Category Archives: Emergency Appeal
On 4th June I travelled to Nepal to join CBM’s team of local staff and emergency response specialists, who have been working since the devastating earthquake on April 25th to ensure that people with disabilities and injuries receive the help they need. Here is my first blog from Nepal, after a very moving day in Bhaktapur.
This ancient city lies nine miles east of Kathmandu. At its heart lie four connected courtyards containing some of Nepal’s most famous UNESCO World Heritage Sites, many of which were damaged or destroyed by the earthquake that shook Nepal on 25 April 2015. In the main Durbar Square, around the base of one of the damaged temples, is an exhibition of photos of some of those who lost their lives, either because they were unlucky enough to live in old or poorly constructed homes or caught by the falling masonry in the web of narrow streets that characterise the area. Many of the photos show the faces of elderly men and women, or very young children, both groups disproportionately affected by natural disasters, but there are also faces of many other people, caught indiscriminately by either the first quake, or the one that followed two weeks later on May 12.
In one picture, a teenage girl in school uniform smiles shyly at the camera. Just a few yards away, a group of girls and boys of around her age are donning hard hats and picking up shovels before dividing into teams and heading off in different directions. Their matching t-shirts declare them to be members of the local community who are volunteering in street clearing initiatives. This is one of the worst hit areas of the city and the lanes are still clogged with rubble, sometimes piled under the eaves of damaged houses, sometimes still filling the street so that you need to scramble over to get through. Despite other parts of Kathmandu being almost untouched, here there is not a road or side street which remains untouched. Everything is covered with a thin film of dust, and the few shopkeepers who have ventured to open up again, busy themselves continuously with dusters and rags.
I am with Pramita Shrestha, a social worker from KOSHISH, a CBM local partner that offers psychosocial counselling and trauma care in the Bhaktapur District. Pramita describes the additional support the psychologists and counsellors are providing, not only for those with mental health problems that they were already supporting, but also to an estimated 3,500 earthquake survivors who will need psychosocial support over the next few months. This is one of the less visible after-effects of a disaster of this scale but one which touches on the lives of so many survivors. Schools have just reopened again and we are passed by rows of neat white shirts and royal blue skirts, matching ribbons bouncing above – but numbers are down as many children are too anxious to leave their parents, too scared to enter the school building or, with the many aftershocks still being experienced, too sleep-deprived to function well. People have also started to return to work where they can, or to the social activities they used to enjoy and we see a few small groups of men on the verandas of undamaged houses playing cards or board games, while women sit in twos and threes knitting. But there are also those who sit in their doorways staring into space, and KOSHISH is reporting new cases every day of people of all ages struggling to come to terms with what has happened. Sadly for all those that come, as many remain unwilling to seek treatment for any kind of mental health condition which remains widely misunderstood and taboo in Nepal, as in many places.
We come across a single house collapsed among a row of otherwise intact buildings. Further along, two stories of a house withno side wall stand open to the air, as if a huge serrated knife has sliced vertically through the building. As we approach, we see two figures rolling brick pieces down a corrugated iron sheet propped against the wall. On every street we come to, similar activity is beginning to take place. People on rooftops, shovelling debris. People pushing wheelbarrows of dust out of alleyways or carrying piles of bricks to the truck that cannot make its way down the blocked streets where life has started to go on once again. Around the next corner, we come across a slogan daubed on a partially collapsed wall, “We will rise again”. Later someone walks past with this printed on a t-shirt.
The photos in Durbar Square are one of the ways that the city is mourning its loss and it will take decades before the country is close to full recovery. But this slogan has started to appear across the city and perfectly reflects the resilience of a nation that is already working hard to pick itself up and move forward. KOSHISH was there in the days immediately following the earthquake, providing psychological first aid as vital as the bandages being so much more visibly applied, and it will continue to support for the long term the efforts of the Bhaktapur community to “rise again”.
I arrived in Nepal on May 12th, some hours after the massive aftershock that caused more casualties and a number of additional damages to properties and infrastructure.
I could see in the faces of people how their lives were shaken again, and how they didn’t see where and how to ensure the safety of themselves and their families. My first night in Kathmandu was broken by a number of aftershocks that woke me up and made me run outside in search of safety.
Though earthquakes are not new to me, every time it makes me realise how frightening they are, bringing a feeling of helplessness.
