UNICEF Sierra Leone newsletter, July-Sept 2014 by UNICEF Sierra Leone

UPDATE SIERRA LEONE Unite for children

July - September 2014

OVER 1 MILLION HOMES REACHED WITH CRUCIAL LIFE-SAVING MESSAGES ON EBOLA PREVENTION THROUGH THE HOUSE-TO-HOUSE EBOLA TALKS Issa Davies, Communication Ofﬁcer, UNICEF Sierra Leone

he Government of Sierra Leone, through the Emergency Opera ons Centre, Ministry of Health and Sanita on with support from UNICEF and other partners, embarked on three days of House‐to‐ House Ebola sensi za on (Ose‐to‐ose Ebola tok) and preven on in every district in Sierra Leone from 19 – 21 September.

The campaign, which ini ally aimed at reaching 1.5 million households with basic life‐saving informa on through talks, the distribu on of Informa on Educa on & Communica on (IEC) materials and s ckers on Ebola, was a remarkable success with 94 % of the popula on reached according to independent monitors.

This campaign was simultaneously complemented by a UNICEF supported project of radio discussions and sensi za on by the Independent Radio Network (IRN) and the Sierra Leone Associa on of Journalists (SLAJ) through a network of 51 radio sta ons across the country. “Those whose homes were not reached got the messages through the radio…” said President Ernest Bai Koroma, President of the Republic of Sierra Leone who said he was very pleased with the organisa on of the campaign. “This is an opportunity to hear what families want to know about Ebola. If people don't have access to the right informa on, we need to bring life‐saving messages to their doorsteps,” said Roeland Monasch, UNICEF Representa ve in Sierra Leone. “The ﬁght against Ebola will not be won in treatment centres only; it also needs to happen in every household.”

A total of 28,544 volunteers including youths, health workers and social mobilizers were dispatched all over the country in groups of four. The teams generally comprised of a health worker, an NGO member, a teacher and a youth volunteer. At the end of each talk a bar of soap was handed over to every household reached as a demonstra on of the importance of hand washing with soap to prevent the spread of Ebola. Fatmata, 23, a volunteer and a member of the Youth and Child Advocacy Network (an NGO), was among the teams that worked in Freetown. With training facilitated by UNICEF, she said she felt empowered and passionately communicated Ebola preven on messages to residents at Moe Wharf, one of Freetown's densely populated slums. “Wash your hands frequently with soap so that you could be prevented from Ebola! Don't touch dead bodies even if they are your loved ones and call 117 to report such cases!” she said loudly amid a crowd of residents who had gathered to listen to her.

UNICEF is a member of the Emergency Opera ons Centre (EOC) and supports ac vi es in ﬁve of the pillars that have been set up under the Ebola Opera ons Centre and the Na onal Ebola Taskforce. These are: Coordina on; Social Mobiliza on, Surveillance and Laboratory, Logis cs, and the Child Protec on/Social Protec on pillar.

One of the residents in this community, a young mother of four, a er listening very carefully to the messages, said: “Before I used to hear people shou ng 'Ebola Ebola' but I did not know how to prevent it; now I understand how to prevent Ebola.”

The UN Mission on Emergency Ebola Response (UNMEER), with headquarters in Accra, Ghana, was recently established to lead and coordinate the collec ve UN response on Ebola in Sierra Leone, Guinea, Liberia and other poten ally aﬀected countries. As at 27 October, over 3,500 people in Sierra Leone have been infected with the virus with a cumula ve total of 1,044 deaths. A total of 737 have survived the disease and have been discharged from treatment centres.

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RADIO LESSONS FOR SCHOOL CHILDREN Rosmarie E. K. Jah, Reports Ofﬁcer, UNICEF Sierra Leone

“That is why this school in a radio programme is important as it could serve as an eﬀec ve tool to keep children academically engaged and focused in the midst of this adversity.”

eptember 8 was a sad day for thousands of school children in Sierra Leone. Normally it would have been the start of the school year, but regular schooling has been suspended indeﬁnitely. The measure was taken by the Government to protect children from the risk of Ebola infec on. Schools will remain closed un l it is safe for children to go back. In a country, where the literacy rate is only 42 percent, this is an enormous setback.

In order to keep educa on going, UNICEF and partners are suppor ng the Ministry of Educa on, Science and Technology with the radio educa on programme. Aiming to reach 1.8 million children with quality educa on opportuni es, the na on‐wide programme involves 41 radio sta ons at na onal and community levels.

