Sierra Leone: Promoting health at the heart of the communities

MSF’s health promoters go into the high risk areas of Freetown to assist communities in recognizing and preventing Ebola. They also take on the delicate task of supporting survivors and the families of Ebola’s victims.

Just in front of the Prince of Wales school, a custodian scolds seven-year-old Mamadou for being late on his first day. It could be a normal scene in any place, but in Freetown, Sierra Leone, it has an added meaning. After six months of interruption due to the Ebola outbreak, schools have just reopened and the traffic of children in their coloured uniforms brings a rare atmosphere of chaotic serenity to the streets of the city.  

The Prince of Wales school has been the centre of MSF activities in Freetown during the past five months. In the grounds of the school, where the Ebola management centre was built, MSF workers fought against the disease hoping to see this moment: the Prince of Wales once again being a place for children.  

“The situation is improving in Sierra Leone, but there are still new Ebola cases almost every day,” says MSF’s head of mission, Fran Miller. “This is why we focus our activities in the communities, to identify and respond promptly to every new case, while continuing to inform the population about the importance of remaining vigilant.”

Sending the right message

For this work to be effective, the participation and the understanding of the community are crucial. Although health messages about Ebola are broadcast by all radio stations, and there are posters on every street corner, denial and fear among the population is still prevalent. Teams from Médecins Sans Frontières therefore conduct health promotion activities in the most dense and complex areas of Freetown, informing the communities on best practice to prevent the spread of the disease. “Our work is not just to inform,” says Kim Federici, MSF’s health promotion manager in Freetown. “We also build knowledge and trust, we have dialogue with the communities, and sometimes we advocate for them.”  

“Explaining how to react to a suspected case of Ebola requires the capacity to empathise with the community, to understand their fears and problems and to adapt the message to the context,” Kim continues. “This is where our national health promoters, with their in-depth knowledge of the communities and their emotional intelligence, are so important.”

Musa Tary is part of MSF’s health promotion team in Freetown. As he walks through the city’s slums, he is well aware that the risk he is taking is extremely high. “When we go into the heart of a community, we don’t have any personal protective equipment (PPE) to protect us,” he says. “In the hotspots, we just don’t know what we will find. We interact with the community in a very intimate way, we play with children, we talk with potentially high-risk contacts, and at any moment someone could just touch us and say ‘I am sick, help me’.”  

Healing the wounds of Ebola

Health promoters not only explain to communities how to identify, prevent and respond to the disease, but together with mental health counsellors, they fight stigma and offer psychological support to survivors and the families of Ebola victims inside the communities. “Some people have been stigmatised for having survived when other family members died,” says Patrick Sam, a school teacher now working as a mental health counsellor for MSF. “In other cases, we face social and economic problems. Ebola has destroyed entire families, leaving widows, orphans, people without any income and only the support of their families and their communities.”  

Patrick is with Aissatou outside her mother’s house. Aissatou was discharged from the Prince of Wales Ebola management centre on 4 February, along with her 14-year-old daughter. In the same centre, she lost her husband and four of her children. Patrick reflects on the situation: “We need to encourage them, to motivate them to start again. Sometimes it is difficult even for us to know what to say – there are situations that are far beyond our capacities as health promoters,” he says. “We can support them, but we cannot fix their problems. Sometimes it is just the communities themselves that can help themselves; sometimes it is just time.”

Before leaving, Patrick asks Aissatou where her daughter is, and if she is well. “She is back at school,” Aissatou says.