New Ebola case in Sierra Leone underscores lingering challenges

FREETOWN — It has been less than a week since Sierra Leone, Guinea and Liberia, the three countries most affected by the worst known Ebola outbreak in history, were declared free of transmission of the virus. 

But there has already been a setback, with the death of a woman, Mariatu Jalloh, in Sierra Leone, announced by the government on Friday.  

Officials say that flare-ups should be expected and that they are much more prepared now to deal with them. 

Sidie Yahya Tunis, a spokesman for the Ministry of Health and Sanitation, said teams were quickly deployed to investigate the death, which has been traced to a northern area of the country.

“All steps we have taken so far are based on lessons learned dealing with Ebola the past 18 months. The fact that we are able to move teams quickly into the district, identify contacts within a day and isolate them — it’s all based on lessons we have learned,” he said. 

Still, there is reason to be concerned, with 106 people in quarantine. Tunis said Jalloh’s family members washed and buried her body. This is how many people in Sierra Leone traditionally pay their respects to loved ones who have died, but it is dangerous because the virus is spread through direct contact with bodily fluids. It is also one of the main reasons the disease spread so quickly during the initial outbreak in West Africa, which began in 2013. More than 11,000 people died, including nearly 4,000 in Sierra Leone.

He said that the biggest challenge in the crisis was persuading people to change these behaviors and that community engagement, which involved getting authorities such as religious leaders in local communities to understand Ebola and explain it to others, was one of the leading factors in tamping down the epidemic. 

Tunis warned that even though the country is Ebola-free, that doesn’t mean the virus is gone forever. He said that even now, there needs to be a push for more community engagement.

Sierra Leone’s Red Cross Society is leading work on the issue. 

“People probably got complacent or didn’t understand that they need to be vigilant,” said Abu Bakarr Tarawallie, the country’s head of communications for the organization. “So what we are doing at the moment is heightened community engagement, which we have already started in [some] districts.” 

He added that professional burial teams need to put back on standby. These teams played a key role by allowing families to have a respectful burial but without having the traditional touching and washing of corpses. 

Still, Tarawallie said, the biggest lesson learned was that everything should have been done faster. 

Local officials and international community have been criticized for not responding more quickly to the outbreak. The World Health Organization has been slammed in particular for not declaring the outbreak a global emergency sooner. It was declared in August 2014, months after the outbreak started.

That the country had a poor health system to begin with was also a challenge.

“Of course, an emergency of this nature can destabilize even the well-prepared nations,” said Tarawallie. “Because of the fact that Ebola is a strange disease, it was not known about, there was not too much interest.”

This is the first known time an Ebola outbreak has had so many survivors. According to the World Health Organization, there are about 17,000 Ebola survivors, including just over 4,000 in Sierra Leone.

The survivors have played a crucial role in learning more about this disease and its aftereffects. It’s now known that the virus can be found in semen, breast milk and eye fluids after recovery.

Massah Stevens is an Ebola survivor. She worked as a nurse who fought in the crisis in 2014 at the Red Cross treatment center in Kenema, a hot spot for the disease in the eastern part of Sierra Leone. When Ebola was at its peak, she contracted the virus while treating a patient. Now, like many Ebola survivors, she is suffering from complications.

“I normally get muscle pain, joint pain and even the eye problems,” she said. 

Medication is supposed to be free for survivors, but she said but she often has to pay for it. She said researchers should develop special medications for survivors like her.

She added that she believes people became complacent too soon after the outbreak ended and thinks there should be special health care workers on standby to deal with more possible cases. 

Her biggest worry is for the future of her children. She hasn’t been able to find a job since her recovery, partly because of her health issues and partly because of the lack of available jobs, even though all health care workers who fought in the Ebola crisis were supposed to be hired by government hospitals.

Stevens said that despite all these challenges, she is grateful to have survived and hopes the setback does not last long in her country.