From the Editor’s Keyboard

The Ebolarization of Every Death in Sierra Leone

15 September 2014 at 19:52 | 1334 views

By Alhassan Fouard Kanu, Guest Writer, Freetown, Sierra Leone.

The magnitude and spread of the Ebola outbreak in Sierra Leone requires enormous commitment of resources and robust sustained response capacities. The unprecedented outbreak has necessitated the institution of uncomfortable measures in a bid to contain the surge in the spread of the disease. Some of the containment measures include the banning of the operations of mushroom clinics/hospitals to ensure all cases are reported to government health facilities. Another measure is discouraging burial rites undertaken by relatives without proven evidence of the Ebola status of the dead.

Both of these measures have huge implications on authorities as well as to the wider public. Discouraging patients attendance in some of the mushroom health facilities, drug stores and home care by health professional is basically to minimize community exposure to the virus. However, health workers at all service delivery points are grappling with considerable fear in the handling of patients as they perceive any ill person as an Ebola suspect. This suspicion of every patient has negative consequences on demand creation for services. The panic-stricken public is dissuaded from frequenting health facilities even for traditional ailments such as malaria and typhoid fever, fearing that they will be treated with suspicion, and often be tagged as Ebola suspects. Often, suspected individuals are isolated whilst tests are carried out to rule out Ebola. The stigma and discrimination in such circumstances are huge to the individuals and their families. This accounts for the low number of patients at health facilities across the country, as people seek alternative health providers. Those who can ill-afford private clinics would revert to dangerous health seeking behaviours leading to increase in deaths.

In order to prevent or reduce the high level of community exposure through household care and customary burial procedures, every death is now considered Ebola-related. Whilst relatives still have the chance of burying their dead, this will only take place after certain procedures. Firstly, the relatives must, by law, inform the authorities by calling 117 about the death.

The responsible authority, that is the District Health Management Team (DHMT) will send a surveillance team to the home of the deceased. The team carries out a comprehensive history of the deceased, including travelling history and contacts of the deceased. The generated information will guide the process of ascertaining whether the death was secondary to an Ebola infection.

Surveillance is then followed by the collection of a specimen from the body. Swabs are taken and sent to the laboratory for analysis. If the result of the test is negative of the Ebola virus, the body is then handed over to the relatives for burial. If the result proves otherwise, the burial team will step in to firstly disinfect the room/home where the body had laid waiting for hours or days. The body will then be taken by the burial team for processing and burial.

The perceived deprivation among the populace from offering a befitting burial for their loved ones is leading to fear, panic and resistance to such measures. There are occasions where burial teams have been chased away as seen recently in Black Hall Road, Freetown, Shelmingo in Bo and Masongbo in Bombali district.

Most painful in this process is the delayed response of burial teams to attend to the bodies and/or ascertaining the Ebola status of the dead. Bodies sometimes lay waiting for days in houses and there are incidents of youths barricading roads to force officials to collect near-decomposing bodies in their communities.

In response to these lapses, the newly appointed Minister of Health & Sanitation, Dr A.B. Fofanah has stepped in to prevent such ugly situations and above all, to ensure that the dead are treated with the respect they deserve despite their Ebola status. Just one week after his Parliamentary confirmation, the Hon. Minister is working tirelessly with the relevant authorities in the Western Area DHMT and has ensured an increase in the number of burial teams by 100%, with the requisite vehicular support and necessary gears provided. The burial teams are deployed in zones: East, Central and West of Freetown. Modalities are being put in place to ensure laboratory results of swabs from the deceased be made available within hours after collection.

Also being considered is the decentralization of burial sites within Freetown and its environs as only one cemetery is being used at the moment. Where cemeteries across Freetown are used, it will reduce the time of ferrying bodies from distant areas through the terrific traffic in the city to the only designated cemetery. These measures will ensure a speedy response for burials and prevent the embarrassment of bodies left in the street or decomposing in homes.

Should there be unnecessary bottlenecks within government institutions to the handling of burials, I would like to recommend that the task be privatized and handed over to competent entrepreneurs to effectively manage burials within Freetown as seen in the privatization of the cleaning the city which is now being done by Massada.This is to protect the government from the embarrassment of having bodies decomposing in homes or littering the streets. This has the potential of sparking riots in communities.

I would like to commend government for the weekly risk allowances provided for health workers and burial personnel. Health workers are encouraged to adhere to the Nightingale Pledge or Hippocratic Oath as appropriate in the care of Ebola suspects or patients and the dead. As citizens, our prayers and appreciation for those at the fore of this fight as well as adhering to the containment measures are critical to see us successfully through this herculean task of kicking Ebola out of Sierra Leone in the shortest possible time.