IFRC


The challenge of modifying long-held customs in the midst of an Ebola outbreak

Published: 14 January 2015 15:53 CET

Catherine Kane is a senior communications officer for the International Federation of Red Cross and Red Crescent Societies. Based in Geneva, she was recently deployed to Sierra Leone to support beneficiary communications initiatives as part of the Red Cross response to the ongoing Ebola outbreak.

Three weeks ago, a dear friend whom I’ve known for almost 20 years died of breast cancer. I was 5,000 kilometres away on another continent. I wanted to gather with people. I wanted a hug. I wanted to offer my support and help to her husband and three children. Through social media, email and Skype, I reached out to mutual friends and family to give and receive comfort. I tried to find a way to attend the viewing, wake and memorial service, but it was too expensive at the last minute. I was grief stricken and torn at the inability to participate in my cultural funeral practices.

The people of West Africa, particularly Sierra Leone, Guinea and Liberia, are similarly and indefinitely stripped of this privilege. This is not because they have chosen to work far from home; it is because Ebola has stolen from them. Recently deceased victims of Ebola carry the highest viral load. This is how Ebola is transmitted: through infected bodily fluids. People who contract Ebola do so through intimate contact with someone who has symptoms or who has died of the disease. The victims are the most loving of West African society: parents of sick children, people who care for ill family and friends, health workers and people – mostly women - who prepare bodies for burial. These are the ones who touch blood, sweat, vomit and excrement in their efforts to help.

To combat this, education about the disease and convincing people to abandon, indefinitely, their most ingrained customs, is critical. While operating and scaling up treatment, holding centres, and clinical facilities so that sick people can be treated in a safe environment by skilled health professionals is vital, so too must communities learn how to help themselves. Red Cross teams, composed of trained local volunteers who are both familiar with and speak the local dialect, are working in collaboration with community leaders in crowded urban areas and remote mining villages to make this change. They do contact tracing, which involves finding every person who had contact with an ill person and doing daily health checks for three weeks, and social mobilization, which includes sharing information on how to avoid transmission, healthy sanitation habits and self-reporting to a health facility immediately when symptoms develop. Moreover, they guide people to not touch dead bodies at all and to contact the Red Cross to provide safe and dignified burials. This is a difficult message to convey, even to fellow community members, especially as it defies important cultural practices.

Yesterday, I attended the safe and dignified burial of an elderly man in a village in Sierra Leone’s Western District. The village was accessible via heavily rutted dirt roads. Under a leafy tree canopy, the beneficiary communication specialist from the Red Cross talked to the community, his words punctuated by wailing from within the home. After the first part of the conversation, the burial team entered the home, dressed fully in protective gear. To their dismay, the body had been wrapped in a cloth. This action, intended to be kind and respectful, meant that each person who touched the corpse could have been infected. Consulting with the headman, the Red Cross worker spoke again, assuring the community that teams would return promptly to do safe and dignified burials if anyone else died, but pleaded with them to not endanger their friends and family by touching someone.

A tall man in the crowd spoke up, saying the deceased had been an old man who probably didn’t have Ebola. But his symptoms were consistent with the disease, the Red Cross worker said, and many people in the village came in and out every day and could have easily transmitted the disease, especially to an elderly person whose immune system was weaker. He answered more questions, noting each of the details in a telephone survey designed to track epidemiological data and to collect community questions and input, then respectfully departed, letting the community know that Red Cross workers would come to check their health for the next three weeks and to share more information.

The team talked, as our truck bumped back out on the road. We were disappointed that there could be more cases and that educating people about safe burials had not yet been effective. It was then I recognized what an uphill battle we faced. If I had the choice when my friend died, would I have wiped her brow, cleansed her body, and hugged her one more time? Knowing what I do about this deadly disease, I am forced grievingly to say, “not if my life depended on it.” Instead, I found new traditions of sharing words, sending money to her children’s education fund, and praying. I hope the people in West Africa, like me, can also find consolation in similar modified practices.




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