Learning From Ebola to Fight Malaria

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  • The remote health post in Koribondo has no electricity, the sole midwife rushes from one pregnant woman to another, and nurses use buckets to fetch water from a nearby well. On a rainy afternoon, dozens of mothers waited under a leaky roof to get themselves and their babies tested for malaria. Many had walked for hours on dirt paths to reach the clinic. The motorcycle ambulance, meanwhile, sat idle. There was no fuel for it.

  • A year after Sierra Leone was declared free of the Ebola virus, this small country in West Africa is struggling to rebuild its health system. Malaria remains the most common cause of illness and death, accounting for more than 40 percent of outpatient morbidity and 38 percent of deaths among children under five. Malaria alone killed twice as many people in 2014 than the Ebola outbreak. But Sierra Leone is hopeful the hard lessons learned while coping with the Ebola epidemic will help the country, with the support of partners, build new lifesaving strategies that will also stop any future outbreaks from becoming a global threat.

    A mass distribution of antimalarial drugs, implemented during the peak of the Ebola outbreak with the support of UNICEF, WHO and the Global Fund, brought home some vital clues: the importance of more effectively training and deploying community health workers, as well as the role of social mobilization. The thousands of men and women who stepped in to fight malaria and Ebola, displaying extraordinary heroism and compassion, prove an inspiration as the country seeks a brighter future. “When communities are involved, it makes a big difference,” said Dr. Brima Kargbo, Sierra Leone’s Chief Medical Officer. “That was our main lesson.”

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    During the peak of the Ebola outbreak, the Global Fund mobilized an emergency fund to support an antimalarial mass drug administration. The goal was to reduce malaria cases and decongest health centers overwhelmed by the Ebola epidemic. Given the similarities in Ebola and malaria symptoms, it was crucial to reduce malaria cases and allow Ebola patients to be more easily diagnosed and treated.

    The effort, which involved careful planning, procurement and distribution of medicines, training, deployment of staff and close monitoring, reached 95 percent of targeted households in Ebola hotspots and resulted in sharp reductions of febrile cases.

    “We worked from dawn to dusk, going house to house,” said Mabinty Dumbuya. Overcoming negative perceptions proved a challenge. “We did community meetings and brought bread and ginger beer.” The campaign played a vital role in restoring trust between the community and the health system, which had been severely eroded by misinformation and myths surrounding Ebola.

    Sierra Leone was recovering from civil war when it was struck by the Ebola virus in 2014. With widespread levels of poverty and
    illiteracy, Sierra Leone has long had one of the world’s highest maternal mortality rates. The Global Fund has identified challenging operating environments – countries or regions affected by poor governance, disasters or conflict – as one of the key areas of focus
    of our 2017-2022 strategy.

    Sierra Leone had made hard-fought gains against maternal deaths and malaria with the expansion of access to tools such as
    insecticide-treated nets, diagnostic testing for children and preventive treatment for pregnant women. But services for malaria and
    other infectious diseases fell into disarray when Ebola hit. The Global Fund is investing US$103 million between 2016 and 2018
    to rebuild services to fight HIV, TB and malaria and strengthen systems.

    Community health workers like Isala Sesay are essential to fighting malaria in Sierra Leone, which killed an estimated 7,800 people
    in 2014 – twice the 3,956 who died of Ebola. “The community knows us and accepts us,” said Isala, who goes to far-flung villages to
    deliver basic healthcare. The government is developing a strategy to more effectively deploy and train the country's 15,000
    community health workers.

    Kultumi Bungura was working as a malaria nurse when she got Ebola from a patient. Ebola killed 221 front-line health workers in Sierra Leone, which already had one of the world’s lowest doctor-to-patient ratios. The soft-spoken Kultumi survived. After being
    discharged, she went back to her clinic. “It’s our duty to help our people.” The mother of four suffers from headaches and
    vision problems, common ailments of Ebola survivors.

    The Koribondo health unit, which serves 7,000 people in central Sierra Leone, illustrates the harsh conditions faced by most facilities
    in rural areas. Patients must walk for hours to reach the clinic, which is severely underequipped. Poor education contributes to late
    referrals. Malaria may be fatal if treatment is delayed beyond 24 hours after the onset of symptoms.

    Ebola brought deep social and cultural changes to people’s lives. Shaking hands was shunned to avoid contagion. Even traditional storytelling was affected. The grandmother of Alie Bai Kargbo stopped her evening tales after Alie (second to right) and
    two relatives got Ebola. With healing, storytelling returned to this family of welders. In Alie’s favorite tale, a village blacksmith
    outwits a group of friends who keep dropping by at midday to eat his lunch.

    With the support of many partners, Sierra Leone hopes the hard lessons learned will lead to a brighter future. The 2016 Malaria World Report said sub-Saharan Africa has seen great progress against malaria. But the report also warned of substantial gaps in program coverage in many countries in the region, particularly in high-burden countries with fragile health systems.