WHY THE FIGHT AGAINST EBOLA IS AN HERCULEAN TASK IN SIERRA LEONE – OUR SIDE OF THE STORY

The unprecedented prevailing outbreak of Ebola in West Africa can properly be described as a conundrum, so confusing and difficult to solve. Many questions have been asked by the inquiring minds with regards to the appearance of this outbreak in this region of Africa where it has never occurred before, and far from where it has always occurred, East Africa, but especially why it has reached such an alarming rate of becoming both an epidemic and a pandemic. The spate of this outbreak, if not stemmed with maximum efforts locally and internationally, has the potential of becoming Africa’s Black Death. The symptoms pointing towards that direction are already evident in the rising death toll, the tripling percentage of new infections which is devastating the lives of many people and debilitating the entire pillars of society.

Apart from the direct and immediate consequences of this hemorrhagic fever, that is, the soaring death toll, this Ebola outbreak is reeling the economies of private and public investments, as many citizens are continually losing their jobs and their means of livelihood, many companies and industries are folding up, amidst the escalation in the prices of the essential goods and services, leaving behind its trail a whole lot of psycho-social problems like traumatized orphans and stigmatized survivors. It also has the potential of triggering social and political upheavals that can bring down governments as the security concerns mount.

The principal aim of this paper is to tell of our story, shocking and scandalous as it may be, in order to bring to the knowledge of the international community the magnitude of this outbreak and its causes. Secondly, this paper aims at provoking the thoughts of the local intelligentsia, especially the Sierra Leonean educationists, and policy makers, to pull together lessons we can learn from this outbreak and to proffer meaningful recommendations to the powers that be for the making of national social welfare policies that can improve the living standards of Sierra Leoneans.

THE PRESENCE OF EBOLA IN THE SUB-REGION

Since its first recorded outbreak in history in the Democratic Republic of Congo in 1976, the Ebola virus was a household name in East Africa, but never in West Africa. Owing to this, this first outbreak in this sub-region of Guinea, Liberia and

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Sierra Leone, has sparked off many diverse debates over its veracity as Ebola. For those who have accepted it to be truly Ebola, it has been a nagging question wondering how it migrated from East Africa to Guinea (West Africa), where it first appeared in February 2014 before spreading to Liberia and Sierra Leone.

However, a credible published research has shown that this sub-region is not devoid of Ebola. The thorough joint research conducted and published by representatives from the US Army Medical Research Institute of Infectious Diseases, Maryland, USA, in partnership with the late Sierra Leonean erudite doctor, Sheik Kumar Khan, of the Kenema Government Hospital, Kenema, Sierra Leone, revealed the latent presence of the Ebola virus together with other deadly viruses like yellow fever, Rift Valley fever, chikungunya, and Marburg in the Gola Rain Forests that boarder these countries.1

THE EXPONENTIAL DIFFUSION

Recently, the WHO has described the alarming rate of infection or transmission of this outbreak as ‘rampant’, and that is exactly what it is. The question, however, that many find puzzling is on the causes of such an exponential diffusion and transmission of the virus. This can be attributed primarily to ignorance or lack of sufficient knowledge about the Ebola virus and its modes of human to human transmission. This ignorance runs across from the government, through the Ministry of Health and its health personnel to the social populace. For the greater majority of Sierra Leoneans, this is the first time of hearing of a sickness called Ebola, not to talk of knowing its fatality and the means of stopping its spread. And so because of this abysmal ignorance the government, the health services and the population lacked the knowledge of stemming it and putting it under control.

This outbreak also reached its overwhelming dimensions on account of our ill equipped and impoverished medical and health care (infra)structures. It is not an exaggeration or pessimism to wonder if there are up to three hospitals in Sierra Leone that one can consider to be good when we view them in the light of 1 EID Journal, Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone, Volume 20, Number 7—July 2014. Let us note, however, that there have been and there continue to be are a number of international TV shows in which some medical personnel and journalists purport that this particular strain of Ebola virus in West Africa is the outcome of a laboratory error rather than a natural outbreak. Can the truth of such allegations be ascertained? It is difficult to tell. The only sure fact is that the precious lives of many innocent and defenseless Africans are lost on daily bases, especially children and women deprived of the most fundamental right, the right to existence, while the entire continent of Africa is continually being depopulated by this Ebola and HIV/AIDS.

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the criteria of WHO and international standards. And even those that we may consider to be good according to our local standards are few and far apart. Those hospitals, with the exception of the Lassa Fever Department of the Kenema Government hospital, have ill equipped and inefficient laboratories to diagnose Ebola. Before the installation of new Ebola testing facilities by the international doctors, the Kenema Lassa Fever Laboratory was overwhelmed with blood samples it could not manager to analyze. The patients of those blood samples had to wait for a couple of days before knowing their Ebola status. In the interim the Ebola positive patients die infecting their medical care takers and their relatives, thereby multiplying the number of infections.

