Unicef Sierra Leone newsletter, Jan-Mar 2015 by UNICEF Sierra Leone

UPDATE SIERRA LEONE Unite for children

January - March 2015

Hopes of saving academic year from Ebola as Sierra Leone children head back to school By John James Communication Specialist

After being shuttered by the Ebola virus, schools in Sierra Leone reopened in April – a challenge in protecting children’s health, but also a chance to look to the future.

an Sankoh, 12, can’t quite decide if he wants to be an engineer or a pilot when he grows up. But whether he ends up studying plans or flying planes, he knows he needs to

be in school – something he hasn’t done for nine months because of the Ebola outbreak that has killed more than 3,400 people in the country since May 2014. “I miss school, and I miss my teacher,” Jan says. “When my teacher teaches me to understand, I miss that. And I miss my friends when we are seeking and hiding. I miss them all.” The good news is that Jan’s primary school in Wellington, on the eastern side of Freetown, Sierra

Leone’s capital, reopened in April. Along with around 1.8 million learners previously enrolled in school, Jan can finally return to the classroom. Planning for the reopening of schools started at the end of 2014. Together with UNICEF and other partners, the government drew up g u i d e l i n e s o n t h e s a fe reopening of schools in the context of Ebola. While the number of Ebola cases has dropped and the majority of districts are now without a case for more than 21 days, precautions are still needed. “Our number-one concern remains getting to zero Ebola cases in Sierra Leone,” says UNICEF Representative Roeland Monasch. “In this context, we want to make sure children are as safe as possible both to reassure parents, and to protect their children.” Every student’s temperature will be taken on arrival at school each morning to detect for signs of fever, and UNICEF has supplied 24,300 hand washing stations to reduce the chances of infections. UNICEF has also trained 9,000 schoolteachers in Ebola prevention, safety guidelines and psycho-social support. UNICEF has also worked on a massive social mobilization campaign to inform communities about the reopening of schools. The concern is that the break in schooling may become permanent for some if they don’t get back into the school system soon. To encourage students to return, the Government has announced it will pay school fees for the next two years. Out of school Reports suggest that the extended period of school closures has had a negative impact on children, and not just in terms of delayed education. “Some of them we see them in the communities: we see them in the market places selling,” says Elizabeth Kamara, head teacher at Jan’s primary school. “You

know they are doing this child labour only for them to survive, helping their parents for them to have their daily bread. When we ask them: how are you feeling when you are not going to school, they say they feel very sad, you know. So, I think they want to come to school now – they want schools to reopen now.” Already prior to the Ebola outbreak, figures from the Sierra Leone Education Country S t a t u s Re p o r t 2 0 1 3 indicated that 233,000 c h i l d re n o f p r i m a r y school age were not attending school. The Ebola epidemic has hit schoolchildren and teachers heavily. Preliminary results of a school needs assessment survey by the Government suggest that 181 teachers and 945 students died of Ebola virus disease, while 597 teachers and 609 students contracted the disease but survived. Learning saves lives In an attempt to reduce the impact of school closures, UNICEF has worked with the government to establish daily school radio programmes broadcast on 41 radio stations so children can learn at home. It is also distributing 17,000 solar-powered radios. Still, there is no substitute for a classroom. One student who cannot wait to get back to school is Patricia Vandy, 17, who is in secondary school in Waterloo: “I like going to school because I want to improve myself and I want become a good citizen tomorrow,” she says. Patricia says the tragedy of the Ebola outbreak has convinced her of her dream to become a medical doctor. “This Ebola, it inspired me a lot to become a doctor, because if there were no doctors in this country, this disease will not be able to come to an end,” she says. “I really like doctors. I really like to save lives.”

January - March 2015

Ebola survivors begin to find acceptance By Issa Davies Communication Officer

Yeabu Kalokoh, 18, carries her daughter, Grace (in red), as they mingle with the rest of the family at their home compound in Makeni town, Bombali district, Sierra Leone. © UNICEF Sierra Leone/2015/Davies

A young mother and daughter, survivors of Ebola, demonstrate that surviving – and defeating – the deadly virus is in many ways a community effort.

eabu Kalokoh, 18, is beaming with smiles as she holds her baby girl, Grace, and gently caresses her. The young mother and her nearly 2year-old daughter share the terrible ordeal and the good

January - March 2015

fortune of escaping the deadly grip of the Ebola virus. They have joined more than 400 Ebola survivors in Sierra Leone's Bombali District to share their experiences and to discuss issues of stigma and discrimination. This latest conference for survivors, organized by the Ministry of Social Welfare, Gender and Children's Affairs, with support from UNICEF, and held in the district capital Makeni, is a chance for Yeabu to meet other survivors and get encouragement to continue her recovery.

