Common sense is part of the answer
SIERRA LEONE is one of the world’s poorest countries. From 1991 to 2002, it suffered a devastating civil war that claimed 70,000 lives and wrecked the health system. What little remained of it was gutted by an Ebola outbreak in 2014, which killed lots of doctors and nurses. As a result, the country has only some 400 doctors to treat its 7m people. Corruption also makes the nation sicker. Most people have to pay bribes to doctors and nurses for basic treatments.
Nonetheless, Sierra Leone is doing better at beating back neglected tropical diseases (NTDs) than almost anywhere else in Africa. Fifteen years ago as much as half the population was infected with the worm that causes onchocerciasis, or river blindness. Many villagers in the south-east used to think it was perfectly normal for people to go blind after 30, says Mary Hodges, from Helen Keller International, a charity that works on blindness and malnutrition. Yet by 2017 only 2% of people carried the worm, and there had been no new cases recorded of people going blind from onchocerciasis in a decade. Elimination is expected by about 2022.
There are several reasons why Sierra Leone has pulled off this remarkable feat. Paradoxically, one is the extraordinarily high prevalence of NTDs. Because the entire population was exposed to at least one NTD, the government made it a priority early on, says Dr Joseph Koroma, who managed its programme. And instead of dealing with these diseases separately, Sierra Leone tackles them all at once. Each year it provides drugs for four major diseases to everyone at risk. Treating people at roughly the same time reduces the chances of them reinfecting one another. It also saves money because health workers can visit each village only once instead of several times a year.
Ending the stigma is also important. Radio programmes where panels of experts, victims and local leaders answer calls from listeners about their concerns have helped to break down misconceptions and encourage people to get treatment. It is no good just lecturing villagers about how river blindness is caused by the black fly when they think it is witchcraft, says Dr Hodges.