A team from Direct Relief is traveling through West Africa to better understand the needs of health care partners and formulate long-term strategies for strengthening health systems devastated by the Ebola outbreak. Our Communications Director, Tony Morain, shares his observations from Sierra Leone.

The trip to the Wellbody Clinic in Kono District, Sierra Leone, run by Direct Relief partner Wellbody Alliance, began with a drive to an air force base on the other side of the country’s capital, Freetown. The route followed a tree-lined beach and then veered inland to a lively thoroughfare of people tending road-side shops or working construction – occupations that would fetch a middle-class wage in the U.S.

For every few billboards displaying an advertisement, an Ebola advisory or cautionary graphic rose above the city’s densely packed buildings.  As pedestrians and motorbikes threaded the gaps of morning traffic, vehicles bearing the insignia of the U.N. or other response agencies served to remind the city’s two million residents of a crisis they likely won’t forget.

At the air force base, we met Raphael Frankfurter, Wellbody’s Executive Director, and boarded the helicopter after a brief precautionary talk by a UN safety officer.

The flight lasted a little over three hours, landing several times along the way to drop off aid workers in other towns. It takes ten hours by car to navigate the 225 miles between Freetown and Kono, an area hit hard by the war more than a decade ago.

People there can rarely afford a visit to the capital, but Raphi told a story during a brief refueling stop of a woman who made the drive in search of care for an abdominal fistula that formed from a Caesarean-section.

When the woman arrived in Freetown, she learned the hospital would only perform the surgery after confirming she was Ebola-free – a prudent measure on the hospital’s part, but with testing resources in short supply, certainty could mean a wait of several weeks.

The treacherous conditions brought on by Ebola have often compelled medical staff to weigh their inclination to treat the sick against the risk of doing so.

With impressive calibration, the team at Wellbody manages to balance high-quality care with a palpable sense of community at their clinic.

Kids play happily on the well-kept grounds while mothers and their babies gather on the steps of the bright blue and white buildings and talk casually among themselves and the staff.

Fanta, a community health worker (CHW), embodies what Wellbody works to achieve.

She told us of her first days at the facility as a patient in 2009. She was gaunt from HIV before Wellbody staff provided a regimen that restored her health. They also offered her a job. She brims with pride as she explains what it’s like to help people in her community through situations like the one she overcame five years ago.

Wellbody employs hundreds of community health workers like Fanta. Many joined at the height of the crisis and have played a crucial role in the response ever since.

Early each morning CHWs begin their daily rounds, going door-to-door in their neighborhoods to meet with residents and conduct surveys for Ebola symptoms. They accompany those who are symptomatic to a nearby community care center for further evaluation.

Beyond Ebola, the investment in additional CHWs has revealed a large number of conditions that would otherwise go undiagnosed. In a single day last month, CHWs identified 27 people with HIV who weren’t receiving treatment.

The care provided by doctors and nurses is crucial, and the right supplies are essential to their efforts, but a case-count of zero will only be achieved through community participation. As Wellbody’s efforts clearly illustrate, a community’s role in the fight against Ebola–and for better health overall–is paramount.

Related posts: From the Field: Battle Against Ebola Continues in Sierra Leone; From the Field: Health Facilities in Sierra Leone Work to Restore Services