Restarting lives Ebola has killed more than 3,500 people in Sierra Leone, but around 3,000 people have also been infected and survived. Although survival is a great triumph, the victory can be bittersweet, as many survivors face difficulties restarting their lives in their home communities. Fortunately, Yeabu and her baby have run into little discrimination since their discharge – on the contrary, they have been warmly received by their relatives and the whole community in a small but boisterous Makeni neighbourhood. “As soon as we saw her coming with her baby, we were taken aback!” says an excited Pa Alimamy Kalokoh, Yeabu's father: “The whole community rushed to welcome them with songs of praise and dance.” There are 48 people living in the compound, Pa Kalokoh says, and radios are placed in strategic By Issa Davies, Communication Officer, UNICEF Sierra Leone positions in the evenings so that everybody can hear the Ebola messages that are being broadcast. “This is unusual, but we are being persuaded every day by persistent appeals on the radio and social mobilizers who move from house-to-house telling us that survivors pose no harm to their communities and that everybody must willingly welcome them back,” Pa Kalokoh says. Changing attitudes UNICEF co-leads the social mobilization effort that is part of the national response to Ebola. Radio has proved to be one of the most effective ways of reaching communities, and messages are broadcast on 62 radio stations. The messages are also backed up with one-on-one outreach. “Especially in the early days of the Ebola outbreak, survivors were being driven away from their communities, but this is now seldom the case, as we keep disseminating persistent messages to communities for them to embrace survivors,” says Ibrahim Vibbi, a social mobilization volunteer in Makeni. “We usually go from house-to-house,

especially in the villages, educating communities on the need for them to show love and acceptance to survivors.” A third Knowledge, Attitude and Practice (KAP) survey, conducted last December by Focus 1000 with support from UNICEF, reveals that stigma and discriminatory attitudes towards survivors have sharply decreased. Only eight per cent of people responding said they would not welcome survivors back in their communities – in contrast with 75 per cent in the first survey, conducted in August 2014. Accepted The change in community knowledge and the increasingly positive attitude towards survivors have had a clear impact. When he realized that his daughter had developed a high fever and started vomiting, Yeabu's father and some neighbours called 117, the emergency Ebola hotline. Previously, it was common for families and communities to hide their sick and tend to them on their own – the perfect opportunity for the disease to spread. “Out of 48 people in my compound, only three people were infected: my wife, who unfortunately succumbed to the disease, my daughter and granddaughter,” says Pa Kalokoh. “Apart from that, all of us are safe from the disease, because we followed the messages from the radio and the social mobilizers.” Everyone in the compound underwent the 21-day quarantine, to ensure no one else had contracted the virus. “We were confident, but still apprehensive, that none of us would develop any symptoms of the disease,” Pa Kalokoh says. Joining some other members of her household to launder clothes, Yeabu expresses her happiness at returning home. “I feel so good that my family and community warmly accepted me back into the fold.”

January - March 2015

James and his siblings pass their quarantine in a UNICEF-supported OICC, under the care of survivors like OICC manager Alfred Pujeh (left). © UNICEF Sierra Leone/2015/Francia

Taking care of Ebola affected children By Margaretha Francia Communication Officer

UNICEF's Observational Interim Care Centres provide new hope for Ebola affected children, and a new mission for the Ebola survivors who serve in them.

i c t u re s q u e m o u nta i n s a n d l u s h greenery adorn the fields surrounding the Observational Interim Care Centre (OICC) in which James Kamara* and his six siblings pass day 18 of their quarantine. A soft breeze flows through the bright yellow building, carrying the laughter of children. These children are under supervision for having potentially come into contact with Ebola. Here, they

January - March 2015

pass their quarantine playing with carers who interact with the children without the benefit of partitions or personal protective equipment (PPE) suits. The reason? All 12 of the staff here are, themselves, Ebola survivors. Care for vulnerable children James, who is 13 years old, lost his father, uncle and three brothers to Ebola. The emotional scars are fresh. “Ebola has affected the lives of children in my community, especially my household,” James says. “We have lost our relatives, and we couldn't play freely anymore. We felt discriminated against because other people didn't allow us to get close to them. They even refused to help us fetch water.”

To help care for children like James, the Sierra Leone Ministry of Social Welfare, Gender and Children's Affairs (MSWGCA), with support from UNICEF, has established OICCs. The purpose of the OICCs is to provide care and protection for children who have been in close contact with a parent, caregiver or a relative infected with the Ebola virus, who do not exhibit symptoms and who do not have any other family members available to look after them. The OICCs care for 20–25 children at a time. The children stay for a surveillance period of 21 days. They are monitored so that any sign of Ebola can be detected early and, in the event that symptoms develop, they can be referred immediately for appropriate care. Teams also seek to trace extended families or identify a caregiver with whom the child can be placed at the end of the quarantine period. If a solution is not found, then Interim Care Centres (ICCs) can be a safe place for children awaiting a longer-term outcome. The OICC is guided by the principle that family preservation and reintegration must be the first priority at all times. If it is not possible, then kinship care or foster care can be options. A supportive – and protective – environment “We are cared for well at the centre,” says James. “Our caregivers feed us well and talk to us when we feel sad.” Fourteen OICCs are currently in operation, covering 12 districts, with a total capacity of 275 beds. Since the start of the emergency, 407 children have been cared for at UNICEF-supported OICCs. “'Contact children' need special care and support during this quarantine period,” says Hani Mansouriam, UNICEF Child Protection Chief. “Imagine if you were a child whose loved ones died, you are discriminated against and living in fear of getting sick or dying? “The OICCs help prevent unnecessary infection risks while promoting a safe and protective environment, minimizing abuse risks, reducing trauma and promoting resiliency among Ebola-affected children,” he continues. “Exposed children used to accompany their symptomatic caregivers for treatment, putting

