After two decades of working in Sierra Leone, Concern Worldwide was on the ground when the deadly West African Ebola epidemic hit in 2014. As we now fight history’s second-deadliest outbreak in the DRC, we wanted to take a look at the human side of Ebola with four stories from our responders in Sierra Leone. Confronted by myth and fear, Ebola responders often risk their lives twice over: First, by risking contracting the disease, second by exposing themselves to violent attacks from locals. Here are the stories of four women — from a community nurse to a diminutive Irish accountant — who took the risk in order to save lives. 

“My sister died. Now I want to work harder to fight Ebola.”

There was a day in late spring that changed everything for Cecilia Babyoh, a nurse in the eastern district of Kailahun. A stranger came to Cecilia’s home. The woman was sick and she had been referred to Cecilia, who treated her in her home and then took her to a community health center. 

That was early on, and there was no talk of Ebola then. So Cecilia didn’t think that her life might be in danger from doing her job. “Then she got a fever,” says her younger sister, Baindu Saidu, a fellow community health nurse. “By then she knew it was Ebola. She took herself to the hospital in Kenema. A few weeks later she died there in the isolation unit.”

Baindu Saidu is currently supervising and training traditional birth attendants in Bo District

For Baindu, who supervises and trains traditional birth attendants in Bo District, that tragedy made her more determined to fight the epidemic. She expanded her work with the health workers to move beyond training them to help new mothers and their babies to include training them about Ebola, and about how to protect themselves.

“I tell people I am an example,” she says. “My sister died. Now I want to work harder to fight Ebola.” At first the health workers she trains didn’t believe the disease was real. Baindu, however, swayed their minds and they began taking precautions preventing an untold number of deaths. 

“The scariest part was that the information was confusing and incomplete.”

Katie Waller, Concerns Participatory Design Advisor, was the Program Officer for Innovations for MNCH initiative of Concern in Sierra Leone

I remember reading the news of the potential Ebola outbreak in Guinea in February 2014, just as I was finishing a two-month stint in Sierra Leone. Ebola is one of those diseases you hear about in public health school that is both fascinating and terrifying, the stuff of Hollywood movies and computer games, but you never expect to come across it in your career. It all felt far away and unreal. While it crossed my mind that the outbreak could enter Sierra Leone, after a month or so it seemed unlikely. I didn’t think Ebola would become a reality for my friends or the beneficiaries of our aid.

However, as I prepared to return to Sierra Leone at the end of May, several cases of Ebola were identified there. It was as if an alarm bell went off: it’s here, it’s actually happening. My colleagues and I followed the news closely. The scariest part was that the information was confusing and incomplete, making it hard to know whether we were taking the right precautionary steps. Though the outbreak was said to be fairly isolated and not directly affecting our work, we couldn’t stop thinking about it. What would happen if a case were to be identified in the districts where we work? What if…? What if…? 

Katie Waller in Sierra Leone

Throughout the month, the scale of the outbreak continued to grow and so did the number of stories rolling in from others in the field. A friend and colleague lost a family member — a health professional — to the disease. Hearing this made my heart break. I can only imagine the confusion that people experience when their loved ones fall sick and are whisked off to an isolation unit, never to be seen again. The second feeling I had was anger. Health professionals are rare and precious in Sierra Leone and they are also most at risk of contracting Ebola. Protecting them is not impossible, but it often feels that way. Incidents like this highlight the weaknesses of the local health systems and the urgent need for us to keep building and strengthening them.

“I never thought I would have to take a call like that.”

Kristen Cahill was the Senior Program Manager for Innovations for MNCH in Sierra Leone during the 2014-16 epidemic and recalls that time

Every Monday since the Ebola virus appeared in Sierra Leone, my weekly routine was to check my email for the latest Ebola case numbers and confer with field staff for updates on the ground. Every Monday, I hoped the answer would be the same: No confirmed cases in Bo, the capital of Sierra Leone’s Southern Province and its second largest city. 

For a time, we managed to stay free of the disease. But before I could even open my computer one Monday morning, I received a text message. A child had died from Ebola at a private clinic just outside Bo.

“You can never fully prepare yourself for something like Ebola. It’s so intangible, so unreal. All I could do was brace myself for the next text or phone call.”

The child’s family had fled to hide with relatives in Bo when two of their children had tested positive for Ebola. They fled for the same reasons many people do: a misunderstanding of the disease, an overwhelming fear that their children would die alone in an isolation ward, and the idea that the family would be unable to give the body a proper burial.

The attending nurse was unaware that the child was suffering from Ebola. She had no capacity to manage the disease and exposed herself to infection just by trying to do so. The child died in the clinic. 

I’d been a nurse for over ten years, six of those in Africa, and I never thought I would have to take a call like that. You can never fully prepare yourself for something like Ebola. It’s so intangible, so unreal. All I could do was brace myself for the next text or phone call.

“There were days when you had to stop and remind yourself what you were doing.”

Freetown’s Kingtom cemetery is a place that will forever be associated with the Ebola virus. Nearly 6,400 people were buried there in a 6-month period between 2014 and 2015, with as many as 80 burials per day. 

Because of a government decree designed to halt the spread of Ebola, everyone who died in Freetown during the outbreak was given a full medical burial. Traditional funeral practices in West Africa had been a major factor in the spread of the virus. In October 2014 Concern Worldwide and the International Federation of the Red Cross took over what was then a very chaotic burial system. 

That’s where a diminutive Irish accountant from Balcoo, County Fermanagh, comes in. 

At the height of the Ebola crisis, Kingtom cemetery handled up to 80 burials a day, requiring a huge degree of organization.

Sheena McCann, known affectionately in the area as Aunty Sheena, worked with Concern for 15 years prior to the epidemic. But nothing could have fully prepared her for overseeing what would become our award-winning safe burials program. 

“I suppose there’s a certain logic to burial grounds — trying to manage the space, making sure the records are accurate and figuring out a system to cope with the demand,” McCann explains. And during those dark days of late 2014 the demands were huge, with cool heads needed to prevent total chaos. “If you can imagine dozens of burials every day, carried out by teams in full protective gear and with all the people and activity that goes alongside that, it was quite a challenge. But we managed.”

As space ran short, new ground was cleared and hundreds of new graves were dug by hand each week. At one stage Concern was employing nearly 300 people and managing a fleet of 36 vehicles to keep the whole system going. Eventually, all burials were transferred to another site at Waterloo, just outside the city.

Kingtom cemetery in Freetown was the main cemetery used for burials during the height of the Ebola crisis, with up to 80 burials a day. Sheena McCann is in charge of Concern’s Safe and Dignified burial program.

Looking out across row after row of headstones, Sheena McCann continues, “alongside preventing the spread of Ebola, what we really wanted to do was to make sure that families could say goodbye to their loved ones with dignity and to know exactly where they were buried. Previously many bodies had been buried in unmarked mass plots.”

Ebola responders post-epidemic

The medical burial system in Sierra Leone, which is generally acknowledged as having played a key role in the fight against Ebola, was decommissioned after the country was declared EVD-free. Concern worked with many of the men and women who risked their lives daily, often facing ostracization for their efforts, to find new sources of income and to re-integrate into their communities.

“You realize that this was somebody’s child.”

Reflecting on that time, the logistician in Sheena McCann drops away and her face softens. “There were days when you had to stop and remind yourself what you were doing — especially when you saw the children’s burials,” she says. “When you see a burial team member carrying a child in a little white body bag with great respect and dignity, and placing it in a grave… that takes your breath away. You realize that this was somebody’s child.”