonetheless afforded me an unusual conversation with the family and its immediate neighbours. Very irritated, Mohamed Kamara, Louisa’s uncle, heckles the person in charge of community surveillance and tension increases by a degree. The intervention team imposes itself by its calm. To deviate Mohamed’s anger I ask him questions about his family and his story; curious, Louisa approaches and listens, the link is established. The atmosphere progressively becomes more relaxed and smiles illuminate faces in spite of the distance imposed by the care protocol, in spite of the spectre of a diagnosis that will take close to 48 hours…Resigned, Louisa looks at the departing ambulance taking away her mother and little sister…impossible for her to accompany them…
And immediately she must move aside to leave room for the decontamination team that takes possession of the house. Bedding is taken away to be incinerated; all objects that may have been contaminated are sprayed with a chlorine solution… This is without doubt the most violent moment of the intervention as it exposes to everyone’s looks an intimacy violated by the necessary suspicion of the sickness and emphasises that the family is a menace for all… Fortunately, right afterwards the brand new equipment supplied by the project arrives. The atmosphere becomes more relaxed, smiles come back…
How to express one’s empathy when the rules forbid any contact? How to write about an activity that dehumanises? I thus deliberately chose to evoke this encounter, incomplete but beautiful, this sketched portrait that gives a face to the anxiety carried with this disease.
By accompanying one of our teams, I was able to measure the technicalities and the difficulties of the near 3800 interventions carried out by our team members in the heart of the community. Just as many episodes of trying “extraction” and then stressful “decontamination”, and to speak the truth, most impressive! And even so, in the case of Agnes the context was rather favourable, a quiet neighbourhood, with an accessible dwelling and neighbours prepared for this type of intervention by regular communication…But the anxiety and the dramatisation linked to the amplitude of the procedure and to the protective suits were all the more tangible that each person could believe, at this stage of the epidemic, to have escaped from the worst, to be finally out of danger.
Amongst all my field visits, this is one of those that will leave me with an indelible trace. The population of Sierra Leone, just recovering from a merciless civil war and confronted with immense poverty, was fully struck by the Ebola crisis and its cortege of terror, movements of panic and its individual tragedies…The simple reading of reports or stories will never replace the tangible experience of chaos that the support teams had to endure; of the necessary complexity of the procedure to be established; of the physical and psychological trial that the respect of stringent security measures represents; of the omnipresence of a danger visible only by the tragedy it provokes. It is said of a zone infested with anti-personnel mines that it is “contaminated”…While observing the intervention of our team in the community, I caught myself thinking that the sly threat of the Ebola virus resembles the one which war rubbish maintains in places where civilians live; of course, the consequences are not of the same nature but de-mining and the technical gestures of those intervening to eradicate the virus have in common their simplicity and the requirement of an absolute rigour in implementation to be protected from danger; the slightest mistake can have dramatic effects. If I went to Sierra Leone it is first to pay tribute to those who believed that such a project was possible and to all those who implemented it at the peril of their life. They have written one of the most beautiful and generous pages of the history of our organisation.
Ethics are said to be the search of a response to an unprecedented situation, the expression of an authentic freedom rather than an obligation, an aptitude to try and act in spite of everything…The most impressive is of course the dilemma between the rigour of procedures and the need to express one’s empathy; but it is also the dedication of the thousands of volunteers who have served their community in spite of everything. Beyond the multitude of individual dramas this crisis has been the ferment of a surge of brotherhood in which Handicap International must feel proud to have participated. I was also very impressed by people’s capacity to face adversity, to remain steadfast, to overcome and finally to look ahead to rebuild their lives, what is commonly called resilience. I was impressed by the spirit of tolerance that prevailed between the two main religions to which the community refers, in a city where collective taxis feature indifferently “Allah is great” or “Clap for Jesus”; the situation could just as well have ignited, in the search for guilty people supposed to be at the origin of this calamity…Nothing of this kind occurred. Better, not having been able to touch each other during long months of imposed physical distance, this beautiful tolerance permitted most people to appreciate the universal dimension of the Moslem salute. An inspiring symbol, in the context that worries and divides so much today’s societies.
As soon as I arrived, Sophie, the new Project Manager, had organised meetings with the national team managers. Arthur detailed for me the impressive set-up of social mobilisation and training with the implication of nine historical partners of Handicap International when the decision not to leave the country was taken. Later, I would have the chance to visit one of the partners in the company of Amanda, Inclusion Coordinator present during the whole Ebola crisis. In total, 240 community based volunteers, amongst which 40 handicapped persons, will have ensured a systematic screening of the neighbourhoods within our zone of intervention. I am struck by the amplitude of the project, the territorial coverage, the controls installed, the correct use of the declaration forms in spite of a high illiteracy rate, but also the alert mechanism to identify dangerous behaviour such as traditional burials…The organisation of testimony by survivors also played an essential role, without omitting the remarkable type of prevention involving 1000 Freetown prostitutes, a high risk population for itself and the whole community.
