By Dr. Habib M Sesay Senior Lecturer, FBC
Introduction
The objective of this piece is to articulate the escapades of Ebola haemorrhagic fever virus in the Economic Community of West African States in general and Sierra Leone in particular in recent time. In that regard, the author will examine the political, economic, social and cultural impacts of the scourge since its outbreak in the sub-region of West Africa about two years ago. Analysis of the unpreparedness of governments of countries in the path of the epidemic characterised by absence of modern medical equipments, dilapidated structures and, the indispensable role of the international community in containing the dreadful disease are vital integral components of this exercise.
‘Ebola’ is a dreadful disease caused by Filoviridae, cuevavirus and Marburg family virus. It is a deadly viral disease that destroys internal organs and tissues and, causes massive internal haemorrhage. Ebola is contagious through contact with body fluids. The virus has killed thousands of gorillas and chimpanzees in West Africa and has high mortality rate among human beings. The Ebola haemorrhagic fever virus was first discovered in Yambuku village where the outbreak of the disease first occurred in Zaire (now Democratic of Republic Congo) by Professor Peter Piot, who is currently the director of the London School of Hygiene and Tropical Medicine in 1976.
Ebola virus is named for the Ebola River where it was first identified. Incidentally, another outbreak occurred in Nzara and Mardi rural communities about six hundred Kilometers away in the Republic of Sudan2. The virus was spread by close personal contact and use of contaminated syringes in hospitals and clinics with little or no knowledge of the virus to medical practitioners who were unable to treat infected patients because the disease was new. Three years later, there was another outbreak in a gold mining community in Sudan in 1979. The virus was initially thought to be yellow fever, but was later identified as Ebola virus in 1995. Although the disease has mostly been confined to relatively small outbreaks in poor rural communities, it has sporadically spread to other areas including Gabon (1994 &1996), Uganda (2000 & 2007), Europe and North America before it appeared in West Africa. The World Health Organization data below illustrates that the Democratic Republic of Congo was the first country affected by Ebola and has the highest infection rate in Africa.
African Countries Affected by Ebola Haemorrhagic Fever Virus 1976 - 2008
Year Country Infection Death Percentage
1976 Zaire (D R Congo) 318 280 88
1976 Sudan 284 151 53
1979 Sudan 34 22 65
1994 Gabon 31 21 68
1996 Gabon 60 45 76
2000 Uganda 425 224 53
2001 DR Congo 59 44 75
2003 DR Congo 143 128 90
2007 DR Congo 264 187 71
2007 Uganda 149 37 25
2008 DR Congo 32 14 44
Source: World Health Organisation List
In the same vein, the World Health Organisation data below shows the global infections of the virus and the toll on human lives between 1976 and 2012. During that period, the pandemic affected two thousand four hundred persons and about one thousand six hundred patients (67%) died before it was contained in two years. Suffice it to say that the recent outbreak of Ebola haemorrhagic fever virus in the Economic Community of West African States in 2014 was unexpected. It caught the citizenry and governments of countries of the sub-region ‘off-guard’.
Ebola Haemorrhagic Fever Virus Pandemic: Outbreak and Confirmed Cases of Countries in the World 1976 – 2012
Year Country Ebola Virus Species Cases Deaths Case Fatality Rate
1976 Zaire (DR Congo) Zaire 318 280 88%
1976 Sudan Sudan 284 151 53%
977 Zaire (DR Congo) Zaire 001 001 100%
1979 Sudan Sudan 034 022 65%
990 USA Reston 000 000 0%
1992 Italy Reston 000 000 0%
1994 Gabon Zaire 052 031 60%
1994 Cote d’Ivoire Tai Forest 001 0 0%
1995 DR Congo Zaire 315 254 79%
1996 Gabon Zaire 031 021 57%
1996 Gabon Zaire 060 045 75%
1996 Republic South Africa Zaire 001 001 100%
000-01 Uganda Sudan 425 224 53%
’01-02 Gabon & DR Congo Zaire 124 097 78%
’02-03 Republic of Congo Zaire 143 128 89%
2003 Republic of Congo Zaire 035 29 83%
2004 Sudan Sudan 017 007 41%
2005 Republic of Congo Zaire 012 010 75%
2007 DR Congo Zaire 264 187 71%
2007 Uganda Bundibugyo 149 037 25%
2008 Philippines Reston 000 000 0%
‘08-09 DR Congo Zaire 032 014 47%
2012 Uganda Sudan 024 017 70%
2012 Uganda Sudan 007 004 55%
2012 DR Congo Bundibugyo 057 029 55%
Total 2388 1590 67%
Source:http:www.westbriton.co.uk/RFA-Argus-arrives-Africa-start-total-war-Ebola... 23856902-detail/story.html”.west briton
Mode of Transmission of Ebola Virus
Ebola haemorrhagic fever virus is an infectious disease. It is transmitted through exposure to body fluids and tissues from infected animals such as bats and non- human primates. Research indicates that the first case of Ebola came about through contact with blood from organs and body fluids of an infected animal. Also, the virus is transmitted to persons through direct contact with the blood, secretions and other bodily fluids of infected persons. Although laboratory tests indicate that successful infection is possible in rodents and bats but not in arthropods and plants, the natural reservoir and mode of transmission to humans is yet to be confirmed. Animal to human transmission do occur during hunting and consumption of the reservoir species and infected non-human primates. Additionally, butchering, consumption of bush meat and foods contaminated with bats’ faeces are major sources of transmission.
