After Reaching 42 Days with No Ebola Cases, One Thing Rings True for Sierra Leoneans: “We are all Survivors”

Ebola affected every Sierra Leonean in or out of the country. It altered our planned activities at work, as we could no longer travel upcountry. My children sat painfully at home for more that a year when they should have been learning in school. We lost families and friends. Yes, Ebola has not only changed me, but it changed our culture. I no longer do handshakes or hugs. I am not as keen as I was in the past to attend funerals. I insist that my family always carry hand sanitizers.

Sierra Leone President Ernest Bai Koroma. Photo credit: Dauda Musa Bangura

Sierra Leone President Ernest Bai Koroma. Photo credit: Dauda Musa Bangura

Now that outbreak has been declared over, for those of us here, one thing rings true: “we are all survivors.”

Sierra Leone recorded the first case of Ebola on May 24, 2014 and the World Health Organization (WHO) declared the country free of Ebola on November 7, 2015, after going 42 days without new cases. This milestone resulted in widespread jubilation. Already the streets are lined with wedding cars, and so much gathering here and there.  The end of Ebola is so timely as it ushers in the Christmas holidays and the New Year. We have felt deprived for almost two years and everyone I know has determined to enjoy themselves well.

But some Sierra Leoneans are approaching the news with caution. Speaking at an official declaration ceremony on November 7 at the Bintumani Hotel in the capital city of Freetown, Yusuf Kamara, a healthcare worker and an Ebola survivor who lost 16 members of his family, lamented, “for us, Ebola is not over.” He appealed to Sierra Leone President Ernest Bai Koroma and his development partners to address “the many, many health problems we still suffer from.”

For his part, President Koroma thanked the 35,000 Ebola response workers and honored all those who died. “I am here today as your Head of State to tell you that collectively we have prevailed over this evil virus,” he said. He declared November 18 as National Ebola Day, and revealed that November 21, 2015 will be a national day of thanksgiving.

Sierra Leoneans celebrating to mark the 42 days of no new Ebola infections. Photo credit: Dauda Musa Bangura

Sierra Leoneans celebrating to mark the 42 days of no new Ebola infections. Photo credit: Dauda Musa Bangura

As the Government of Sierra Leone was making their celebration, many others where doing their own bit: the traditional and religious leaders, women’s movement, the “Okada” boys (association of motorbike riders), the entertainment industry, private sector, and international and national development partners. It was a rainbow moment for Sierra Leone. Everyone had a reason, or otherwise found a reason to celebrate. They paid tribute to the dead, saluted the brave health care workers, hailed the burial teams, made heroes of the survivors and celebrated the sacrifices that they made to bring the virus to a halt.

At a jam-packed candlelight vigil organized by the women of Sierra Leone on November 6, the names of all the health workers who lost their lives to Ebola were read out and awards given to some key partners who fought the “war.” Words cannot describe the anxiety held across all of the nation’s 14 affected districts during the last week leading to the declaration. In a mournful tone, Fatmata Katta, a Program Officer with the Health Communication Capacity Collaborative (HC3) project Sierra Leone tried, saying, “it’s been a tough week,“ adding, “I teared each time I listened to the reflections on the radio.”

For Maseray Foray, a 15-year-old student at Waterloo Street in Freetown, she was happy for the stigmatization to stop. “I did not get Ebola, but I got the treatment and I can only imagine what our survivors are going through,” she said, explaining her experience with immigration when trying to visit another West African country. “Today is the happiest day of my life as I would no longer be seen as a virus,” she said.

According to WHO, a total of 8,704 people in Sierra Leone were infected during the outbreak. Some 3,800 people survived and 3,589 died. From those who sadly lost their lives, 221 of them were healthcare workers including 11 doctors. They were all remembered and honored vividly during the many celebrations that took place across the nation on this day.

Candlelight vigil. Photo credit: Dauda Musa Bangura

Candlelight vigil. Photo credit: Dauda Musa Bangura

This outbreak highlighted the critical role that social and behavior change communication (SBCC) plays in containing transmission. Reflecting on the emergency response in a working paper titled, “The Ebola Response in West Africa ODI,” a question was raised about the consequences of not prioritizing SBCC early enough to contain the spread, as responders focused more on bio-medical interventions. “Given the scale of the outbreak and the vastly insufficient treatment facilities, should decreasing transmission through behavioral change (rather than through case isolation) have played a dominant role?” The article went on to quote Claudia Evers, an Emergency Coordinator of MSF, to say, “Instead of asking for more beds we should have been asking for more sensitization activities.”

