Now Ebola is out of the headlines, these countries are experiencing development in reverse

At the entrance to Kenema Hospital, the region of Sierra Leone worst affected by Ebola, I noticed a small memorial stone. I first assumed it was to remember the patients who had succumbed to Ebola there - but I was wrong

Margaret Batty
Sunday 03 January 2016 15:15
A cemetery in Waterloo, east of Freetown, Sierra Leone, where dozens of children are laid to rest, November 2015
A cemetery in Waterloo, east of Freetown, Sierra Leone, where dozens of children are laid to rest, November 2015

Do you know what your core body temperature is? Mine is 36.2°C, give or take minor fluctuations.

I know this not because I am a hypochondriac, but because it was taken countless times each day during a recent trip to Liberia and Sierra Leone - at army road blocks every few miles, at the entrance to every office or hotel, and at each stage of check-in for my flight.

The number everyone dreads is 37.5°C, because that denotes fever - one of the symptoms of the Ebola virus.

'Don't touch. Minimize contact' advisories are everywhere. People recoil involuntarily from handshakes. The insidious stress creeps up day by day under the monitoring, the curtailing of personal freedom in the interests of global health.

Imagine this as your daily reality for nearly two years.

While driving back to Monrovia airport at the end of my visit, which had stirred uncomfortable and raw emotions - empathy, fear, stigma, powerlessness, compassion, anger - my Liberian WaterAid colleague, Oretha, casually told me about an incident last summer, when she got a fever and was terrified that it might develop into Ebola.

As a precaution she had to tell her 9-year-old son that he could not come near or touch her. He had already been cooped up at home for months, because schools had closed and curfews were in force to try to contain the deadly epidemic.

In his moment of anguish and terror, his mother could not console him with a hug or a cuddle. Imagine the torment for both mother and son. Words are a poor substitute indeed for the power of touch.

The world and the headlines have moved on now. Guinea has been declared Ebola-free in the last fortnight. Sierra Leone had its final Ebola quarantine lifted in November. Liberia has been declared 'Ebola free' twice already, only to be set back again.

On 23 November 2015, 15-year-old Nathan Groote died in a Monrovian Ebola isolation ward - one more family tragedy to be endured, and a severe national blow. Nathan's younger brother and father, both also initially feared infected, were released from the Ebola Treatment Centre on 3 December with a clean bill of health.

Liberia is now in its 42-day quarantine period yet again. Let us pray to whoever is listening that Nathan, the 11,315th life known to have been claimed by Ebola, is its last victim.

The longer-term effects of this epidemic are not yet well understood. There are more than 17,000 Ebola survivors, who face a new jeopardy - stigma and discrimination as they are shunned at work, school and in their communities, for fear they might still be infectious. Others are too afraid to use health services, afraid that they might still somehow catch the dreaded virus. Myths and rumours easily ignite in such a febrile atmosphere.

Another headline you may not have seen is that countless people died during the height of the epidemic not from Ebola but from treatable conditions such as diarrhoea, malaria, complications at births, and road traffic accidents. People were too afraid to present with Ebola symptoms such as diarrhoea in case they were quarantined; if they didn't have the Ebola virus before quarantine, the chances of contracting it in a ward without rigorous infection control, or even running water or functioning toilets, were high.

Maternal mortality increased by 30 per cent during the epidemic as women actively avoided health centres for fear they might contract Ebola, and delivered their babies at home without clean water, good hygiene or skilled midwives, often with tragic results.

Liberia, Sierra Leone and Guinea are now experiencing development in reverse. Countries that were already among the poorest in the world (83 per cent of Liberians live on less than $1.25 a day) had already endured the bitter legacy of brutal conflicts, and in recent months devastating heavy rains which have washed away roads.

A man washes his hands outside the Kenema Government Hospital in Kenema, Sierra Leone, November 2015. Sierra Leone was declared Ebola-free in November, however anyone entering the hospital is required to wash their hands and submit to a temperature check. Credit: WaterAid/Monique Jaques

The Ebola epidemic has rolled back years of hard-won socio-economic gains. These are traumatised people and nations – and the recovery phase requires intense and sustained international support, in the form of health system strengthening, support for basic and essential services including water, sanitation and hygiene, psychological counselling expertise, open trade and investment, and much more.

How can Liberia even contemplate resilience to another outbreak of disease when less than 2 per cent of the population has hand-washing facilities at home, and less than half of those with both soap and water?

The international response to the outbreak showed inadequacies in institutional leadership. Now, there is dangerously glib talk of 'lessons learned'. A key lesson (re)learned was that local communities and local leaders are the first critical interface for epidemic containment, which begs the question: why was this ever neglected?

The concept of collective 'health security' has also regained fashion, along with awkward questions about the ethics of individual health security - whose security is most important? West Africans'? Europeans'? Mine? Yours? Nathan's?

At the entrance to Kenema Hospital, the region of Sierra Leone worst affected by Ebola, I noticed a small memorial stone. I first assumed it was to remember the patients who had succumbed to Ebola there. But as I squinted at the small chiselled letters, I saw they read "doctor, midwife, hospital, orderly".

The memorial honours the 37 staff who died of Ebola at this one district hospital, some of the more than 500 health workers who died of Ebola across West Africa. We owe it to these people to stop talking and start doing.

Ebola proved how interconnected the global community is. We are only as safe as the most fragile state, and we are all equally deserving of health security, underpinned by safe water, sanitation and hygiene. That includes all of our families: yours, mine, Emile's and Nathan's.

Margaret Batty is Director of Global Policy and Campaigns at WaterAid

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