Person to person transmission occurs through close physical contact with body fluids including semen, genital secretions, sweat, vomit, urine, tears, saliva, contact with objects such as needles, solid clothing contaminated with infected secretions and breast milk of lactating mothers infected with the virus. The modes of transmission of Ebola are land, air and sea. Those in transit from affected areas, laboratory staff, nurses, physicians who work with infected patients and animals in spite of the personal protection gear are at high risk.
The symptoms of the Ebola virus include high fever above 37.50 C, nausea, vomiting, diarrhea, severe headache, abdominal pain, fatigue, prostration and sore throat. Hospital workers have frequently been infected with Ebola during outbreaks through close contact with infected patients, insufficient use of correct infection control precautions and barrier nursing procedures. Also,an outbreak of Ebola virus is fuelled by traditional burial practices during which mourners have direct contact with bodies of the deceased.
“What is Ebola? How is Ebola Contacted?”
Acquisition of the virus via sexual contact with a convalescent case is possible as the virus is present in semen for up to three months after recovery. Ebola virus is not spread through routine social contact such as shaking hands and sitting next to asymptomatic individuals. Scientific evidence indicates that human beings are infected with Ebola virus if they came in contact with infected animals. Also, research shows those who came in contact with infected chimpanzees, gorillas and antelopes alive or dead in Cote d’Ivoire, Republic of Congo and Gabon contacted the virus. Hunting of migrating fruit bats was a source of outbreak of Ebola in the Democratic Republic of Congo in 2007.
Ebola Haemorrhagic Fever Virus in the Economic Community of West Africa
The Ebola haemorrhagic fever virus disease currently causing havoc and death in the Economic Community of West African States is the largest outbreak in the history of the disease. Indeed, West Africa has experienced more cases of the disease in 2014 than previous outbreaks in the region. The appearance in West Africa of the Zaire Ebola virus which was the first type of the virus was initially reported in a village in Guinea close to the border with Sierra Leone and Liberia. The current crisis began on 18th March 2014 when health officials in the Republic of Guinea announced the outbreak of a mysterious fever that struck like lightning. Subsequent analysis indicated that the virus emerged when a teenager from a bat – hunting family contacted the disease in the Republic of Guinea in December 2013. Research also shows that consumption of bush meat such as rats, bats and monkeys common among the Kissi, Gola, Kpelle and Mende people living in Kailahun District in Sierra Leone and Gueckedou, Macenta, Nzerekore and Kissidougou Prefecture in Guinea where the outbreak of the virus was first discovered and quickly spread like lightening along the common borders into regional trading centres in the Mano River Basin where the three countries share trade and cultural norms and values common to the ethnic groups are sources of the virus. In June 2014, officials of Medicine san Frontiers declared that Ebola was out of control when Guinea reported almost one hundred cases in the week ending 15th June 2014. Indeed, the Republic of Guinea was initially the epic centre of the spread of the Ebola virus disease in Liberia and Sierra Leone.