However, one month later, the situa on has changed: While schools are s ll closed, educa on and learning have been able to con nue through an innova ve teaching ini a ve. On October 7, the Ministry of Educa on, with UNICEF support, launched an Emergency Radio Educa on Programme for pre‐ primary, primary and secondary school children. For the next three months, classes will be broadcast for four hours a day, six days a week.

In order to keep children interested in and curious about the lessons, the radio presenters are trained to ensure child‐ focused programmes. The radio curricula also include psychosocial teachings and life skills components to give children addi onal support in coping with the Ebola crisis. Especially for parents who are concerned about their children's economic trajectory, the radio educa on programme provides hope.

“Although Ebola has disrupted the school system, we must not allow it to disrupt the con nuous cogni ve development of school children even if they are not going to school,” said Roeland Monasch, UNICEF Representa ve in Sierra Leone.

July - September 2014

The trainer from the Centre of Control Disease, Ben Levy, teaches a workshop participant on how to use the double pair of latex gloves to avoid being infected with Ebola. ©UNICEF/2014/Bade

THE FIGHT AGAINST EBOLA CAN BE WON THROUGH KNOWLEDGE Health workers trained on the use of personal protective equipment in Sierra Leone Yolanda Romero, Communication Consultant, UNICEF Sierra Leone

wenty students sit in a classroom in Freetown listening to a trainer. It should be a common scene, but the topic, Ebola and their ages (most are in their 40s) makes this a diﬀerent type of lesson.

Since the beginning of the outbreak 98 out of 124 health workers conﬁrmed as Ebola posi ve have died. Preven ng the infec on of health workers is an important priority as the response grows.

They are all health workers, including nurses and doctors, learning how to prevent infec on in a highly contagious environment. The training given by members of the Atlanta‐ based Center for Disease Control and Preven on (CDC), has been organized by UNICEF in collabora on with the Ebola Response Consor um (ERC), the Interna onal Rescue Commi ee (IRC), Concern Worldwide and Save the Children, with funds from DFID. It aims to teach health workers how to correctly work with Personal Protec on Equipment (PPE) to screen pa ents, isolate suspect cases and con nue providing rou ne health care services (immuniza on, ANC, HIV, TB, Malaria, pneumonia, nutri on) to the popula on, especially women and children under ﬁve. This is cri cal to restore conﬁdence in the health system for both health workers (so they feel safe) and the popula on (so they feel healthcare workers are professional and know what to do to protect them). This workshop is a 'training of trainers' so they can then in turn train more health workers across the country in infec on preven on and control. Those trained will go on to train a further 1,200 health units country‐wide.

July - September 2014

The needed luxury: infec on control “In countries with fragile health systems, infec on control is a luxury, more than a necessity”, says Ben Levy from the CDC. Ben adds that stopping contagion seems to be a ques on of knowledge and resources and that while health professionals in Sierra Leone are very engaged and have many years of experience, “they are not used to the appropriate level of infec on preven on control, neither for the pa ents nor for themselves.” In the ini al stages of the outbreak equipment was in limited supply. Now knowledge and medical materials are arriving in country. UNICEF has airli ed almost 472 metric tons of equipment like chlorine, latex gloves, and plas c body‐bags to support infec on control and stop the loss of more valuable health worker lives. The country has an average of one doctor for every 33,000 people.

EBOLA ORPHANS IN SIERRA LEONE Rosmarie E. K. Jah, Reports Ofﬁcer, UNICEF Sierra Leone

October 2014, the Family Tracing and Reunifica on (FTR) network has iden fied 2,220 children as being directly affected by the Ebola crisis in 12 of the districts – 1,100 girls (49 percent) and 1,120 boys (51 percent), with the majority coming from Kenema (402), Tonkolili (382) and Western Area Urban (247). A recent Knowledge A tude and Best Prac ces (KABP) survey conducted by UNICEF, Focus 1000 and Catholic Relief Services (CRS) in 1,413 households across the country confirmed that Ebola survivors are facing high levels of s gma, shame and discrimina on from communi es, which is undermining their resilience to con nue with their lives.

n Sierra Leone, 22% of the about 3,500 conﬁrmed Ebola cases are children. Regionally, 26 million people, including 10.3 million children are living in areas aﬀected by Ebola.

