COVID-19: A view from the frontline in Sierra Leone

Rosaline, a nurse in Kakoya health facility in Koinadugu district, Sierra Leone

Rosaline was a frontline worker during the Ebola crisis. Now she is helping people prepare for the coronavirus.

Rosaline is a nurse in Kakoya health facility in Koinadugu district, Sierra Leone, which is a facility that is partnered with CARE.

Rosaline was born into a very large family in a remote area of Koinadugu district. She was the 8th daughter, and her family was poor; there was no money for her to go to school. Her uncle sponsored her to get an education, and she made it until secondary school, when she moved to Kabala and became a volunteer community health worker with CARE. Her monthly stipend allowed her to pay her way through school, graduate well, and attend nursing school, and now she has returned to her community to work as a primary health nurse. She delivers babies, gives vaccinations, and is also a first point of contact for sick people in her community.

Rosaline, a nurse in Sierra Leone, with a patient
Rosaline attending to a woman in the health facility

What is the situation like in Sierra Leone right now? Are people worried?

The situation is not easy. People worry a lot. There are a lot of things that are happening in Sierra Leone. We, the nurses, are putting everything in place. Even traditional authorities, they are putting everything in place, because the counsellors are worrying a lot. There are suspected cases in Guinea, and they are our nearby neighbours. So, we worry a lot about this disease.

What kinds of things are people doing?

We have set up handwashing stations at every public place – in community gathering places, in schools, at the health facility, everywhere. And people don’t shake hands. Most of the gatherings that were happening before have been stopped. No nightclubs, no football, no gathering, no traditional societies, everything has been stopped. Right now the country is at a standstill. Infection prevention and control protocol is our first area of work; we do community engagement meetings, we do our outreach. In our centres, we use our Infection Prevention Control (IPC) protocols, we wear our masks, we don’t touch patients, we take their temperatures, and we wash our hands regularly. Even for deliveries, we disinfect every instrument and we wear our masks. We are focusing on outreach and community engagement for now.

How do you do community outreach, how do you get people to trust you?

I take my motorcycle and go out to the communities within the catchment area, and sit with them to explain this new virus and how they should be aware and start to protect themselves. Sometimes they are hesitant, and they don’t believe me at first, but then I explain it more, and they come around. They trust me, because I’ve come from them, I was born in this area and they know me. So, they know to trust me when I tell them something that is this important.

What are you preparing for in relation to coronavirus?

We are preparing to implement our infection prevention and control protocols. We have taken out our personal protective equipment. We have a small amount that we received from CARE, but we need more to be able to protect ourselves. We’re expecting to receive some from the district soon, but what we have right now is not enough.

What are you worried about – what do you think will be the worst case scenario?

We are worried, because it will affect us as health workers. If there are cases here in Sierra Leone, we are the front liners, because we touch patients, we receive patients, so we are worried a lot, and hope that it will not spread easily, because this is a very dangerous disease.

Me personally I’m worried about this disease, because just a few years ago we had Ebola, and now we worry about Coronavirus. Because our population is not so big here. So if it comes here, we won’t be many left…

We’re worried as well because we don’t know if we will get sponsors [international aid] to fight the disease, because the whole world is fighting it too, and there may not be enough resources to help us fight the disease here too. So if it happens here, it won’t be easy for us. We worry a lot.

What did you learn from the Ebola outbreak that is applicable with this coronavirus outbreak?

I was at this facility during Ebola. During Ebola the first and most important thing was to wash hands. And then to bring people to the hospital, not to keep them in the house. For now, we don’t have IPC materials. We don’t have much left over from before, and most of it is old.

As a health worker I learned how important it was to follow IPC protocols – don’t touch patients, and refer people to higher levels in the health system when they experience symptoms. I also learned how important it was to do community outreach, to call community meetings, to inform every person about the disease, and how to recognise and to prevent it. It was especially important to emphasise handwashing – each house should have a handwashing station to be able to wash hands, this was a really important thing to have.

What advice do you have for workers fighting the epidemic?

During Ebola, many of us health workers died. But I think that if this disease is to happen in Sierra Leone, we won’t die like we did before, because we will follow our IPC protocols from the start. My advice is to make sure you take care of yourself, think about your life first, about your family, and protect yourself. Don’t rush to the patients, follow the protocols, and take care of yourself.

Why do you choose to work on the frontline and respond to disease outbreaks?

I became a health worker because my father died from sickness, and I wanted to save people’s lives in my community.

CARE’s planned COVID-19 response in Sierra Leone

CARE is coordinating our COVID-19 response with the World Health Organisation (WHO), the U.S. Centers for Disease Control and Prevention (CDC), and other leading public health and humanitarian actors, as well as the Ministry of Health and Sanitation of Sierra Leone and local community leaders. CARE’s response to infectious disease, such as the West African Ebola outbreak in 2014-15, has centred on bolstering community mobilisation activities to raise public awareness and promote safe health and hygiene behaviors. In our Ebola response CARE was able to engage effectively thanks to our existing community ties in countries heavily affected by the outbreak. CARE Sierra Leone’s response to COVID-19 will similarly build on close cooperation with community members, and with local partner organisations closest to the communities at highest risk.

CARE’s response will focus on scaling up safe water supplies to facilitate good personal and household hygiene, gender and protection (especially sexual and gender-based violence protection), sexual and reproductive health rights, and psychosocial support including psychological first aid. Examples of activities the country office will carry out include: provision on IPC supplies (such as face masks, gloves, hand wash liquid soap, aprons, safety boots, hand sanitisers), community disease surveillance meetings, prevention and preparedness planning meetings with district officials, printing IEC materials and health education banners.

CARE places a special focus on women and girls, who often face specific challenges during emergencies. Based on CARE’s past experience, we can anticipate disproportionate economic and social effects on women and girls. CARE is preparing accordingly to support women in dealing with the fallout of a devastating pandemic.

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News and stories are provided by CARE staff working to support our emergency responses and long-term development programmes.