Fred then presents me the Inclusive Education projects. The Ebola crisis having put on stand-by all usual activities, the link with our partners and their beneficiaries was nonetheless maintained, usefully put to profit for the diffusion of prevention messages and then, courses were set up thanks to local radios. Later on, Handicap International will get involved in the “Back to School” campaign, which was at its peak at the time of my visit, so as to contribute to the fight against superstitions concerning Ebola and work to rebuild confidence in the security of schools. Maud and Chanele, her replacement, lastly presented to me the “Protection” project, within a consortium covering 8 districts, with three objectives: the mapping of services and the training of actors; the identification and individual follow-up of vulnerable people; support for the essential protections services that would request it.
The next day, departure for Hastings, approximately one hour’s drive from Freetown, where the Ambulance and Decontamination platform was established. Guided visit by Pauline of all the components and meeting with the different teams. That morning activity is moderate, a level become customary with the slow-down of the epidemic over the last weeks. Everything seems to breathe well mastered rigour and routine, with a smooth operating mode. During the entire visit Gaëlle focuses on an attentive observation of the respect of procedures. The more I go ahead in the discovery of the complexity of protocols, the training stakes and those concerning control of their rigorous respect, the more I tell myself that one had to be solid and courageous to believe, in the crisis and run for it context in which the decisions were taken, that we would be able to set up such a system!
Like other visitors before me, I submit willingly to the ritual of getting dressed with the protection equipment used by the intervention teams… but I must interrupt the exercise before the end. Heat? Lack of water? Hunger? Claustrophobia? A little bit of all this, no doubt… With the suit, the tightly adjusted mask and the hood, I all of a sudden have the anguished feeling of not being able to breathe any more… So why continue?… My respect for the trial endured by all users of this equipment, several times a day and under much more stressful conditions, was all the more greater!
Very quickly I adhere to the requirement expressed by Gaëlle of an important effort of capitalisation; first of all to analyse how this impressive system was put into place; but also to draw all the lessons learnt, to evaluate risk taking in terms of competence scales, difficulties in recruitment, “damage” in human resources and, finally, of reputation. Beyond the numerous elements of satisfaction that must be praised once again, we must be fully conscious that we ran behind the epidemical curve, while, in this field, it is by far preferable to be situated ahead of it. This capitalisation will also permit to analyse up to what point the imperatives of this mobilisation, exceptional from every point of view, have been able to improve our operational mode and our capacity to react. As everybody already knows, this type of crisis will reproduce itself, be it in Sierra Leone or in other countries.
The convoy towards the waste incineration site completed this very uncommon personal experience. At the end of a road both dangerous and interminable to reach the site where the soiled personal effects and bedding are burnt and buried –logically in a place far away from town- I will be given the opportunity of visiting the nearly adjoining immense “Ebola cemetery”. Solitary moment of recollection in front of the tombs aligned and disappearing far out of sight, bringing together in one single place the 9000 hastily buried bodies of all the people who died in Freetown during the crisis, whatever the cause of death may have been…The engraved plates that progressively replace the forest of simple aligned wooden stakes, with anonymous numbers, confer to this isolated sanctuary, silent and deserted, the status of a poignant national memorial.
Night-time return to Freetown for a surprise reception organised “in the honour of the co-founder”; Speech by Fred expressing the appreciation of all for this visit, a signal for them of the importance attached by Handicap International to this programme and the stakes of the forthcoming period. I pronounced, for my part, the respect and pride felt in the different headquarters towards our teams mobilised to prevent the propagation of the sickness; vibrant moments of reciprocal emotion, coloured with good humour and wit, punctuated by a shared drink… as many of them still had more than an hour to drive to rejoin their families after a week passed far away from home. Without forgetting an improvisation by James –in charge of the ritual of temperature taking and disinfection of hands at each entry to the office- who possesses besides a real talent in rap and slam!
A few days after my return to France, I was informed that Agnes and her daughter were able to return to their home in good health and I rejoiced imagining them reunited, installed on the brand new bedding that the project supplied them with! When I took pictures, I promised Louisa and Mohamed Kamara that I would send some back to them. Now, when everybody rejoices that Sierra Leone has become again “Ebola free”, this article I also wrote for them and their next of kin.
Translation courtesy of Philip Wade
At the beginning of November 2015, the World Health Organization declared Sierra Leone Ebola free.
Two new cases, a twenty-two year old student and her aunt, were later reported in January 2016. However, the virus, which claimed the lives of over 4,000 lives in Sierra Leone, and around 11,000 overall, seem to wear off.