Download why the fight against ebola is an herculean task in sierra leone – our

yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

West Nile fever wikipedia , lookup

Hospital-acquired infection wikipedia , lookup

Middle East respiratory syndrome wikipedia , lookup

Pandemic wikipedia , lookup

Henipavirus wikipedia , lookup

Marburg virus disease wikipedia , lookup

West African Ebola virus epidemic wikipedia , lookup

Ebola virus disease wikipedia , lookup

The unprecedented prevailing outbreak of Ebola in West Africa can
properly be described as a conundrum, so confusing and difficult to solve. Many
questions have been asked by the inquiring minds with regards to the appearance
of this outbreak in this region of Africa where it has never occurred before, and
far from where it has always occurred, East Africa, but especially why it has
reached such an alarming rate of becoming both an epidemic and a pandemic.
The spate of this outbreak, if not stemmed with maximum efforts locally and
internationally, has the potential of becoming Africa’s Black Death. The symptoms
pointing towards that direction are already evident in the rising death toll, the
tripling percentage of new infections which is devastating the lives of many
people and debilitating the entire pillars of society.
Apart from the direct and immediate consequences of this hemorrhagic
fever, that is, the soaring death toll, this Ebola outbreak is reeling the economies
of private and public investments, as many citizens are continually losing their
jobs and their means of livelihood, many companies and industries are folding up,
amidst the escalation in the prices of the essential goods and services, leaving
behind its trail a whole lot of psycho-social problems like traumatized orphans
and stigmatized survivors. It also has the potential of triggering social and political
upheavals that can bring down governments as the security concerns mount.
The principal aim of this paper is to tell of our story, shocking and
scandalous as it may be, in order to bring to the knowledge of the international
community the magnitude of this outbreak and its causes. Secondly, this paper
aims at provoking the thoughts of the local intelligentsia, especially the Sierra
Leonean educationists, and policy makers, to pull together lessons we can learn
from this outbreak and to proffer meaningful recommendations to the powers
that be for the making of national social welfare policies that can improve the
living standards of Sierra Leoneans.
Since its first recorded outbreak in history in the Democratic Republic of Congo in
1976, the Ebola virus was a household name in East Africa, but never in West
Africa. Owing to this, this first outbreak in this sub-region of Guinea, Liberia and
Sierra Leone, has sparked off many diverse debates over its veracity as Ebola. For
those who have accepted it to be truly Ebola, it has been a nagging question
wondering how it migrated from East Africa to Guinea (West Africa), where it first
appeared in February 2014 before spreading to Liberia and Sierra Leone.
However, a credible published research has shown that this sub-region is
not devoid of Ebola. The thorough joint research conducted and published by
representatives from the US Army Medical Research Institute of Infectious
Diseases, Maryland, USA, in partnership with the late Sierra Leonean erudite
doctor, Sheik Kumar Khan, of the Kenema Government Hospital, Kenema, Sierra
Leone, revealed the latent presence of the Ebola virus together with other deadly
viruses like yellow fever, Rift Valley fever, chikungunya, and Marburg in the Gola
Rain Forests that boarder these countries.1
Recently, the WHO has described the alarming rate of infection or
transmission of this outbreak as ‘rampant’, and that is exactly what it is. The
question, however, that many find puzzling is on the causes of such an
exponential diffusion and transmission of the virus. This can be attributed
primarily to ignorance or lack of sufficient knowledge about the Ebola virus and
its modes of human to human transmission. This ignorance runs across from the
government, through the Ministry of Health and its health personnel to the social
populace. For the greater majority of Sierra Leoneans, this is the first time of
hearing of a sickness called Ebola, not to talk of knowing its fatality and the means
of stopping its spread. And so because of this abysmal ignorance the government,
the health services and the population lacked the knowledge of stemming it and
putting it under control.
This outbreak also reached its overwhelming dimensions on account of our
ill equipped and impoverished medical and health care (infra)structures. It is not
EID Journal, Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone, Volume 20, Number 7—July 2014.
Let us note, however, that there have been and there continue to be are a number of international TV shows in
which some medical personnel and journalists purport that this particular strain of Ebola virus in West Africa is the
outcome of a laboratory error rather than a natural outbreak. Can the truth of such allegations be ascertained? It is
difficult to tell. The only sure fact is that the precious lives of many innocent and defenseless Africans are lost on
daily bases, especially children and women deprived of the most fundamental right, the right to existence, while
the entire continent of Africa is continually being depopulated by this Ebola and HIV/AIDS.
an exaggeration or pessimism to wonder if there are up to three hospitals in
Sierra Leone that one can consider to be good when we view them in the light of
the criteria of WHO and international standards. And even those that we may
consider to be good according to our local standards are few and far apart. Those
hospitals, with the exception of the Lassa Fever Department of the Kenema
Government hospital, have ill equipped and inefficient laboratories to diagnose
Ebola. Before the installation of new Ebola testing facilities by the international
doctors, the Kenema Lassa Fever Laboratory was overwhelmed with blood
samples it could not manager to analyze. The patients of those blood samples had
to wait for a couple of days before knowing their Ebola status. In the interim the
Ebola positive patients die infecting their medical care takers and their relatives,
thereby multiplying the number of infections.