Linked to this impoverished health care system is the acute shortage of ambulances to commute the blood samples of Ebola suspects and the Ebola positive patients, who until the recent intervention of the international doctors, have always been carried away to the Kenema Government Hospital which was the only testing laboratory and the Ebola treatment centre in the country. Bombali District in the northern province of Sierra Leone had only one functioning ambulance when the outbreak reached that district. This acute shortage of ambulances is not peculiar to the Northern Province alone. One can imagine the precarious situation that our nation faced in this current Ebola outbreak. And Kenema itself which is located in the eastern region of Sierra Leone, sometimes require up to six or seven hours of drive to reach from many parts of the country. This gives you a picture of how the health care responses are further derailed. Furthermore, mechanisms were not put in place for the multiple substitutions of the ambulance drivers who are constantly plying the route to Kenema. This led to the somersault of one of the ambulances carrying eight Ebola positive patients from Bombali District to Kenema, adding salt to injury. When questioned on the cause of the accident, the driver bluntly reported that he was over-worked, always carrying blood samples and patients, and had no time to rest, and so he dozed in sleep.

The shortage of ambulances in the hospitals and health centres has another side effect in the rapid spread of the Ebola virus in Sierra Leone. Since the government made it mandatory that the corpses of Ebola patients, and in fact all corpses, should be buried by the Ebola burial team instituted nationwide, this shortage of ambulances and vehicles to convey the dead created a disaster for

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some families who had to keep their dead for up to three days in their homes while waiting for the arrival of the ambulances to bury their dead. In the disgusting sight of the decomposing bodies of their relatives, a thing that is appalling to everyone and everywhere in the world, relatives had to take the risk of burying their dead with the unprotected means available to them. By so doing the virus, which is much more aggressive on cadavers, gets transmitted at ease to others.

Another factor responsible for the exponential diffusion of this Ebola outbreak is the outright denial of the existence of the virus in the early months of the outbreak, and even now, by a greater percentage of the population, and even some medical personnel. The denial of the deadly virus stems from several reasons. We can attribute the first reason to the ignorance of the killing virus. Being a strange phenomenon of successive deaths, the people attribute those deaths to witchcraft, sorcery, generational curses, demonic attacks and some even say it is the wrath of God falling on our nation in order for us to turn our hearts back to God. Such attributions of the deaths by Ebola makes us fall under the theological stage of August Comte’s social positivism, the stage that corresponds to the infantile period of humanity, when events in the physical nature and in mankind were explained through the intervention of supernatural powers and where the natural laws were seen as a manifestation of the will of the gods as they direct the beings of nature. In fact I was taken to a spot at Masuba, the worst hit section of the Northern City of Makeni, where people purport to be the crash spot of the witch plane that caused all those deaths from that part of the city. This denial of Ebola as the agent of the massive deaths and our recoiling to myths and religion for the explanation of this natural phenomenon and calamity has aggravated the spate of the outbreak.

Owing to the fact that the deaths are associated with such mysterious causes, the people resort to traditional healers and sorcerers whom they think can heal them through the power of the spirits. Thus, the denial of the scientific medicine and the resort to the traditional healers further enlarges the circle of infections of new cases of Ebola in Sierra Leone since those traditional healers get infected by the patients and transmit the infection to their apprentices and relatives. This scenario occurs mostly in the rural settings and remote villages which are far from the reach of hospitals and clinics.

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There is another strong reason for the outright denial of the existence of Ebola as the virus killing the masses. This is the distrust and the lack of confidence in the politicians. Banking on the general negative perception of politicians in Sierra Leone on account of their selfishness and insatiable thirst for money and power, the Ebola sensitization moves sparked off divergent reactions from the population, especially the elite, when they learned that each of the 214 parliamentarians of Sierra Leone had received the sum of Le 69,000,000 ($14,000) from the central government for Ebola sensitization in their constituencies. When there was little concrete evidence to show for in the disbursement and utilization of those funds, most people cried foul and accused the politicians of trading the idea of Ebola as a ploy to rake in more money from the international community for their enrichment. And as such the national Ebola sensitization stride was dented and the virus itself was branded ‘unreal.’ On account of this, the real existence of the massive killer virus was questioned and the moves to combat it frustrated. In a society where 70% of the population is illiterate or lack critical thinking, Ebola was dismissed and denied vehemently or explained as some strange plague that has visited our country. Thus, we can see why the outbreak has become both an epidemic and a pandemic in Sierra Leone.

In conjunction with the distrust of the politicians, a strange rumour circulated among the illiterate villagers in many regions of Sierra Leone alleging that the politicians have cooked up the idea of Ebola in order to extract five drums of blood they need to perform ritual sacrifices to consolidate their grip on power for the next general elections due in November 2017. This theory was built on the blood samples taken from the numerous Ebola suspects, blood sent to the Ebola laboratories in the east of Sierra Leone. Such a theory, banal as it may be, made the villagers and the illiterate not to bring their sick to the hospitals; rather, relatives take their sick either to the traditional healers, or to the mushroom clinics or even to nurses and other medical personnel where they are treated in the homes of these healers. One can imagine the fatal consequences of treating patients at home, patients whose Ebola status cannot be determined there and then, and in homes where there are practically no protective mechanisms against contamination. This further explains the magnitude of the spread of Ebola in Sierra Leone.