them at a high risk of contracting Ebola. The OICCs have taken away this unnecessary risk.” Ebola develops more rapidly and with a worse outcome in children, especially among children under 5, who are not able to communicate their symptoms. Most OICCs are located within close proximity to an Ebola Treatment Centre or Holding Centre to facilitate the rapid transfer of children displaying symptoms. A 'family' of survivors Alfred Pujeh manages the OICC in which James and his siblings have resided these three weeks. He lost 11 family members and is, himself, a survivor of Ebola. He has considerable empathy for the children under his care. Alfred answered the call for survivors to take part in eradicating Ebola. He considers his work and the work of other survivors who act as nurses, caregivers, cooks, cleaners and security personnel to be important in helping to contain the virus. “If it were not for this centre, we will lose more children to Ebola,” he says. “Once, we had four children from the same family. Two of them tested positive. We immediately isolated them and so the two remaining children were not infected.” Kadie Panda, a caregiver at the centre, lost nine family members to the disease. She, herself, contracted Ebola while looking after for her sick mother, who eventually passed away. Kadie cares for the children in the centre in the same loving way she cares for her own. Every morning, she checks all the children for symptoms of Ebola and alerts the nurse if any of them become sick. She bathes and feeds them, and observes their interaction with other children to see if they need comfort and attention. “When I see children who are sad, I tell them: Don't allow yourself to get depressed and get sick. We have gone through this same situation, and we survived. We will care for you and advocate for your needs to be taken care of,” Kadie says.

January - March 2015

Time to go home

he says.

In three days, James and his brothers and sisters will be brought back to their village. James is excited to go home and says he misses his family, and he misses helping out on the farm. He has big dreams for his future, and so he is also looking forward to going back to school.

And what are his dreams? “I want to become president of Sierra Leone. If I become president, I will rule the country well, educate every child and care for children without parents.” *Names of the children have been changed to protect their identities.

“I want to go back to school because education is important and it could help you achieve your dreams,”

Kadie Panda, one of the OICC's caregivers, holds her youngest ward, All staff members of the OICC are survivors with a mission to help contain Hannah Kamara*, who is 5 years old. Because the staff are Ebola survivors, Ebola and protect the future of the children of Sierra Leone. they can interact with the children without personal protective equipment. © UNICEF Sierra Leone/2015/Francia © UNICEF Sierra Leone/2015/Francia

Community Care Centres in Sierra Leone save lives in Ebola-hit areas By Issa Davies Communication Officer

Abdul Thullah (centre) and his family © UNICEF Sierra Leone/2015/Davies

henever 50-year-old farmer Abdul Thullah passed through Pate Bana village in Bombali district, Sierra Leone, to work on his farm, he would remark the shiny white tarpaulin tent structures that had recently been erected. Sometimes, from afar, he would observe the workers moving around inside, dressed in their overalls or space-suit like protection suits. “I was bewildered and so one day I asked a fellow farmer in the village what the structures and people were all about,” said Mr Thullah. “He told me the tent structures were clinics or holding centres for suspected Ebola patients and the people in spacelike dressings were the nurses and health workers who take care of these patients.” What he could not know at the time was that soon he would have a much closer view of those tents.

These structures are known as Community Care Centres (CCC), which UNICEF helped set-up in Pate Bana (Bombali district) and 45 other communities in five districts in Sierra Leone since November, largely with funds from DFID. The government facilities provide temporary care and isolation to persons showing Ebola signs and symptoms until the results of their blood tests are revealed, usually a day or two later. “As soon as a suspected case of Ebola reports at the centre, we triage them and provide interim care and support,” said Nurse Zainab, the head nurse at Pate Bana CCC. “If they are positive after their test results are out, we send them to the treatment centres; if negative they are discharged when stable and without symptoms for three days. Follow-up can be done at the community health centres if needed.” The Pate Bana community was chosen for a reason – Ebola has claimed the lives of around a hundred people in the community, and the village (population 200) was put under quarantine for two months. To date, across all districts covered by the UNICEF-supported CCCs, over

January - March 2015

“I was strong enough to have walked to the CCC on my own without any support from anybody,” he added. “When the nurses saw me coming, they warmly welcomed me and told me to sit in a room after which they immediately dressed up in their PPEs [Personal Protective Equipment] and started administering treatments to me.”

over 17,000 patients have been triaged with around 800 patients admitted.

“The nurses at Pate Bana CCC were very friendly and nice and they gave me food three times a day, plenty of water, a nice bed to sleep on and a blanket to keep me warm,” he continued. “I was in the Pate Bana CCC for two days awaiting the results of my tests and on the third day an ambulance came to take me away. I knew I was positive.”

Mr Thullah was one of the positive cases. “I was working in the farm one afternoon when one of my wives came to me feeling sick with high fever,” he said. “I felt sorry for her, held her close to me and wiped away the sweat that was pouring off her body. I advised her to go the hospital which she did.” She travelled the 8 miles to the Magbethe Treatment Centre in Makeni but later died. A few days after touching his sick wife, he too started feeling sick and immediately reported himself to the local CCC in Pate Bana.

