A hot, noisy night full of mosquitoes but empty of sleep. Today is a chance to get linked in to the local community and make sure that the Ebola Centre does not become a white (African) elephant, shunned when it opens, nor an isolated island in the existing district health system stream.

I attend the regular morning Command and Control meeting, run as the name suggests by the Sierra Leonean army. 

National politics overtook the running of the national Ebola response in early November when the President essentially fired the Ministry of Health and asked the Royal Sierra Leonean army to take over.

Not surprisingly there is a tension between the two approaches – the army full of tactics and the Ministry of Health full of strategy.

The Command and Control meeting is run in full military style with barked orders and updates.

The officer running the meeting informs us that if any suspected Ebola patient tries to get too close at a checkpoint then the usual army terms of engagement will be followed. It brings up images of a whole new form of delayed-detonation suicide attacks at security checkpoints.

Then to a community briefing of local stakeholders from the Royal Engineers and an opportunity to meet the local Paramount Chief. 

Moyamba is one of 14 chiefdoms in the district and paradoxically as the location of the Ebola Treatment Centre, appears to have been the least effected.

Chief Gulama, the rather suave and snappily dressed community leader, ascribes their local success to robust checkpoints that have kept the Ebola patients from other chiefdoms at bay.

I ask him if he is worried about the sudden influx of Ebola patients to this town when the Centre opens its doors, but he seems prouder of the achievements of its location here than any threat to his Ebola defences.

Everyone is impatient. They need the centre to open now, and while December 15 seems scarily close to me, it is an age away for the community who have set up their own holding centre to isolate patients in the absence of any more appropriate clinical facilities.

I will have to take a look at this holding centre when I get the chance – sounds a bit like a concentration camp.

USAID come down from Freetown to investigate how their recent offer of a fully-staffed PCR lab will fit into the Ebola Centre plans. Within a few minutes of their arrival it becomes clear that it won’t.

The beautifully constructed Ebola Centre laboratory is not the space they are looking for – in typical American fashion their intention is to bring a full functioning stand-alone lab and helicopter it in (complete with 12 staff).

The Royal Engineers Staff Sargent smiles and gently shakes his head. I am waiting for him to say that it is possible, but it is going to cost us.

There does not appear to be enough space on this tightly designed floorplan and the USAID folk head back to Freetown to discuss with their Department of Defence. Meanwhile we need to get a plan B.

We shortlist our first 20 local nurses and arrange for WHO training to start tomorrow. In addition we need an army of ‘hygienists’ who can help decontaminate the wards. 

This sweet-sounding title essentially involves clearing up all the extremely toxic blood, vomit and diarrhea from the Ebola patients, so it’s not going to be a hugely enticing job description. However we will need people with intelligence, care and precision to undertake this most dangerous of roles.

Fortunately for us (though less fortunately for the education of an entire generation of school children) all the schools have been closed in an effort to reduce person-to-person spread. This provides a crucial pool of unemployed school teachers who are keen for work and we can be confident will pass the intensive training.

On the way out of the Ebola Centre building site I ask the local contractor for his observations about the epidemic. He tells me that one unintended consequence is that nobody is having sex anymore, and infidelity has disappeared. 

A biblical plague indeed.

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