Three weeks later, life has become quasi-normal in Kathmandu, with its traffic jams, crowds in the street, shops and restaurants all open. If you don’t travel to affected areas you won’t see that two major earthquakes hit the city only few weeks back. Though people are still talking a lot about them and every day small aftershocks remind all of us that it has happened.
Working with partners – ensuring inclusion
It’s been three weeks of working with partners to provide support to the most affected people, to raise awareness about persons with disabilities and older people and to make sure that all of them are included and have equal access to relief, despite the challenges posed by isolated and remote villages and the upcoming rainy season.
Our partners are doing a great job to save lives and contribute to the effort made to assist people in need through trauma care and rehabilitation, organising medical outreach camps, providing psychosocial support – trying to help people to regain independence and normality in their lives. However, we still hear stories from persons with disabilities and older people not being able to access distribution points and being left behind – unintentionally – by relief stakeholders. It is a hard job to reach out to the most at-risk, as often they are not informed, cannot reach the front of the queue and their voices are not heard.
What would you do?
What would you do to find food if you are an 80 year-old man living more than a three-hour walk far from the main road and next city? You will walk downhill, hoping to access a relief package, and then find out that you have to carry a 30 kg bag back uphill …and that you can’t do it. You will seek support, but all other people are also too busy trying to survive to help you.
What would you do if you are a blind person trying to find out where distributions are happening and how to access them, only to discover that you have to compete to be front of the queue as there are not enough supplies for all? Obviously you’ll be at a disadvantage, and most likely you’ll lose out.
What would you do if you are a deaf person, having been transferred by helicopter to Kathmandu for trauma care and have no clue of what is happening to you as no one can communicate with you?
These are only few stories, but many more like this are reported every day…
It is great that donors and organisations are moving towards inclusive policies and frameworks, but exclusion happens on the field. What would you do if you were that relief worker and have limited aid to distribute? Field workers must be supported to turn inclusive policies into inclusive humanitarian action.
Advocating for inclusion
CBM works with our partner the National Federation of Disabled in Nepal (NFDN), supporting them to identify persons with disability and older people and assess their needs to then mobilise humanitarian stakeholders to respond to them. It is very encouraging as many of these organisations are willing to make the extra effort, but lack knowledge or information to ensure inclusion.
Bhojraj Ghimire, CIL Kathmandu (checked shirt) takes part in the workshop on disability inclusion organised by CBM and the International Federation of Red Cross and Red Crescent Societies (IFRC) in Kathmandu
Early last week I gave a two-hour orientation on disability inclusion to Red Cross staff, and the head of the delegation said:
“The Red Cross movement was created to help the most difficult to reach and the ones who couldn’t care for themselves, and yet in our response we reach only the easy one. We need to make the extra effort to access all those who are living in remote areas, who are facing barriers to access relief and whose rights we should protect.”
Well, this kind of statement and willingness to walk the extra miles is very encouraging as it will support the relief worker to pay attention and develop the mechanisms to help the older man to carry home his 30 Kg of goods, the blind person to find the distribution point and be in front of the queue or the deaf person to access a sign language interpreter to understand what is happening to him and get news from his family.
I will travel back to Europe soon but I’m confident that our partners will continue to raise their voices and to make them heard by all. Change is coming!
Krishna Gautam is a Past-President of the Mid-Western Chapter of ‘National Federation of the Disabled Nepal’ (NFDN) and founder member of ‘Centre for Independent Living’ (CIL) in Kathmandu. Presently, he works with the CIL as the General Secretary. He lives with his wife and two children in Kathmandu.
In this interview with CBM’s Ashok Shah, Krishna Gautam talks about his experience during the earthquake on 25th April and the work CIL plans to do in the aftermath for the rights of people with disabilities.
When did you start CIL? What’s the idea behind starting this organization?
“We started CIL in Kathmandu in 2006. We were a group of ten people with disabilities who believed it’s important to work with rights-based approach in disability sector. Earlier, whatever we did mostly centred around charity based approach… What CIL wants is that the disability movement must be led by people with severe and profound disabilities; and their issues must be addressed and resolved by persons with severe disabilities themselves. That’s the reason we started CIL.”
Where were you during the 25th April earthquake? What did you experience on that fateful day?
