Kenema Government Hospital
The Kenema Government Hospital (KGH) is located 300km east of Freetown, in Kenema, Eastern Province, Sierra Leone, an area with the highest incidence of Lassa Fever in the world. This region is endemic to an array of tropical diseases including Malaria, Yellow Fever, Tuberculosis, intestinal parasites as well as Lassa Fever. Despite enduring a bloody civil war for over a decade prior to its end in 2002, newfound peace has made it possible to re-establish and expand the biomedical infrastructure, and continue Lassa Fever research in this region.
Lassa Fever Program
Sierra Leone has played a crucial role in the advancement of Lassa Fever research since the mid-70s when Joe McCormick of the Center for Disease Control (CDC), set up a field site at the Nixon Memorial Hospital in Segbwema, 100km west of Kenema. In 1979, Dr. Aniru Conteh, a Sierra Leonean physician, joined the CDC team. Dr. Conteh dedicated his life to treating patients with Lassa Fever and became known as the world's leading specialist on the disease. Once war broke out in the early 90s, the CDC shut down its activities in Sierra Leone and moved its research to neighboring Guinea. Despite insecurity and lack of resources, Dr. Conteh and the rest of the Sierra Leonean Lassa Fever Program staff continued their work, moving their operations to Kenema Government Hospital. Through ten years of war, thousands of patients including United Nations peacekeepers and rebel fighters were treated at KGH. The Lassa Isolation Ward remained open despite instability and it is perhaps the notoriety of the killer disease that ensured its safety.
In March 2004, Dr. Conteh sustained a needlestick injury while treating a patient and became infected with the Lassa virus. Tragically, he died 18 days later from the disease he had dedicated his life to eradicate.
Today, the work of the Lassa Fever Program has expanded to include treatment, containment, prevention and research. The current team consists of medical staff led by Dr. Donald S. Grant, the Chief Physician at the Lassa ward, and supervised by Nurse Mballu Fonnie. The day to day activities of the Lassa Fever Program are being lead by Program Coordinator Simbirie Jalloh. In addition, the Program has an Outreach team that is responsible for case investigation, surveillance and sensitization campaigns. They work closely with the Ecology team who are tasked with rodent trapping and extracting samples from the multimammate rat, Mastomys natalensis.
Tulane University has a long-standing partnership with the Lassa Fever Program at the KGH. When it was established in 2004, Tulane was contracted as the principle implementing partner of the Mano River Unione Lassa Fever Network program (MRU-LFN), a diverse group of organizations working together to develop national and regional prevention and control strategies for Lassa Fever, as well as focusing on building the capacity of the laboratory at the hospital. Since then, the work conducted by Tulane and its partners at KGH has grown to include new lines of research and public health surveillance.
The Lassa laboratory is located on the grounds of the hospital and is divided into a general clinical laboratory for routine diagnostics, and a BSL 2 suite for handling samples from suspected Lassa Fever cases. The Director of the Lassa Laboratory, Augustine Goba, manages a team of three laboratory technicians who diagnose patients using enzyme immunoassays and lateral flow tests. Currently the laboratory possesses equipment and trained personnel for diagnostics using ELISA, real-time and conventional PCR, and immunofluorescent antibody tests.
The Lassa Ward at KGH is the only Lassa Isolation Unit in the world. The building is separate from the rest of the hospital ensuring the highest level of infection control. Within the ward, the medical staff adhere to strick universal precautions when interacting with patients. Personal Protective Equipment (PPE) consists of barrier gowns, gloves, face masks and face shields. All patients in Sierra Leone with suspected Lassa virus infection are referred to KGH. Once Lassa fever has been confirmed, they receive a ten-day course of intravenous Ribavirin as well as anti-malarials and broad-spectrum antibiotics.
Overwhelmingly, Lassa Fever is a disease that affects the poor living in rural housing without proper sanitation and pest control resources. The cost of treatment can therefore be a huge deterrent for sick individuals seeking medical attention. Dr. Grant points out that patients with Lassa Fever receive treatment free of charge at KGH. Due to the highly contagious nature of the virus and its ability to spread rapidly through entire communities, the government has wanted to ensure that everyone has access to the necessary drugs and care. All medication is provided free of charge by the government and even food is made available to the inpatients of the Lassa ward.