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The outright denial of the deadly virus has attendant consequences. First among these is that people do not take the necessary precautions of prevention from contracting the virus. The ‘’Don’t Touch’’ or ‘’Avoid Body Contact’’ warnings are not heeded to. And at the face of our intimacy seen in our communal eating and drinking from the same dish and cup, our sharing of beds and even clothing, little would you wonder why this outbreak has reached such an alarming rate. When we also look at our African traditional care for the sick by the extended family, all we see is a myriad of occasions of transmissions of the infections taking place since the primary care takers of the sick and the visiting sympathizers shake hands with the sick, touch their bodies to sound their temperature and sit on the beds of the sick or even share beds with them at night. This scenario gives you an idea of the rate of transmission of the virus as a result of the denial of its existence.

Abject poverty is another overriding factor responsible for the spread of the Ebola in Sierra Leone. In fact in my opinion, it ranks high among the principal factors of the spread of Ebola. Since most families are extremely poor, they cannot afford to pay the medical bills of hospitals, and as a result they take their sick relatives to the traditional healers or to the nurses in the neighbourhood, people who can accept anything the family of the sick has to offer them. And interestingly enough, in Sierra Leone, not only nurses treat the sick at their homes, but also anyone associated with hospitals, especially people like laboratory technicians, theater assistants and pharmacists. Talking to some of the doctors and nurses at the Holy Spirit Catholic Hospital in Makeni, they told me that most of the Ebola infections among the medical personnel emanated not from their contacts with patients at hospitals, but rather, from treating patients in houses. And the reason why medical personnel treat the sick at home is not unconnected to poverty, since they do it to top up their meager salaries. However, some do it out of sympathy for their poor neighbours.

Poverty plays another role in the current Ebola diffusion. Many homes in Sierra Leone have the problem of overcrowding and very poor sanitary and toilet facilities. In fact hygiene, both personal and environmental, is not practiced in most of the social settings in our country. Apart from the slums, ‘Big Yards’2 are very common in all the cities and big towns in Sierra Leone. Such habitations litter 2 These are clusters of shanty houses built around an open space, where the highly populated inhabitants share horrible pit toilets that are hardly ever emptied or sanitized.

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Sierra Leone because the poor families cannot afford decent dwelling places and so they rent such sub-human habitations which are the breeding grounds of many infectious diseases and the recipe for the transmission of cholera and Ebola. This explains why you often hear of ten or more people dying from the same ‘house’ in the reports of the statistics of death by Ebola.

Poverty has another toll in the Ebola deaths in Sierra Leone. This comes from the quarantined homes whose inhabitants are barred from going out of their houses to any other place. Based on the extremely high unemployment percentage in Serra Leone, this ban on the quarantined people make those people live on the brink of starvation since they cannot fend for themselves by staying at home. One cannot negate the fact that there are efforts made by the government and many NGOs and faith based charities to bring food supplies to these homes, but these are grossly inadequate and sometimes even inappropriate to the dietary habits of the people. In fact, the survey we conducted as a university (UNIMAK) has revealed that the poor homes are discriminated against; the more attractive a quarantined house is or the more well-to-do a quarantined family is, the more food is supply to that house or family, and vice versa. As a result of this discrimination some people die in the quarantined homes, not of Ebola but of starvation. And this also explains why the people refuse to report of Ebola deaths in their houses. They fear being quarantined and left without a possibility of being properly and timely supplied with food and other essential items like money for topping up their phones, buying batteries for their torches, and many other non-food items they need.

Cultural beliefs and practices also contribute a lot to the exponential spread of Ebola in Sierra Leone. Principal among these is the washing of corpses. Following strictly our African traditions, a corpse should not be buried without being ceremoniously washed by at least five people. From time immemorial, this has been a practice in Sierra Leone, a practice that many still esteem even in the face of the current outbreak. Unfortunately, religion is also aiding this tradition. For some religious sects, the moment a person breaths out his/her last, that cadaver should be washed immediately and buried without delay. Some religious sects even suggest those washing the corpses to smear their faces, hands, feet with the water spilling over from the cadaver. This is specifically done at the funeral rites of Imams. And this constitutes for our people a fitting burial. This

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traditional ceremonial funeral rite becomes even more Ebola devastating in the case of the funerals of traditional rulers and the leaders of secret societies. The funeral of such people is an occult ceremony done at night in the society bush. It is rumoured that the cadaver of such people is dismembered and some of the organs used for magic and some other occult practices. In the face of such practices the rate of infection is unimaginable if such a person dies of Ebola.