As a result of porous borders, trade and other activities,Ebola crossed in to Liberia in March 2014 and became the second country in the Mano River Union to contact Ebola. The presence of the Ebola virus disease in Liberia threatened the already fragile and weak post-war economic recovery. In spite of endemic poverty, infrastructural decay, corruption, lack of piped – borne water, outrageous power cuts in urban communities including the capital - Monrovia and above all, profound distrust between political power elites and the citizenry, Liberia made significant progress in the postwar recovery effort. As a public health crisis, Ebola is a humanitarian and security threat. Between March and September 2014, there were about 2184 confirmed cases of Ebola virus and 1212 deaths. There were not enough facilities to cope and treat emergencies.
The ministry of public health and social affairs officials of Senegal provided the authorities of the World Health Organisation with details of a case of Ebola virus disease on 30August 2014. The case was recorded on 29 August 2014. The Pasteur Institute Laboratory in Dakar tested and confirmed the case to be Ebola. It involved a twenty one-year male who arrived in Dakar by road from the Republic of Guinea on 20August 2014. The individual lived with his relatives in the outskirts of the city. Authorities in the Malian capital – Bamako, confirmed the death of the first Ebola patient on 25 August 2014. The deceased was a two - year old girl who accompanied her parents from Guinea. Furthermore, an infected Islamic preacher from Guinea who was initially diagnosed with kidney disease in a clinic in Bamako died a few days later. Unfortunately, the two female health workers who cared for the cleric contacted the disease and also perished. The Republic of Mali recorded six deaths caused by Ebola before the World Health Organisation officials declared the country Ebola free in January 2015.8 Before the outbreak of the deadly Ebola disease, the health sector of the Federal Republic of Nigeria was engulfed in a protracted and bitter industrial action over conditions of Service. Ebola virus was transmitted to Nigeria by an airline passenger from Monrovia, Liberia. As soon as it was realised that dreadful virus was in Nigeria, the strike was called off. The infected airline passenger was quarantined and federal and state government officials tackled the problem with the utmost attention it deserves. The crisis was brought to a speedy end. Within a short time, the Federal Republic of Nigeria was declared Ebola free by the World Health Organisation.
Ebola Haemorrhagic Fever Virus in Sierra Leone
Prior to the current Zaire strain virus outbreak, Ebola never appeared in Sierra Leone or anywhere in West Africa. Kpondu village, Kissi Teng Chiefdom, Kailahun District was un-officially believed to be where Ebola virus started. From the onset, the citizenry, national government in general and the ministry of health and sanitation in particular were handicapped and caught off guard. At the time of the outbreak, hospitals, community health centres and clinics in Sierra Leone had limited modern medical equipments. Additionally, the medical facilities were (still are) dilapidated colonial structures with fewer beds, drugs, and ambulances. As a result of the glaring deficiencies, a cross section of the citizenry with strong traditional norms and believes made it difficult for physicians, nurses and other medical staff of community centres and clinics to treat patients.
Fruit bats are popular food source for ethnic groups in Eastern Sierra Leone and wildlife is a natural carrier of the Ebola virus. Interestingly, both are natives of the Sub-region of West Africa. The Gola forests in the south eastern Sierra Leone are breeding ground of bats and a major source of bush meat. The epidemic is thought to have infected Sierra Leoneans in Kailahun District officially on 25 May 20014 when mourners returned from a funeral of a traditional healer who attempted to heal Ebola patients in the neighbouring country. Tracking of the source of infection, it pointed to the death of a well known and respected traditional healer in the Republic of Guinea who desperate patients sought her advise and care. As more people became infected with the virus in the Gola Forests, the assumption predictably was that the herbalist became infected with the virus and later died. Hundreds of mourners came from surrounding villages to grace her funeral. Investigations by health authorities revealed that infection of mourners were linked to Ebola virus when according to traditional funeral rites her body was washed for burial which appeared to have infected women who were in the room with the corpse.
The minister of health and sanitation confirmed the death of a female herbalist in Sokoma Village, Kissi Teng Chiefdom, Kailahun District. Seven mourners who came in contact with the corpse became ill with one of them critically affected with virus after being tested and confirmed. Political leaders appealed to the citizenry to take precaution including getting close and touch the corpse of Ebola victims. Between 25 May 2014 and June 30,2014, Ebola was on the rampage in the three countries in the Mano River Union and in spite of advice from government authorities, traditional norms and beliefs caused relatives to defy physicians and removed patients from clinics and hospitals.
Incidentally, Ebola statistics are alarming according to an annotated Ebola Situation Report sponsored by the World Health Organisation on cumulative cases and cumulative deaths in the under-mentioned three countries in the Mano River Union with widespread and intense transmission.