“I was in Nepalgunj [a town about 500km west of Kathmandu]… I was invited at a friend’s place for lunch. At the entrance, two persons carried my wheelchair and helped me get inside the house. After lunch, we were just watching TV and talking to each other when the ground began to shake, making such a terrible noise. Before I could make sense of what was happening, the hosts had left the house and reached the garden outside…
The ground continued to shake and I thought I’ll fall off the wheelchair. Later, the hosts came back and helped me get out of the house. The earth was shaking even when we reached outside. It was such a horrifying experience. Luckily, it was a single-storey house…”
When did you return to Kathmandu? How difficult was it to reach the capital after the quake?
“Actually, I was to take a flight back to capital that Saturday evening. But due to the earthquake, all flights were cancelled. Even telephone connections were down. An hour later, I could finally speak to my family in Kathmandu and got to know that my daughter was slightly injured… Later, I somehow boarded an overnight bus from Nepalgunj to Kathmandu to be with my family. On 26 th April, I could finally meet my wife and children. But a few hours later there was another massive aftershock. I was so worried about my family…”
What are you doing for fellow persons with disabilities who are affected by the earthquake?
“For the first few days, we were so scared that we could not leave our families. The aftershocks kept coming and we couldn’t do anything at all. Meanwhile, we have been calling our Disabled Person’s Organisations (DPOs) in the affected districts to know about the damage caused to persons with disabilities. Also, we have set up some tents in an open ground in Jawalakhel as temporary shelter for people with severe disabilities whose shelters have collapsed and have nowhere to go. At the moment there are about 15 persons in the tents here, most of them wheelchair user and severe spinal conditions. We are expecting some more persons with severe disabilities from worst hit districts like Kavre and Sindhupalchowk. They can stay here up to 3 months, or till the time they have no other alternative… In the coming days, we’re also trying to provide peer counseling and assistive devices in this shelter.”
Tomorrow, you’re going to attend the Protection cluster meeting. How do you plan to advocate for the rights of persons with disabilities?
“I believe, persons with disabilities are the first casualties during the earthquake. They are also most likely to be left behind and forgotten during the immediate rescue and relief work. So, we’re planning to organize as many persons with disabilities and attend the cluster meeting tomorrow. We’ll put forward that access to relief supplies and temporary shelter must be inclusive of persons with disabilities. For that I think we need to organize, make our presence felt in such meetings, only then our voices will be heard. Most importantly, we’re going to advocate that the earthquake will result in many more people with injuries and disabilities who will need to be looked at seriously. The government needs to look into the issues of their recovery and rehabilitation, and later the issue of employment as well.”
Why do you think disability issues needs to be advocated in such cluster meetings? Why is disability forgotten?
I think that’s because we haven’t been able to raise our issues effectively, or mainstream our issues at the national level. The reasons for this could be that we aren’t yet organized among ourselves, we lack coordination and we’re yet to demonstrate our strength and impact as a group and community. We are still inside our houses. Time has come that we leave our houses and fight for our rights.”
As well as providing medical care and emergency support to people with disabilities and injuries in Nepal, CBM is working closely with Nepalese Disabled People’s Organisations to help ensure that all relief and reconstruction efforts are disability-inclusive.
As we watch the events unfold in Nepal since April 25, we are reminded of the extra challenges that people with disabilities experience during disasters. Those with physical disabilities may struggle to flee to safety or travel long distances for essentials like food and water. The methods used to communicate an approaching disaster may not consider the needs of people who live with blindness, deafness or learning disabilities. Temporary shelter facilities, as well as other relief and longer-term recovery services, may not be accessible. And suddenly there is an influx of people experiencing new disabilities within the population; physical trauma caused by an earthquake, for example, may lead to the amputation of limbs or spinal cord injuries.
At the same time, people with disabilities show incredible amounts of resilience in emergencies. There are countless stories of people with disabilities helping their own community members. I think back to working in Haiti with CBM after the 2010 earthquake. Key members of our community rehabilitation team had disabilities themselves, yet refused to let disability equal inability. They worked hard within our teams to ensure that the needs of their whole society were being met.
This week, in the UK, we celebrate Mental Health Awareness Week- a perfect time to talk about the importance of mental health in disasters. People with psychosocial disabilities (those living with disabilities caused by mental illness) are often left behind during a disaster. In the Philippines after Typhoon Haiyan, we heard stories of people living with mental illness who had been chained in their homes and were unable to flee to safety when the typhoon was approaching. In addition, access to mental health care – and psychotropic medicines in low and middle income countries is an ongoing issue. During a disaster, the ability to access care and medication often shifts from challenging to virtually impossible.
