I am writing now from Freetown, Sierra Leone, and on Monday, November 3rd I will get off the plane at Ben Gurion Airport. Have you bought into the Ebola hysteria? Will you be afraid to be in my company? Do you think I should be quarantined before I am set free to walk the streets of Haifa, my home town?
Have I been nervous being here? Yes, to a degree. Am I sorry I came? Heck no! I am in the eye of the epidemic, part of an IsraAID humanitarian team, all of us contributing what we can to help “kick the Ebola virus out of Sierra Leone,” to quote one motto on a street sign here. And I want you to know that Sierra Leone is a lot more than Ebola. I want you to be open to coming here as a tourist when the epidemic will have been conquered and life can slowly start to return to normal. I want you to understand that the remarkable people of Sierra Leone were still licking the wounds of civil war as they made their way into democracy, optimistically seeing prosperity within grasp, when they were suddenly hit with this tragic epidemic. Most of all, I want you to know that the vast majority of people who come here to help do not get the dreaded virus.
This is a country with a well-educated population, many of them Sierra Leoneans who grew up abroad and returned home from the Diaspora a few years ago to contribute to the building of a modern nation. At the same time, about half the adult population is still illiterate and not yet joining the world of today.
The Ebola epidemic has everyone here justifiably scared. People live with a fear that has changed everything about the way they need to go about their daily lives. Signs everywhere tell people not to touch: no handshakes, no hugs, not even brushing up casually against people as you walk down the street as happens in any normal place in the world. Before you enter any building, whether it is a restaurant, hotel, office or government building, store or supermarket, you must wash your hands with either chlorine solution or medicinal strength sanitizing soap. In many places, your temperature is taken before you gain entrance. You should not travel by public transportation or even taxi because you have no way of knowing who sat in the seat before you, nor what they touched in the vehicle.
Kids are home from school, probably due to the fact that they get there by public transport or school buses and because it would be hard to keep them from playing contact sports or getting into fights. They cannot play with a ball, because it passes from one person’s hands to another’s and sweaty palms can transmit the virus. You do not send your kids to play with friends in another house because you cannot be sure all parents are as careful as you are regarding following the rules reducing the chances of infection. However, it is difficult to keep kids indoors all the time and you will see many children out in the streets unsupervised, and these children are usually from the lower uneducated classes.
I can get infected if I run my hands along the banister I use to help me climb up or down a flight of stairs in a public building – if that banister was likewise touched by an infected person who also was already showing symptoms of being sick. In fact, I can catch it if I touch anything that was recently touched (or vomited on, or bled out on, or spit on) by someone who is actively contagious,. And then, only if I have an open sore where I touched the contaminated object, or if I rub my eyes with my now-infected finger or put that finger into my mouth. That is why people here wash their hands and have their temperature taken repeatedly ad nauseum. Just in case.
However, I want to make it clear that the virus has spread not because it is so easy to catch — because it is NOT — but because it was not contained well when the outbreak began. I remember that there was an Ebola scare in Uganda when I was in South Sudan in 2012. In that case, containment was achieved after only 24 people contracted it, and 17 died. That was because Uganda was already well-practiced in responding to the disease and acted quickly.
The fact that the virus has grown to epidemic proportions in Sierra Leone (and I suppose this is partly true for the other West African countries as well) can be attributed to two main dynamics. On the one hand, there is a great deal of suspicion of the government due to still unhealed scars from the civil war. This means that people in outlying areas believed for a long time that rumors of Ebola were just that: rumors, a conspiracy on the part of the government to punish the opposition. That meant that they did not accept the reality of the threat and did not comply with prevention imperatives. This is only now beginning to change.
Secondly, because the culture and traditions that provide meaning and security for the population are in direct conflict with prevention practices, compliance is handicapped. Let me give one simplified example of this (the situation is far too complex to be fully described in a short article): funeral rituals are central to Sierra Leonean societal structure and spirituality. Out of respect, family members lovingly wash the body and prepare it for burial. However, the virus is most virulent in the body fluids of the recently deceased. Therefore handling of the body for traditional burial practices is rife with danger for all involved. Families are supposed to call an official burial team to come and collect the body (if the person died at home) so that it can be handled in a way that prevents spread of the virus. This leaves families, however, unable to mourn according to tradition, putting them into a kind of spiritual limbo, and so many resist. Furthermore, due to serious lapses in communication, families are often not notified of the location of the (unmarked) grave of a loved one buried by authorities. Since visits to family graves comprise an important part of their spiritual lives, there is resistance to cooperating with this decree and some families continue to bury their own dead, thereby falling easy victim to infection.
In Liberia, where rates of infection have supposedly declined, it is theorized, in fact, that people are reporting fewer sick relatives and deaths because Liberia has begun cremating bodies (the best way to handle deceased Ebola patients), something that is abhorrent to West Africans regardless of their religion. Sierra Leone will not take the chance of instituting cremations as the population would be in an uproar against that. It is hard enough to get them to comply with calling for the burial teams.
Furthermore, initial response time was slow because there is little medical or administrative infrastructure in the areas outside the major cities and towns. One positive outcome of this epidemic is that by the time it will have been contained there will potentially be well-functioning medical and mental health service networks throughout the country (IsraAID is here to provide support regarding the psychosocial response to the epidemic and, therefore, to the design and implementation of mental health infrastructure).
I have not been anywhere near an Ebola isolation unit, treatment center or home where families were caring for Ebola-infected relatives; I have not attended a traditional burial ceremony. Therefore, my friends, you do not have to keep me in either official or unofficial quarantine for 21 days after my return home. I promise to go to hospital (it is only a 5-minute walk from where I live) should I have a fever. I will not try to second-guess any fever within that 21-day window, will not assume it is just the flu and take the chance of putting anyone (including myself) at risk. I will consider it good practice if the health ministry sends someone to take my temperature every day during that time; in fact, I would welcome it. That would give me the feeling that proper respect is being given to this deadly virus, without being hysterical about it.