Fortunately, ten days after being admitted to the Magbethe Treatment Centre, Mr Thullah was discharged as a survivor. “I, together with the rest of my family [one other wife and five children], would have probably died in my village if the CCC hadn't been established close to my community.” “It provided me with the necessary care and early support when I needed them most,” he said.

Shengbeh Pieh Memorial School before and after the decommissioning of the CCC © UNICEF Sierra Leone/2015/Monasch

January - December 2015

Ebola Community Care Centres â&#x20AC;&#x201C; what do Sierra Leoneans really think? By Aarunima Bhatnagar Communication for Development Specialist

o travel to most of the Community Care Centres (CCCs), you need to drive for at least three hours inland from the coastal capital Freetown. I'd packed my bags with a mix of fear and excitement. But above all, I was really curious to meet the Ebola-affected communities in which we were working. How had people's lives changed since Ebola arrived, and what 10

were their attitudes to the CCCs in Tonkolili, Bombali and Kambia districts? The CCC model has been a key part of the fight against Ebola in Sierra Leone and 46 out of 58 CCCs in the country were built for the Government by UNICEF with local partners, creating 404 Ebola beds (around a quarter of the overall national Ebola bed capacity).

January - March 2015

As the name suggests, CCCs are built in communities with community buy-in. The whole process starts with extensive community meetings to get their views on how many CCCs they think are needed and where they should be built. Now that the CCCs have been open a couple of months, I led a team to carry out community focus group discussions with men, women and youth to get their verdicts on the facilities and the Ebola fight. The focus group discussions took place in five villages in the three districts with the Temne and Limba ethnic communities. On a bright hot day I remember visiting one women's group 15 miles down a dusty bumpy road. People crowded around the car to offer us coconuts and fresh bread. We found the women sitting around their huge cooking pots, while a radio blasted out music. They gathered around, with some smiling and laughing while others whispered to each other. It didn't take long for them to open up. Drawing together the conclusions from the various discussions I took part in, there were some broad themes. Initially people we spoke with said there had been a lot of fear as people started hearing about Ebola but didn't have the information on how it was spread. As one woman said: “I was not even aware of Ebola in my community till someone died. Then I thought: this can kill!'’ All the women said they were concerned about their children's health, and with the schools closed, the difficulties of keeping the children occupied. Girls have been helping their mothers with household chores or selling vegetables, while boys have mostly been playing. The majority of the respondents in the groups said they now approved of the CCCs, but many said they did not initially understand their purpose. ''I have gone to the Ebola centre myself, when my child had fever. It's not very far from home and the nurse was so helpful and kind, gave me all the information on Ebola and told me not to worry, they would provide treatment and protect my child,” said one focus group member. Young people in the youth focus group seemed particularly positive about the CCCs: “I prefer the CCC and I believe that it gives us the treatment we need.

January - March 2015

You also get malaria tablets and fever tablets. It's like a hospital: big and clean.” Another said: ''It's in our community. My father was involved in the construction of the CCC. I am a mobiliser myself and I tell people to use the CCCs, sometimes, even take them there myself.'’ But for some in the groups they were initially scared when the CCCs were being set-up because of their direct association with Ebola. They told me in one women's group that the traditional practice says, “We take care of sick at home and have always done that, our traditional practices are very effective. We never took the sick to the hospital, unless it was an emergency. We are trying to change that now.” Now, we found high levels of trust and confidence in the CCCs in all groups. When we asked them about how perceptions had changed, it was clear that the communities had come a long way. Before, respondents said there was discrimination against people working in the CCCs. People didn't believe Ebola was real, or they said that: ''Ebola killed you anyways, so why go to a hospital? Die at home and with dignity'' and that “Whenever you would even walk by a CCC, people would think they have Ebola.'' Another said ''People thought it was a place to draw blood and give you Ebola.” Now they said they had “So much information on these centres and, on Ebola, you feel confident, to access and not shy.” Another said: “They are a good investment for the community.” I came away with the clear impression that the communities we visited have benefited from the establishment of the CCCs, made possible by DFID funding. They have helped enable people to overcome the fear of Ebola; improve their health-seeking behaviour; and brought a sense of community ownership. I travelled back to Freetown with a feeling of pride and happiness that the CCCs have had a positive impact on the lives of these people and have been so crucial in curbing the spread of the outbreak, which could have affected many more if the CCCs had not been there.

Ward 356 social mobilizer Zainab Rogers (left) advises Hassan Bangura, 20, what he should do if one of his loved ones begins showing signs of Ebola. © UNICEF Sierra Leone/2015/Davies

Social mobilizers empower 'hotspot' communities to fight Ebola in Sierra Leone By Margaretha Francia Communication Officer

“Communities are at the forefront of the response” – UNICEF Global Ebola Emergency Coordinator, Barbara Bentein

n a bright, hot day, Andrew Koroma and Mohamed Conteh walk through Freetown's congested Rokupa community, armed with a megaphone, posters and flyers. This small team of social mobilizers is here because one particular community is currently under its second 21day quarantine after recording an Ebola death.

