Captured and cut: FGM returns to Sierra Leone despite official ban | Umaru Fofana

Khadija Balayma Allieu sits on her hospital bed, grimacing at every movement of her legs. It has been five days since she was forcibly genitally mutilated, she says.

As she receives treatment in the eastern Sierra Leonean town of Kenema, Khadija, 28, recounts what she went through at the hands of five cutters. She is now in hiding because the soweis – as the cutters are known locally – are looking for her.

Khadija says she was blindfolded and held by five or six women. “They gagged me as I shouted. Then [one of them] started cutting. They held my head down. I started bleeding profusely. I tried screaming but there was cloth inside my mouth.”

Khadija, the mother of a 12-year-old boy, says she was left locked inside the house for four days “without food or medicine”. Eventually, the police were alerted. They raided the house, extracting her through a smashed window.

Living in fear of FGM in Sierra Leone: ‘I’m not safe in this community’

As Khadija explains her nightmare, she constantly wipes away tears and turns her sunken eyes towards the window, to be sure no one is coming to get her. She is in genuine fear for her life.

The woman accused of cutting her, Elsie Kondoromoh, is an influential figure in Sierra Leone. Initially detained by police, she was released when hundreds of cutters mounted a protest outside the police station. Kondoromoh’s supporters have been to the courthouse to make a case for legal investigations against her to be dropped.

Police inspector Marty Tarawille said: “[Kondoromoh] was with us [at the police station] but the sowei people came in numbers …They were singing, they were shouting that we should leave that lady [alone] … If we had not released her it would have been a problem for us in this station.”

The case highlights the challenges facing anti-FGM campaigners in Sierra Leone. The minister for social welfare, Sylvia Blyden, has said the government’s focus is on children under 18. This is seen as leaving adult women free to decide what they do with their bodies.

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Sierra Leone minister on fgm pic.twitter.com/aGJi4Sy7Es

FGM has been banned in the country since emergency health measures were introduced after the Ebola outbreak in 2013. But despite the continued ban, the practice has returned through all-female secret societies, the Bondoand condemnation by the authorities has become increasingly absent.

In August, a young woman died in the northern town of Makeni shortly after undergoing the procedure, prompting the arrest of several soweis. In another recent case, police say children were rescued from a disused house in Magburaka, also in the north, after undergoing an initiation ceremony.

The World Health Organisation estimates that 88% of women in Sierra Leone between the ages of 15 and 49 have undergone FGM.

That the women who converged on the police station were able to secure Kondoromoh’s release is indicative of the power soweis wield in Sierra Leonean culture. Civil society organisations have called for Khadija to be evacuated from the town, expressing concern for her safety, but fear of the soweis is such that campaigners are afraid to come to the fore.

“The soweis are so powerful that nowhere in Sierra Leone will be safe for her again,” one activist says.

Soweis protest in Kenema after police detained a local leader. Photograph: Umaru Fofana

Kondoromoh, who is national vice-president of the Sowei council, admits she carried out the procedure but says she did not force Khadija to go through with it. She claims Khadija asked for it.

“She met me at home saying she was being taunted by her fellow women because she had not been circumcised,” says Kondoromoh. “She came to me to initiate her and asked how much it would cost. I told her that I did not want anything from her because she was being provoked. I took her to a nearby society bush to initiate her”.

Kondoromoh says Khadija asked to stay with her until she recovered because she would be taunted if she went back home: “I bought her provision. I woke up every morning to prepare food for her before leaving home.”

Medics treating Khadija say her condition is improving, but predict it will take some time for her to heal both medically and psychologically. One nurse described her as “badly traumatised”.

“With elections in early 2018, it is unlikely the government will take any serious action against the soweis, who will now be emboldened by their apparent success in having their way,” says a local journalist whose radio station has been threatened if it continues to cover the issues surrounding FGM.

He believes that even if the matter reaches court – “which is unlikely” – the victim will be in danger if she testifies.

Captured and cut: FGM returns to Sierra Leone despite official ban | Umaru Fofana

Ebola epidemic in Sierra Leone may be above, say well being staff

The extended-working Ebola epidemic in Sierra Leone is all but more than soon after nearly 13,500 instances and virtually 4,000 deaths, these fighting the condition feel.

The final situation in Sierra Leone was an eight-month-outdated child, who was hospitalised nearly two weeks ago and died 4 days later on.

None of the 29 individuals who had speak to with the kid and have been moved from the densely packed Freetown slum of Magazine Wharf to a voluntary quarantine facility have so far proven indications of illness.