All the blame could not be cast upon the people for resorting to traditional healers when they suspect having contracted the Ebola virus. In the early days of the outbreak, WHO and other international medical experts openly proclaimed in international broadcasting stations that Ebola has no known cure. And this declaration has been picked up by all local media houses, community radio stations, sensitization jingles, and the like, repeating it like a responsorial psalm that Ebola is incurable. The logic of the simple minds was to avoid going to the hospital for Ebola treatment since there is, in their own thinking, no scientific medicine or remedy to cure the Ebola illness. Therefore, many in the rural areas sought alternative means to get cures, and so they went to traditional healers and spiritualists. They, in turn, get infected by these run-away patients.

Blame can also be cast on the commercial motorbike riders, commonly (called ‘Okada’) for the spread of the Ebola in Sierra Leone. These ‘okada’ riders carry both the dead and the living Ebola victims on their pillions to practically any place and at any hour of the day or the night when hired. Since the government had put out a national ban on private burials of the dead, except by the government medical burial team, bereaved families who want to dodge this burial team hire these bike riders to carry their sick and dead to distant locations where they can be healed, in the case of the sick, or where the dead can be given fitting burial, a thing that they think the official Ebola burial team does not do. Owing to the fact that the bike riders are so numerous and found all over the country, this practice was wide spread. Some of these bike riders sometimes do this act out charity for their relatives, friends and neighbours. However, some do it purely for money. It was for this reason that the president of Sierra Leone, Ernest Bai Koroma, made a press release a couple of months ago restricting the operation of commercial bikes to run from 7:00 a.m. to 7:00 p.m. This restriction cannot be applied in the villages where there are no police officers to enforce the regulation, and so the practice of transporting the sick and the dead on motor bikes

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continues unabated in the hinterland thereby propelling the spread of the Ebola virus.

The Ebola virus has reached this spate of spread in Sierra Leone also because of the distrust of the nurses in government hospitals by the social populace. When the outbreak reached such heights, almost all private hospitals, clinics, dispensaries, etc, were closed down by an official decree of the government. This closure came as a result of the assumption that their infrastructures were grossly inadequate do deal with Ebola cases and their personnel lack the necessary protective gear and knowledge on dealing with Ebola. Thus the government hospitals, which are very few in the country, were overwhelmed by the number of patients showing up there. And based on the number of medical personnel who have lost their lives and who continue to die, the nurses in the hospitals are completely petrified of contracting the virus. As a result of this, they tend to be ‘over-protective’ of themselves by disallowing any proximity with patients. This over-protection boarders with utter neglect of all patients, Ebola victims or not, whom they just abandon in the hospitals, especially those patients who do not have a strong social influence or strong personality to advocate for their treatment.

Coupled with this neglect is the spraying of patients with chlorine, whose concentration is sometimes too strong or disproportionate. The same thing happens to Ebola suspect patients carried in the ambulances to the isolation and treatment centres. Therefore, various accusations have been levied against medical workers, allegations that they also cause the deaths of some people by suffocation. As an attendant consequence of this accusation, many people refuse to take their sick relatives to hospitals or inform the Ebola task force of having a sick person in their quarantined homes. And as a result, people continue dying in the country, either of Ebola or of other illnesses.

The spraying of highly concentrated chlorine on Ebola patients when carried in ambulances has a traumatic effect in the onlookers who vouch not to be taken to treatment centres on ambulances. Listening to the accounts of the people of Tambiama in the Gbendembu Ngowahun Chiefdom in Bombali District, who stood by and looked helplessly at their relatives be sprayed with the intoxicating chlorine in the ambulances that whisked them away, one could understand why all those relatives ran away into the bush to avoid being

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quarantined and eventually being taken away to treatment centres. This practice of medical workers putting Ebola suspects in ambulances, spraying them in the ambulances, closing the doors of the ambulance while they take them to distant places that sometimes require seven to eight hours along horrible roads is inexplicable to us. The fear of being treated in such a manner makes people evade being carried away to treatment centres, thereby causing the rising number of Ebola deaths.

There have been several instances that Ebola suspects deliberately dodged the ambulance for fear of dying and being buried in strange land. This has to do with the African world view, especially on the concept of the dead: we live with the dead. This is why in the rural settings, the dead are buried in marked graves in the neighbourhood so that their offspring and siblings can come from the city to cry over their graves and talk to their dead in their place of rest. Seeing that those who die in the treatment centres far from home are never taken back home for burial, some sick patients, together with their family members, decide not to be taken away from their homes on the basis that if they die, which many believed they would, they could not be buried in the neighbourhood where their relatives can point at their graves later on. Automatically, such people who die at home pose more risk of infecting their surviving relatives.

The massive politicization of the entire Ebola saga also lends a blow on the efforts of government to curb this outbreak in Sierra Leone. Kailahun district, where the first incident of Ebola occurred in Sierra Leone was accused of having brought another calamity into the country. This is because both the ‘ndogbowusu’3 insurrection that provoked the killing of many people in the late 80s in Sierra Leone, and the protracted Civil War in Sierra Leone in the 90s, had their inception in the same district. There was, therefore, a seeming neglect of the outbreak by all the powers that be. It took government a considerable length of time for it to make a public statement and a decision to tackle the outbreak.

