In early 2014, the West African nation of Sierra Leone seemed as though it was finally putting its decade long civil war behind it.
MSF in Sierra Leone 2014
Tens of thousands of people died between 1992-2002 and the recovery was horribly protracted.
In the years prior to the outbreak, the country of more than 5.5 million had experienced substantial economic growth.
But the epidemic would have a disastrous effect on the economy, to education and, perhaps worst of all, the country’s healthcare system.
Médecins Sans Frontières/Doctors Without Borders (MSF) first worked in Sierra Leone in 1986.
"The woman’s upper body was curved around one middle bed leg, her legs wedged around the opposite middle bed leg, her lower legs and feet protruding from under one side of the bed, her face from the other, staring up into a blank nothing, her mouth stretched wide, the desperate death-mask I am coming to recognise.
"She was still breathing but could not respond, even to moan.
"Despite training in Brussels, briefing in Freetown and Bo and Kailahun, an ever-increasing pile of tales of misery, and my own past experience, I admit I was dumbfounded.
"I began to reach toward her and realised there was nothing, nothing to be done. I turned to Konneh stupidly and, bless him, even from within the depths of my PPE (personal protective equipment) and his, he had the compassion to say it to me in words - “We cannot do anything for her, Patricia”.
"We could not move her, lift her - we could not even wrestle her from under the bed. We had no proper equipment, we had limited time and energy, we had come for other tasks, the discharge of survivors."
MSF’s work in Sierra Leone: 2014
Cases of Ebola were first confirmed in the east of Sierra Leone, near the border with Guinea, at the end of May.
Even before the Ebola outbreak, people in Sierra Leone had limited access to medical care and the health system was both under-resourced and overburdened.
Paediatrics and maternity prior to outbreak
We were working in the country at Gondama, near the city of Bo, running an emergency paediatric and maternity hospital as well as a midwifery clinic in response to the devastating levels of maternal and infant mortality in the country.
When the first cases of Ebola were confirmed, the Ministry of Health asked MSF to intervene. Teams opened an Ebola management centre (EMC) on the outskirts of Kailahun town on 26 June, where testing and care was available for those people suspected of having the virus.
Our teams also launched outreach, health promotion and disease surveillance activities, and trained local health staff.
Community health workers
Community health workers were trained to deliver messages about how people could protect themselves from Ebola and what to do if they showed signs or symptoms of the disease.
An MSF psychologist provided support to patients and to families who had lost loved ones. As the virus quickly spread across the country, patients arrived by ambulance from locations up to 10 hours away.
The Kailahun EMC had a maximum capacity of 100 beds. In addition, MSF constructed a small maternity unit in October where pregnant Ebola patients could receive specialised care within the high-risk zone.
In December, to address the threat of malaria and to avoid confusion with Ebola due to the similarity of initial symptoms, MSF recruited and trained some 6,000 volunteers to carry out a four-day, door-to-door distribution of antimalarial treatments in partnership with the Ministry of Health.
Some 1.5 million people in the Freetown area were reached.
Find out more in our 2014 International Activity Report.
At the end of 2014, MSF had 959 staff working in Sierra Leone. We first worked in in the country in 1986.
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