The next 90 days remain crucial to ensure that the country remains at zero cases. The public is mandated to continue calling the emergency Ebola free hotline when a death occurs and for the swabbing of all bodies for testing before burials until mid-2016. The country’s economy was badly hit during this period and now has much more challenges to worry about. These include how to care for its survivors, the stigmatization they face and their many ailments including vision problems, fatigue, joint pain and depression and how to cater for its estimated 12,000 orphans and over 10,000 teenagers left pregnant during Ebola. Sierra Leone, however, owes the upscale of hand washing practices nationwide and the observation of infection prevention and control measures in health centers to the “unwelcome guest.”

Emma Vincent, Program Officer II, HC3 Sierra Leone Program. Photo credit: Dauda Musa Bangura

Emma Vincent, Program Officer II, HC3 Sierra Leone Program. Photo credit: Dauda Musa Bangura

The country also remains vigilant of it its borders with neighboring Guinea, the source of the Ebola outbreak, which is still struggling to contain the disease. Meanwhile, Liberia was declared free of Ebola on September 3, 2015.

“Indeed it has been a joyous moment for us that at long last we can start to heave a deep sigh of relief from the outbreak, which has dealt a heavy blow on all aspects of our lives,” said Sierra Leonean Reverend Alimamy Kargbo. “But we will never never give up.”

Ebola, other Health Threats Challenges Resilience of Fragile Health Systems

The total number of Ebola cases crossed the 23,000 mark this week.


Phebe Hospital in Bong County, the tertiary hospital for the county. Photo courtesy of Anna Helland.

It’s a big number, and yet it still fails to show the total damage of the Ebola epidemic – not just the deaths, but the loss of trust, traditions and fragile health systems. NPR has a lovely multimedia piece on one Liberian community traumatized by Ebola that does show that toll. What is striking in the piece is not so much the trauma, though, but the resilience. Amid the trauma, we see the face and hear the words of a woman whose husband and his other wives have died of Ebola, and she is left to care for all of their children. “The same love their mothers gave to me, I give to them,” she says. I had to read that sentence twice to grasp that it wasn’t the love the mothers used to give to their children that she now tries to provide, but that she is dipping into a deep well of love these women had for each other. In the same story a man talks about what happened in his village and their work to pull themselves back together. He says “If my neighbor’s not happy, I’m not happy.”

Another NPR story profiles a grandfather who survived Ebola in an ebola treatment unit (ETU), and then stayed in the ETU to nurse his beloved five year old granddaughter through the disease. These are stories of family and community resilience and love, and they are moving and inspiring.

It would be so nice to conclude that because families are strong, and communities are resilient, that they will survive and thrive and we therefore haven’t failed them.

But the same NPR multimedia piece has photos of the community’s clinic, staffed by a nurse. There used to be a community health worker, too, but he died of Ebola. These photos give some idea of the fragility of the health structure in contrast to the resilience of the community.

How fragile are the health systems in Liberia, Sierra Leone and Guinea?

  • The U.S. has 2.5 doctors for every 1,000 people. Liberia has 1 doctor for every 100,000 people.
  • Sierra Leone, Liberia and Guinea rank 5, 8, and 13 in the global maternal mortality rate, reflecting an abysmal lack of access to and use of trained health providers during birth.
  • The infant mortality rate in Sierra Leone, Liberia and Guinea had fallen dramatically in recent years, but their rates are still some of the highest in the world. In Liberia about 1 in every 10 infants dies before the first birthday.
  • Per capita spending on health in Sierra Leone is $205, in Guinea it is $67, and in Liberia it is $102. If we stay in the “L” section of the WHO’s list of health indicators, we see that Lithuania spends $1,426 per capita, Lebanon spends $979, and wealthy Luxembourg spends $6,341 per person.

All of this before Ebola. And it isn’t as if these countries have inherently high rates of maternal and infant death; these rates are clear reflections of health care systems that don’t fully serve their populations, for a whole host of reasons.

Ebola has shone a harsh light on the fact that our global resilience to a virus like Ebola rests on the resilience of the health systems in Liberia and Sierra Leone and Guinea. There is no isolation, there are no islands, when it comes to global health. Perhaps it was tempting to think there were, and that the fragility of the Liberian health system was a tragedy only for Liberians. Other diseases and tragedies have illustrated our interconnectedness over the years – HIV/AIDS, SARS, avian flu, terrorism – but I wonder if this is the first time we have really seen how all countries are really only as resilient as that system built on that little clinic, staffed by that one nurse, in that village at the end of a dirt road in West Africa.