“Ebola Stops With Me”

(a slogan that’s ubiquitous around Freetown-painted on walls and printed on t-shirts worn by locals manning checkpoints, armed with thermometers and hand sanitizers)

I was joined by an American doctor working for WHO (World Health Organization) for dinner the other night. He’d clearly had a brutal day.

His job is to trace contacts of Ebola patients. He goes to the homes of patients and tries to find everyone the patient would have come into contact with whilst infected. That day, he’d gone to the slums near the beach looking for a certain contact. He was asking people where the man lived and the neighbors pointed to a shelter made of tin that was about 4′ X 4′. They named four different people, including the contact in question. The doctor said “no, no, four men can’t possibly live in there”. They all said yes, they live here. “Surely there’s a misunderstanding”, the doctor repeated, “four men can’t possibly live in there and I need to know specifically where this man lived and who lived with him”.

One of the neighbors turned to him and said “this is Africa, doctor”.

It was one of those moments that hits you like a ton of bricks.

Of course, four adult men live in a space unfit for shelter the size of a toilet room. Just like another recent case that came from an area where more than 80 people were sharing one latrine.

“This is Africa, doctor”.

He continued with the visit and uncovered some frustrating information.

When a person dies at home, the number 117 should be called immediately for a safe burial team to arrive and take the corpse. What we’re finding is that transmission is still occurring for unsafe burials despite widespread messaging on 117 and safe burial teams. What the doctor found out was that people are delaying the 117 call in order to complete the traditional preparation of bodies (washing) before their loved ones are taken away and never seen again.

Washing dead bodies is the number one cause of Ebola transmission.

This is so frustrating to learn as it feels like a major step backwards after all of the sensitization around burials. There are signs all over Freetown that say “Save Yourself Do Not Touch or Wash Dead Bodies”.

And yet here we are, 11 months since the index case in Sierra Leone, and we are still battling this. It shows just how difficult it is to change behavior especially with regards to such sensitive traditions and beliefs.

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