The World Health Organization (WHO) estimates that after an emergency, the number of people experiencing mental disorders can as much as double within the population. At the same time, normal signs of distress within a population increase greatly. This information highlights something very important. First, there is a great need to continue to care for people with psychosocial disabilities after a disaster. In fact, the need has now doubled. But secondly, suddenly there is a large amount of psychosocial stress being experienced within the general population. This stress is a normal reaction to loss and to exposure to distressing events. Many will recover from these experiences, however a number of those who need psychosocial support can benefit from simple, cost-effective approaches such as Psychological First Aid.
CBM recognizes the importance of mental health and psychosocial support during emergencies. We also place a high value on the knowledge and understanding that our local partners have during emergencies within their countries. This is why CBM works hand in hand with our partners during and after emergencies.
In Sierra Leone, for example, our Enabling Access to Mental Health programme had already established an active mental health advocacy group, the Mental Health Coalition – Sierra Leone. The Coalition had become a focal point for mental health system development, in collaboration with the Government of Sierra Leone. When the Ebola outbreak started in West Africa, the Coalition was in the perfect position to support the coordination of mental health and psychosocial actors in Sierra Leone. They were able to advocate for better psychosocial support for health care workers. They also pushed to have mental health professionals (trained under the Enabling Access to Mental Health Programme) placed strategically throughout the country to offer support for those experiencing signs of distress and ongoing care for people with psychosocial disabilities. The Coalition supported the adaptation of training and activities to the local context, and advised on the development of strategies, policies and basic packages. Because we had a trusted partner already engaged on the ground, CBM was able to mobilize financial support so that they could continue their impressive work.
Now, looking to Nepal, CBM is currently implementing response work, again with strong partners, to offer mental health and psychosocial support. Already, CBM is a partner with a national level mental health group- KOSHISH. Our emergency response unit based in Kathmandu has been liaising with them since the earthquake struck, as part of our overall response, and we are now at the stage of providing them with support to be able to meet immediate psychosocial needs of people affected by the earthquake, and to improve access to basic relief aid as well as to specialise services for persons with psychosocial disabilities. In addition, we will draw on the knowledge and experience of our partners doing Community Based Rehabilitation work throughout Nepal. They are in the perfect position to provide their communities with psychosocial support, and we are already working to ensure that relevant staff members are also trained in Psychological First Aid.
People with Epilepsy often face similar stigma and discrimination in their communities as those with psychosocial disabilities. For this reason, we encourage our partners to also include people with Epilepsy into our mental health and psychosocial support programmes.
Addressing mental health and psychosocial needs is essential for complete and effective disaster response. I hope that by highlighting the work of CBM in emergencies, the experience, rights and needs of people with psychosocial disabilities, are clear. But more importantly, I hope to have shown a way to approach these challenges – not only will this strategy improve the situation for many individuals affected by the current emergency, but will build their resilience for the future, and therefore that of their families, communities and society as a whole.
CBM is working to bring urgent relief to people with disabilities in Nepal after the earthquake on 25th April, and provide vitally needed healthcare for both physical and mental health needs.
It has now over a year since the Ebola outbreak started in Guinea. CBM supported partners in Guinea and Sierra Leone – 2 of the 3 most affected countries – were forced to scale down their routine activities like community eye care, cataract operations, and community mental health care. The loss of local staff either from Ebola or due to difficulties in travel, and the reduction in clients coming for services has led to a risk of insolvency of institutions, among other negative effects. By extension, tens of thousands of people who depended on them for health, and other social services are no longer getting the services they require resulting in greater disability and deeper poverty.
CBM is working with a grass-roots organisation in Sierra Leone to reduce the vulnerability of people with disabilities and their families to Ebola through awareness raising strategies.
Dr Julian Eaton, Psychiatrist and CBM Mental Health Advisor for West Africa, tells us more about the mental health programme and its role in responding to psychosocial needs of the population in Sierra Leone.
Our activities in Sierra Leone since the Ebola outbreak started
When the Ebola crisis began in March 2014, our programmes in Sierra Leone were affected. Due to the rapid spread of this disease, there were significant travel bans imposed, bans on public gatherings, closure of schools, reduction in the use of hospitals by people etc. Routine cataracts and surgeries came to a standstill and routine programmes started collapsing.
We needed to continue supporting our existing partners as there was no income flowing in due to lack of day-to-day expenses of operations and surgeries etc. Business services started collapsing due to the lack of finances and there was a massive gap between what was existing and what was needed by the people.