Linked to this impoverished health care system is the acute shortage of
ambulances to commute the blood samples of Ebola suspects and the Ebola
positive patients, who until the recent intervention of the international doctors,
have always been carried away to the Kenema Government Hospital which was
the only testing laboratory and the Ebola treatment centre in the country.
Bombali District in the northern province of Sierra Leone had only one functioning
ambulance when the outbreak reached that district. This acute shortage of
ambulances is not peculiar to the Northern Province alone. One can imagine the
precarious situation that our nation faced in this current Ebola outbreak. And
Kenema itself which is located in the eastern region of Sierra Leone, sometimes
require up to six or seven hours of drive to reach from many parts of the country.
This gives you a picture of how the health care responses are further derailed.
Furthermore, mechanisms were not put in place for the multiple substitutions of
the ambulance drivers who are constantly plying the route to Kenema. This led to
the somersault of one of the ambulances carrying eight Ebola positive patients
from Bombali District to Kenema, adding salt to injury. When questioned on the
cause of the accident, the driver bluntly reported that he was over-worked,
always carrying blood samples and patients, and had no time to rest, and so he
dozed in sleep.
The shortage of ambulances in the hospitals and health centres has another
side effect in the rapid spread of the Ebola virus in Sierra Leone. Since the
government made it mandatory that the corpses of Ebola patients, and in fact all
corpses, should be buried by the Ebola burial team instituted nationwide, this
shortage of ambulances and vehicles to convey the dead created a disaster for
some families who had to keep their dead for up to three days in their homes
while waiting for the arrival of the ambulances to bury their dead. In the
disgusting sight of the decomposing bodies of their relatives, a thing that is
appalling to everyone and everywhere in the world, relatives had to take the
risk of burying their dead with the unprotected means available to them. By so
doing the virus, which is much more aggressive on cadavers, gets transmitted at
ease to others.
Another factor responsible for the exponential diffusion of this Ebola
outbreak is the outright denial of the existence of the virus in the early months
of the outbreak, and even now, by a greater percentage of the population, and
even some medical personnel. The denial of the deadly virus stems from several
reasons. We can attribute the first reason to the ignorance of the killing virus.
Being a strange phenomenon of successive deaths, the people attribute those
deaths to witchcraft, sorcery, generational curses, demonic attacks and some
even say it is the wrath of God falling on our nation in order for us to turn our
hearts back to God. Such attributions of the deaths by Ebola makes us fall under
the theological stage of August Comte’s social positivism, the stage that
corresponds to the infantile period of humanity, when events in the physical
nature and in mankind were explained through the intervention of supernatural
powers and where the natural laws were seen as a manifestation of the will of the
gods as they direct the beings of nature. In fact I was taken to a spot at Masuba,
the worst hit section of the Northern City of Makeni, where people purport to be
the crash spot of the witch plane that caused all those deaths from that part of
the city. This denial of Ebola as the agent of the massive deaths and our recoiling
to myths and religion for the explanation of this natural phenomenon and
calamity has aggravated the spate of the outbreak.
Owing to the fact that the deaths are associated with such mysterious
causes, the people resort to traditional healers and sorcerers whom they think
can heal them through the power of the spirits. Thus, the denial of the scientific
medicine and the resort to the traditional healers further enlarges the circle of
infections of new cases of Ebola in Sierra Leone since those traditional healers get
infected by the patients and transmit the infection to their apprentices and
relatives. This scenario occurs mostly in the rural settings and remote villages
which are far from the reach of hospitals and clinics.
There is another strong reason for the outright denial of the existence of
Ebola as the virus killing the masses. This is the distrust and the lack of
confidence in the politicians. Banking on the general negative perception of
politicians in Sierra Leone on account of their selfishness and insatiable thirst for
money and power, the Ebola sensitization moves sparked off divergent reactions
from the population, especially the elite, when they learned that each of the 214
parliamentarians of Sierra Leone had received the sum of Le 69,000,000 ($14,000)
from the central government for Ebola sensitization in their constituencies. When
there was little concrete evidence to show for in the disbursement and utilization
of those funds, most people cried foul and accused the politicians of trading the
idea of Ebola as a ploy to rake in more money from the international community
for their enrichment. And as such the national Ebola sensitization stride was
dented and the virus itself was branded ‘unreal.’ On account of this, the real
existence of the massive killer virus was questioned and the moves to combat it
frustrated. In a society where 70% of the population is illiterate or lack critical
thinking, Ebola was dismissed and denied vehemently or explained as some
strange plague that has visited our country. Thus, we can see why the outbreak
has become both an epidemic and a pandemic in Sierra Leone.
