Commentary
By Melbourne Garber, USA.
As this Ebola Virus Disease (EVD) ravages Sierra Leone, Liberia and Guinea we are all praying and hoping that with the now massive international effort to the region, it will eventually be defeated sooner rather than later. The latest projections, if this is not contained quickly, do not bear thinking. This has morphed from an epidemic to a regional pandemic.
However, apart from the obvious concern due to the EVD, interest in expanding my knowledge of the above subject was piqued from a conversation I had in August with Dr. Festus Cole, a Sierra Leonean historian (who had researched epidemics in colonial Sierra Leone), as we discussed the Ebola outbreak after a piano recital we had attended. Being the fledgling that I am when it comes to early Sierra Leone history; I decided to do some research of my own. I have summarized the information I uncovered below and in so doing marveled at some of the similarities between then and now. I also have to acknowledge the research of Ismail Rashid, whose publication in August 2012 on epidemics in colonial Sierra Leone was a good resource. I have written this because I felt it would be useful to highlight the fact that Sierra Leone has had a somewhat tormented past with epidemics and has come through them and thus wanted to compare and contrast them with this latest epidemic.
Since the founding of the Province of Freedom in 1787, there has been a host of different epidemics in Sierra Leone: yellow fever, smallpox and influenza as well as several cholera outbreaks. I have focused on the first three and excluded cholera outbreaks, except to mention the most recent outbreak in 2012 that sickened about 13,000 people in Sierra Leone and Guinea, and killed 392 in Sierra Leone.
Yellow Fever
Yellow fever epidemics were very prevalent in the 19th century and it was more fatal to whites than the settlers and indigenous Africans. The first recorded case of yellow fever in this region was identified in 1764 before the founding of the Province of Freedom and Freetown. The following are the dates I was able to find that referenced a yellow fever epidemic and the fatalities as recorded. The number fatalities stated may not have included any Africans as the records tended to refer white casualties.
Year(s) Fatalities
1815-16 26
1823 89
1825 263
1826 115
1829-1830 11
1837-39 137
1845-47 N/A
1859 100
1862-68 N/A for these years
1872 250
1878 N/A
1884 50
Since the 1900s, once the disease was better understood and a vaccine developed, there appears to have been sporadic instances of yellow fever outbreaks, but nothing rising to the level of an epidemic. The last recorded instances of yellow fever in Sierra Leone were recorded in 2003, 2009 and 2011.
Smallpox
From what I was able to uncover, smallpox epidemics appear to have been more common in Sierra Leone than any other. Historical records also reveal that for many centuries smallpox was the major disease of the day and wiped out many indigenous nations, especially in the Americas. Christopher Fyfe in his book on Sierra Leone referenced smallpox epidemics in 1801, 1824, 1856-1859, 1872 and 1905. There also appears that there was another epidemic in 1829 that killed 285 people. The 20th century saw smallpox outbreaks in 1915-16, 1933, 1946, 1955-56, 1957 (5,000 cases were reported), 1962 and 1967-68 (over 2,800 cases were reported and was the highest reported rate in the world).
During the epidemic in 1915-16, the smallpox outbreak extended throughout the colony and protectorate. Ismail Rashid, writes:The people of the Karene were suspicious and resented colonial medical efforts regarding them as intrusive and restrictive. In many areas, people concealed the disease and refused to accept medical advice. Dr. Woods complained: Every effort was made by chiefs and people to hide not only individual cases but widespread infection in towns and even chiefdoms. Another doctor, Clearkin, reported that Africans pretended to accept advice and ignored it as soon as European medical officers left. Others simply left when the team arrived in their area to administer vaccination. Many people had no experience of vaccination and were afraid of being injected with juju.And additionally:The inhabitants Karene, overwhelmed by the magnitude of the outbreak, resorted to fatalism. Many concluded: Allah has sent it, it was not man’s work.The sense of fatalism was compounded by the outbreak of the deadly Spanish influenza pandemic in 1918.
The eradication of smallpox in Sierra Leone commenced in January 1968. In a paper by Dr. E.C. Cummings, the Chief Medical Officer, titled "The Smallpox Eradication Program in Sierra Leone," he stated that smallpox was more of a rural disease in Sierra Leone and because of the relative inaccessibility and intimate living of the smaller villages, combined with the preparation and burial rituals of infected corpses (sounds familiar!), allowed for the transmission of the disease. By July, approximately 30% of the population had been vaccinated and the eradication program was concluded by May 1969. Once an infection was identified, the whole village was vaccinated and monitored to ensure no new outbreak occurred.
The last case of smallpox in Sierra Leone was recorded on 5 April 1970, 15 months after the eradication program was enacted.
Influenza
According to UN figures, influenza and pneumonia are the second largest causes of fatalities in Sierra Leone after malaria. An influenza epidemic was recorded in Sierra Leone in the 1890s, but though the records indicate it affected the natives in larger numbers; it only recognizes that 10 cases were reported in the British army.
The most significant influenza epidemic in Sierra Leone occurred in 1918. This was known as the Spanish influenza pandemic that ravaged the entire world between 1917 and 1919 and claimed a total of twenty million people in its wake. It arrived in Sierra Leone in August 1918 and was devastating to a country that was just recovering from a smallpox outbreak a couple of years earlier. Within 5 weeks the flu had claimed the lives of 1,072 people. In Freetown, about two-thirds of the local population contracted the flu. Nationally, over 75% of the population was infected and over 2,000 died.
As Dr. Festus Cole wrote in his PhD research: Many areas had mass burials with twenty to thirty corpses sharing the same grave. In Kambia, the graves of the dead stretched for a quarter mile. A false theory that was debunked was that the virulent form of this virus mutated after it arrived in Sierra Leone and spread to Europe. At the same time the flu reached Sierra Leone it also traveled northward to Senegal and the Gambia and southward to Ghana where about 9,000 people died and on to Nigeria, where about 512,000 people lost their lives. Also in South Africa, over a 100,000 people lost their lives.
Conclusion
This Ebola virus appears to have the potential to be more deadly and virulent than anything we have experienced in Sierra Leone or in our region. However, I believe that understanding our history is important to ensure that we learn from it. In our now more inter-connected world and with the rapid access to information and technological advancement, it is my fervent hope that wherever and however a vaccine(s) to eradicate this virus is/are being developed, it is accelerated and made available to the affected populations to ensure that it does not become a global pandemic like the Spanish influenza of 1917-19.
As detailed above, Sierra Leone has had a fair share of epidemics over the last two hundred years, but from the current response to the Ebola outbreak, we have to significantly improve our health system and elevate our educational standards. Cleanliness and lawlessness have to be tackled relentlessly and continued infrastructure development is a necessity.
Sierra Leone cannot afford to do things the way it used to. Things have to change. Let’s kick Ebola out and rebuild our nation.
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