21 month old baby Fatu (name changed) Kailahun survived Ebola. Surrounded by the nurses who helped her make it through the disease, she was released from the hospital on 7 August 2014. Her recovery was a message of hope for people in Sierra Leone: survival is possible, even for very young children. The average survival rate in Sierra Leone is around 32%, whilst early treatment increases the chances of survival.

During the Ebola outbreak in Sierra Leone, UNICEF is promo ng psychosocial wellbeing and the recovery of Ebola survivors. In order to strengthen child protec on mechanisms, UNICEF also supports Family Tracing and Reunifica on efforts and distributes relief packages to affected children.

Roeland Monasch, UNICEF Representa ve in Sierra Leone visited Fatou: “This weekend, at the Ebola Emergency Opera ons Centre, I was introduced to the youngest Ebola survivor: Li le Fatou”, says Roeland Monasch. However, joy and sadness go hand in hand. “Sadly, her parents didn't make it.” Fatu survived the Ebola infec on but lost her parents in the same struggle. She became an orphan.

Fatou's story however con nues with hope and is exemplary in terms of community support. She found a new mother in Hawa (name changed) who adopted her. Hawa worked as volunteer in the hospital where Fatou recovered. Going home, Fatou was welcomed by two sisters – Hawa's other daughters. The brave woman is coping without a husband at her side. “We will manage!” she says with a big smile. She dreams that Fatu will become a doctor because she is strong and survived Ebola.

People, especially children, who survive Ebola are o en trauma zed and distressed, having lost their caregivers, rela ves and friends to the disease. This is compounded by the loss of livelihoods and fractured social networks in an environment characterized by high levels of poverty. Fatou's fate is shared by many children in Sierra Leone. As of 21

July - September 2014

HEALTH WORKERS: THE HEROES WHO CARRY THE BURDEN OF A BRUTAL DISEASE Jo Dunlop, Communication Consultant, UNICEF Sierra Leone

ne of the many tragic narra ves that has come out of the ongoing Ebola outbreak in Sierra Leone is the staggering number of health care workers who have become infected while trea ng Ebola pa ents. To date, 124 health workers in Sierra Leone have been infected with the virus and 98 have died The majority of nurses infected worked in the Ebola treatment unit on the grounds of Kenema Hospital, the epicenter of one of the most severely affected districts. Staff have been ravaged by the disease. One of the most profound losses felt by the country and the medical community was that of Sierra Leone's only hemorrhagic fever specialist, Dr Sheikh Umarr Khan, who died on 29 July. Dr Khan ran the Lassa Fever Unit in Kenema, which then evolved to become an Ebola treatment centre, and he treated the first Ebola pa ent at Kenema Hospital. At the me of his death he was hailed as “A Na onal Hero”. Kenema Hospital has also lost 23 nurses to the disease including the Sister‐in‐Charge Mbalu Fonnie and the nurse who then replaced her, Sister Nancy Yoko. Deputy Matron Josephine Sellu says her life has been changed forever by this disease. “Losing so many colleagues and friends has taken its toll, it's really painful for us. We are Sierra Leoneans, we have to work here to fight this disease.” UNICEF's health programme has a strong focus on strengthening the health workforce through training. The loss of health care workers, according to Dr Augus n Kabano, UNICEF's Health Manager, is a step backwards for the country's health system. “This Ebola outbreak has had a devasta ng impact on the health workforce of Sierra Leone. It has corroded the morale of these workers who have lost colleagues, friends, and mentors while destroying much‐needed skills and knowledge. Sierra Leone already had a shortage of doctors and nurses. For the country to then lose almost 100 health workers is a tragic loss.” As the outbreak con nues to spread, the challenge now is finding enough health workers to respond to the growing caseload. Those risking their lives working on Ebola wards need proper training and equipment to ensure that the dangers can be adequately managed. “We need to make our nurses feel safe, we need to ensure there is correct equipment and training, otherwise more health workers will die and less health workers will be willing to do the job,” says Deputy Matron Josephine Sellu. So far UNICEF has airli ed 472 metric tons of emergency supplies to Sierra Leone through funds provided by the World Bank and DFID with air freight support from the European Commission Humanitarian Office (ECHO). This equipment includes, amongst other items, the vital personal protec on suits such as coveralls worn by health care workers on Ebola wards.