In conjunction with the distrust of the politicians, a strange rumour
circulated among the illiterate villagers in many regions of Sierra Leone alleging
that the politicians have cooked up the idea of Ebola in order to extract five
drums of blood they need to perform ritual sacrifices to consolidate their grip on
power for the next general elections due in November 2017. This theory was built
on the blood samples taken from the numerous Ebola suspects, blood sent to the
Ebola laboratories in the east of Sierra Leone. Such a theory, banal as it may be,
made the villagers and the illiterate not to bring their sick to the hospitals; rather,
relatives take their sick either to the traditional healers, or to the mushroom
clinics or even to nurses and other medical personnel where they are treated in
the homes of these healers. One can imagine the fatal consequences of treating
patients at home, patients whose Ebola status cannot be determined there and
then, and in homes where there are practically no protective mechanisms against
contamination. This further explains the magnitude of the spread of Ebola in
Sierra Leone.
The outright denial of the deadly virus has attendant consequences. First
among these is that people do not take the necessary precautions of prevention
from contracting the virus. The ‘’Don’t Touch’’ or ‘’Avoid Body Contact’’ warnings
are not heeded to. And at the face of our intimacy seen in our communal eating
and drinking from the same dish and cup, our sharing of beds and even clothing,
little would you wonder why this outbreak has reached such an alarming rate.
When we also look at our African traditional care for the sick by the extended
family, all we see is a myriad of occasions of transmissions of the infections taking
place since the primary care takers of the sick and the visiting sympathizers shake
hands with the sick, touch their bodies to sound their temperature and sit on the
beds of the sick or even share beds with them at night. This scenario gives you an
idea of the rate of transmission of the virus as a result of the denial of its
Abject poverty is another overriding factor responsible for the spread of
the Ebola in Sierra Leone. In fact in my opinion, it ranks high among the principal
factors of the spread of Ebola. Since most families are extremely poor, they
cannot afford to pay the medical bills of hospitals, and as a result they take their
sick relatives to the traditional healers or to the nurses in the neighbourhood,
people who can accept anything the family of the sick has to offer them. And
interestingly enough, in Sierra Leone, not only nurses treat the sick at their
homes, but also anyone associated with hospitals, especially people like
laboratory technicians, theater assistants and pharmacists. Talking to some of the
doctors and nurses at the Holy Spirit Catholic Hospital in Makeni, they told me
that most of the Ebola infections among the medical personnel emanated not
from their contacts with patients at hospitals, but rather, from treating patients in
houses. And the reason why medical personnel treat the sick at home is not
unconnected to poverty, since they do it to top up their meager salaries.
However, some do it out of sympathy for their poor neighbours.
Poverty plays another role in the current Ebola diffusion. Many homes in
Sierra Leone have the problem of overcrowding and very poor sanitary and toilet
facilities. In fact hygiene, both personal and environmental, is not practiced in
most of the social settings in our country. Apart from the slums, ‘Big Yards’2 are
very common in all the cities and big towns in Sierra Leone. Such habitations litter
Sierra Leone because the poor families cannot afford decent dwelling places and
so they rent such sub-human habitations which are the breeding grounds of many
infectious diseases and the recipe for the transmission of cholera and Ebola. This
explains why you often hear of ten or more people dying from the same ‘house’ in
the reports of the statistics of death by Ebola.
Poverty has another toll in the Ebola deaths in Sierra Leone. This comes
from the quarantined homes whose inhabitants are barred from going out of
their houses to any other place. Based on the extremely high unemployment
percentage in Serra Leone, this ban on the quarantined people make those
people live on the brink of starvation since they cannot fend for themselves by
staying at home. One cannot negate the fact that there are efforts made by the
government and many NGOs and faith based charities to bring food supplies to
these homes, but these are grossly inadequate and sometimes even
inappropriate to the dietary habits of the people. In fact, the survey we
conducted as a university (UNIMAK) has revealed that the poor homes are
discriminated against; the more attractive a quarantined house is or the more
well-to-do a quarantined family is, the more food is supply to that house or
family, and vice versa. As a result of this discrimination some people die in the
quarantined homes, not of Ebola but of starvation. And this also explains why
the people refuse to report of Ebola deaths in their houses. They fear being
quarantined and left without a possibility of being properly and timely supplied
with food and other essential items like money for topping up their phones,
buying batteries for their torches, and many other non-food items they need.
Cultural beliefs and practices also contribute a lot to the exponential
spread of Ebola in Sierra Leone. Principal among these is the washing of corpses.
Following strictly our African traditions, a corpse should not be buried without
being ceremoniously washed by at least five people. From time immemorial, this
has been a practice in Sierra Leone, a practice that many still esteem even in the
face of the current outbreak. Unfortunately, religion is also aiding this tradition.
For some religious sects, the moment a person breaths out his/her last, that
These are clusters of shanty houses built around an open space, where the highly populated inhabitants share
horrible pit toilets that are hardly ever emptied or sanitized.
cadaver should be washed immediately and buried without delay. Some religious
sects even suggest those washing the corpses to smear their faces, hands, feet
with the water spilling over from the cadaver. This is specifically done at the
funeral rites of Imams. And this constitutes for our people a fitting burial. This
traditional ceremonial funeral rite becomes even more Ebola devastating in the
case of the funerals of traditional rulers and the leaders of secret societies. The
funeral of such people is an occult ceremony done at night in the society bush. It
is rumoured that the cadaver of such people is dismembered and some of the
organs used for magic and some other occult practices. In the face of such
practices the rate of infection is unimaginable if such a person dies of Ebola.