Country Cumulative Case Cumulative Deaths
Guinea-Conakry 3792 2527
Liberia 10666 4806
Sierra Leone 13541 3952
Total 28005 11287
Source: World Health Organisation: Ebola Situation Report (August 2015).
Political, Economic, Social and Cultural Impact of Ebola Haemorrhagic Fever Virus on Sierra Leone
The political, economic, social and cultural impact of the Ebola scourge during its early outbreak, when it spine out of control was devastating. The Ebola menace affected every aspect of life of the Sierra Leonean society. In an emotional address to the nation, President Ernest Bai Koroma appealed to his panic stricken compatriots to stay calm. The president sought and received massive assistance from the international community led by experts from the United Nations World Health Organisation, contingent of the British Army and Medicines sans Frontiers. It is important to point out that Medicine sans Frontiers was among the first international contingent of humanitarian support that arrived in eastern Sierra Leone to salvage the Ebola scourge.
The government established firm control of the epidemic, when the president declared state of emergency in Kailahun and Kenema Districts, built quarantine treatment centres across the nation including rural and urban Western Area, closed the borders with Guinea-Conakry and Liberia to reduce cross border activities, ordered the establishment of military and police security check points for mandatory screening of passenger vehicles which was difficult to implement because of many alternative routes along the porous borders and established free emergency telephone Hotline 117. Indeed, the seasonal rains between May and October caused flooding with serious consequences and worsened the already complex struggle to contain the scourge.
Notwithstanding the above audacious precautionary measures taken by a desperate government, the cumulative infection cases and cumulative death continued to rise to fifteen per week with no end in sight. In that regard, President Koroma made two significant nationwide broadcasts in March and September 2014 respectively during which he ordered nationwide ‘lock down’ on 27 - 29 March 2014 and 19- 21 September 2014. Everyone stayed home during the mandatory six-day period. The ostensible reason for the lockdown was to stem the infection rate of the Ebola virus.
The economic impact of Ebola was equally devastating as ‘land preparation’ and ‘rice planting’ season began in May. Many farmers were infected and succumb to the disease. Essentially, the Ebola epidemic came to Sierra Leone from neighbouring Guinea-Conakry without warning and it spread like wild fire. The epic-centres: Kenema and Kailahun cities in the eastern region are about two hundred and four hundred kilometres respectively from Freetown. Kailahun city is closer to the borders between Sierra Leone, Liberia and Guinea-Conakry. And therefore the impact of the Ebola virus was severer in Kailahun District where staple foods: rice, yam, sweet potato, garden eggs and pepper as Well as cash crops: cocoa and coffee are produced. Suffice it to say that the Eastern Region of Sierra Leone was gripped with panic and uncertainty.
Unemployment took a dramatic turn for the worse when multinational firms that invested in mining and non-mining sectors of the economy and hired thousands of employees closed operations and left the shores of Sierra Leone. The economy continued its downward trend when Arik Air, Kenya Airways, British Airways and other European carriers cancelled flights to Lungi International Airport. Sierra Leone became economically isolated. The lockdowns restricted air, land and sea travel and caused the shortening of market hours which distressed hawkers and street vendors. Indeed, many hawkers and vendors lost their meager capital when the daily activities were adversely affected and they bought food during the lockdown. Daily wage workers were also economically disadvantaged.
The social impact of Ebola virus on the Mano River countries including Guinea –Conakry, Liberia and Sierra Leone as illustrated in the table on page 10 cannot be over emphasised. There were 28,005 confirmed, probable, and suspected cases and 11,287 deaths in the three countries. Although the crisis began in the forested Kissidougou Prefecture in Guinea -Conakry, it registered the lowest infection cases: 3,792 and deaths: 2,527. While Sierra Leone registered the highest cumulative infection cases: 13,541, Liberia registered the highest deaths: 4,806 out of 10,666 cumulative cases with Sierra Leone: 3,952 deaths in second place.
The deaths caused by Ebola in Sierra Leone left behind many widows, widowers and children without parents. And more significantly, it would be scientifically difficult to determine the number of children made orphans by the dreadful virus. The victims of the deadly virus include physicians, nurses, health workers as well as teachers. Sierra Leone lost at least twelve medical doctors and about fifteen nurses. Incidentally, Dr. Sheik Omar Khan, a renowned haemorrhagic fever virus specialist was among the physicians who perished. While the national government with the assistance of friendly governments, United Nations and philanthropists may support orphans in Sierra Leone for example Don Bosco Orphanage in the short run, their future is bleak during economic recessions in donor countries when donor funds dry up.
