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After Ebola. Sierra Leone’s abandoned treatment centres

The abandoned Ebola Treatment Centre [ETC] at Makeni was one of a handful of centres in Sierra Leone built to contain and treat the deadly Ebola disease that devastated three West African nations and put the world on high alert.  

A treatment centre and a testing lab, this place was built from scratch to provide beds, medical and psychosocial services to those affected.

Now it's a skeleton site left to ruin, containing nothing but discarded rubbish and echoes of the plague it was built to fight

A sign warning against the traditional washing of corpses still remains © Meryl Westlake

'High risk' sign remains at Makeni Ebola Treatment Centre sign

Ebola in Sierra Leone 

Ebola signs outside Binkolo Health Clinic Peter Caton

Ebola signs outside Binkolo Health Clinic.

Ebola in Sierra Leone killed 3,956 people, including 221 healthcare workers (WHO, March 2016).  

It was a pandemic. A state of public health emergency was enforced. Major businesses and developmental works were completely stopped. Businesses and contractors fled. Many International NGOs withdrew staff from the field. Many villages were quarantined. Life ground to a halt.   

The West African Ebola outbreak became the epicentre of global news. 

The international community responded, supporting local front line staff who worked tirelessly and bravely to tackle the outbreak through centres like the ETC. 

On 7 November 2015 the outbreak was declared over. Yet, a year after this joyful moment, the country has yet to return to the development path it was on. 

Remains of Makeni Ebola Treatment Centre Peter Caton

Remains of Makeni Ebola Treatment Centre

Survivors of Makeni treatment centre 

Ebola came to Makeni after a sick man was smuggled to a local healer near his village.  Those that came into contact with the man - particularly the relatives who washed his corpse (a Sierra Leonean tradition) - were infected. The disease spread like wildfire.  

The fear of death that it came with is unimaginable. People were too afraid to meet each other, buy food in the market and or even hug their neighbours.  

Ibrahim Karmara, a former VSO ICS volunteer says, "When someone is quarantined in a house with an Ebola patient, the community would cry. But they weren't crying for that person. They were crying for themselves, because at the beginning, that diagnosis meant their death too." 

"Villages are more vulnerable, because when someone is sick everyone comes to visit. When they found it was Ebola it was too late." 

Debris at Makeni Ebola Treatment Centre Sierra Leone Meryl westlake

Abandoned protective gear carpets an entire room

Makeni Ebola Treatment Centre Now

Doors, windows, toilets, gas tanks and transformers have all been ripped apart. The emptiness is overwhelming.  

No corner was spared.  Abandoned protective gear carpets an entire room. With the odd trouser leg or arm poking out of the pile, it feels as if the person wearing the hazmat suit had just disappeared.  

Despite being stripped bare, it's not hard to imagine how this site functioned during the outbreak. .  

There is faded writing on the floor marking placements for vomit and stool buckets.  

'High Risk Area' signs and broken orange tape indicate where the 'Ebola-positive' patients were kept.  Reports of life at the ETC say ambulances were queuing outside, such was the rate of admissions. 

There were wards too for suspected patients. Now, it's just a shell of a structure, marked out only by tent foundations. It's where anyone presenting with symptoms would stay waiting for their test results. Many died in the 48 hour wait, such was the backlog at the lab. 

At the height of the pandemic this ETC, 17 people were admitted in one day, 12 discharged and 8 died.  The bravery and compassion of local and international staff putting themselves on the front line just to care for those who were scared, sick and dying is beyond commendable. 

Ebola cemetery at Makeni, Sierra Leone Meryl Westlake

Ebola cemetery near Kenema, Sierra Leone 

The Ebola cemetery 

Bodies were carted away to a nearby cemetery to be buried safely. Relatives were denied the comfort of the traditional washing, instead watching from the perimeter.  

This graveyard was built by Islamic Red Cross, which invested in a beautiful space for those who lost their lives. Ebola often claimed the old, the young and those already weakened. Black wooden headstones indicated the batch dates at which people were buried. One says 'one year old'.  

At the biggest graveyard in Waterloo, near Freetown, a local groundskeeper explained, "We were just burying people in mass graves, up to 15 in one." 

"We were just burying people in mass graves, up to 15 in one."

Ibrahim shares other stories, "I heard of one village that only had a few survivors. People ran to the bush where they died.  

"The place smelled. Bodies were apparently all over. There were a lot of missing people who were in the bush. I was told there were trucks of bodies having found them in the bush." 

Hand prints of staff and survivors on the walls of the ETC in Makeni © Meryl Westlake

Hand prints of staff and survivors on the walls of the ETC in Makeni

A memory that won't fade

Ebola is very much a living memory outside of the haunted ETC. Makeni, Bo, Kenema and their surrounding villages are blazoned with public awareness warnings on hygiene, traditional practices and stigma. Everyone knows someone affected.  

VSO complemented efforts of the Ministry of Health and Sanitation and local civil society organisations in containing the spread of Ebola virus, and continue working with them to build a health system that is essentially resilient.

A resilient health workforce with more knowledge and skills can absorb shocks if any outbreak occurs in future.

But Sierra Leone, already one of the world's poorest countries, is struggling to get its mainstream healthcare system up to scratch. It is hard to prioritise the Ebola centres due to lack of adequate resources with the government for such health infrastructures.

Moving forward 

Despite the decay at Makeni treatment centre, it leaves a positive legacy.  

Clear infection protocols are evident at nearby Makeni Regional Referral Hospital well as early testing. Alongside this, vital healthcare staff are undergoing training with the first VSO international volunteer back in the country.  

Yet Sierra Leone's healthcare infrastructure remains weak. More investment is needed to increase healthcare services that were already fragile. Not just to meet the needs of the people, but to be prepared for what could happen in the future. 

VSO is working to support a quality healthcare service delivery system in Sierra Leone.

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