All the blame could not be cast upon the people for resorting to traditional
healers when they suspect having contracted the Ebola virus. In the early days of
the outbreak, WHO and other international medical experts openly proclaimed in
international broadcasting stations that Ebola has no known cure. And this
declaration has been picked up by all local media houses, community radio
stations, sensitization jingles, and the like, repeating it like a responsorial psalm
that Ebola is incurable. The logic of the simple minds was to avoid going to the
hospital for Ebola treatment since there is, in their own thinking, no scientific
medicine or remedy to cure the Ebola illness. Therefore, many in the rural areas
sought alternative means to get cures, and so they went to traditional healers and
spiritualists. They, in turn, get infected by these run-away patients.
Blame can also be cast on the commercial motorbike riders, commonly
(called ‘Okada’) for the spread of the Ebola in Sierra Leone. These ‘okada’ riders
carry both the dead and the living Ebola victims on their pillions to practically any
place and at any hour of the day or the night when hired. Since the government
had put out a national ban on private burials of the dead, except by the
government medical burial team, bereaved families who want to dodge this burial
team hire these bike riders to carry their sick and dead to distant locations where
they can be healed, in the case of the sick, or where the dead can be given fitting
burial, a thing that they think the official Ebola burial team does not do. Owing to
the fact that the bike riders are so numerous and found all over the country, this
practice was wide spread. Some of these bike riders sometimes do this act out
charity for their relatives, friends and neighbours. However, some do it purely for
money. It was for this reason that the president of Sierra Leone, Ernest Bai
Koroma, made a press release a couple of months ago restricting the operation of
commercial bikes to run from 7:00 a.m. to 7:00 p.m. This restriction cannot be
applied in the villages where there are no police officers to enforce the
regulation, and so the practice of transporting the sick and the dead on motor
bikes continues unabated in the hinterland thereby propelling the spread of the
Ebola virus.
The Ebola virus has reached this spate of spread in Sierra Leone also
because of the distrust of the nurses in government hospitals by the social
populace. When the outbreak reached such heights, almost all private hospitals,
clinics, dispensaries, etc, were closed down by an official decree of the
government. This closure came as a result of the assumption that their
infrastructures were grossly inadequate do deal with Ebola cases and their
personnel lack the necessary protective gear and knowledge on dealing with
Ebola. Thus the government hospitals, which are very few in the country, were
overwhelmed by the number of patients showing up there. And based on the
number of medical personnel who have lost their lives and who continue to die,
the nurses in the hospitals are completely petrified of contracting the virus. As a
result of this, they tend to be ‘over-protective’ of themselves by disallowing any
proximity with patients. This over-protection boarders with utter neglect of all
patients, Ebola victims or not, whom they just abandon in the hospitals, especially
those patients who do not have a strong social influence or strong personality to
advocate for their treatment.
Coupled with this neglect is the spraying of patients with chlorine, whose
concentration is sometimes too strong or disproportionate. The same thing
happens to Ebola suspect patients carried in the ambulances to the isolation and
treatment centres. Therefore, various accusations have been levied against
medical workers, allegations that they also cause the deaths of some people by
suffocation. As an attendant consequence of this accusation, many people refuse
to take their sick relatives to hospitals or inform the Ebola task force of having a
sick person in their quarantined homes. And as a result, people continue dying in
the country, either of Ebola or of other illnesses.
The spraying of highly concentrated chlorine on Ebola patients when
carried in ambulances has a traumatic effect in the onlookers who vouch not to
be taken to treatment centres on ambulances. Listening to the accounts of the
people of Tambiama in the Gbendembu Ngowahun Chiefdom in Bombali District,
who stood by and looked helplessly at their relatives be sprayed with the
intoxicating chlorine in the ambulances that whisked them away, one could
understand why all those relatives ran away into the bush to avoid being
quarantined and eventually being taken away to treatment centres. This practice
of medical workers putting Ebola suspects in ambulances, spraying them in the
ambulances, closing the doors of the ambulance while they take them to distant
places that sometimes require seven to eight hours along horrible roads is
inexplicable to us. The fear of being treated in such a manner makes people evade
being carried away to treatment centres, thereby causing the rising number of
Ebola deaths.
There have been several instances that Ebola suspects deliberately dodged
the ambulance for fear of dying and being buried in strange land. This has to do
with the African world view, especially on the concept of the dead: we live with
the dead. This is why in the rural settings, the dead are buried in marked graves in
the neighbourhood so that their offspring and siblings can come from the city to
cry over their graves and talk to their dead in their place of rest. Seeing that those
who die in the treatment centres far from home are never taken back home for
burial, some sick patients, together with their family members, decide not to be
taken away from their homes on the basis that if they die, which many believed
they would, they could not be buried in the neighbourhood where their
relatives can point at their graves later on. Automatically, such people who die at
home pose more risk of infecting their surviving relatives.