Ebola – deaths and situations in the past 21 days

“We will wait to see if any of those high-risk people create [Ebola] but if not, and even if they do, we have them safely out of the neighborhood. Our hope is that that is the last bit of this outbreak,” said Marshall Elliott, director of the United kingdom government’s interagency taskforce, which is operating the response with the Sierra Leone government and army.

An operation launched in June aimed at what seemed to be an intractable reservoir of illness amid parts of the population of Kambia and Port Loko in the north of the country seems to have been a good results.

There have been no cases in Kambia or Port Loko for effectively over a month, “which is actually, really good”, said Elliott of Operation Northern Push. “It’s really challenging for any of us who have worked on this for a extended time to ever truly feel totally assured and relaxed due to the fact we have had surprises in the past. We stay vigilant.”

The west African epidemic was the greatest ever outbreak of Ebola by a lengthy way. The illness – initial recognized in 1976 – had only impacted a handful of hundred folks at any one particular time ahead of. There have been almost 28,000 instances across west Africa given that December 2013 and about eleven,300 deaths.

At its peak last autumn, there had been far more than 700 situations a week, just in Sierra Leone, which meant the responders could do minor far more than gather bodies and urge families to report to the authorities anyone who was sick or dead.

Josephine Sesay carries a 7-month outdated girl, who died in November 2014, from the Race Course spot of Freetown. Photograph: Nikki Kahn/The Washington Post

Concern of being placed in an isolation unit with others who may possibly have the disease deterred numerous from undertaking so – as did the adherence to cultural traditions that spread the contagion, involving care for the sick and burial rites which includes washing and kissing the body.

Sierra Leone is on the alert for circumstances crossing its northern border with Guinea, but that country is now undertaking much better than expected and it is believed, stated Elliott, that the profitable vaccine trials produced a large impact.

The vaccine proved to be a hundred% productive in defending these who have been provided it. It was supplied to all contacts of anyone diagnosed with Ebola. Between those who chose not to have it, some developed the illness.

Wellness workers resting outside a quarantine zone at a Red Cross facility in the town of Koidu, Sierra Leone, in December 2014. Photograph: Baz Ratner/Reuters

The very same vaccine is getting provided to wellness workers in a trial in Sierra Leone, but the Guinea trial will now be extended right here also. “The president has signed off getting the Guinea protocol for the vaccine right here. It will still consider a couple of weeks. The WHO [World Well being Organization] are equipping themselves – setting themselves up to enable that to happen,” said Elliott.

“But hopefully truly we won’t need to have to. We do now genuinely really feel we’re in a spot where we might have observed the final of situations.”

Ebola – confirmed circumstances by week

At the weekend, Sierra Leone’s president, Ernest Bai Koroma, visited the Tonkolili district to celebrate the finish of what Elliott stated people hoped would be “the final ever huge quarantine of this outbreak”. Much more than 500 people, the total population of the village of Massesebe, were quarantined. It was triggered by a man who absconded from quarantine in Freetown, in order to check out his mom at the end of Ramadan. He fell unwell and infected two other people there. But the village is now clear of the condition.

The final stages of the outbreak have been quite hard function. The Northern Push in June was launched to attempt to re-energise these fighting the condition in the country’s most remote and classic districts. “Getting them to finish standard burials [in which washing the entire body was a route of transmission of the virus] and accept that treatment was for their benefit was quite difficult. People kept hiding themselves and going to traditional healers and carrying out unsafe burials,” explained Elliott.

But property-to-property visits and sheer persistence appears to have paid off. The drop in instances in Port Loko and Kambia has also impacted on Freetown, simply because marketplace traders and people hunting for perform in the city came by boat to the wharves and at times brought infection with them.

A quarantined house in Port Loko, Sierra Leone, in October 2014. Photograph: Michael Duff/AP

Good results has been down to painstaking investigation with the aid of many in the community, some of whom have survived Ebola or been in quarantine themselves and could allay some of the dread and suspicion amongst their neighbours. Surveillance teams have been able to get total family chains, with the names and addresses of every single person contaminated and their contacts.

Scientific developments have also helped. It is now possible to track spread of the virus by means of genetic sequencing. It was this that showed that the mother of the child who died final week had been contaminated. She had hidden from the authorities and recovered at residence, but transmitted Ebola to her little one daughter.

Ebola interactive

Ebola epidemic in Sierra Leone may be above, say well being staff

Ebola: 50 circumstances and 25 deaths reported in Sierra Leone, Liberia and Guinea

West African countries and worldwide health organisations have adopted a fresh method to battle the ebola epidemic. Photograph: Alliance Images/Alamy

Fifty new situations of Ebola and 25 deaths have been reported in Sierra Leone, Liberia and Guinea given that three July, as the deadly virus continues to spread in households, the Planet Health Organisation (WHO) explained on Tuesday.

