The Kerry Town Ebola treatment centre stands alone in a large clearing in the Sierra Leonean forest, about an hour’s drive from the capital, Freetown. It is reminiscent of tuberculosis sanatoria built in Victorian times well away from cities, both to give the patients the benefits of nature and to protect everybody else from infection.

British Ebola treatment facility in Kerry Town. The Scottish nurse diagnosed with the Ebola virus was working at the newly built hospital run by the charity Save the Children

All the Ebola treatment centres that have sprung up in west Africa are recognisable by their white tented structures, but Kerry Town, begun early on by the Sierra Leonean military under orders from the Ministry of Health and now run by Save the Children, has a line of walled buildings that look at least semi-permanent. These are the wards, secured behind two layers of fenci ng to make sure there can be no physical contact between those with Ebola and visitors or staff who are not wearing the spacesuit-style protective clothing.

Kerry Town bustles. It has a sizable contingent of NHS volunteers, around 20 Cuban doctors and many local staff too. The staff room is full. There is a cartoon drawing of a human on the wall with body parts labelled in English and Spanish. There are lists of teams for each shift through the day and the night as well – three nationalities on each shift. It seems less formal than some of the other treatment centres, where a quasi-military discipline appears to be enforced. But the procedures have to be exactly the same – it is the only way to stay safe.

Patients at Kerry Town, where drips and lines for drugs can be put in 24 hours a day, are doing well, but half still die and many are children.
Opened in the last weeks of November amid fanfares, Kerry Town was the first British government-funded treatment centre in Sierra Leone and was heralded as the flagship of the UK effort and the beginning of the end of Ebola in the west African country. Sierra Leoneans queued at the gates.

But the expectations, Save the Children says now, were always too high. Within weeks it was under fire in both Sierra Leone and the UK for having few of the 80 beds filled. And the infectionof Pauline Cafferkey, who was one of the first wave of NHS volunteers at the centre, is the latest setback in what has proved a difficult chapter for the charity.

In a recent exclusive interview in Freetown, Save the Children International’s global humanitarian director explained that the charity had gone beyond its comfort zone in undertaking to manage an Ebola centre, but had felt it was duty-bound to step up because there was nobody else to do it.

Michael von Bertele told the Guardian that Save the Children had been put under massive pressure to get the flagship centre open faster than it thought was possible – in buildings that were not well designed for the purpose. He said the charity had initially been resistant when approached by the Department for International Development, which was funding the project, and the Sierra Leonean government.
“Our reaction was – you must be crazy. My initial response was ‘no’. Then they pleaded with us,” he said.

Save the Children had been in the process of building an emergency health capability following a merger with Merlin, a medical NGO. The charity wanted to be able to help in disasters like Haiti. But Von Bertele’s plans envisaged a long and steady scale-up, to the point eventually where they would be able to respond to an Ebola outbreak, within three years.

Kerry Town Ebola treatment centre on the outskirts of Freetown, Sierra Leone.

However, he said the major medical organisations, Médecins Sans Frontières, the Red Cross and the International Medical Corps, were overstretched and could not take on another treatment centre. Save the Children had worked in Sierra Leone for 30 years. “Our name was fixed in people’s minds long before we were asked,” he said.

So it agreed to take on the Kerry Town site. “We felt there was a moral obligation to do it,” said Von Bertele. “Recognising the need, the UK links with Sierra Leone, we felt that if we didn’t do it, it would delay the point at which the epidemic would come under control.

“The thing that swung it for us was that WHO said they would provide a Cuban medical team. I reckoned we couldn’t recruit and train a medical team in the time frame. We made it very clear from the start that we would struggle to do that,” he said. “I originally said not before 13 December. Then the Ministry of Health said we want it open by the end of October. We opened on 5 November.”

There was huge pressure, he said. The construction was slower than planned and did not finish until 4 November. They had to recruit and train many unskilled Sierra Leonean staff to work as hygienists and in other support roles. They were promised a contingent of NHS volunteers and also directly recruited nurses and doctors in the UK themselves – including the healthcare worker now being treated for Ebola at the Royal Free hospital in London.
There were also issues around the building, which had been designed by the Ministry of Health and built by the Sierra Leonean armed forces, supervised by the UK’s Royal Engineers. “In August we came out and made quite a lot of suggestions to modify it, but it was going up so quickly,” said Von Bertele.

Ebola treatment centres must have strict one-way “flow” or movement of staff and patients, from the safe “green” areas into the “red” where there is increased risk of infection as they proceed, so that there is no risk of anyone carrying the virus from a high risk into a low risk zone.

“We would have made the wards bigger and probably changed the flow,” said Von Bertele. “We took advice from MSF and had a clinician in the UK. Basically it is fairly simple infection control measures – it is plumbing and flow.”
The other particular issue for Kerry Town was the mixture of nationalities working there. Few of the Cuban doctors spoke English and few of the NHS staff and none of the Sierra Leoneans spoke Spanish. “From a standing start it takes a long time. In three languages with people who have never worked together, it takes even longer,” he said. But they have recently turned the corner, he believes.

Despite these obstacles, Save the Children says it is providing a high standard of care at Kerry Town, particularly for children, who are frequently referred there because of the charity’s name. The staff work night shifts as well as day shifts, which does not happen in all treatment units, so they are able to use drips and give drugs 24 hours a day. It also hosts a Public Health England lab, which means access to testing is swift.
As of 12 December, it had admitted 103 confirmed cases, 34 of them under the age of 17, including seven below the age of five. By Boxing Day, all 80 beds were operational. Save the Children says it has admitted over 200 patients, and 66 have been discharged. The mortality rate is around 50%, it says.

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