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Sierra Leone
Wednesday, June 29, 2022

Denial and Disconnect Add to Toll of Ebola in Sierra Leone


WATERLOO, Sierra Leone — At first, the chief said nobody was sick in his community. Then he said that if anybody was sick it was because of witchcraft. Then he acknowledged that health workers were removing several suspected Ebola patients every day. In fact 15 corpses had been taken in less than a week from the community, but the chief did not admit that.

Persistent denial has been harmful to the fight against the virus. It stretches from the village to the state house, and it echoes into the circles of some of the international agencies now thick on the ground in Sierra Leone and the other Ebola-afflicted nations in West Africa.

That tendency to minimize the damage being caused by the disease — the hardship and death it is inflicting — has been perceptible since the outbreak was first discovered in March. But the denial’s effect is to prolong the suffering.

There is a disconnect between what is happening on the ground, inside houses, hospital wards and the grim holding centers where children, women and men are painfully dying of Ebola, and much of the official response.

Last week, international health officials voted on a key change in strategy. Recognizing that the virus had spread beyond their ability to bring all patients to treatment centers, they agreed to at least distribute painkillers, protective gloves and rehydration fluid to those suffering in their homes.

The top Sierra Leone official in charge of the Ebola response was absent for the vote. He was meeting bankers, he said afterward, and denied that the chance in policy had even been made. International officials said he left the room before the vote took place.

The distance between the needs and the response is evident in other ways as well. Burial workers drive rickety, thirdhand vans to collect bodies, some of them unable to make it up the country’s steep hills. Yet the parking lot of a leading United Nations agency in the capital, Freetown, was packed last week with idled, gleaming-new four-wheel-drive vehicles, at least 30 of them. As the officials met inside their air-conditioned offices, there was a drastic shortage of ambulances in the country.

Ebola’s victims die in abysmal conditions, often without adequate food, water or medicine, in shanties or mud-brick houses. Outside a house here, an 11-year-old boy, himself infected, dumped a bucket of water on his wailing 2-year-old brother, also sick, in an attempt to cool his raging fever. Meanwhile, at the country’s only five-star hotel, African Union officials in fine suits hold important meetings to discuss the Ebola response. The rubber boots necessary to go into the infected areas are nowhere in evidence, but armed bodyguards are.

The burial workers, who handle highly infectious corpses but had not been paid their weekly $100 salary by the government, threatened to go on strike last week. An adviser to the health official responsible complained that she did not know “why they are so impatient.”

The angry burial workers milling about could have told her, had she cared to speak to them. They pointed out that they were the ones exposed to the dangers of fighting the disease.

“The work is very risk,” said Sahr Kohmba.

Then there is the stigmatization they are subjected to: “I don’t have family now; my family has all abandoned me,” said Mamadou Jallow, another burial worker. “We want to buy something to eat. They won’t sell to us.”

The delay in wages was hard for many of them to understand, given the aid flowing into the country. One government official said Sierra Leone had received more than $40 million in cash to fight Ebola.

One of the most contentious examples of the disconnect in Sierra Leone is the death statistics reported by the government. Nobody except the health ministry here thinks that they bear much relation to reality. But if the number of victims is sharply undercounted, how can the response be adequate?

Some days, no Ebola deaths are reported for the whole country. On other days, five or so are registered. And then, suddenly, there will be 100 or so deaths reported.

Meanwhile, a visit to a single holding center can easily turn up a half-dozen or more deaths in one night. These places are simply death traps for many Ebola patients unable to find a scarce hospital bed. At the main cemetery in Freetown, the capital, the burial-workers’ daily haul runs to 15 or more.

“We know they are undercounting,” said one leading international health official in Freetown. “We don’t know by what factor,” he said. Yet the World Health Organization continues to rely on the government’s statistics.

A former top official, Sylvia Olayinka Blyden, who left the government two weeks ago, was more blunt in a recent online post, calling the health ministry’s statistics “dishonest, deceitful” and “shameful.” The ministry “continues to make a FOOL of the Government with ridiculous numbers being announced,” wrote Ms. Blyden, until recently one of President Ernest Bai Koroma’s top advisers.

Last week in Freetown, a body lay on the street in the Aberdeen neighborhood, covered in a sheet. The residents, angry that it had not been taken away, barricaded the street and threatened a riot.

But eventually the body was collected. The burial teams had gone back to work, even without being paid.

Credits: The New York Times

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