Detailed NY Times story on Sierra Leone lockdown aftermath

FREETOWN, Sierra Leone — The most ambitious and aggressive government campaign against the Ebola epidemic gripping parts of West Africa began on Friday when Sierra Leone ordered everyone in the country to remain indoors for three days, suspending commerce, emptying the streets and halting this beleaguered nation in its tracks in an attempt stop the disease from spreading.

Calling the struggle against Ebola a matter of life or death, the government mustered police officers, soldiers and nearly 30,000 volunteers to go house to house, hoping to educate the country about the dangers of Ebola and identify people who might pass the disease to those around them.

“Some of the things we are asking you to do are difficult, but life is better than these difficulties,” President Ernest Bai Koroma said in an extraordinary radio address on Thursday night explaining the national lockdown.

From the start, the limits of the government campaign were evident. The warnings, mobilization and exhortations quickly clashed with the reality that cases here are surging and the infrastructure to deal with them hardly exists.

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There is no large-scale treatment center for Ebola patients in the capital, Freetown, so many patients have to be placed in a holding center until they can be transported to a facility hours away — that is, if an ambulance can be found to pick them up and if those packed facilities have room.

The countrywide lockdown showed the desperation among West African governments — particularly in the three hardest-hit countries, Guinea, Liberia and Sierra Leone — as they grapple with an epidemic that has already killed more than 2,600 people and shows no signs of slowing down.

While governments in the region have already cordoned off large swaths of territory in hopes of containing the outbreak, none have attempted anything on the scale of what is being tried here. The government says it wants to visit every residence in this country of about 6 million, with the aim of instructing people in how to stop the disease from being transmitted and to find out who is harboring sick people, with potentially deadly consequences.

“We have been sending lifesaving messages through radio, TV and print, but it’s not enough,” said Roeland Monasch, a representative for Unicef, which supported the government effort, providing money, advice and information materials. “We need to take information to where people are.”

In the streets of the capital on Friday, one woman lay curled in a fetal position, eyes shut, precariously balanced on cardboard sheets next to an open gutter in front of locked storefronts. From a wary distance, the anti-Ebola volunteers said she had high fever. Hours of calls had produced no ambulance.

A small crowd, including the police, soldiers brandishing guns, presidential advisers and spectators taking cellphone pictures of the immobile woman, milled about. A medical worker said two more bodies in the vicinity needed attention. But still there was no ambulance.

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Kroo Bay, a densely populated area of Freetown, Sierra Leone, on Friday. The neighborhood, a perennial home of cholera outbreaks, sits in a sea of muddy lanes and open sewers in which pigs forage. Credit Samuel Aranda for The New York Times

“They are not responding; they say they have lots of cases now,” said a volunteer, Alhassan Kamara.

Finally, a rickety ambulance pulled up, more than five hours after the initial calls, the volunteers said. But the loosely outfitted attendants refused to pick up the sick woman: they had no chlorine spray and said it was not their job. A loud anti-Ebola jingle played on a car radio. It took a second ambulance, and the president of a moped club who quickly suited up in protective gear, to get the sick woman bundled off to uncertain care.

On nearby streets, other volunteers were going house to house to warn people of the disease’s dangers. Normally clogged streets in the capital were empty, stores were shut down tight, and pedestrians were rare on the main thoroughfares.

The senior United Nations envoy appointed to work on the Ebola crisis, Dr. David Nabarro, said he was struck by the yawning gap between the spread of the disease and the ability to fight it. The world needed to increase the efforts on the ground many times over, he said.

That would include “the capacity to treat between 9,000 and 10,000 people within the countries at any time,” he said. “To get there, we need to get extra people and cash into the countries, obviously, but also we need fantastic organization and logistics that are second to none.”

Dr. Dan Lucey, an American who volunteered in an Ebola holding center at a Freetown hospital, described the situation as horrific. “There were not enough beds, space,” he said. “When you first see this, you say this is totally intolerable. It can’t be this bad,” he said after returning home. “It was an incredible, searing experience not like anything I’ve ever seen.”

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Without treatment units in the capital, he said, patients who tested positive for Ebola had to be driven at least four hours away. Those who tested negative could be exposed to Ebola while they waited. When Dr. Lucey volunteered, there was just one other doctor present. Patients were housed together in open wards with a plastic curtain between beds, awaiting their test results. At the foot of each bed were three buckets — one for urine, one for stool, one for vomit.

“There were body fluids everywhere,” he said. Fuel for the ambulances could be hard to come by. “It’s beyond belief until you see it day after day,” he said.

Dr. Oliver Johnson, a British physician currently working at the hospital with King’s Health Partners, said Friday that the 18-bed unit had received 10 patients during the first day of the lockdown and now had four physicians. He said two other isolation units had opened in the Freetown area in the past several days. “We’re starting to see more beds, more supplies. More staff are coming to work,” he said.

Sierra Leonean health workers, who he said have worked bravely, are now being offered hazard pay. “Things are improving,” he said, but “the real question is whether we can get ahead of the curve. We’ve been seeing more new patients than we’ve been able to build new beds.”

The United States is planning to build as many as 17 Ebola treatment centers in Liberia, with about 1,700 treatment beds, while the United Nations is planning an expanded mission in the region, based in Accra, Ghana, according to Anthony Banbury, the United Nation’s Ebola operation crisis manager. It is intended to be more nimble than the United Nations’ notoriously bureaucratic operations, bringing in as many as 500 trucks and jeeps from other missions in Africa, possibly paying teams in one country to speed up safe burials, buying fuel for monitoring teams in another country, or offering helicopters to transport health workers where they are needed.

But even with the promises of help, international health officials are worried by what they describe as a rapid growth of cases here in Sierra Leone’s capital — a dense urban environment where containment is difficult and the ability to respond is limited.

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Volunteers in Freetown prepared to go house-to-house to warn people about Ebola’s dangers. Credit Samuel Aranda for The New York Times

“The situation in Freetown is very worrisome as cases increase,” said Michael Goldfarb, a spokesman for Doctors Without Borders. “Without an immediate, massive, and effective response, there could be an explosion of cases as has been witnessed in Monrovia,” he added, referring to the capital of Liberia.

Whether Sierra Leone’s lockdown will constitute an effective response is open to question. Despite the mobilization, the volunteers hardly appeared to be thick on the ground. In some neighborhoods, residents said they were yet to see any of the green-vested young men and women who had volunteered.

In other neighborhoods, the volunteers — many of them students, all working for no pay — complained that there was no response to their knocks at most houses. If they arrived without supplies like soap or chlorine, residents were not interested in speaking with them, the volunteers said.

Where there was a response, it was often followed by cursory admonitions to residents to wash their hands, report on neighbors suspected of illness and wear long-sleeve shirts at the market.

At one house, several volunteers talked loudly at once about hand washing, leaving the residents visibly dazed. At another, they were amazed to discover residents who were supposed to be under quarantine because of their suspected exposure to Ebola, but were actually unguarded and free to roam about. At still another, one gave out questionable information about the Ebola virus — seeming to contradict some basic precautions.

Well into the morning, the house-to-house visits had yet to begin in Kroo Bay, a densely populated neighborhood of iron-roof shanties where roughly 14,000 people live, despite officials saying they would start at dawn. The police cruised into Kroo Bay on a pickup truck, yelling at residents to go indoors and warning of imprisonment. People simply stared at the officers and continued lingering as the police drove off.

“The policeman is doing his thing, and I am doing my thing,” said Kerfala Koroma, 22, a building contractor. “We can’t even afford something to eat on a normal day. How can we get something now?”