In a statement, the UN company explained that the most recent figures from wellness ministries in the 3 nations showed a total of 844 circumstances like 518 deaths in the epidemic that began in February.

Guinea’s ministry reported two deaths since 3 July but no new cases in the previous week, the WHO stated, calling the circumstance in the affected area of West Africa a “mixed picture”.

Sierra Leone accounted for 34 of the new situations and 14 deaths, while Liberia reported sixteen new circumstances and nine deaths, it mentioned, adding: “These numbers indicate that energetic viral transmission continues in the local community.”

A WHO spokeswoman, Fadela Chaib, said: “This means that the two principal modes of transmission are property care, individuals who care for their relative at house, and in the course of funerals, are nevertheless ongoing. If we do not cease the transmission in the many hotspots in the three nations we will not be capable to say that we manage the outbreak.”

West African countries and global health organisations adopted a fresh strategy last Thursday to battle the world’s deadliest Ebola epidemic to date. Measures consist of better surveillance to detect the virus and enhancing cross-border cooperation.

Ebola: 50 circumstances and 25 deaths reported in Sierra Leone, Liberia and Guinea

seven factors why Sierra Leone is winning towards neglected tropical illnesses

Young children relax in a lobby in Aberdeen street of Freetown, Sierra Leone. The country has made important progress in eliminating NTDs. Photograph: Alamy

The Lancet just lately published a report on gains created towards reaching the 2020 neglected tropical ailment (NTD) elimination ambitions set by the 2012 London declaration. Despite being one particular of the world’s poorest countries, Sierra Leone, in particular, has produced amazing strides.

Ahead of the existing NTD manage programme, about half of the districts noticed in excess of 50% of their youngsters contaminated with schistosomiasis (snail fever) just before they reached 14. By 2010 mass drug administration had reached, and has since maintained, 100% geographic coverage of people at chance of NTDs, outperforming neighbouring countries.

This quick progress has been sudden in the submit-conflict setting. By the finish of the rebel war in 2002, most wellness services were broken, ill-equipped and their personnel and communities traumatised. Many overall health pros had been evacuated during the war and had tiny chance or incentives to return.

Although sustained funding from USAid is 1 explanation behind the country’s success, other nations like Nigeria, with robust funding and better resourced overall health sectors and public communications programs, have not created the very same degree of progress. So why has progress in NTD control in Sierra Leone been so swift? Right here are some crucial lessons behind Sierra Leone’s achievement.

one. Dimension matters

Although infrastructure remains a challenge, especially during the rainy season, Sierra Leone is tiny and most communities can be reached in a sturdy 4-wheel drive inside of a day’s travel from Freetown. This can make implementing, and evaluating a nationwide NTD programme considerably a lot more manageable.

2. Invest in nation-particular investigation

There has been a long-standing academic interest in tropical conditions in Sierra Leone. This can be traced back nearly a century to what is now recognized as the Liverpool School of Tropical Medicine, exactly where research commenced in diseases contracted by sailors returning from the country.

In addition, Glasgow University has contributed to developing human resource and investigation capability since the 1980s with two local universities and a neighborhood NGO. These have all supplied broad foundations of knowing and operational encounter which have been utilized in the advancement of post-war management programmes.

3. Decentralise healthcare to attain marginal populations

The Regional Government Act in 2004 known as for the lively participation of communities in public policy discourse and selection generating to boost the delivery of basic providers. The adoption of neighborhood-based approaches, and the decentralisation of wellness care delivery solutions, has had a important affect. This is notably evident in vulnerable and resource-constrained settings in rural communities where the NTD burden is most prevalent.

four. Offer sufficient training to wellness leaders

Typically in Sierra Leone healthcare was delivered by people without formal training. After the war, health care officers that lead the district teams have been sponsored by WHO for a public well being masters degree at Leeds University, giving rise to a new generation of well being leaders much better positioned to give service with accountability.

five. Never underestimate the energy of neighborhood

The higher NTD burden has been a key motivating issue. Neighborhood neighborhood drug distributors volunteer to go from residence to house to conduct village censuses, offer details and administer NTD drugs. The inspiration of the 29,000 volunteers and that of the one,500 wellness staff that train and supervise them come from the clear improvement they see in the overall health and wellbeing of their communities.

