(By Dr Benedict Gannon, Senior Microbiologist Lead, UK-PHRST)
 
OUTBREAK RESPONSE
 
I arrived in Sierra Leone in August 2017 after severe floods caused a horrific landslide on the outskirts of Freetown. It was in my first month as a core deployable member of the UK Public Health Rapid Support Team (UK-PHRST), the multi-disciplinary team of infectious disease specialists created to support countries responding to outbreaks.
 
My role in this deployment was to lead a surveillance operation in collaboration with the Sierra Leone Ministry of Health and Sanitation (MoHS) to ensure prompt recognition of any water-borne diseases that the flood waters could promote. The greatest fear was a return of cholera to the Freetown Peninsula, a potentially devastating prospect for the camps recently set up for the thousands of people displaced from their homes by the mudslide and the many communities struggling against rising flood waters.
 
In this 4-week deployment, the team successfully worked with MoHS responders to strengthen detection and rapidly investigate cases, while helping the government’s Emergency Operation Centre interpret data to plan appropriate interventions. We also assisted with daily surveillance of displaced people in camps and flooded communities, established a new laboratory to deal with extra cases, and trained staff to test for enteric bacterial diseases, including those due to salmonella, shigella and cholera.
 
RESEARCH
 
To further build capacity, we initiated a research collaboration using the surge laboratory to identify the prevalent enteric pathogens in Freetown. With the support of the Chief Medical Officer, the MoHS and the Deputy Clinical Director of the hospital, the project went ahead at Connaught hospital, the main tertiary referral hospital in Sierra Leone. The King‘s College-Sierra Leone Partnership (KSLP) provided clinical input and their full-time presence in the hospital was essential to the project. The lab work was done by UK-PHRST and the training of Connaught laboratory scientists was done with the help of World Bank-sponsored laboratory staff. Results from the project will assist in directing limited resources to provide effective laboratory diagnostics for many outbreak-prone enteric diseases.
 
CAPACITY BUILDING
 
The research and capacity building project at Connaught Hospital facilitated further understanding of challenges faced by the laboratories in Sierra Leone. Talking to staff and colleagues, we found that virology knowledge and practical experience of modern diagnostic techniques were limiting factors for the development of effective and sustainable laboratory diagnostics for outbreak-prone pathogens. To address this, the UK-PHRST now contributes to a virology module in the University of Sierra Leone BSc for Medical Laboratory Science curriculum, which incorporates practical classes using the UK-PHRST mobile laboratory, the “lab-in-a-bag”.
 
For me, one of the most personally satisfying developments was when two of the BSc students joined the enteric disease research project, spending 12 weeks on a placement as part of their degree studies. Both students proved to be dedicated individuals and worthy additions to the project team, with one of them achieving the award for the best project from his graduation year. The courage and commitment they show in the face of the daily difficulties they must overcome is a constant inspiration to me. Both students were due to present their work at an international conference in Ethiopia in March but this was postponed due to the COVID-19 pandemic. The virology teaching put all the BSc students in a good position to respond to the pandemic with three of them now directly involved in testing for the disease. One stressed the importance of the UK-PHRST teaching saying that he already knew of the coronavirus family, including SARS, because of the course and that the practical training was very useful as it taught the exact methods now used for COVID-19 testing in Sierra Leone. These students are part of the future, further boosting Sierra Leone’s capability to provide effective outbreak response diagnostics.
 
With continued international support to health strengthening projects, the future for Sierra Leone’s health and outbreak response capacity will continue to improve.
 
Dr Benedict Gannon, Senior Microbiologist Lead, UK-PHRST
 
My interest has always been in the application of microbiology either as a diagnostic scientist or researching into novel diagnostic and treatments for infectious disease. I have extensive virology and bacteriology experience as both a Biomedical Scientist, working in the Rare and Imported Pathogens Laboratory and as a Post-doctoral research scientist at the University of Bristol.
 
My current role as the Senior Microbiologist Lead has been to shape and implement Microbiology and the UK-PHRST's flight case laboratory into the UK-PHRST triple remit for outbreak response, research and capacity development. Working across these three areas allows, not only reacting to epidemics by deployment, but to be actively engaged in building up local capacity in low and middle-income countries to respond to future outbreaks by supporting overseas institutes and people. This work includes projects in Sierra Leone, Sudan, Nigeria, Uganda and Turkey.
 

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