A finger of accusation was also pointed at the APC ruling government by the SLPP opposition party that the government tacitly neglected the outbreak in Kailahun. It was purported that Kailahun, a stronghold of the SLPP, was abandoned to its fate in order to weaken its demography for the population 3 This was a violent political upheaval that took place in the Eastern and Southern Province of Sierra Leone in the 80s. It was directed to ousting the then ruling APC party, considered a Northern party, that remained in power for twenty-four years.

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census due to have been conducted this year, a census that can also determine the erection of new constituencies or the cancellation or amalgamation of others. Because of this, the right decision of quarantining the entire the Kailahun district was not taken on time by the government, probably on the fear of a negative interpretation of the move by the ‘other side.’4 And since Kailahun district was not quarantined in the early months of the outbreak, the Ebola virus diffused like wild fire reaching everywhere in such a country of high social mobility.

Politicization and tribalism play another role in the spread of the Ebola in Sierra Leone. A negative rumour circulated in the northern province of Sierra Leone that patients from the tribes of the north (especially the Temnes and the Limbas) who were taken to Kenema and Kailahun (in the eastern province dominated by the Mendes), where the only treatment centres of Ebola in the early months of the outbreak were found, were not only abandoned to their fate, but even given medical products that hasten them to their graves. This ethno-politicized rumour stems from another rumour that the Mendes vouched to let the northern tribes experience the bitterness of Ebola since they, the northerners, who dominate the present government failed to take the appropriate decisions to control the outbreak when it started in the ‘Mende line.’ This politicized and rumour landed a grievous blow on the stride to combat Ebola as a great number of Ebola patients from the north refused to take the medications and food served them in Kenema and Kailahun. Medical personnel in the treatment centres in Kenema and Kailahun and some of the Ebola survivors have confirmed that some of the deaths were caused by the utter refusal to take the medication and food offered in these treatment centres, thereby hastening them to their graves.

There is another sad and very unfortunate scenario eating up the frantic efforts at arresting the Ebola outbreak in Sierra Leone. This has to do with the power struggle and fight for supremacy among those charged with making decisions and pointing the road to the end of Ebola. This is typical of Makeni City, and Bombali District as a whole, where personality conflicts and the struggle for supremacy among the medical personnel, politicians, traditional rulers and the so-called echelons of the township engaged in an open show of political intrigues and the forming of cabals to elbow others while refusing to collaborate together

4 This is a cliché that has emerged in the political arena of Sierra Leone when people refer to the opposite side of political alliance or political party. This, however, shows how ours is a nation that is highly polarized along political, regional and tribal lines. And this manifests how everything is politicized in Sierra Leone.

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for the good of the dying masses. It seems the underlying interest behind this struggle for supremacy is the selfish desire of making money out of the Ebola response activities. It is an open secret that many in the corridors of power are turning this saga into a business and money making adventure. The consequence of this is the distrust and lack of collaboration and coordination of efforts from certain sectors of the local leadership who are disgruntled.

There has also been a high level of sabotage employed by some individuals or groups of individuals derailing the efforts of those fighting to put the outbreak under control. There has emerged recently a sprawl of allegations that some members of the public clandestinely poison water-wells and spray homes with toxic chemicals at night. Even though the police made a press release of not having evidence of someone caught in the act of carrying out such malicious acts and of not knowing the chemicals used, the fact of the intoxication of water wells and homes cannot be denied. The incident of the chemical sprayed at No. 8 Magburaka Road in the city of Makeni is an undeniable evidence of intoxication which cannot be negated by neither the police nor those who sustain the allegation as a conspiracy theory. Officials of the University of Makeni have called on the Sierra Leone Police to step up their security strategies and their night patrols rather than blatantly negating the perpetuation of the malicious acts. We have also called on the Sierra Leone Water Company (SALWACO) to do water analysis on the reported wells to ascertain the veracity of the allegations in order to avert the death tolls. Whether they are mere allegations or not, the fact is that these rumours are diverting the attention of the population and the state officials from the Ebola diffusion, thereby creating utter confusion and a loss of direction in tackling the outbreak.

It is unbelievable to learn that the spread of the Ebola virus in Sierra Leone can also be attributed to the callousness of some victims who maliciously infected others. At the pick of their frustration and the knowledge of an imminent death awaiting them, some infected victims gathered up their remaining strength, left their homes and ran into the homes of other people embracing those they meet their, lying on the beds of other people as a deliberate act of infecting others so that others can also die with them. Such an act took place at Patebana Marank village, right in the presence of the Paramount Chief of Bombali Shebora Chiefdom, P.C. Bai Shebora Kasagna II, and his entourage of sub-chiefs, who were

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not only helpless to stop those young men, but utterly shocked and amazed at such a show of callousness. It was only after a strong appeal from the Paramount Chief that those young men were dissuaded from their malicious act, but not after they had already infected many others. This act can suggest why more than one hundred people died of Ebola from that village.

