December 2: A fast response to a fast-growing problem

He leads the military and DfID response in Sierra Leone and offers an honest and thoughtful reflection of the current emergency. This is the largest and most complex disaster response programme that DfID has undertaken.

He tells me how most disasters strike and then recede. Ebola in contrast just gets bigger and bigger. Most of DfID’s programmes involve simple interventions such as vaccination programmes or medical support.

This war on Ebola is dependent on changing people’s behaviour - how they treat the dead, burials, not touching in a very tactile society. Behaviour change is the Holy Grail for most of health care, but nowhere as urgent as here.

He tells me that with Ebola the speed of the emergency is such that a day is a week, a week is a month and a month is a year. He is clearly proud of the UK’s response - how the army has built five mini-hospitals that would normally take a year, all in six weeks.

The Task Force has tried to take a whole system approach, not just focusing on the Ebola Centres. In particular the command and control structure run by the UK and Sierra Leonean Military has enable effective coordination of notification, alerts, transport of cases and isolation.

The final but critical link in the chain is the beds at the Ebola Centres. I push him on when we will get ahead of the infection curve and not surprisingly he is cautious - the first quarter of 2015 he offers with wide confidence intervals.

I bring my list of ‘challenges’ (problems) no lab yet (!); how are we going to deal with 300m3 of stores; we need PPE to train our new staff with; difficulties with the Norwegian base camp; organising the inauguration (optimistically).

I also want to try to install CCTV to provide a simple and cheap method for monitoring staff and patient safety. He makes phone calls and solves problems. Wonderful. He rushes off with the promise to visit us.

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