“This community is one of the worst cases,” says Mr. Koroma. “We have around 28 quarantined homes, 30 survivors, 20 deaths and 5 who are in treatment centres. “Of the 60 people here who were infected, around 50 tested positive so far. They will start their quarantine again because someone died this morning. We also have three new fresh cases here, so we have to work hard.”

January - March 2015

Hotspot busters Mr. Koroma and Mr. Conteh are among 788 'hotspot busters' in Sierra Leone. Hotspot busters deploy rapidly to communities that are considered hotspots of the epidemic, as part of an immediate response to an outbreak. Members of the community themselves, hotspot busters are trained to intensify social mobilization activities and increase engagement of communities to stop the spread of Ebola. They conduct one-on-one sensitization sessions, house-to-house visits and public awareness-raising. To ensure that the hotspot is covered, the social mobilizers activate youth, women and volunteer networks in each community and reach approximately 9,000 households every week. They are involved in active community surveillance and are approached by community members to call the 117 Ebola hotline to refer sick loved ones to hospital. “The only way to 'bust the hotspot' is to make sure that community members are empowered, engaged and active,” explains UNICEF Sierra Leone Chief of Communication for Development Kshitij Joshi. “We ensure that the social mobilizers are from the community and know the context so that tailor-fit strategies are able to respond to what the particular community needs.”

community influencers, women and youth groups; partnership with 97 per cent of radio channels for Ebola education; use of SMS technology for real-time monitoring; and leading the community engagement process and social mobilization activities in and around community care centres. Evidence-based outreach A Knowledge, Attitude and Behaviour survey conducted in October reveals that social mobilization is working. Compared to results from the first such study, in August, there has been a marked positive change in people's knowledge, attitude and intention to modify behaviour, in the context of Ebola. More than 90 per cent of respondents accepted three key means of preventing Ebola, compared to 79 per cent in the previous study. The proportion of people who also accepted that Ebola can be prevented by avoiding contact with blood and other body fluids increased from 87 to 92 per cent. Ninety-four per cent of respondents accepted that Ebola can be prevented by avoiding funeral or other burial rituals for someone who has died from Ebola, up from 85 per cent. The proportion of respondents who hold any form of discriminatory attitude towards Ebola survivors decreased significantly – from 94 to 46 per cent. United against Ebola

Since the initiative began, hotspot busters have carried out social mobilization in more than 344 hotspot communities nationwide. Some 275,103 households have been reached on their house-to-house visits. Awareness and change The Hotspot Busters initiative is a key element of UNICEF's response to the Ebola outbreak in Sierra Leone. As co-chair of the National Social Mobilization Pillar, the organization works closely with the Health Education Division of Sierra Leone's Ministry of Health and Sanitation. It provides technical support for evidence-based programme planning and management and coordinates social mobilization partnerships at national and district levels. Among the activities UNICEF supports are mapping and engagement of traditional and religious leaders, key

January - March 2015

That cases are still appearing in some communities indicates that more can be done. Fortunately, the partnership between UNICEF and the Health for All Coalition on the Hotspot Busters project is bearing fruit: In Ward 355 in Portee, Western Area Urban, community spirit is paving the way for better coordination, reporting and trust of social mobilizers, contact tracers and other Ebola workers in the community. Christopher Jones is Chief Coordinator of the Portee Ebola Response Alliance Volunteers (PERAV). This 35member organization was created to assist Ebola workers sent to Ward 355 to help eradicate Ebola. Mr. Jones and his volunteers help their neighbours understand why Ebola workers such as the Hotspot Busters are coming into their community. They work in close partnership with the social mobilizers when

families resist the efforts. “We try and make them understand the nature of what Ebola workers are trying to do,” says Mr. Jones. “We help the people understand the essence of driving this Ebola out from our community. “We have been successful in making people accept that Ebola is real, to allow people from NGOs to talk to them.”

integral to their overall Ebola response. Councillor Alusine Conteh is from the community in which PERAV is active. “More than a hundred per cent the social mobilizers have been helpful to us,” he says. “They work around the clock as a member of the community, always with us and always involved. They investigate the issues, go to the homes to educate people and report if there are sick persons to make sure they are taken to the hospital. “They are very important to us.”

Community leaders also consider the social mobilizers

The SMS reporting revolution takes on Ebola, in Sierra Leone By John James Communication Specialist

Every evening, Alfred Pujeh pulls out his basic mobile phone and answers SMS text message questions about the Observational Interim Care Centre where he helps care for children under quarantine for Ebola. © UNICEF Sierra Leone/2015/Francia

e recently met Ebola survivor Alfred Pujeh, one of the dedicated staff who look after vulnerable children while they are under quarantine for Ebola, at Sierra Leone's new Observational Interim Care Centres. He and other workers around the country are also helping to wage

one key battle in the fight against Ebola – with their phones. At the end of the working day, Alfred Pujeh sits down at his wooden office desk, reviews his notes – and pulls out his phone. It's reports time, in this Observational Interim Care Centre (OICC) in Sierra Leone.

