The rows of white tents that used to house patients at the Ebola Treatment Centre in the Moyamba District of Sierra Leone have been disinfected and taken away, and the smell of smoke and chlorine that once filled the dusty air has faded.
This time last year, the centre was on the frontline of the fight against Ebola. At the weekend the country marked six months since it was declared free of the virus, thanks in part to the team of medics who worked here at the height of the epidemic. But while the threat of Ebola has diminished, a new, bigger public health emergency has silently erupted.
Years of underinvestment coupled with the diversion of resources to tackle Ebola have tipped Sierra Leone's health system into a state of crisis. At the Moyamba District Hospital, incubators for newborn babies, essential medical drugs, surgical equipment and even, at times, electricity, are all in short supply. Most worryingly of all, the reserves of trust between communities and healthcare services are drying up fast.
In the areas worst affected by Ebola, thousands living with malaria, HIV and other chronic health conditions are too afraid to visit doctors or hospitals. Fear of contracting the disease saw attendance levels drop drastically in 2015, sometimes to lower than 30% of pre-Ebola rates.
Dr John Wright, a volunteer for medical charity Doctors of the World, was one of the first doctors to arrive at the treatment centre, and went back to visit when it closed last November.
"Back in 2014, Ebola was the biggest public health emergency in modern history," he says. "Doctors and nurses from all over the world stepped up to the plate and came together when Sierra Leone needed help to tackle this terrible outbreak."
Now, his concern is about Sierra Leonean's perception of their own healthcare system. "Health providers lost trust from the community," says Dr. Wright. "Hospitals and health clinics became plague centres during the epidemic, because that's where you caught Ebola, by mixing with other patients. It's been a challenge getting that trust established again, so that people come back to get family planning, child immunisations, and HIV and TB treatments."
Now, Doctors of the World is creating a recovery programme alongside the Moyamba District Health Management team to help rebuild trust and put together the pieces of a broken system. Chronic underfunding and the erosion of confidence in healthcare services are causing more deaths than Ebola ever did. Last year, as many deaths were recorded in the Moyamba District in four months as in previous one-year periods, with 40 per cent being children younger than five. Women and children continue to suffer the most from lack of general care for avoidable conditions, including measles, polio and complications due to not presenting at childbirth.
The programme will provide medical training, rehabilitation, support groups for Ebola survivors and community engagement to roughly 300 health clinics in Moyamba, Koinadugu and Port Loko.
"We will work directly with communities and their local health clinics - equipping and training, but also building trust between the two groups," explains Doctors of the World's International Programme Manager, Gareth Walker. "In addition, we have designed innovative programmes to tackle particular problems. Remote communities, difficult terrain, and poor communication are severe difficulties, but innovative solutions offer hope to change this."
The rebuilding effort focuses on supplying district health services with adequate provisions of drugs, training in pharmacy management and a fleet of ambulances able to access hard-to- reach areas.
Crucially, the programme also plans to provide facilities, such as isolation centres, and teach medics the skills needed to manage outbreaks, in the hope that these communities will never again be ravaged by a disease like Ebola.
"I want to see washing and clean water readily available at village level," says Dr Wright, on his vision for the future of Moyamba and beyond. "I want to see health centres with enough drugs and enough trained staff to look after the local people. It's important that we build a resilience into the system that prevents epidemics, and builds back trust in the community."
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