CBM’s first response to the outbreak was to redirect our efforts as much as we could, within the framework of our programme, to support the mental health and psychosocial response to the outbreak.
CBM projects in Sierra Leone
The ‘Enabling Access to Mental Health’ Programme (EAMH) supported by CBM has been active for the past four years in Sierra Leone. Addressing the consequences of mental health is an important part of standard Ebola response. Today, this programme focuses more on the specific mental needs of people affected by this disease. It provides mental health facilities to families of Ebola victims, children who are now orphans, health workers who are under a huge amount of stress and survivors who are marginalised by their families and communities.
The programme has dedicated three blocks to:
- Block 1, Capacity Building: support the 21 mental health nurses trained by the EAMH programme in the districts, so they can provide services for those who are suffering the consequences of the outbreak. Other efforts, like the provision of trainers and specialists to prepare teams of other organisations (such as child protection) are also being made.
- Block 2, Advocacy: The EAMH has also established the Mental Health Coalition that brings together stakeholders to advocate for the inclusion of mental health in the government’s agenda. The Mental Health Coalition has been engaging from the beginning of the outbreak with the response pillars of both, the Ministry of Health and the Ministry of Social Welfare, to ensure that the mental health component of the outbreak is not neglected and that local actors are taken into consideration. The Coalition, being one of the main actors in this area, works in close collaboration with WHO, UNICEF, and the other NGOs.
- Block 3, Awareness: Radio programmes and support to the other blocks are being provided, to raise awareness about the psychosocial consequences of the outbreak, and to fight stigma and discrimination.
To address the massive increase in needs CBM has also added more resources to scale up support for psychosocial disability. We have collaborated closely with the WHO to write a standard manual for psychosocial first aid (both in English and in French). This manual is currently being used by national governments, WHO and other international and local NGOs in Sierra Leone, Nigeria, Mali, Guinea, Togo and Liberia.
In Sierra Leone the Mental Health programme has been the strongest programme supporting services outside psychiatric hospitals. It has deployed nurses who are the main referral for people doing counselling.
Building Resilience for persons with disabilities during the Ebola Crisis
Another project has begun to ensure the resilience of people with disabilities to the outbreak. CBM has liaised with our local partners in Sierra Leone to adapt all official messages from the WHO, UNICEF and the government, to ensure they are accessible for people with disabilities.
We are adopting a participatory approach in this project – our partners are conducting training sessions for Organisations for Persons with Disabilities (DPOs), who in turn train communities in the villages. We have involved key organisations in this project – specialist schools for hearing impairment, amputee groups etc. so that people with disabilities can have a say in how they want messages to be transmitted to them. Right now our collaborating local partner organisations are identifying other DPOs and organising workshops.
Disaster Risk Reduction and preparedness in Nigeria and Togo
We are strengthening capacities of Mental Health workers to provide mental health support in crisis situations. All these projects are strongly focused in working through our local partners, capacitating them, working in collaboration and therefore, assuring sustainability and continuation after the Ebola crisis period.
Beyond the realm of mental health, CBM is supporting existing partners involved in eye health in Sierra Leone, to sustain their programmes and to reduce the vulnerability of their target group to Ebola. The partners have had to scale down their eye health activities in their catchment areas thereby depriving communities of much needed eye health service. A person who is blind is doubly vulnerable compared to able-bodied members of society due to the fact that they require support in their daily living as a result of an inaccessible environment. A key strategy Ebola health workers are promoting is the “don’t touch rule” to reduce the spread of infection. Such a rule, to a person who is blind completely immobilises them and elevates their risk of infection to Ebola.
In this context, CBM eye health partners aim to: increase the knowledge of their staff and traditional leaders regarding Ebola to enable them to effectively sensitize communities in the catchment area; and to work with DPOs to reach out to persons with disabilities especially persons who are blind.
The current Ebola epidemic has overloaded and stressed health infrastructure in the affected countries; the number of health care workers – already insufficient before the outbreak – has gone down even further as many health workers became infected and lost the fight. Social stigma towards survivors of Ebola and their families has increased thus worsening distress and isolation. Family and social ties have been severed; cultural practices have been over-turned; and livelihoods have been severely strained.
In future, the affected countries, and the international community will have to engage at a much wider scale to re-establish the socio-cultural, economic, and political systems, which Ebola has severely shaken. This will be a critical and indispensable step if the affected countries are to overcome future public health challenges like the current one.