The massive politicization of the entire Ebola saga also lends a blow on
the efforts of government to curb this outbreak in Sierra Leone. Kailahun district,
where the first incident of Ebola occurred in Sierra Leone was accused of having
brought another calamity into the country. This is because both the
‘ndogbowusu’3 insurrection that provoked the killing of many people in the late
80s in Sierra Leone, and the protracted Civil War in Sierra Leone in the 90s, had
their inception in the same district. There was, therefore, a seeming neglect of the
outbreak by all the powers that be. It took government a considerable length of
time for it to make a public statement and a decision to tackle the outbreak.
This was a violent political upheaval that took place in the Eastern and Southern Province of Sierra Leone in the
80s. It was directed to ousting the then ruling APC party, considered a Northern party, that remained in power for
twenty-four years.
A finger of accusation was also pointed at the APC ruling government by
the SLPP opposition party that the government tacitly neglected the outbreak in
Kailahun. It was purported that Kailahun, a stronghold of the SLPP, was
abandoned to its fate in order to weaken its demography for the population
census due to have been conducted this year, a census that can also determine
the erection of new constituencies or the cancellation or amalgamation of others.
Because of this, the right decision of quarantining the entire the Kailahun district
was not taken on time by the government, probably on the fear of a negative
interpretation of the move by the ‘other side.’4 And since Kailahun district was
not quarantined in the early months of the outbreak, the Ebola virus diffused like
wild fire reaching everywhere in such a country of high social mobility.
Politicization and tribalism play another role in the spread of the Ebola in
Sierra Leone. A negative rumour circulated in the northern province of Sierra
Leone that patients from the tribes of the north (especially the Temnes and the
Limbas) who were taken to Kenema and Kailahun (in the eastern province
dominated by the Mendes), where the only treatment centres of Ebola in the
early months of the outbreak were found, were not only abandoned to their fate,
but even given medical products that hasten them to their graves. This ethnopoliticized rumour stems from another rumour that the Mendes vouched to let
the northern tribes experience the bitterness of Ebola since they, the northerners,
who dominate the present government failed to take the appropriate decisions to
control the outbreak when it started in the ‘Mende line.’ This politicized and
rumour landed a grievous blow on the stride to combat Ebola as a great number
of Ebola patients from the north refused to take the medications and food served
them in Kenema and Kailahun. Medical personnel in the treatment centres in
Kenema and Kailahun and some of the Ebola survivors have confirmed that some
of the deaths were caused by the utter refusal to take the medication and food
offered in these treatment centres, thereby hastening them to their graves.
There is another sad and very unfortunate scenario eating up the frantic
efforts at arresting the Ebola outbreak in Sierra Leone. This has to do with the
power struggle and fight for supremacy among those charged with making
decisions and pointing the road to the end of Ebola. This is typical of Makeni City,
This is a cliché that has emerged in the political arena of Sierra Leone when people refer to the opposite side of
political alliance or political party. This, however, shows how ours is a nation that is highly polarized along political,
regional and tribal lines. And this manifests how everything is politicized in Sierra Leone.
and Bombali District as a whole, where personality conflicts and the struggle for
supremacy among the medical personnel, politicians, traditional rulers and the
so-called echelons of the township engaged in an open show of political intrigues
and the forming of cabals to elbow others while refusing to collaborate together
for the good of the dying masses. It seems the underlying interest behind this
struggle for supremacy is the selfish desire of making money out of the Ebola
response activities. It is an open secret that many in the corridors of power are
turning this saga into a business and money making adventure. The consequence
of this is the distrust and lack of collaboration and coordination of efforts from
certain sectors of the local leadership who are disgruntled.
There has also been a high level of sabotage employed by some
individuals or groups of individuals derailing the efforts of those fighting to put
the outbreak under control. There has emerged recently a sprawl of allegations
that some members of the public clandestinely poison water-wells and spray
homes with toxic chemicals at night. Even though the police made a press release
of not having evidence of someone caught in the act of carrying out such
malicious acts and of not knowing the chemicals used, the fact of the intoxication
of water wells and homes cannot be denied. The incident of the chemical sprayed
at No. 8 Magburaka Road in the city of Makeni is an undeniable evidence of
intoxication which cannot be negated by neither the police nor those who sustain
the allegation as a conspiracy theory. Officials of the University of Makeni have
called on the Sierra Leone Police to step up their security strategies and their
night patrols rather than blatantly negating the perpetuation of the malicious
acts. We have also called on the Sierra Leone Water Company (SALWACO) to do
water analysis on the reported wells to ascertain the veracity of the allegations in
order to avert the death tolls. Whether they are mere allegations or not, the fact
is that these rumours are diverting the attention of the population and the state
officials from the Ebola diffusion, thereby creating utter confusion and a loss of
direction in tackling the outbreak.
It is unbelievable to learn that the spread of the Ebola virus in Sierra
Leone can also be attributed to the callousness of some victims who maliciously
infected others. At the pick of their frustration and the knowledge of an imminent
death awaiting them, some infected victims gathered up their remaining strength,
left their homes and ran into the homes of other people embracing those they
meet their, lying on the beds of other people as a deliberate act of infecting
others so that others can also die with them. Such an act took place at Patebana
Marank village, right in the presence of the Paramount Chief of Bombali Shebora
Chiefdom, P.C. Bai Shebora Kasagna II, and his entourage of sub-chiefs, who were
not only helpless to stop those young men, but utterly shocked and amazed at
such a show of callousness. It was only after a strong appeal from the Paramount
Chief that those young men were dissuaded from their malicious act, but not after
they had already infected many others. This act can suggest why more than one
hundred people died of Ebola from that village.