6. Harness the power of technology

In 2010 mobile technology and independent monitors have been introduced to facilitate the tracking of mass drug administrations in genuine time, enabling the NTD programme crew to see progress and issues immediately, as well as to validate results. This has been critical in the post-conflict setting in which speedy internal migrations and urbanisation takes place.

seven. Tailor communication to regional demands

Tailoring messages for viewpoint leaders, overall health staff, volunteers and the public in the context of local culture and conventional beliefs has been important to controlling the illnesses. Frequently asked questions must be extensively pre-examined, routinely revised, and aired on radio programmes that encourage listener participation. Public mobile phone-in and SMS messages aid maintain the dialogue pertinent and the considerations of the public swiftly addressed. Facebook and other net sources have significantly assisted make sure messages get to even the most difficult-to-reach communities in remote spots.

There is nevertheless a lot to be accomplished if we are to reach the 2020 global elimination targets, but learning from countries like Sierra Leone, who have succeeded towards all odds, is a phase in direction of conserving and bettering the lives of millions.

Dr Mary Hodges is the Sierra Leone country director for Helen Keller Worldwide. Comply with @HelenKellerIntl on Twitter.

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seven factors why Sierra Leone is winning towards neglected tropical illnesses

Nutrition: in Sierra Leone breast is greatest

Sierra Leone is marketing breastfeeding as a essential policy for decreasing stunting and malnutrition. Photograph: Chaloner Woods/Getty Photos

Explaining why nutrition has been considerably maligned, head of growth, equity and livelihoods at Save the Kids, David McNair stated: “Nutrition has been the Cinderella problem of growth. It truly is been a hidden problem because it isn’t going to display up on death certificates.”

In 2013 healthcare journal, the Lancet, confirmed that malnutrition is the underlying result in behind 45% of youngster deaths beneath 5. The figure is even larger in Sierra Leone in which 57% of deaths of kids below five are attributable to malnutrition. A Unicef’s 2010 survey also discovered that 44% of children in this small west African nation had been stunted – a symptom of lack of satisfactory nutrients.

But the government is displaying it has the political will to deal with the issue, having signed up to the Nutrition for Development agreement and joined the Scaling Up Nutrition (Sun) motion, a collective effort from governments, civil society, the UN, donors, firms and researchers. It really is involvement in Sun is being led by the vice-president’s workplace.

“It is come to the point where everyone knows it’s not just health associated, you require to have all the players on board to tackle malnutrition,” says Aminata Shamit Koroma, director of food and nutrition at Sierra Leone’s the ministry of well being.

As the nation moves from submit-conflict (the civil war ended in 2002) to emerging marketplace (GDP growth was 15% in 2012), the government realises that it should shift from therapy of malnutrition to prevention. Agriculture, schooling, gender equality and sanitation all have a position to perform in this.

“We have witnessed that ladies with a larger educational degree are significantly less very likely to have malnourished young children. You want excellent sanitation. You require food to be inexpensive, available for folks to be able to buy and feed themselves,” says Koroma, who was in London for the launch of the Generation Nutrition campaign in which thirty NGOs are pledging to end kid malnutrition with this generation.

In Sierra Leone, Koroma focuses on marketing breastfeeding as a essential policy for reducing stunting and malnutrition amongst younger generations. The message that babies must be exclusively breastfed for the first six months of their lives is broadcast above the radio, for the duration of awareness weeks and by way of mom-to-mother assistance groups.

“Experienced mothers counsel younger mothers,” she says. “We’ve identified that the barrier to exclusive breastfeeding is tradition. Grandmothers inform mothers they need to give the baby water since it really is thirsty. We use this identical medium [grandmothers] to go back to the mothers and say, you will not have to give the infant water. Breast milk has everything the little one wants for the initial 6 months.” The mother-to-mom initiative began with three assistance groups of 20 mothers every and has grown to 3,000 help groups across the nation.

As effectively as grandmothers, the Sierra Leone Nationwide Foods and Nutrition Protection Policy 2012-2016, targets fathers. “We have discovered that when they get to know about the benefits of breastfeeding they help their wives,” says Koroma. “A single myth is that if you are sexually active in the course of breastfeeding the youngster will get ill. So we inform them that this is not correct, in truth it will help you, due to the fact for the 1st six months if you actively solely breastfeed it assists to end acquiring pregnant.”

One more motivating element for fathers is that if their infants are breastfed they never have to get foods for them for their initial six months of daily life. “When they find out, some fathers will truly push their partners to breastfeed simply because this is cash in their pocket,” says Koroma.