In the coming months, CBM will participate, with other development agencies and the governments of the three affected countries, in a major conference looking at lessons learnt in mental health and psychosocial support from the outbreak, and how we can work together to rebuild mental health services.
I work as an ophthalmologist and Medical Director at two CBM projects in Sierra Leone, the Lowell and Ruth Gess UMC Eye Hospital in Freetown and the Baptist Eye Hospital in Lunsar, which is situated about 100 km from the capital city.I am acting as Medical Director at the UMC hospital presently because of the absence of an ophthalmologist there.
Impact on CBM-supported eye-hospitals
The Ebola epidemic has significantly affected eye care work in both hospitals, especially over the last 3 months since the declaration of the state of emergency in the country. During this time several districts have been placed under quarantine, restricting the freedom of movement of people around the country.
There is increasing hardship because of the deteriorating economy. Many people have lost their sources of income because of redundancy from their jobs or losing their businesses. As a result of this we’ve experienced 60% reduction in patients’ turnout at the UMC hospital in Freetown and over 80% in Lunsar. Revenue generation in the two hospitals has also been significantly affected and we are struggling to find enough funds to pay salaries and cover the day to day running costs of each hospital.
The staff are given day to day updates and tips about the Ebola outbreak during our morning devotions. We have frequently emphasised the need for preventive measures particularly in the workplace. All patients visiting our hospitals are subjected to thorough self-hand washing either with soap or chlorine as well as temperature checks. It is compulsory for all staff attending to patients to wear gloves for any procedure that may require contact.
For the last week, all surgeries have been temporarily suspended because one of our colleague doctors was infected while treating a patient and is currently at the Ebola treatment centre. He was the head of the Kissy General Hospital – the hospital that we share the same compound with in Freetown. The general hospital has been locked down but the eye hospital where I work has continued to run.
He was a close colleague of mine. So far, 5 doctors have contracted the Ebola virus disease and died from it – he is the sixth and is fighting for his life. [Update: Dr Martin Salia, the surgeon from Kissy General Hospital, has been airlifted to the USA, where he remains in a critical condition - Reuters].
On a personal note, my family and I have come very close to contracting the Ebola virus in recent times. 2 months ago my wife had a caesarean section. She was operated on by the Spanish doctor who contracted Ebola virus disease in Sierra Leone and later died in Spain. The doctor had already started to feel unwell around the time of the surgery. He even fainted and almost collapsed towards the end of the surgery on my wife that day. Therefore I placed myself and my family in semi-quarantine for 21 days. I was really worried. I thank God that he protected me and my family.
My wife and baby are ok – we had a baby boy, his name is Victor Emmanuel. I gave him the same name as the doctor who delivered him, Dr. Manuel Garcia.
Impact on day to day life
The epidemic is now rapidly spreading and expanding in the city of Freetown. Everyone is living in constant fear and suspicion of each other, the epidemic has affected every aspect of life.
It has virtually paralysed large sectors of the economy in SL. International businesses on which the economy of the country depends have either moved out or significantly scaled down operations, resulting in the loss of much needed national revenue from such organisations or companies.
Many institutions have taken drastic measures to better manage their limited finances. One example is the Lungi International airport which has been compelled to slash salaries of workers by 40% due to the suspension of many international flights. Small businesses have experienced significant drops in daily sales as the purchasing power of most people in the country has reduced due to lack of jobs or mass redundancy in many institutions.
Local trade fairs called “lumas” used to be organised in different parts of the country on a weekly basis and were the source of income for most petty traders. However, as a result of the law on avoiding mass gatherings, these markets have been banned since the declaration of the state of emergency.The situation has also brought a significant reduction in income generation for these small scale traders also.
On the social front there has been virtually no form of night life since the banning of operations in all night clubs and cinema halls. Many Sierra Leoneans are ardent supporters of the European club football, especially the UK’s Premiership. However sports centres have been banned from operating so many fans cannot watch their teams live on television.
On the other hand, exchange rate of the Leones to international currencies keeps on falling. There has been one main factor for price hikes especially for essential commodities such as rice and other foodstuffs.
The Ebola outbreak stated during the active farming season for most areas of the country. At the same time, epicentres of the disease were quarantined. This included whole districts and led to the disruption of most farming activities as farmers abandoned their farms.
Most people in quarantined areas have been prevented from getting engaged in their day to day business activities for their survival. This has resulted in hunger, and starvation for many people. To salvage the situation, the international aid agencies such as the World Food Programme and local Non Governmental Organisations have started helping out with food supply to affected people.
