Sierra Leone is presently experiencing an outbreak of mpox, with an average of 29 new cases each day as of the last week of June.
Doctors Without Borders/Médecins Sans Frontières (MSF) is responding in Freetown, the country’s hotspot zone, as well as in Kenema, Bombali, and Tonkolili districts in the eastern and northern provinces of the country. Below, Agnes Dama, MSF’s medical referent for the mpox response, tells us about her daily work and the challenges of treating this stigmatized disease.
Mpox is not new to Sierra Leone. This is the fourth time that we are recording cases. The current outbreak is hitting the Western Area Rural district and the capital city the most; these are densely populated areas with over 1 million residents. On January 16 this year, the Ministry of Health declared mpox a public health emergency. Presently, all districts in the country have recorded cases, with over 4,000 cumulative cases recorded since the outbreak started.
Mpox is endemic in around 10 countries in Central and West Africa, and it is a contagious viral disease that can spread between animals and people as well as through close contact between individuals. When the disease is not treated in a timely manner, it can lead to complications and death for affected people, especially if their immune system has been compromised by other diseases.
With mpox, you can tell that patients are in a lot of pain. I feel terrible seeing them suffer like this. For some of them—fortunately a minority—their bodies are covered with swollen pustules, and it makes it hard to sit or lie down. There are instances where the pustules entirely cover the genitals which is extremely difficult for the patient.
Stigma creates barriers to timely care
There are a few government hospitals in Freetown, the capital, that are receiving people who have mpox. Initially, mild cases of mpox were being managed through self-isolation and severe cases were admitted to health facilities. However, because of stigmatization, lack of awareness, and fear, many people do not report to treatment facilities. We see instances of complete denial by patients, with mpox being referred to as chickenpox and being treated with alcohol, local clay, and traditional herbs.
The Ministry of Health has been focusing on vaccination for high-risk individuals, social distancing regulations, increasing public awareness, and ensuring that everyone, regardless of the severity of their diagnosis, receives treatment in a health facility.
MSF’s response to the outbreak
To support the response, MSF rehabilitated the infectious isolation wards of Connaught Hospital, which is the national referral hospital, and Kenema Government Hospital. We also trained Ministry of Health staff on cost-efficient measures like the production of chlorine using water, salt, and electricity.
Following a spike in the number of confirmed cases, we set up a 50-bed capacity mpox treatment center for moderate and severe cases in the Calaba Town neighborhood of Freetown.
Misinformation about the disease creates fear
We received our first patient in the center on June 11. I could tell there was a mixture of emotions among my team because for some of them this was their first time providing care for patients with an infectious disease. I had a wave of different emotions seeing this patient myself. He had several swollen pustules on his body.
Some patients arrive at the center feeling as though they have no hope of getting better, and they have seen a lot of misinformation about mpox. It is hard for them to accept that they have mpox and inform their family or friends because of the stigmatization that they might receive in their communities, and their traditional beliefs about treatment. With the psychosocial counseling we are providing in the center, I am seeing more acceptance, and patients are slowly understanding their diagnosis and regaining trust that they can be cured.
MSF in Sierra Leone
MSF has also expanded support for the mpox response in Bombali and Tonkolili districts in the northern province of Sierra Leone, working in close collaboration with the Ministry of Health on active health promotion and community engagement, targeting at-risk groups as well as contact tracing. Clinical support is also provided with case management for moderate and severe casesat Makeni Regional Hospital in Bombali district and Magburaka Government Hospital in Tonkolili district. Our teams support the response with medical supplies, human resources, training of Ministry of Health staff on case identification, management, sample collection, and transportation for testing. To reinforce the country’s testing capacity, MSF donated and installed a generator for the Central Public Health Reference Laboratory in Freetown.