The nutrition policy also recommends the establishment of a code of conduct for the advertising and marketing of breast milk substitutes. The code has however to be drafted but Koroma says it is on the agenda for this year. A report from Save the Youngsters launched last year located that businesses that generate breast milk substitutes are nonetheless placing children at danger by promoting their product as superior to a mother’s milk.

“A lot of men and women truly feel that this is an situation that was dealt with in the 1980s and 1990s,” says McNair. “But we stay concerned by the position of large companies in making an attempt to influence and weaken legislation around ensuring code compliance at a country level.”

Despite the fact that Koroma is realistic that Sierra Leone will not meet the millenium development aim of eradicating hunger by 2015, she is optimistic that the nation can accomplish this by 2020. “We’ve noticed now that nutrition is on the growth agenda of the government,” she says. “When the president of Sierra Leone talks about what he hopes to do, now he mentions nutrition.”

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Nutrition: in Sierra Leone breast is greatest

Relatives take away Sierra Leone Ebola sufferers from clinic

Wellness staff don protective fits in the course of an operation at an Ebola isolation centre in the village of Kampungu, in the Democratic Republic of Congo. Photograph: Ho New / Reuters/REUTERS

Family members of Ebola sufferers in Sierra Leone have been removing their loved ones from local community overall health centres in spite of protests from health care employees, amid warnings from the Globe Overall health Organisation that the deadly and hugely infectious illness is nonetheless spreading across West Africa nearly two months after an outbreak was initial reported.

Guinea’s capital Conakry has recorded its 1st new Ebola cases in a lot more than a month, although 5 individuals have died in Sierra Leone’s very first confirmed outbreak of Ebola virus, according to the WHO.

The spread of the outbreak, which Guinean authorities had said had been contained, risks additional complicating the fight against the virus in a region previously struggling with weak healthcare methods and porous borders.

“The predicament is serious, you cannot say it is underneath handle as circumstances are continuing and it is spreading geographically,” Dr Pierre Formenty, a WHO professional who just lately returned from Guinea, informed a news briefing in Geneva on Wednesday.

“There was no decline. In truth it is due to the fact we are not ready to capture all the outbreak that we have been beneath the impression there was a decline,” he stated.

In Sierra Leone, the family of one particular female stated they eliminated her from the clinic in Koindu town, in the country’s east, simply because they did not believe in the healthcare method and feared she would die if a planned transfer to the common hospital in the town of Kenema went ahead, Amara Jambai, the wellness ministry’s director of illness prevention and management, advised Reuters.

On Wednesday, Jambai informed the BBC that a total of 6 sufferers had been “aggressively” removed from care in Koindu, in defiance of health care workers.

Ebola, a haemorrhagic fever with a fatality rate of up to 90%, is believed to have killed nearly 200 folks in neighbouring Guinea and Liberia since March in the initial deadly look of the illness in West Africa.

The West African outbreak spread from a sparsely inhabited corner of Guinea to the capital, Conakry, and into Liberia, creating panic across a area struggling with weak healthcare methods and porous borders.

When asked about the risk posed by the woman’s removal from hospital in Kenema, Jambai said: “She can infect others, her household members and also these in the neighborhood. There is no news of her problem simply because she has been taken away so we need to have to search and uncover her and make certain that it (Ebola) does not spread.”

Jambai said lawmakers and local community leaders would try out to speak to family members members and persuade them to return her to hospital. There has been no news of the woman, whose identity has been stored secret, because she was taken from Koindu to her village nearby, Jambai said.

In Guinea, Telimele and Boffa – two districts north of Conakry that had been previously untouched by the condition – the two confirmed outbreaks by way of laboratory testing, the WHO mentioned. Twelve situations, including four deaths, have been reported there amongst 23 and 26 May, although suspected Ebola infections had been documented in the adjacent districts of Boke and Dubreka.

Aboubacar Sidiki Diakité, who heads the Guinean government’s efforts to halt the virus’s spread, mentioned the origins of all the new outbreaks had been traced back to cases in Conakry.

“The problem is that there are households that refuse to give details to wellness staff. They hid their sick to try to deal with them by way of classic techniques,” he told Reuters.

The WHO has documented a complete of 281 clinical circumstances of Ebola, such as 185 deaths in Guinea given that the virus was very first identified as Ebola in March. The condition is believed to have killed eleven men and women in Liberia, believed there have been no new cases there because 9 April.

Ebola is endemic to Democratic Republic of Congo, Gabon, Uganda and South Sudan. Researchers feel the West African outbreak was induced by a new strain of the virus.

Relatives take away Sierra Leone Ebola sufferers from clinic