Impact on people with disability
We don’t have specific data on disabled people so far directly affected by the outbreak. However in any crisis situation people with disability are at greater potential risk of the negative impacts of that situation and this one cannot be an exception.
One of the major precautions to take to prevent someone being infected by Ebola is avoiding body contact. However, blind people, in particular, depend on their sense of touch and human guides to get around. The guide is usually a younger member of the family who is sighted. In such situations it can be difficult to prevent the spread of Ebola by body contact from the guide to the blind person or vice versa.
One incident made an impression on me a couple of weeks ago; I witnessed a blind couple walking along the street in Lunsar. They had a small boy aged around 10 years leading them. The wife’s right hand was placed on the shoulder of the little boy and the husband’s right hand was on the right shoulder of the wife. Such a manner of contact is a recipe for transmission of the virus.
The mentally challenged and hearing impaired are also at greater risk unless the right preventative measures reach them in the right format.
Another major area of impact is on the source of livelihood for those disabled people who depend on the benevolence of the public. With the present economic difficulty they are less likely to get the same support as before. Some disabled people have also lost their care givers or bread winners to the Ebola virus disease.
On the other hand the majority of people who are avoidably blind cannot access eye hospitals under the prevailing situation to have their sight restored.
Public education and Ebola
As a medical doctor with some background knowledge about the deadly nature of past Ebola outbreaks in other countries, I knew that the country was in for big trouble immediately when we heard about the deaths of many people from unexplained diarrhoea and vomiting in a small town bordering with Liberia in late May 2014.
The outbreak in this small part of the country was mismanaged due to several factors. One was the lack of sufficient response from the Government coupled with the denial factor and resistance from the locals. If this small region had been cordoned off immediately this outbreak would not have reached this magnitude as it has now.
The illiteracy rate in SL is very high. As a result there is a lot of denial and resistance to the containment efforts of the Ebola virus disease. The communal lifestyle of most African homes, where overcrowding is commonplace, creates a suitable environment for the spread of the deadly or rapidly fatal Ebola viral disease. So unless people are repeatedly educated about Ebola and its preventative measures, it will continue to spread.
There is also the issue of traditional burial practices especially for society leaders, which has been one of the main ways that people have been infected with the virus.
Everyone has the right to life,and therefore access to informationfor the prevention of disease and the maintenance of health, so it is necessary to embark on disability inclusive awareness campaigns to capture all persons in society without discrimination.
Message to people in the UK
I want to take this opportunity to say a big thank you to CBM UK, to CBM Lomé [West Africa Regional Office, Togo]and to all those who contribute in diverse ways to offer resources to bring this project together.We thank you all for your generous donation.
We are still far from beating the Ebola virus disease in Sierra Leone. In fact, it is spreading faster than ever before, by a factor of 9 according to theAfrican Governance Initiative’s recent assessment. According to the latest official figures, 4683 people have been infected and close to 1200 have died, but even these are underestimates.
Meanwhile as I said before, the 6th medical doctor to have contracted Ebola is a young surgeon and close colleague of mine who is presently at the treatment centre in Freetown fighting for his life.
So once more we thank you all for standing by us during this difficult and dark period in the history our country.
Your contribution is certainly directed towards a worthwhile cause, for which you will receive god’s richest blessings in return.
The team are now hard at work in Iloilo city turning planning and assessments into action. After several days of assessing the needs of affected communities, we spent today buzzing around headquarters (the office of or partners ADPI) putting our plans into action.
The team are starting to feel tired from several long days in the field, but spirits remain high. As funds from donations to CBM start to come through, the team have begun focusing its efforts on arranging logistics to ramp up the relief efforts to those most in need.
I observed the team, both ADPI and CBM, working hard to turn the needs assessments into a relief program that will reach the most vulnerable in the communities, especially those people with disability.
The work isn’t easy, there is so much to organise. It seems that supplies in Iloilo city are already running low. There are volunteers to coordinate, food and other goods to procure and packages to assemble. And it all needs to be done urgently. ADPI’s dedication to the relief effort is inspiring!
It was with a tinge of sadness that I said farewell to the team today after an action-packed few days.
The CBM team is splitting in two. Willy and I headed back to Manila, while Gilbert and Ira remained in Iloilo city to support ADPI in their emergency relief efforts. One group photo and many farewell hugs later, I realise that the rapid assessment team had only been working together for four days, yet it felt like a lot longer.