July - September 2014

OVER 470 MT OF DRUGS AND EQUIPMENT AIRLIFTED TO FIGHT EBOLA IN SIERRA LEONE By Issa Davies, Communication Ofﬁcer, UNICEF Sierra Leone

transferred to the diﬀerent Ebola holding/treatment centres across the country.

ith funds from The World Bank and DFID and logis cal support from the European Commission Humanitarian Oﬃce ( E C H O ) U N I C E F has procured and facilitated the delivery of a cumula ve total of over 470 metric tons of assorted drugs and other medical supplies for the treatment of people who have contracted Ebola in Sierra Leone.

“These supplies were iden ﬁed by the Emergency Opera ons Center as crucial in the ﬁght against Ebola in the country and as soon as we received the go‐ahead we responded. We will con nue to boost the Ministry of Health and Sanita on's response mechanism to the disease,” said Roeland Monasch, UNICEF Representa ve to Sierra Leone.

Eight flights have landed at the Lungi Interna onal Airport with U N I C E F procured drugs and medical equipment since 5 September when the first chartered UN aid cargo plane arrived. The © UNICEF/2014/Stephens | supplies include latex gloves, intravenous fluids, assorted an bio cs and personal protec ve equipment—supplies that are urgently needed to fight the Ebola epidemic. “The World Bank is commi ed to improving the health of the people of Sierra Leone and elimina ng Ebola, which is taking so many lives and undermining the great development gains Sierra Leone has made in recent years,” said Ato Brown, the World Bank's Country Manager in Sierra Leone. Within 36 hours of placing the first order, the items were dispatched and had reached Sierra Leone. The supplies are being

July - September 2014

EBOLA THREATENS THE IMPROVEMENTS MADE TO MATERNAL HEALTH BY THE FREE HEALTH CARE IN SIERRA LEONE By Jo Dunlop, Communication Consultant, UNICEF Sierra Leone

ains made through Sierra Leone's Free Health Care Ini a ve over the past four years are under threat due to the devasta ng Ebola outbreak that has swept across West Africa. In April 2010 the Ministry of Health and Sanita on in collabora on with UNICEF and other health partners implemented a bold strategy to provide free drugs and improved health services to pregnant and lacta ng women, and children under five. Over the past four years, free essen al drugs and medical supplies have been made available to this target group through 1,200 peripheral health units. Basic emergency obstetric facili es across the country have been supplied and health worker trainings have increased the number of midwives in the country. These extensive changes in Sierra Leone's health system have reaped some measurable improvements for the health of women and children. There has been an overall increase in health service u liza on of about 60 percent since 2011. According to the 2013 Demographic Health Survey 97 percent of women received antenatal care from a skilled health provider. By removing a cost barrier and ensuring availability of life saving drugs, the Free Health Care Ini a ve increased the a endance levels at health facili es, as well as demand for health services across the popula on. However the catastrophic impact of the Ebola virus on Sierra Leone's popula on and health system is threatening to undo these improvements. Since Ebola cases were first recorded in Sierra Leone in May 2014, reports from across the country have demonstrated a decrease in a endance at health facili es and a decrease in deliveries at hospitals. According to Margaret James, a UNICEF health officer managing the maternal health programme, the

July - September 2014

reduced number of pregnant women and mothers seeking health care is reflec ve of the fears around Ebola held by the community. “Women are not going to health facili es because they are scared of either becoming infected by Ebola, or because they think they could be diagnosed with Ebola and end up in an isola on ward where they could die,” she says. “There is a real risk that we will revert back to the culture of using tradi onal birth a endance, where women deliver in the home, without the support of a mid‐wife.” At the Maternity Unit in the grounds of Kenema Hospital, there has been a decline in the number of deliveries in the past few months. In May there were 147 deliveries and in August the number was 114, a 22 percent decrease. According to mid‐wife Margaret Fatoma, women are scared to come to the hospital. “Since Ebola arrived we have had fewer women coming to the hospital. They are scared so they are choosing to stay in their homes to deliver their babies with tradi onal birth a endants or without assistance” she said. Fear of a ending hospitals is also affec ng a endance at the hospital's under five clinic. In March there were up to 70 mothers a ending each day with their babies. Throughout September the daily number has been as low as 18. The clinics provide essen al immuniza ons for babies and rou ne checks that are vital for the early years of a child's life when they are most vulnerable to disease. “The challenge now is to sensi ze mothers to ensure they understand Ebola and realise that they should not stop a ending clinics and seeking healthcare. If we are to fight Ebola we must also take care of the health of women and children while doing it,” said Margaret.