January - March 2015

Flash messages to Freetown The newly established facility, run by the government and set up with UNICEF support, looks after children who may have come into contact with the deadly Ebola virus, for a 21-day surveillance period. Every evening, Mr Pujeh pulls out his basic mobile phone and answers SMS text message questions from the Ministry of Social Welfare, Gender and Children's Affairs on how many children are in the centre, on gender and age and on how many children have been discharged during the day. Within a split second, the results are in Freetown, which is nearly four hours away by car, where the ministry, in turn, compiles his results with similar data from all corners of the country. There is no need for an internet connection, a sophisticated phone, or even phone credit – just a basic handset with a network connection. “For traditional reporting, you have to sit down and write and it will not get to the appropriate people easily,” says Mr Pujeh. “It will take time to reach the main office. “But now, it is very easy.” Armed with open source for a key battle Getting data quickly has been a key battle in the fight against Ebola, which has caused more than 3,500 confirmed deaths in Sierra Leone since May 2014, according to the National Ebola Response Centre. That is where the RapidPro free open-source platform comes in, launched globally by UNICEF in September 2014. It isn't the world's first mobile phone reporting platform, but it is one that's remarkably well adapted to the field – easy to set up and usable on pre-existing equipment and phone networks in all but the remotest places. “Any sort of tracking, monitoring and data pooling that you can think of can be done with RapidPro,” says Shane O'Connor, UNICEF Sierra Leone's Technology for Development officer, who has worked with the programme teams on setting up the customized reporting apps.

January - March 2015

RapidPro's cloud-based, multi-language and multichannel (SMS, voice, Twitter) architecture has allowed UNICEF and its partners to quickly scale systems that can deliver life-saving information and services to those who need them most. Since its launch, more than 20 million messages have been sent to/from beneficiaries in over a dozen countries around the world. It was first used in Sierra Leone by the UNICEF team behind the Ebola Community Care Centres (CCCs), who set up 46 centres in five districts with 404 beds in less than two months, between November and January. The CCC teams, often located in isolated chieftaincies, needed to communicate information on triage numbers, admissions and results to Freetown on a daily basis so experts could keep abreast of the latest caseload trends. With RapidPro, the CCC team were able to set up the SMS reporting system in just a few days, without the months of design and programming normally needed on a project like this. Broader applications Since then, just within the Sierra Leone office, the platform has been used for daily and weekly OICC monitoring, reporting from the district protection desks, following up on Family Tracking and Reunification and daily and weekly monitoring by the social mobilization team. It also forms the backbone to the newly launched U-Report polling network. “We are using a network of 788 monitors across the country using the RapidPro platform for real-time and independent monitoring of social mobilization activities,” said Kshitij Joshi, head of Communication for Development at UNICEF Sierra Leone. As well as reporting on activities organized by the national Ebola social mobilization pillar, which is co-led by UNICEF and which brings together all actors in the sector, field monitors can also report on adverse social and behavioural practices like secret burials and body exhuming. Thanks to the successes so far, the UNICEF Education team are using the system to monitor the reopening of schools. Nutrition supplies and HIV treatment could also soon be monitored this way. It can take as little as

half a day to build a new app. Mr O'Connor stresses that, like any technology solution, it is not a 'magic bullet' for every situation, and care is still needed to make sure field reporters know how to start using the system, and understand exactly the sort of information that each question is asking for.

But the mix of high-tech and low-tech has made datasharing and responses far faster than they otherwise would have been, in an Ebola outbreak in which speed has been of the essence.

Celebrating the miracle that is Moses By Margaretha Francia Communication Officer

healthy baby cooing and smiling at the sight of his mother, Moses has surmounted impossible odds at only four months old. The chubby, wide-eyed boy in the pink of health came dangerously close to death five months back when he was still in the womb of his Ebola-stricken mother. “When they told me I was positive for Ebola, I was not happy and my whole family was worried. I felt cold and I had pain all over my body. My eyes changed colour,” says Moses' mother Isatu Mansaray as she recounts getting sick around the time she was due to give birth. “I was worried that my baby would get Ebola from me.” Thankfully, Isatu delivered safely and the baby tested Moses at 1 month

negative for Ebola. The mother and son have much to celebrate. The prognosis for pregnant Ebola patients and their newborns is especially grim. There are only a few cases wherein both mother and baby survive and recover from the disease. When they do survive, another challenge presents itself—mothers who contracted Ebola cannot breastfeed their children as the virus stays in breastmilk for around 90 days. This poses a risk to the infant who needs proper nutrition to get the best start in life. A strong foundation UNICEF believes that giving children a good nutritional foundation is key to ensuring their physical, mental and social development. Children who are well-nourished learn better and are better able to fight infections,

Moses at 4 months

Moses receives Ready-to-Use Infant Formula as his mother recently recovered from Ebola and may be carrying the virus in her breastmilk. ©UNICEF Sierra Leone/2015/Francia

January - March 2015

which is especially important in this health emergency. The effect of good nutrition lasts well into adulthood, and is a key ingredient in nation-building. “For any nation that is aspiring to develop, nutrition is the most important component of human capital development,” UNICEF Sierra Leone Nutrition Manager, Faraja Chiwile, says. “Investing in nutrition has high gains in terms of reducing expenditures in health and education, and providing the country with a quality workforce. If you want to build a developed and prosperous nation, you have to have a healthy and wellnourished population.” Nourishment for the vulnerable In Sierra Leone, nutrition is a challenge with 12.9 percent of children malnourished. Traditional beliefs on infant feeding can be harmful to children. To help children's nutrition at this especially difficult time, UNICEF provides a host of interventions to benefit both mother and baby. UNICEF is a key partner of the Sierra Leone Ministry of Health and Sanitation in providing children with the nutrition they need to be able to survive and thrive. Helping guide the strategies and protocols that are responsive to the current emergency, and providing health workers with much needed training are key elements of this work. Delivering nutritional supplies to health centres, Ebola holding and treatment centres, as well as quarantined households also ensures that the most vulnerable children are reached.