Another factor contributing to the spread of Ebola in Sierra Leone is the dishonesty of people in recounting the true nature of their illnesses when they go to seek medical help either from the hospitals or from the traditional healers. At the summit of the sensitization of the symptoms of Ebola, medical personnel and everyone was on the lookout for such symptoms, but some of the infected victims and their families who bring their sick to be treated in hospitals or in the homes of nurses and traditional healers do not narrate the true stories of the symptoms. They would rather present their case as if it is one of malaria or typhoid fever and some backache. Knowing that they would not be touched or treated easily if they tell the symptoms of Ebola, they do not even confess of the vomiting and diarrhoea they experience. And so those health caretakers unknowingly contract the virus from them.

This current outbreak is still soaring because the mechanisms put in place for the tracing and isolation of Ebola suspects are too inadequate. The personnel charged with the duty of tracing people who have come into contact with Ebola confirmed patients are too limited compared to the geographic scope of the outbreak; the isolation units called ‘holding centres’ are grossly insufficient and the quarantined homes are poorly guarded by security personnel. Owing to this, the carriers of the virus permeate the entire fabric of society carrying the virus from one location to the other without restraint.

In my quiet moments after reflecting on the entire reasons that fueled this outbreak, I came realize one outstanding factor responsible for the magnitude of this outbreak. The love and compassion for one's relatives has blinded many people from taking the necessary precautions against contracting the virus. The care for the sick and the vehemently condemned practice of washing dead bodies contribute a lot to the spread of Ebola in Sierra Leone. Let us empathize with our people, without justifying them. After several interviews conducted with some of the people who participated in the ritual washing of dead bodies, and after seeing

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the last moments of Ebola victims, I came to realize that the desire to preserve the dignity of their loved ones propelled them to do such acts.

The death bed of Ebola patients is a dreadful and disgusting sight; excreta, vomit and blood issues litter all over the body of the patient and his/her bed in a dehumanizing way. The stench and the sight are awful! No one would like another person to see his/her loved one lying in that messy situation. Thus, people hastily tidy up the cadavers of their loved ones and clean up the mess before others (sympathizers and the burial team) arrive. It is exactly at this point that the virus, which is hyperactive on cadavers, is transmitted to other people. Thus, the drive to preserve the dignity of their loved ones and the respect for the dead has lead immensely to the spread of the Ebola virus in Sierra Leone through the washing of corpses.

THE EFFECCTS OF EBOLA IN THIS IMPOVERISHED NATION

The Ebola virus is leaving in its trail series of social and economic problems. Some are remote but others are immediate. Among those that are immediate and that need an urgent attention is the case of orphans. You find them everywhere Ebola has reached in Sierra Leone. They are not only highly traumatized by the sudden deaths of both parents, but also rejected and stigmatized in some instances by their relatives. There is urgent need to train personnel on psycho-social counseling to help these traumatized survivors.

Another real problem that the Ebola outbreak has left for our nation is the alarming rate of teenage pregnancy. As participants in the Ebola sensitization team in the entire Northern Province and Western Area, we have witnessed to the lamentations of many parents whose teenage girls have been impregnated during this impasse. Many parents cast the blame on the indefinite closure of schools following the state of emergency declared by the president of the nation. They argued that the activity vacuum or idleness of the teenage girls provided the opportunity for them to resort to sexual activities as an option to keep themselves busy. Teenage pregnancy during the Ebola period is a national cry, everywhere one hears it.

This disheartening reality of teenage pregnancy has in turn produced a general atmosphere of disenchantment on the part of parents. People are disgruntled against the government on whom they heap accusations of poor

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leadership in a crisis moment. Whether their claims are legitimate on not, the people blame government and all parliamentarians for having brought this demise on them. It may not surprise us to see a dramatic shift in political allegiances in the next general elections.

There is also a serious atmosphere of unrest and uneasiness bordering on trauma in the minds of the relatives of Ebola patients who are being whisked away to treatment centres. In most cases the relatives are not informed (neither by the Ministry of Health nor the Ministry of Social Welfare) of the state of their loved ones, whether they are dead or alive, not even which particular treatment centres they have been taken to. They live in a state of psychological torture because of lack of information about the state of their loved ones. The University of Makeni, in partnership with the Caritas Makeni of the Catholic Church, has set up what is called Patient Tracer Group charged with the responsibility of tracing the whereabouts and the state of Ebola patients and informing their relatives duly.

There is also a growing enmity in some rural communities against those who inform the Ebola Response Team of sick people in the neighbourhood. Since some patients and families loathe the negativity around the ambulance and the going to distant hospitals for treatment for the reasons enlisted above, those informants are frequently being targeted and molested creating a recipe for reprisals, feuds and vendettas. Such instances breed the potential for chaos in an already tense and volatile atmosphere.

