Fighting back: the unsung heroes of the battle against Ebola

Written by Kieran McConville

In the late summer of 2014, as the outbreak of Ebola gathered pace in the West African nation of Sierra Leone, a decision was taken by its government to make it mandatory that everyone who died in the capital, Freetown, be given a “medical burial” within 24 hours. Such burials involved teams dressed in full protective clothing removing and burying the body in a designated cemetery.

It is estimated that up to 80 percent of Ebola transmissions… were the result of contact with dead bodies.

By late October the outbreak had reached critical levels, and Concern Worldwide was asked to step in and help manage the burial teams and the cemeteries. Since then, Concern has overseen the burial of over 15,000 people in Freetown and the surrounding area.

This is the story of one such burial team:

Distress

The arrival of the Ebola virus has disrupted many of the cultural and societal norms in Sierra Leone. The prohibition on large gatherings and the guidelines for avoiding bodily contact have been difficult for a people who are usually highly social and interactive. But the restrictions placed on the families of people who have died — whether as a result of Ebola or not — have caused particular distress.

Community members watch a burial team at work

Community members look on as Concern Worldwide’s Burial Team 7 attends the home of a 44-year-old woman in Freetown who has recently died, probably from Ebola. Photo: Kieran McConville.

Contagion

Traditionally, there is a lot of complex ceremony that surrounds the death, wake, and burial of a loved one. Much of this involves friends and family touching the body. The high risk of post-mortem contagion was the main reason for the introduction of medical burials. According to some studies, a body can remain contagious for up to a week after death, and it is estimated that up to 80 percent of Ebola transmissions in Sierra Leone’s Western Area (essentially Freetown and its surrounding area) were the result of contact with dead bodies.

Since Concern took over, 98% of burials are considered safe.

Members of "Burial Team 7" remove the body of a 44-year-old woman

Members of Burial Team 7 remove the body of a 44-year-old woman from her home in Freetown. It is suspected that she died of Ebola. Photo: Kieran McConville.

Burial teams

By the beginning of 2015, Concern was managing 14 burial teams of 12 members each. In addition, it was managing 100 cemetery workers who dig and maintain graves at the two operational burial grounds in Western Area. In the initial days of the outbreak, burial teams were working seven days a week and for extremely long hours, yet less than a third of burials were considered safe. Since Concern took over, 98% of burials are considered safe, the roster has become much more flexible, and wages have been regularized. In addition, a dedicated welfare officer was put in place, and counseling made available to team members. Many burial team members were ostracized from their families and communities as a result of their association with the virus, and Concern has been working with communities to counteract stigma and foster recognition of the immense sacrifice these men have made, and continue to make every day.

Members of Concern Worldwide's Burial Team 6

Concern Worldwide’s Burial Team 6 at Murraytown Barracks in Freetown. Photo: Kieran McConville.

Removing the dead from their homes is a difficult and potentially life-threatening task. The body of an Ebola victim can be highly contagious in the hours after death. “I know it is dangerous, but I take my time and feel that I am well protected,” says Daniel Sewah. His job is to operate the chlorine sprayer, used to disinfect the scene and the protective equipment of the burial team. He is the first man in to the location of the body. “I have been doing this every day for over a month now – it’s very difficult,” he tells us, as he loads hazmat suits, latex gloves, face masks and visors into the back of the team’s Land Cruiser. “We lose so much sweat using the PPE (personal protective equipment).”

Daniel Sewah, a sprayer with Concern Worldwide's Burial Team 7.

Daniel Sewah, a sprayer with Concern Worldwide’s Burial Team 7, has a wife and 3 children. “My wife supports me,” he says, “but my neighbors have turned their backs. I am not working for myself, but for my country — for humanity.” Photo: Kieran McConville.

“I know it is dangerous, but I take my time and feel that I am well protected,” — Daniel Sewah

Safe and dignified

Before Concern became involved, there had been a great deal of confusion amongst families as to what happened to their loved ones after removal from their home or center of treatment. Reports of mass burials in unmarked graves caused widespread anxiety, which was heightened because relatives and friends were barred from attending the burial.

View of grave sites

Fiona McLysaght, Concern Worldwide’s Country Director for Sierra Leone, talks with members of Concern’s burial team at King Tom cemetery in Freetown. Photo: Kieran McConville.

From the beginning, the Concern team was determined to ensure that burials were both safe and dignified, and the grieving family was treated with the respect they deserve. Each grave is given a geographical location and a plot number, which are recorded with the information of the deceased. Families are given a card with the details and the contact number for Concern’s family liaison officer. A simple grave marker with the name is erected at the grave site, to be replaced later by something more permanent.

Family and friends pray over the body of Sulaiman Barrie (7), who died on the night of October 31st, 2014 at his home in Banana Water, Freetown.

Family and friends pray over the body of Sulaiman Barrie (7), who died on the night of October 31st, 2014 at his home in Banana Water, Freetown. Photo: Kieran McConville.

A short religious ceremony is allowed at the time of the removal of the body and a small number of family members and friends can also attend the burial, wearing foot protection to prevent contamination.

Grave markers at Waterloo cemetery

Temporary grave markers at the Waterloo cemetery in the east of Freetown, which was built as the King Tom cemetery reached capacity. It is managed by Concern Worldwide. Photo: Michael Duff.