Another factor contributing to the spread of Ebola in Sierra Leone is the
dishonesty of people in recounting the true nature of their illnesses when they
go to seek medical help either from the hospitals or from the traditional
healers. At the summit of the sensitization of the symptoms of Ebola, medical
personnel and everyone was on the lookout for such symptoms, but some of the
infected victims and their families who bring their sick to be treated in hospitals
or in the homes of nurses and traditional healers do not narrate the true stories
of the symptoms. They would rather present their case as if it is one of malaria or
typhoid fever and some backache. Knowing that they would not be touched or
treated easily if they tell the symptoms of Ebola, they do not even confess of the
vomiting and diarrhoea they experience. And so those health caretakers
unknowingly contract the virus from them.
This current outbreak is still soaring because the mechanisms put in place
for the tracing and isolation of Ebola suspects are too inadequate. The personnel
charged with the duty of tracing people who have come into contact with Ebola
confirmed patients are too limited compared to the geographic scope of the
outbreak; the isolation units called ‘holding centres’ are grossly insufficient and
the quarantined homes are poorly guarded by security personnel. Owing to this,
the carriers of the virus permeate the entire fabric of society carrying the virus
from one location to the other without restraint.
In my quiet moments after reflecting on the entire reasons that fueled this
outbreak, I came realize one outstanding factor responsible for the magnitude of
this outbreak. The love and compassion for one's relatives has blinded many
people from taking the necessary precautions against contracting the virus. The
care for the sick and the vehemently condemned practice of washing dead bodies
contribute a lot to the spread of Ebola in Sierra Leone. Let us empathize with our
people, without justifying them. After several interviews conducted with some of
the people who participated in the ritual washing of dead bodies, and after seeing
the last moments of Ebola victims, I came to realize that the desire to preserve
the dignity of their loved ones propelled them to do such acts.
The death bed of Ebola patients is a dreadful and disgusting sight; excreta,
vomit and blood issues litter all over the body of the patient and his/her bed in a
dehumanizing way. The stench and the sight are awful! No one would like another
person to see his/her loved one lying in that messy situation. Thus, people hastily
tidy up the cadavers of their loved ones and clean up the mess before others
(sympathizers and the burial team) arrive. It is exactly at this point that the virus,
which is hyperactive on cadavers, is transmitted to other people. Thus, the drive
to preserve the dignity of their loved ones and the respect for the dead has lead
immensely to the spread of the Ebola virus in Sierra Leone through the washing
of corpses.
The Ebola virus is leaving in its trail series of social and economic problems.
Some are remote but others are immediate. Among those that are immediate
and that need an urgent attention is the case of orphans. You find them
everywhere Ebola has reached in Sierra Leone. They are not only highly
traumatized by the sudden deaths of both parents, but also rejected and
stigmatized in some instances by their relatives. There is urgent need to train
personnel on psycho-social counseling to help these traumatized survivors.
Another real problem that the Ebola outbreak has left for our nation is
the alarming rate of teenage pregnancy. As participants in the Ebola sensitization
team in the entire Northern Province and Western Area, we have witnessed to
the lamentations of many parents whose teenage girls have been impregnated
during this impasse. Many parents cast the blame on the indefinite closure of
schools following the state of emergency declared by the president of the nation.
They argued that the activity vacuum or idleness of the teenage girls provided the
opportunity for them to resort to sexual activities as an option to keep
themselves busy. Teenage pregnancy during the Ebola period is a national cry,
everywhere one hears it.
This disheartening reality of teenage pregnancy has in turn produced a
general atmosphere of disenchantment on the part of parents. People are
disgruntled against the government on whom they heap accusations of poor
leadership in a crisis moment. Whether their claims are legitimate on not, the
people blame government and all parliamentarians for having brought this
demise on them. It may not surprise us to see a dramatic shift in political
allegiances in the next general elections.
There is also a serious atmosphere of unrest and uneasiness bordering on
trauma in the minds of the relatives of Ebola patients who are being whisked
away to treatment centres. In most cases the relatives are not informed (neither
by the Ministry of Health nor the Ministry of Social Welfare) of the state of their
loved ones, whether they are dead or alive, not even which particular treatment
centres they have been taken to. They live in a state of psychological torture
because of lack of information about the state of their loved ones. The University
of Makeni, in partnership with the Caritas Makeni of the Catholic Church, has set
up what is called Patient Tracer Group charged with the responsibility of tracing
the whereabouts and the state of Ebola patients and informing their relatives
There is also a growing enmity in some rural communities against those
who inform the Ebola Response Team of sick people in the neighbourhood.
Since some patients and families loathe the negativity around the ambulance and
the going to distant hospitals for treatment for the reasons enlisted above, those
informants are frequently being targeted and molested creating a recipe for
reprisals, feuds and vendettas. Such instances breed the potential for chaos in an
already tense and volatile atmosphere.