Apart from the trauma of seeing disgusting sights of the dead and burying them, the Ebola Burial Team that has an overwhelming number of corpses to bury on daily bases, is often stigmatized by society. Talking to two of them at the Ebola Cemetery in Makeni, Unisa Bangura and Bobby, they recounted to me their fears, their ordeals and their rejection by society and even some of their family members. Besides the fear of contracting the virus and dying by it as some of their friends have, in some homes, some of them are not only unwelcome to take away the dead but also chased away with batons and pelted with stones. Some of them have been evicted from their homes by their landlords, while some of them are accused of trading burials for money since the more Ebola victims they burry the more they are paid. They live in utter frustration for doing a job that few would venture to undertake. We are heading for a catastrophe if such courageous

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heroes are not encouraged and protected to do such a risky job. Ebola survivors also suffer a similar fate; they are ostracized by their friends and relatives who do not trust the fact of their being completely healed and not having the potential of infecting others. For this reason the government has enacted laws against their discrimination.

The Ebola outbreak is paralyzing the economy of the nation and cutting the livelihoods of thousands of Sierra Leoneans. Many in the private sector have lost their jobs as their employments fold up in the wake of the outbreak. Looking at the pandemic nature of the outbreak, there is hardly any sector of economic life that has not been crippled: most extractive and agricultural companies have either shut down or scaled down laying off their employees; the building and construction industries have been downscaled as well, trade and commerce is hampered, the social industries, especially the hotel services, are closed. In a country already found low in the lather of the UN development index, this Ebola outbreak leaves many more people living on the edge of abject poverty. Consequently, hardship has overtaken the country and there is a dramatic upsurge of beggars and people living on charities or depending on their relatives at home and abroad. The nation is also witnessing to an increase of petty stealing and robbery because of the massive unemployment that has gripped our nation.

The ripples of the current Ebola outbreak in Sierra Leone shall reach out far into the food security of the population in the near future. Because of the outbreak that has affected so many people all over the country, farming activities have been severely stemmed nationwide. Apart from the loss of the manpower through death and the fact that so many families were quarantined and re-quarantined several times, this protracted outbreak has prevented many people from carrying out their agricultural activities. Some farming families have not been able either to plant new crops or harvest those already planted because of the enforced restriction imposed on them. The quarantine follows this procedure: at the death of someone in a house/compound, all the inhabitants of that residence, no matter how many households or individuals there may be in it, are restricted from going out of that residence for a period of twenty-one days. If another person dies within the ambit of that period, the quarantine begins anew. In the communities severely hit, it is a disaster and a great setback for those

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farming communities. As a result we may be experiencing food shortages in the near future, especially the local produce.

LESSONS TO BE DRAWN FROM THIS OUTBREAK AND THINGS TO BE DONE IN ADDRESSING IT

In life the bad things that happen to us matter, but what matters most is what we do with what happens to us. The catastrophe of this Ebola outbreak in the West African sub-region has triggered many thoughts in the minds of people, both the local and the international community. Many investigative minds have asked questions which we may not be able to adequately respond to. Some answers, however, have already been furnished above with reference to the fundamental questions that provoked the epidemic and pandemic nature of this Ebola outbreak. What remains to be addressed are the lessons to learn from this menace and the recommendations to proffer as deterrents to such catastrophes.

Primarily, our health care system and structures need to be strengthened. In most African governments, health care delivery is not a priority in national budgets. Sierra Leone needs to step up heavily its health budget, establish and furnish medical facilities throughout the country, especially in the rural areas. The government also needs to invest more on the training of more medical personnel and support their specialization in the African related health hazards. There is an urgent need to sponsor research on tropical diseases and equip hospital laboratories with modern equipments to fast track medical tests and analysis. The remunerations of health workers also need to be improved to allow our doctors remain in the country or return home after studies other than run away to other countries where they have a promising future.

Taking a keen look at the prevailing outbreak, it is evident that our nation needs to embark enormously on public health education. There are existing health related subjects in all the three levels of education in Serra Leone, the primary, the secondary and the tertiary. However, there is notable deficiency in the curricula of these health subjects, a lacuna between our health problems and the content of material taught in educational institutions. Premium has not been laid these days on environmental care and personal hygiene, not to talk of addressing the reality of malaria, typhoid, hepatitis and hypertension, Africa's

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silent killers. Unless and until educationists draw up detailed curricula that address the Ebola virus for the three levels of education and enforce a general adherence to environmental and personal hygiene for the entire fabric of society, Sierra Leone shall still be found wanting in her health delivery system. This is exactly where the University of Makeni has hit the nail on the head. It has already reviewed its curriculum of the department of Public Health and has laid the foundations for the establishment of a medical school where Africans and non-Africans can specialize in tropical medicine and infectious diseases in Africa.

This health education should not only focus on the educational institutions but the social populace as well. Take a look at some of the unhealthy environments of some residences across the country, from Freetown across the coastal communities to the most remote village, and you will discover some of the reasons why the life span of Sierra Leoneans borders around the age of 40. Thus, just as we have the 'education corner programme' in the community radios scattered all over the country, we are also obliged to create the 'health corner programme' in these broadcasting stations to air health issues nationwide.

