Katherine Mueller, IFRC
“We were close. He was my staff. When they called us that he died, it was so painful. Since then, I’ve not been myself. I can’t sleep. I’m very uncomfortable. At the same time I said, okay, the glove I wore, was I well protected? Those are the types of thoughts going through my mind right now. I feel bad.”
Sister Anthonia is from southeast Nigeria but has been on mission in Pendembu, Kailahun district, Sierra Leone for more than two years. She is now grieving the death of a colleague, a young lab technician of 24 years of age, who passed away after coming into contact with a relative suffering from Ebola.
Her grief is evident as we sit outside a small café in the mid-day heat in Kailahun, the epicentre of the Ebola outbreak in this country. “I feel traumatized,” says Anthonia. “He started having feverish conditions, so we were just thinking it was malaria. We’ve been hearing of Ebola; it never crossed our minds that he may be having it.”
The young lab technician was at work attending to a patient when his symptoms started. “He was so meticulous about universal precautions, he was always on his gloves,” stresses Sister Anthonia. By the next morning, his condition had worsened. “He was weak. He had diarrhoea and was vomiting throughout the night.” Health care professionals took him for treatment. “He never came back,” says Anthonia quietly.
Since then, the soft spoken Sister has been trying to cope with the guilt she feels for not having made sure the young man received proper care immediately, and is worried about her own prognosis. “I need counselling. I’m not myself. They said I could not be tested until I start exhibiting any signs of Ebola. Until now I’ve not exhibited anything, but the fact is that mentally, I’m traumatized.”
Emotional and mental anguish are two facets of the ongoing Ebola outbreak which the Sierra Leone Red Cross Society, with support from the International Federation of Red Cross and Red Crescent Societies, is trying to address. “There is a lot of fear surrounding Ebola, and fear causes stigma. While this strategy can protect the individual, it can also break a community,” says Ferdinand Garoff from the Finnish Red Cross Society, who spent weeks in Kailahun district, starting up a psychosocial support programme. “It is therefore vital that we consider every segment of society when offering psychosocial support, ensuring trust is built so that any support provided is effective.”
Time after time, reports have surfaced of Ebola victims, survivors and their families being ostracized by their neighbours. Misperceptions about how Ebola is spread result in many believing a survivor is still contagious. “I lost my grandmother and two young children to Ebola, and I too was positive,” says Wuyata Ngevao, a 20 year old survivor from Masanta village. “When I was discharged from the treatment centre, my neighbours did not come near me, even though I had my papers proving that I no longer had Ebola.”
In Kailahun, 70 Red Cross volunteers are being trained on how to provide psychosocial support. Interventions differ from a natural disaster, where a simple touch or hug can mean so much. Here, touching is frowned upon, as it is through direct contact with the body fluids of an infected person that the highly contagious virus is passed. Through role playing, volunteers are trained to hone their listening skills, encouraging those they are helping to talk through their distress. Similar programmes will be rolled out in six other districts as the Red Cross scales up its response efforts.
Breaking down barriers
In Sierra Leone, community members traditionally bury their own. It usually falls to the women to prepare the body for burial. Part of the practice includes hugging the body to ensure ancestral lines are continued. But it is at death that the Ebola virus is at its strongest. One of the surest ways to help stop the outbreak is to suspend traditional burials. “You’re asking people not to look after their own sick and dying people, which is the opposite of what they do,” says Garoff. “It is not enough to simply tell people not to do something.”
“This is why, when we now enter a community to prepare a body for burial, and after talking with the elders, we invite the family to come and watch our proceedings,” says Daniel James, coordinator of the dead body management team for the Sierra Leone Red Cross Society. “It is safe for them to watch from the window. They see we are treating their loved one with respect and care; that we will stop for a prayer if they so wish. It is not the ideal situation, but it is a compromise. The family can still be involved and we find it helps dispel some of the rumours of what we are doing with the bodies.”
“Hierarchy is very important to respect, to get the permission of the leaders, who are held in high regard,” adds Garoff, who was instrumental in establishing the psychosocial support emergency response unit for the Red Cross globally. “Religious leaders are also quite strong and hold much influence. But we need to make sure we also reach out to those on the margins, such as biker groups who can reach the younger men who may not listen to their elders.”
When engaging communities, whether to help reduce the stigma against a family which has a loved one suffering from Ebola, or to help reintegrate a survivor, Garoff stresses that messaging needs to be simple and context specific. “People generally accept messages that convey positivity,” he says, “messages of hope and trust, that we are in this together, and that by working together we will weather this storm.”