Apart from the trauma of seeing disgusting sights of the dead and burying
them, the Ebola Burial Team that has an overwhelming number of corpses to
bury on daily bases, is often stigmatized by society. Talking to two of them at the
Ebola Cemetery in Makeni, Unisa Bangura and Bobby, they recounted to me their
fears, their ordeals and their rejection by society and even some of their family
members. Besides the fear of contracting the virus and dying by it as some of
their friends have, in some homes, some of them are not only unwelcome to take
away the dead but also chased away with batons and pelted with stones. Some
of them have been evicted from their homes by their landlords, while some of
them are accused of trading burials for money since the more Ebola victims they
burry the more they are paid. They live in utter frustration for doing a job that
few would venture to undertake. We are heading for a catastrophe if such
courageous heroes are not encouraged and protected to do such a risky job.
Ebola survivors also suffer a similar fate; they are ostracized by their friends and
relatives who do not trust the fact of their being completely healed and not
having the potential of infecting others. For this reason the government has
enacted laws against their discrimination.
The Ebola outbreak is paralyzing the economy of the nation and cutting
the livelihoods of thousands of Sierra Leoneans. Many in the private sector have
lost their jobs as their employments fold up in the wake of the outbreak. Looking
at the pandemic nature of the outbreak, there is hardly any sector of economic
life that has not been crippled: most extractive and agricultural companies have
either shut down or scaled down laying off their employees; the building and
construction industries have been downscaled as well, trade and commerce is
hampered, the social industries, especially the hotel services, are closed. In a
country already found low in the lather of the UN development index, this Ebola
outbreak leaves many more people living on the edge of abject poverty.
Consequently, hardship has overtaken the country and there is a dramatic
upsurge of beggars and people living on charities or depending on their relatives
at home and abroad. The nation is also witnessing to an increase of petty stealing
and robbery because of the massive unemployment that has gripped our nation.
The ripples of the current Ebola outbreak in Sierra Leone shall reach out far
into the food security of the population in the near future. Because of the
outbreak that has affected so many people all over the country, farming
activities have been severely stemmed nationwide. Apart from the loss of the
manpower through death and the fact that so many families were quarantined
and re-quarantined several times, this protracted outbreak has prevented many
people from carrying out their agricultural activities. Some farming families have
not been able either to plant new crops or harvest those already planted because
of the enforced restriction imposed on them. The quarantine follows this
procedure: at the death of someone in a house/compound, all the inhabitants of
that residence, no matter how many households or individuals there may be in it,
are restricted from going out of that residence for a period of twenty-one days. If
another person dies within the ambit of that period, the quarantine begins anew.
In the communities severely hit, it is a disaster and a great setback for those
farming communities. As a result we may be experiencing food shortages in the
near future, especially the local produce.
In life the bad things that happen to us matter, but what matters most is
what we do with what happens to us. The catastrophe of this Ebola outbreak in
the West African sub-region has triggered many thoughts in the minds of people,
both the local and the international community. Many investigative minds have
asked questions which we may not be able to adequately respond to. Some
answers, however, have already been furnished above with reference to the
fundamental questions that provoked the epidemic and pandemic nature of this
Ebola outbreak. What remains to be addressed are the lessons to learn from this
menace and the recommendations to proffer as deterrents to such catastrophes.
Primarily, our health care system and structures need to be strengthened.
In most African governments, health care delivery is not a priority in national
budgets. Sierra Leone needs to step up heavily its health budget, establish and
furnish medical facilities throughout the country, especially in the rural areas.
The government also needs to invest more on the training of more medical
personnel and support their specialization in the African related health hazards.
There is an urgent need to sponsor research on tropical diseases and equip
hospital laboratories with modern equipments to fast track medical tests and
analysis. The remunerations of health workers also need to be improved to allow
our doctors remain in the country or return home after studies other than run
away to other countries where they have a promising future.
Taking a keen look at the prevailing outbreak, it is evident that our nation
needs to embark enormously on public health education. There are existing
health related subjects in all the three levels of education in Serra Leone, the
primary, the secondary and the tertiary. However, there is notable deficiency in
the curricula of these health subjects, a lacuna between our health problems and
the content of material taught in educational institutions. Premium has not been
laid these days on environmental care and personal hygiene, not to talk of
addressing the reality of malaria, typhoid, hepatitis and hypertension, Africa's
silent killers. Unless and until educationists draw up detailed curricula that
address the Ebola virus for the three levels of education and enforce a general
adherence to environmental and personal hygiene for the entire fabric of
society, Sierra Leone shall still be found wanting in her health delivery system.
This is exactly where the University of Makeni has hit the nail on the head. It has
already reviewed its curriculum of the department of Public Health and has laid
the foundations for the establishment of a medical school where Africans and
non-Africans can specialize in tropical medicine and infectious diseases in Africa.
This health education should not only focus on the educational institutions
but the social populace as well. Take a look at some of the unhealthy
environments of some residences across the country, from Freetown across the
coastal communities to the most remote village, and you will discover some of
the reasons why the life span of Sierra Leoneans borders around the age of 40.