Nutrition supplies have been prepositioned at District Medical Stores (DMS) for replenishment to all Ebola centres, as well as to support quarantined households and children under six months of age who are separated or have lost one or both parents. 278 surviving infants like Moses have been receiving supplies of Ready to Use Infant Formula (RUIF) on a biweekly basis since the emergency began. Coming home When the time came for Isatu and Moses to be finally discharged, the mother came home with two weeks' supply of Ready-to-Use Infant Formula (RUIF). RUIF is given only as a last resort when mothers are not able to breastfeed and there are no other safe options to feed the baby. Every two weeks, Isatu goes to the health centre to pick up a new ration of RUIF, as well as have Moses' weight and height monitored. By the time Moses is six months old, Isatu will begin giving him complementary food to support his continued growth and development. “I feel very happy now because I am feeling well. And my baby, he is healthy, he is growing,” Isatu says, beaming with pride. “I pray to God that he will give Moses long life and good health. Because I am not educated, I also pray that my child will get an education, so he can be somebody in the future.”

For the Ebola emergency, UNICEF is directly providing 16 Ebola Treatment Units (ETUs), 47 Ebola Holding Centres (EHCs), seven ETU/EHCs, 12 interim care centres (ICCs) and 14 observational interim care centres (OICCs) as well as 31 Community Care Centres (CCCs) with nutrition supplies. Moses happily drinks his milk as he is fed by his mother Isatu, while his father Usman looks on. Vulnerable children who have been affected by Ebola need proper nutrition to be able to survive and thrive. ©UNICEF Sierra Leone/2015/Francia

January - March 2015

Sierra Leone: staying at zero in an exEbola hotspot By Frederick Bobor James Programme Communication Specialist

had washed the infected corpse which initially provoked the outbreak, a second for those who had visited the home of the initial deceased case, and finally the quarantined home of the first Ebola victim. In addition, they banned movements to and from the community, enforced hand washing, and made sure everyone stopped hiding the sick and washing dead bodies.

This community was one of the hardest hit in the district: you quickly come across orphaned children, widowed women and men, and parents who have lost sons and daughters. Almost the entire town, seemingly picturesque at the base of a local hill, has been through Ebola quarantine measures. Crops have been left in the fields to rot.

Kenema District, on the border with Liberia, was the second to record cases of Ebola in Sierra Leone. Now it has been more than two months since the last case was recorded. As co-lead of the social mobilization pillar in Sierra Leone, UNICEF is working hard to make sure districts like this stay at zero weekly cases, while outbreaks elsewhere are mopped up. Social mobilizers are key to this process.

lose to the centre of Komendeh Luyama village in Sierra Leone's Kenema district is a mud-walled family home that looks much like the others – except the doors and windows are firmly shut.

According to the village residents not a single former occupant of the home is alive – all victims of Ebola.

On Saturday 14 February 2015 we visited the village with a team of social mobilizers, seven in all, including two staff from UNICEF. When Ebola first struck here on 10 October last year widespread denial and certain traditional practices fueled its spread. But it did not take long for us to realise that we were now talking to converts: the residents of Komendeh, around 1,200 people, learned about Ebola safety the hard way. B e fo re E b o l a c o u l d b e contained, the community witnessed 42 infected cases (6 males and 36 females), with 31 deaths and only 11 survivors. We a s ke d co m m u n i t y leaders in Komendeh how they had extinguished the fire. They said they had i m p l e m e n t e d fo u r ke y actions. Firstly, with support from WHO, they established three dedicated quarantined homes – one for those who

The people of Komendeh Luyama are quick to answer our questions: “We will continue to keep the by-laws and will not go back to business as usual,” they assure us. But for behaviour change to stick, there is need for regular reminders. That is why we are going around the former hotspots to make sure no-one is dropping their guard.

The entire family living in this house died due to Ebola.

