global health
After Civil War and Ebola, Sierra Leone Grapples
with Mother Nature
by Deborah Odegbile, MSc, specialist, Global Health
From July 1 through August 14, 2017, over
61 inches of rain fell in Freetown, Sierra
Leone—three times the previous average.
Particularly heavy downpours August
12–14 led to flooding and landslides, the
most destructive of which occurred in
the Western Area Rural District on Sugar
Loaf Mountain. The landslides and floods
destroyed 300 homes, left over 1,000
people dead or missing, displaced almost
6,000 residents and negatively impacted
infrastructure, including several health
facilities. This unprecedented disaster
further strained Sierra Leone’s fractured
health system, still in recovery from a
civil war (1991–2002) and the recent Ebola
pandemic (2014–2016).
APHL in Sierra Leone
APHL has supported projects in Sierra
Leone for almost a decade in collaboration
with the national Ministry of Health and
Sanitation (MOHS) and the US Centers
for Disease Prevention and Control
(CDC), much of that time under the US
President’s Emergency Plan for AIDS Relief
(PEPFAR). This partnership enabled APHL
to play a key role in the Ebola response
when Sierra Leone detected its first cases
in 2014. Following the Ebola crisis, APHL
has expanded its partnership with the
MOHS and CDC, focusing on global health
security against epidemic-prone diseases
under the Strengthening Public Health
Laboratories Internationally cooperative
agreement.
In 2017 the association’s long-established
presence in Sierra Leone enabled it to
assist with emergency response efforts
following the flooding and landslides.
With floodwaters, debris from landslides
and inadequate sewage and refuse
disposal systems elevating the risk of
waterborne disease outbreaks, APHL
stepped in with financial, technical and
logistical support to the Directorate of
Hospitals and Laboratory Services.
PublicHealthLabs
@APHL
Aftermath of landslide on Sugar Loaf Mountain, Freetown. Photo: Wikimedia Commons
Though laboratory infrastructure
remained largely intact, Sierra Leone’s
laboratory system needed urgent support
to contend with cholera and other
enteric diseases such as salmonellosis
and shigellosis. Laboratory capacity
near the Sugar Loaf landslide was of
particular concern. A World Bank damage
assessment report noted that “more than
60% of health facilities had no laboratory
technicians, about half of facilities had
no proper disinfection equipment and
one-fourth of the facilities have [sic]
no electricity or water access.” APHL
provided:
• Emergency phone communications for
30 MOHS laboratory and surveillance
staff, ensuring telephone and internet
connectivity for outbreak response
teams
• Disinfectants, handwashing liquid,
chlorine, hand sanitizers and other
cleaning supplies and tools for 15
laboratories
APHL.org
• Bench aids, standard operating
procedures, result reporting worksheets
and testing algorithms for 10 sites
• Transportation of specimens
• Transportation of on-call personnel
to maintain around-the-clock testing
at the Ola During Children’s Hospital-
Princess Christian Maternity Hospital
(ODCH-PCMH) complex and for staff
reassigned to increase manpower at
laboratories in vulnerable areas
In addition, APHL’s systems strengthening
activities in Sierra Leone helped build
capacity for the ODCH-PCMH laboratory
complex to function as a 24-hour facility
for routine and confirmatory testing of
enteric pathogens.
The tragic events of summer 2017
exposed a multitude of risks to population
health and safety including climate
change, unsafe building practices and
environmental hazards. APHL will
continue to promote a resilient laboratory
network, capable and flexible enough to
respond to a variety of health threats in
an unpredictable world. n
Spring 2018 LAB MATTERS
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