THE JOY OF AN EBOLA SURVIVOR Yolanda Romero, Communication Consultant, UNICEF Sierra Leone

adie is a nurse from Kailahun, one of the districts hardest hit by the Ebola disease in Sierra Leone. Her eyes sparkle with a special brightness, that of happiness, although her cheekbones stand out prominently from her face. She is an Ebola survivor. Dressed in a beau ful purple bubu, with a gold religious medal that highlights her thinness, Kadie smiles, conscious that she has been born again. “I want to get married and have four children,” she says, full of ambi on for the future. She got the blood results in Kailahun centre: Ebola posi ve. “I felt bad but later on I recovered my courage.” Inside the isola on ward she could think. “I didn't believe in Ebola before I felt ill,” she says honestly. “I felt fear, I knew Ebola is a deadly ailment, but I felt hope too.” She started wri ng the milestones of her illness in a small paper she keeps in a black plas c bag as a treasure, alongside her personal photos from before the illness, and also her discharge cer ﬁcate. “On 27 July, I stopped bleeding,” she says poin ng out the targeted date in her personal diary. She got infected by Ebola while working in a Health care centre in Sierra Leone. As a nurse, she was aware of the ﬁrst symptoms: “fever and muscle pain”, which she began feeling from 15 July. Five days later, she was looking at a poster with sensi za on informa on about Ebola stuck on the wall: “I begun vomi ng and blood started to come out of my le eye”. An internal voice shouted: “It's Ebola”.

July - September 2014

About 100 health workers have lost their lives due to the Ebola Virus Disease in Sierra Leone since the outbreak started. Overcoming the dreadful ailment She speaks with such modesty about her dangerous experience that we would think she has come through a common illness. “I was discharged the 28 July,” she says. “I s ll feel pain in the right side of my chest, under my ribs,” she adds taking her hand to the speciﬁc area and making an expression of pain. “And some mes my vision gets blurry.” UNICEF has worked relessly in the implementa on of social mobiliza on campaigns to sensi ze people about the symptoms of Ebola and how to prevent it. Okada drivers, market women, youth groups and civil associa ons have been trained to iden fy the ailment and to take concrete ac on: transpor ng people with symptoms to the hospital. Infected people have a higher survival rate if they receive early treatment at a health facility. Kadie has become a role model for the health workers in Sierra Leone. She has not only survived the ailment, but the fear too. She wants to go back to the front line in the ﬁght against Ebola. As a survivor, she cannot get infected by the same Ebola strain again but above all, she knows that Ebola is not a death sentence.

UNICEF trains market women on social mobilization and preventive measures against Ebola

Sierra Leoneans in the UN abroad, donated motorbikes and recreational materials through UNICEF to the Ministry of Social Welfare Gender and Children’s Affairs for children affected by Ebola UNICEF supports motorbike riders and youths to take Ebola prevention messages to communities in Freetown during the ‘One day of reﬂection’ sensitization event

UNICEF received $65,000 from Leocem Cement (Heidelberg) to ﬁght against Ebola. UNICEF also received $50,000 from Sierra Leone Football Association and $25,000 from Dawnus

In collaboration with UNICEF, the US Center for Disease Control and Prevention train health workers including nurses and doctors on how to prevent infection in a highly contagious environment

In 2014 UNICEF Sierra Leone received contributions from: 

The Governments of Canada, Ireland, Japan, The Netherlands, Norway, Sweden, United Kingdom, United Arab Emirates and USA

For more information, please contact: Issa Davies Communication Ofﬁcer, External Relations, Advocacy and Leveraging Resources, UNICEF Sierra Leone

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The European Union, United Nations, African Development Bank, GAVI Alliance, Global Fund against AIDS/TB/Malaria, Bill & Melinda Gates Foundation, Micronutrient Initiative, United Nations Foundation, IKEA Foundation, CERF, OFDA, The World Bank, OCHA

Telephone: +232 22 235 730/735 Mobile: +232 76 601310 Facsimile: +232 22 235 059 E-mail: idavies@unicef.org

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UNICEF National Committees from: Australia, Austria, Belgium, Germany, Iceland, Italy, Japan, Luxembourg, The Netherlands, Norway, Poland, Sweden, Switzerland, United Kingdom and USA

URL: http://www.unicef.org www.facebook.com/unicefsierraleone www.youtube.com/user/UNICEFSL Follow us on twitter:@UNICEFSL

July - September 2014