January - March 2015

How one Sierra Leone chiefdom avoided Ebola By Margaret James Health Officer

hen I first heard in February that Lugbu chiefdom was one of the few in Bo District that had not recorded a single case of Ebola, my interest was immediately triggered. On 2 March 2015 we got to visit the chiefdom's main town, Sumbuya, for several hours of meetings with traditional leaders, youth, a traditional healer and business people to find out more. In our quest for answers, we got permission from the local Paramount Chief, (PC) Mohamed Allie Nallo, who gave his blessing and got in touch with key people to help us in our research. We held group meetings, one-on-one interviews and even carried out some spot visits. One of the first people we heard from was the official Chiefdom speaker, Braima Samu: “Lugbu chiefdom is strategically located with several entry points – accessed by both land and water. It is a diamond mining area with a large influx of people and a constantly mobile population. It borders four chiefdoms which were all Ebola hot spots – Bagbo, Jaiama Bongor, Tikonko and Bumpe Gao chiefdoms. It was therefore highly necessary that we take extraordinary measures in order for the chiefdom to remain Ebola free.” That seemed like a lot of reasons why Ebola was likely in Lugbu. So, how did the chiefdom escape? In the view of the Chiefdom speaker, it was through good leadership. He said the Paramount Chief “instilled a very robust team work spirit in all of us to ensure the people understand and accept the existence of Ebola very early.” The whole community was encouraged to get involved as contact tracers, alongside those who formally held that title. Local chiefs were told to keep a look out for those in their community, and every resident was encouraged to keep an eye on his or her neighbour. In my notebook, I wrote down three important

January - March 2015

Lugbu Chiefdom: a) chiefdom Stakeholder meeting

A youth explains about the only permitted riverine entering point

responses: Ÿ Early acceptance by the chiefdom population of the reality of Ebola Ÿ Strict enforcement of the chiefdom bye laws Ÿ Good/strict neighbourhood watch To ensure the involvement of all, the traditional leadership developed their own form of a 'cluster' approach. They set up five main chiefdom committees: a Chiefdom Task force and then groups for sensitization, oversight, surveillance, and then discipline. Again, according to the Chiefdom speaker, the bye laws [local rules] were fully implemented without fear or favour: “When the Paramount Chief's nephew died and we found out that he (the Paramount Chief) had never

reported or sought medical care, he was fined Le On that last point, a prominent community 500,000 [about $116] which he paid up front before we businessman, Mohamed Mansaray (known locally as “Capitalist”), told us he himself had been a victim: called the burial team.” “Initially I was very aggrieved when I was quarantined All actions and measures were fully documented by the after I returned from a two week visit to my relatives chiefdom secretary, Chief Denis Kaimasa, in his ledger. outside of Lugbu chiefdom. However I am now happy He explained to us the community rules enacted to fight and appreciative of the action taken by the chiefdom as I believe that this also contributed to Lugbu being free Ebola, including: Ÿ A ban on all social public gatherings, including local of Ebola.” markets, apart from mosques and churches Ÿ A ban on all traditional practices including I mentally noted the importance of discipline and community burials, and the practices of herbalists community ownership of the response. I was impressed that the communities arranged their own incentives for throughout the chiefdom Ÿ All strangers/visitors entering the chiefdom those involved in the Ebola fight because they including indigenes resident outside the chiefdom recognised it was such an important issue. had to report to the authorities – in most cases they Madam Gladys Kanagboh, a women's leader, disclosed were not even allowed to spend a night. Ÿ Vehicles were not allowed to move within the how some of the women's groups were very vigilant in identifying and locating sick persons, and helped in chiefdom after 7pm Ÿ Thirteen checkpoints were erected at all strategic taking them to the health facilities. This disclosure was entry points including riverine communities and also confirmed by Edward Massaquoi, the chiefdom villages. These were all manned by security Task force chairperson who is also a contact tracer. personnel and community vigilante groups who were personally taken care of by the Chiefdom in One of the chiefdom youth leaders, who also doubles as terms of incentives. All boats that normally ply the a teacher and contact tracer, Edward Demby, explained smaller riverine entry points were either removed or the youths' vigilance in ensuring compliance with bye strictly not allowed to land after 6pm. Only the laws. “We were highly supported and motivated by the major riverine entry point in Sumbuya town leadership and the chiefdom people so we never remained opened but with very serious monitoring. encounter any resistance.” Ÿ Any resident leaving the chiefdom for more than three days was either not allowed back, or - if In conclusion, Mr. Samu, the Chiefdom Speaker, allowed - was quarantined in their home without summed up their successful work to keep Ebola out as down to committed leadership, team work, vigilance, anyone visiting them. cooperation and conformity of the chiefdom people. It was hard to disagree.

In 2014 UNICEF Sierra Leone received contributions from: Ÿ

The Governments of Canada, Germany, Ireland, Italy, Japan, The Netherlands, Norway, Sweden, Switzerland, United Arab Emirates, United Kingdom, USA The European Union, United Nations, African Development Bank, GAVI Alliance, Global Fund against AIDS/TB/Malaria, Bill & Melinda Gates Foundation

We also received contributions from UNICEF National Committees in:

Australia, Austria, Belgium, Denmark, Germany, Iceland, Italy, Japan, Luxembourg, The Netherlands, Norway, Poland, Sweden, Switzerland, United Kingdom, Global - Thematic Humanitarian Resp and USA

For more information, please contact: John James Head of External Relations and Advocacy UNICEF Sierra Leone Mobile: +232 76 102 401 Facsimile: +232 22 235 059 E-mail: jjames@unicef.org URL: http://www.unicef.org www.youtube.com/user/UNICEFSL Instagram: unicefsierraleone

Micronutrient Initiative, United Nations Foundation, IKEA Foundation, CERF, OFDA, The World Bank

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Design & Layout by Tolu J. Bade/2015/UNICEF Sierra Leone