Good luck to the team back there in Iloilo!
Today was the third day of the Rapid Needs Assessment and we visited the community of Estancia in the North East of Iloilo province in the Philippines. We started out at the crack of dawn with fish soup – while this was very different from my usual breakfast, I realised how blessed I was to even have food to eat.
The extent of the devastation in Estancia today was truly overwhelming.
It is hard to find the words to describe the scene of complete destruction. As far as the eye could see was total wreckage.
Every school we passed was roofless and classrooms were a shattered mess. The University was completely obliterated. Cars were pinned under collapsed roofs. No tree was left standing. In some places it seemed that only one in every ten houses remained. The destruction was almost unfathomable. Yet among the rubble, people greeted us warmly. They walked with us and shared their stories of the typhoon.
Over the past week our CBM team (Ira, Willy, Gilbert and myself) has joined forces with local partner the Association of Disabled Persons Incorporated (ADPI). ADPI strikes me as a force to reckon with. For the past 22 years they have been working with local government and people with disability to promote the rights of people with disability. With over 1000 members, their local networks are astonishing and in each community we are able to locate people with disability and find out what their needs are, thanks to their strong connections.
Annalyn from ADPI has taken up the task of being my interpreter, cultural guide, information officer, friend and technical advisor. Her wealth of knowledge, patience and dedication to the work continually astounds me. Chatting on the way home today, Annalyn shared a pearl of wisdom with the team:
“People feel that they are lucky to be alive. They have lost everything, but they will rebuild.”
This morning I was the rookie of the team and as we headed out for the second day of our rapid needs assessment, I was not sure what to expect. The further we drove towards our destination, the community of Concepcion, the worse the destruction got. The car was quiet as we witnessed the scenery turn from urban sprawl, to green rice fields, to a tangled mess of shattered houses, fallen power lines and uprooted trees. The devastation was clear – barely any house, land or tree had been spared, but it was hearing people’s stories that really hit home. We met with families, social workers, mayors and people with disability. No matter who they were, everyone had a story. For many, they talked about how afraid they were and how much they had lost. I felt humbled by their willingness to share their stories, and also by their high spirits. But the pain was raw and very real and for many it was too difficult to talk about the future.
The team told me that today was the first day it has not rained in Iloilo since the Typhoon hit five days ago. As the team headed home from a long day, I couldn’t help but notice that drying laundry hung everywhere. Littered among the rubble, draped along fallen tree trunks and hanging over fallen power lines were rows of clothes – from men’s shirts to tiny children’s clothes. It was a small piece of normality among a landscape of destruction. And in an odd way, I found it comforting. It was a reminder that in the aftermath of a crisis, we slowly go back to our simple tasks. One small task at a time.
In Turkana County, there is a general lack of awareness among communities and health service providers on issues related to disability
Often, specialised services and care centres are not available to persons with disabilities and their rights to equal opportunities are compromised.
Persons with disabilities are more vulnerable due to deliberate social exclusion, discrimination and sexual exploitation.
Lack of access to public amenities for people with physical sensory or psychosocial disabilities is concerning.
This project sought to strengthen the capacity of existing health care systems, both at health facility and community levels, to improve the quality and accessibility of essential and emergency health and nutrition services.
The project also sought to improve systems of identification of persons with disabilities and strengthen referral mechanisms to specialised care centres.
Linkages were created with Disabled Persons Organisations (DPOs), the local administration, community volunteers and Community Health Workers to promote awareness and advocate for acceptability and assistance to persons with disabilities.
Provision of assistive devices was also critical in supporting persons with disabilities in dire need of mobility.
The project enabled communities and families with persons living with disabilities integrate them into a more inclusive society, in which they can play a positive and active economic role.
Joseph is one of the many beneficiaries of this CBM intervention
[Joseph, Prosthesis beneficiary, Turkana County]
Since i received this prosthesis I don’t see myself anymore as a disabled person.
Now I am like anybody else, because I can take care of any task.
I can go to the river, collect firewood, run my shop with no help from others.
Before I was idle in the house asking myself who I was and what I was good for.
since I received this prosthesis my life has really changed. I run two different businesses,
I sell these hides and I can support my family.
I am very grateful for the help I received.
CBM is committed to improving the quality of life of persons with disabilities and those at risk of disability in the developing countries of the world
Special thanks to
CBM New Zealand