A friend heard someone say that Ebola is a disease of love.
People know that they
are putting themselves at risk when they care for a sick child or loved
one. But who wouldn't do it? It is human nature to help someone who is
sick.
I think it must be especially difficult to know what to do when a young child is sick. Young children require care and may not be able to communicate when they feel ill. Sierra Leone has the highest child mortality rate in the world at 182 children who die by the age of five per thousand live births per year (http://www.unicef.org/infobycountry/sierraleone_statistics.html, 2012). Approximately 12% of deaths of children under 5 in Sierra Leone are caused by diarrhea ( www.path.org/publications/.../VAD_rotavirus_sierra_leone_fs.pdf) and about 38% of the deaths are due to malaria (http://www.aho.afro.who.int/profiles_information/index.php/Sierra_Leone:Analytical_summary_-_Malaria). Even if a child doesn't die from diarrhea or malaria, she or he is likely to have one of these diseases at some point. So a mother may think that a young child's diarrhea is from ingesting unclean water or a child's fever is from malaria, not Ebola . She may not want to call 117 because she fears that her child will be taken away from her, away to a holding center to await a lab test, where her child might get Ebola from others, or be taken to a treatment center and she might never see her child again. Right now there are few health services for people experiencing problems other than Ebola. So, the mother might wait, or consult a community nurse or a traditional healer, in the hopes that her child is not infected with Ebola.. the mother then may become ill herself. The people we met with today say they want to do more to prevent infections among nurses and traditional healers in communities.
Another point about love - many people in Sierra Leone feel that if they don't wash the corpses of their loved ones, their ancestors will not pass to the afterlife. This is a real and powerful belief that is not so easily changed. The woman who lost 6 family members said that she was not allowed to wash her mother's corpse. She said that one of her friends had a dream that her mother was unhappy because she was unclean. This dream haunts the daughter and adds to her grief.
Washing dead bodies and attending funerals frustrates responders to this outbreak because it is where they suspect that a lot of transmission happens. Corpses are very infectious so people are warned not to touch them or be near them. Many people have stopped attending funerals now or are watching them from a distance, which is great because touching or kissing the corpse is also a tradition. Among people we talked to who had Ebola deaths in their networks, all of them reported going to the funeral but watching from a safe distance. But not washing the body is like a Christian condemning someone to hell (see Les Roberts' blog: http://pfmhcolumbia.wordpress.com/2014/11/28/les-roberts-day-53-what-r0-is-not/). People persist in this behavior, even though Imams and Pastors have warned them against it.
Speaking of pastors, we saw a lot of people gathering together at church today. It was nice to see so many people out, like normal, in their fine Sunday dress.
So how can we get people not to wash dead bodies? This is not an easy question to study.. we know that people are washing and burying corpses in secret when they know they shouldn't. People may not own up to it or they may just tell us what we want to hear. I think there must be some way to acknowledge that people need to be able to wash their loved ones' corpses, while reducing Ebola transmission. As I mentioned in an earlier blog, one of the innovations is allowing people of the Muslim faith to bury white clothes with their dead loved ones. But, still, maybe we need more of this... to somehow acknowledge the need to ensure ancestors' transition to the afterlife while reducing Ebola transmission. In HIV there is what is called a harm reduction approach to transmission among injecting drug users - we don't try to change their drug using behavior, but we give them clean needles to inject so that they don't get HIV. Would it be acceptable for one person to wash a dead body while wearing PPE (personal protective equipment)? What about assigning an elder or an immune Ebola survivor to clean the body? I'm not sure.
How do we prevent the spread of a disease of love? We definitely need to start by respecting people's feelings about their loved ones and their beliefs. This is happening in many ways - we saw good evidence of this at MSF today (more on that later). Today Susan said that instead of messages that say "Don't do this!", how about we say "This is the problem. What can we do together?". There are lots of things people are doing together in this fight.. we need to keep going.
I think it must be especially difficult to know what to do when a young child is sick. Young children require care and may not be able to communicate when they feel ill. Sierra Leone has the highest child mortality rate in the world at 182 children who die by the age of five per thousand live births per year (http://www.unicef.org/infobycountry/sierraleone_statistics.html, 2012). Approximately 12% of deaths of children under 5 in Sierra Leone are caused by diarrhea ( www.path.org/publications/.../VAD_rotavirus_sierra_leone_fs.pdf) and about 38% of the deaths are due to malaria (http://www.aho.afro.who.int/profiles_information/index.php/Sierra_Leone:Analytical_summary_-_Malaria). Even if a child doesn't die from diarrhea or malaria, she or he is likely to have one of these diseases at some point. So a mother may think that a young child's diarrhea is from ingesting unclean water or a child's fever is from malaria, not Ebola . She may not want to call 117 because she fears that her child will be taken away from her, away to a holding center to await a lab test, where her child might get Ebola from others, or be taken to a treatment center and she might never see her child again. Right now there are few health services for people experiencing problems other than Ebola. So, the mother might wait, or consult a community nurse or a traditional healer, in the hopes that her child is not infected with Ebola.. the mother then may become ill herself. The people we met with today say they want to do more to prevent infections among nurses and traditional healers in communities.
Another point about love - many people in Sierra Leone feel that if they don't wash the corpses of their loved ones, their ancestors will not pass to the afterlife. This is a real and powerful belief that is not so easily changed. The woman who lost 6 family members said that she was not allowed to wash her mother's corpse. She said that one of her friends had a dream that her mother was unhappy because she was unclean. This dream haunts the daughter and adds to her grief.
Washing dead bodies and attending funerals frustrates responders to this outbreak because it is where they suspect that a lot of transmission happens. Corpses are very infectious so people are warned not to touch them or be near them. Many people have stopped attending funerals now or are watching them from a distance, which is great because touching or kissing the corpse is also a tradition. Among people we talked to who had Ebola deaths in their networks, all of them reported going to the funeral but watching from a safe distance. But not washing the body is like a Christian condemning someone to hell (see Les Roberts' blog: http://pfmhcolumbia.wordpress.com/2014/11/28/les-roberts-day-53-what-r0-is-not/). People persist in this behavior, even though Imams and Pastors have warned them against it.
Speaking of pastors, we saw a lot of people gathering together at church today. It was nice to see so many people out, like normal, in their fine Sunday dress.
So how can we get people not to wash dead bodies? This is not an easy question to study.. we know that people are washing and burying corpses in secret when they know they shouldn't. People may not own up to it or they may just tell us what we want to hear. I think there must be some way to acknowledge that people need to be able to wash their loved ones' corpses, while reducing Ebola transmission. As I mentioned in an earlier blog, one of the innovations is allowing people of the Muslim faith to bury white clothes with their dead loved ones. But, still, maybe we need more of this... to somehow acknowledge the need to ensure ancestors' transition to the afterlife while reducing Ebola transmission. In HIV there is what is called a harm reduction approach to transmission among injecting drug users - we don't try to change their drug using behavior, but we give them clean needles to inject so that they don't get HIV. Would it be acceptable for one person to wash a dead body while wearing PPE (personal protective equipment)? What about assigning an elder or an immune Ebola survivor to clean the body? I'm not sure.
How do we prevent the spread of a disease of love? We definitely need to start by respecting people's feelings about their loved ones and their beliefs. This is happening in many ways - we saw good evidence of this at MSF today (more on that later). Today Susan said that instead of messages that say "Don't do this!", how about we say "This is the problem. What can we do together?". There are lots of things people are doing together in this fight.. we need to keep going.
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