• emergency care systems, remote and rural medicine
• infectious diseases, tropical
• infectious diseases, viral
• remote and rural medicine
• tropical

It is hot, busy and potentially dangerous. Our deployment to the International Medical Corps’ Ebola Treatment Centre (ETC), near the town of Makeni, started busily enough with a steady trickle of suspect cases but only two confirmed Ebola cases remained in the unit, both survivors who were well and awaiting discharge. Then, a sick man was smuggled out of Freetown in the boot of a car and taken back to his village just outside Makeni.1 ,2 He consulted a traditional healer, was cared for by his family, died and had a traditional funeral where the family wash the body at a time when the patient is most infectious. His brother was the first admission of a wave of patients with confirmed Ebola, followed by his mother, father, nephews, nieces and neighbours. Other facilities in the district had closed so our ETC was the sole referral point for cases from the outbreak (figure 1). This spike in admissions included a number of children and three pregnant patients who delivered, one while in the back of an ambulance awaiting triage and two in the ETC. The rate of admission was so great that at one point ambulances had to queue outside the ETC (figure 2).

ETCs have been set up across Sierra Leone as part of the international response to the global health emergency that has struck West Africa. The Makeni ETC was constructed by the Royal Engineers, with funding from the UK Department for International Development and …