Outside the Beltway

Ebola Continues To Be A Big Problem In Sierra Leone

Doug Mataconis · Friday, November 28, 2014 · 2 comments

While it has largely disappeared from the headlines in the United States, the Ebola crisis continues in Sierra Leone:

While health officials say they are making headway against the Ebola epidemic in neighboring Liberia, the disease is still raging inSierra Leone, despite the big international push. In November alone, the World Health Organization has reported more than 1,800 new cases in this country, about three times as many as in Liberia, which until recently had been the center of the outbreak.

More than six weeks ago, international health officials conceded that they were overwhelmed in Sierra Leone and reluctantly announced a Plan B. Until enough hospital beds could be built here, they pledged to at least help families tend to their sick loved ones at home.

The health officials admitted Plan B was a major defeat, but said the approach would only be temporary and promised to supply basics like protective gloves, painkillers and rehydration salts.

Even that did not happen in Isatu’s case. Nobody brought her food. Nobody brought her any rehydration salts or Tylenol. No health workers ever talked to her about who she might have touched, which means anyone directly connected to her could now be walking through Freetown’s teeming streets, where — despite the government’s A.B.C. campaign, Avoid Body Contact — people continue to give high fives, hug and kiss in public.

Community volunteers said Isatu’s case was the norm, not the exception.

“We have a huge number of death cases,” said Mr. Kabia, the volunteer Ebola coordinator in Isatu’s area, Kissi Town, adding that residents rarely survived because of the slow response.

Discouraged, scared and furious, Sierra Leoneans are taking matters into their own hands. Laid-off teachers (all schools in this country are closed) race around on motorbikes, monitoring the sick. In some villages, informal isolation centers are popping up, with citizens quarantining one another, an incredibly dangerous ad hoc solution being performed without appropriate protection. (United Nations officials say this country is still short hundreds of thousands of protective suits.)

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Sierra Leone has an elaborate Ebola response system — on paper. It starts with a call to 117, the toll-free number for central dispatch. A surveillance team is sent out, then an ambulance takes a patient to a holding center, then blood tests and a proper treatment center where the patient might receive intravenous fluids or other special care.

But the Ebola clinics do not have nearly enough beds, especially in Freetown, and an ambulance will not show up at a sick person’s house unless there is a bed somewhere for that patient. The government says it needs 3,000 beds nationwide but has fewer than half of that now.

Ambulances are hurtling across the country for hours to remote clinics in the east, where there are a few vacancies. The roads are horrendously bumpy; the jungle heat without reprieve. Many patients are dead on arrival.

Western officials are quick to add that even if all the resources were in the right place, that would not stop the virus.

“You can have as many helicopters, ships and kit here as you’d like,” said Lt. Colonel Matt Petersen, a British adviser. “But unless you change behavior, it’s not going to stop transmission.”

Public health professionals are beginning to look harder at Sierra Leone’s culture, which is dominated by secret men’s and women’s societies that have certain rituals, especially around burials. Many people here — just like in other cultures — believe that the afterlife is more important than this one. A proper burial, in which the body is touched and carefully washed, is the best way to ensure a soul reaches its destination.

It is not pure altruism, either. If burial traditions are not followed, people worry they may be haunted by a restless soul. But in a time of Ebola, handling corpses is extremely risky because they are highly infectious. Seventy percent of new cases here, Western officials said, are directly linked to traditional burials.

Kissi Town elders said that their outbreak started in early October after the funeral of a well-known society woman, as members of secret societies are called. Her name was Ya-Wullu, and she was known for handling dead bodies. After Ya-Wullu died from Ebola, an underling insisted on sleeping next to her corpse for three straight days. That second society woman then contracted Ebola too, and it shot through the community, elders said.

“That’s what’s breeding Ebola,” Dr. Songu M’Briwa, a surgeon at a nearby clinic, said. “Secret societies.”

Neighboring Liberia has many of the same secret societies, but some anthropologists said that the Liberian government may have done a better job working with the leaders of secret societies to change burial practices, one possible reason Liberia’s Ebola crisis has been stabilizing.

As long as these cultural practices remain prevalent, then the resources that the West is sending in are only gong to have a limited impact on the spread of the disease. The fact that they have had success in pushing back against these cultural practices in Liberia suggests that it can be accomplished in Sierra Leone as well, but that’s largely going to be something that the government itself will have to do since it is unlikely that outsiders from the West will have much success in that area.