One can deduce from some of the reasons that fueled this outbreak the uncompromising attachments to our African beliefs, customs and practices. Our people could not stop denying the existence of Ebola and attributing its deaths to occult and mysterious reasons, they could not be dissuaded from the washing of corpses, they could not be stopped from the occult ritual burial of traditional rulers and the members of secret societies. More than ever, there is a need to re-model some aspects of our African traditions and world view, not only for the sake of Ebola but also for the sake of doing away with some of our customs and traditions that can be considered barbaric, horrendous and unethical in contemporary age. All the major stakeholders in society, the government, traditional rulers, educationists, anthropologists, NGOs, members of the fourth estate, etc , should all contribute to introducing new paradigms of culture and world view in our society. People in the service industry, especially the film industry, can champion this course. Taking cognizance of this deep rooted allegiance to our African beliefs and traditions, the Academic Dean of the University of Makeni had already developed a special module of critical thinking tailored to imbuing UNIMAK students with the tools for acquiring the ability for

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clear, constructive, critical thinking and problem solving. This is creating a revolution in the minds of young intellectuals who are disseminating it to society.

We presented in this paper the central role of poverty in this Ebola outbreak. The outbreak could have been contained quiet easily if the percentage of the poor was not so much high. The fact of people cramping and slumping together in shanty houses, sharing beds, utensils and unhygienic toilets; the fact of people not going to hospitals when sick because of not being able to pay basic hospital bills, etc, are stack realities of poverty and how it contributed immensely to the dissemination of the Ebola virus. This is therefore a wakeup call for the government of Sierra Leone and the NGOs working here for the socio-economic development of rural communities to step up their efforts towards the eradication of poverty in Sierra Leone. There is no need to comment on the devastating effects of abject poverty on the quality of life and the mortality rate of any country.

Even though Sierra Leone may not be regarded as a country notorious for outrageous criminality, her level of lawlessness is frightening as it permeates every sector of public and private life. If the social populace had been law abiding there would not have been this alarming rate of the spread of the virus that has claimed the lives of 2,163 confirmed deaths5 as of now in Sierra Leone. Despite the enactment of bye-laws for the control of the Ebola outbreak,6 lawlessness provided the recipe for the easy transmission of the virus. Take for instance the lawlessness of the 'okada' riders who carry the Ebola dead and living on their bikes; of the traditional healers and medical personnel who treat Ebola patients at home; of the people washing corpses; of those relatives resisting the Ebola tracing team and burial team; of those burying their dead clandestinely, etc, who have all contributed to the spread of the Ebola. It is worth-noting that lawlessness is part of the syndrome of our nation's inability to grow in the manner of

5 This is the official confirmed figure published by the Ministry of Health and Sanitation on 20 th December 2014. This number shows the victims whose blood samples confirmed them Ebola positive at death. The real number of deaths cannot be ascertained since many more die in the remote settings far from the reach of the Ebola Response Team. 6 The Ministry of Local Government and Rural Development, together with the National Council of Paramount Chiefs, enacted several bye-laws for the prevention of Ebola and other diseases on 11 th August 2014 in order to curb the widespread of the Ebola virus. These bye-laws have been grossly violated with impunity because the law enforcement agencies have been overwhelmed by the demand on them to secure the quarantined homes scattered all over the country. Such lawlessness existed especially on the people washing dead bodies and those transporting the Ebola sick and dead from one place to another and those harbouring their Ebola-suspect relatives who flee to them for refuge.

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prosperous African countries like Ghana and Kenya. Thus, the government of Sierra Leone must do a lot towards the enforcement of law and order if she is to make a breakthrough in the fight against Ebola and her development in general.

In summary, the prevailing outbreak of Ebola in West Africa shall ever remain in the shadows of history, revealing the shocking truth of some of our inept and dysfunctional organs of leadership and socio-economic welfare. This Ebola outbreak compels us, Sierra Leoneans, to strengthen our health care systems, to eradicate poverty, to shy away from holding unto some of our traditional beliefs and practices and to reform our education towards reshaping our African anthropology and world view, our cultural and religious beliefs and practices, and the political aptitude of our leaders, who are expected to show a more robust leadership by taking the timely and appropriate decisions in times of crisis. We call on the echelons steering the fight against Ebola from the medical wing, the political leaders, the security personnel and the stakeholders of society to make an examination of conscience on their determination to see the end of this outbreak. Unless and until there is a concerted effort and real determination without vested interests, other than those of ending this outbreak, our struggle shall continue while we watch the poor dying, the orphans increasing in numbers, the private sector closing down, more people losing their jobs, the economy depleted, and the entire nation becoming disgruntled and restless while history hold us responsible for this demise.

Written by: Rev. Fr. Dr. Leonard Omar Bangura

Dean of Academic Affairs, UNIVERSITY OF MAKENI.

December 20, 2014.

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