Thus, just as we have the 'education corner programme' in the community
radios scattered all over the country, we are also obliged to create the 'health
corner programme' in these broadcasting stations to air health issues
One can deduce from some of the reasons that fueled this outbreak the
uncompromising attachments to our African beliefs, customs and practices. Our
people could not stop denying the existence of Ebola and attributing its deaths to
occult and mysterious reasons, they could not be dissuaded from the washing of
corpses, they could not be stopped from the occult ritual burial of traditional
rulers and the members of secret societies. More than ever, there is a need to remodel some aspects of our African traditions and world view, not only for the
sake of Ebola but also for the sake of doing away with some of our customs and
traditions that can be considered barbaric, horrendous and unethical in
contemporary age. All the major stakeholders in society, the government,
traditional rulers, educationists, anthropologists, NGOs, members of the fourth
estate, etc , should all contribute to introducing new paradigms of culture and
world view in our society. People in the service industry, especially the film
industry, can champion this course. Taking cognizance of this deep rooted
allegiance to our African beliefs and traditions, the Academic Dean of the
University of Makeni had already developed a special module of critical thinking
tailored to imbuing UNIMAK students with the tools for acquiring the ability for
clear, constructive, critical thinking and problem solving. This is creating a
revolution in the minds of young intellectuals who are disseminating it to society.
We presented in this paper the central role of poverty in this Ebola
outbreak. The outbreak could have been contained quiet easily if the percentage
of the poor was not so much high. The fact of people cramping and slumping
together in shanty houses, sharing beds, utensils and unhygienic toilets; the fact
of people not going to hospitals when sick because of not being able to pay basic
hospital bills, etc, are stack realities of poverty and how it contributed immensely
to the dissemination of the Ebola virus. This is therefore a wakeup call for the
government of Sierra Leone and the NGOs working here for the socio-economic
development of rural communities to step up their efforts towards the
eradication of poverty in Sierra Leone. There is no need to comment on the
devastating effects of abject poverty on the quality of life and the mortality rate
of any country.
Even though Sierra Leone may not be regarded as a country notorious for
outrageous criminality, her level of lawlessness is frightening as it permeates
every sector of public and private life. If the social populace had been law abiding
there would not have been this alarming rate of the spread of the virus that has
claimed the lives of 2,163 confirmed deaths5 as of now in Sierra Leone. Despite
the enactment of bye-laws for the control of the Ebola outbreak,6 lawlessness
provided the recipe for the easy transmission of the virus. Take for instance the
lawlessness of the 'okada' riders who carry the Ebola dead and living on their
bikes; of the traditional healers and medical personnel who treat Ebola patients at
home; of the people washing corpses; of those relatives resisting the Ebola
tracing team and burial team; of those burying their dead clandestinely, etc, who
This is the official confirmed figure published by the Ministry of Health and Sanitation on 20th December 2014.
This number shows the victims whose blood samples confirmed them Ebola positive at death. The real number of
deaths cannot be ascertained since many more die in the remote settings far from the reach of the Ebola Response
The Ministry of Local Government and Rural Development, together with the National Council of Paramount
Chiefs, enacted several bye-laws for the prevention of Ebola and other diseases on 11 th August 2014 in order to
curb the widespread of the Ebola virus. These bye-laws have been grossly violated with impunity because the law
enforcement agencies have been overwhelmed by the demand on them to secure the quarantined homes
scattered all over the country. Such lawlessness existed especially on the people washing dead bodies and those
transporting the Ebola sick and dead from one place to another and those harbouring their Ebola-suspect relatives
who flee to them for refuge.
have all contributed to the spread of the Ebola. It is worth-noting that lawlessness
is part of the syndrome of our nation's inability to grow in the manner of
prosperous African countries like Ghana and Kenya. Thus, the government of
Sierra Leone must do a lot towards the enforcement of law and order if she is to
make a breakthrough in the fight against Ebola and her development in general.
In summary, the prevailing outbreak of Ebola in West Africa shall ever
remain in the shadows of history, revealing the shocking truth of some of our
inept and dysfunctional organs of leadership and socio-economic welfare. This
Ebola outbreak compels us, Sierra Leoneans, to strengthen our health care
systems, to eradicate poverty, to shy away from holding unto some of our
traditional beliefs and practices and to reform our education towards reshaping
our African anthropology and world view, our cultural and religious beliefs and
practices, and the political aptitude of our leaders, who are expected to show a
more robust leadership by taking the timely and appropriate decisions in times of
crisis. We call on the echelons steering the fight against Ebola from the medical
wing, the political leaders, the security personnel and the stakeholders of society
to make an examination of conscience on their determination to see the end of
this outbreak. Unless and until there is a concerted effort and real determination
without vested interests, other than those of ending this outbreak, our struggle
shall continue while we watch the poor dying, the orphans increasing in numbers,
the private sector closing down, more people losing their jobs, the economy
depleted, and the entire nation becoming disgruntled and restless while history
hold us responsible for this demise.
Written by: Rev. Fr. Dr. Leonard Omar Bangura
Dean of Academic Affairs, UNIVERSITY OF MAKENI.
December 20, 2014.