As expected, the cultural norms, values, beliefs and assumptions about funeral rites of Sierra Leoneans have been radically pruned. Paramount among the medical provisions for treating Ebola patients and burying victims is wearing personal protection equipment (PPE). Additionally, medical rules and regulations strictly prohibit on one hand getting close and touching patients and on the other hand bathing the body of an Ebola victim. Ebola victims are buried by ‘special burial teams’. Indeed, the above rules and regulations contravene the age-old traditional norms of the Sierra Leonean society. Also during the period that the Ebola virus was on the rampage, cultural initiation festivities into secret societies: Sandi (Women), Poro, Wodei and Gbangbanie (men) were suspended indefinitely. It is important to point out that school and tertiary institutions were closed as a precautionary measure to stem the epidemic.
Conclusion and recommendations
Considering the enormity of the political, economic, social and cultural impacts of Ebola haemorrhagic fever virus on the Economic Community of West African States in general and the Republic of Sierra Leone in particular, the citizenry and the respective governments of countries are to make concerted effort and ensure that Ebola virus disease does not appear again.
After eleven years of carnage during the civil conflict in which an estimated fifty thousand people from all walks of life perished, Sierra Leone lost an estimated 3,952 of its citizens to Ebola virus disease. Furthermore, the severity of the socio-economic impacts cannot be over stated. The economy suffered from the twin problems of falling prices of iron ore, the main international export from which the country derives about ninety per cent of foreign exchange earnings, massive unemployment and plummeted food production. The World Bank Group Report underscores the above and projected the economic dilemma of Sierra Leone: “The Tonkolili mine ceased production in December 2014, though most workers are still being paid a reduced salary. The Marampa mine in Port Loko, ceased production in April 2015, with majority of workers being laid off. Though the direct impact of these mines is limited, affecting up to 7500 employees, a large number of businesses that were suppliers to the mining operations have also being adversely affected. According to the most recent IMF Country Report, the Sierra Leonean economy is projected to suffer a substantial contraction in 2015.
Similarly, funeral rites and initiation into traditional secrete societies are transformed. The most significant positive impacts of post- Ebola on Sierra Leone are substantial cash flows into government treasury in the absence of tax revenue from the international community led by major powers and a few developing countries: Gambia and Cuba and world bank group which made it possible for the government to continue to pay salaries and benefits to senior citizens during the height of the scourge, presence of a variety of drugs, and ambulances in the country.
May I also point out that before the outbreak of Ebola virus disease; there were about twelve ambulances in Sierra Leone? With support of donor countries, United Nations and its affiliate agencies and, World Bank group, Sierra Leone currently has about two hundred ambulances. The establishment of the National Ebola Response Centre (NERC) facilitated preparation of reports about daily progress made to contain the dreadful virus which was readily available to the citizenry and international community. Also, the inauguration of ‘Project Shield’ in October 2015 designed to test the semen of male Ebola survivors as a way forward to keep them safe from infecting their partners is laudable.
To prevent another Ebola attack and future epidemic, it is important that the Government of Sierra Leone considers the under-mentioned recommendations.
- Allocate adequate budget to the ministry of health and sanitation for drugs, ambulances, hospitals, community health centres and clinics.
- Modernise equipments in hospitals, clinics and community health centres.
- Improve ‘conditions of service’ of health workers
- Eradicate slums and open drainages in unban centres.
- Construct affordable two-bed room self-contained low cost houses for the citizenry.
- Facilitate sharing of information between government, health officials and the citizenry in West Africa in general and the Mano River Union particular as a way forward to reduce future epidemic.
NOTE: The published item is a paper delivered by Dr Sesay at the African Graduate School of Management and Leadership, South Legon in Accra, Ghana. It was orgnised by the World Education Forum between the 9-14, November, 2015.
About the author: Dr. Habib M Sesay Senior Lecturer Department of Political Science Faculty of Social Sciences and Law Fourah Bay College University of Sierra Leone Mount Aureol, Freetown Republic of Sierra Leone.
(C) Politico 11/02/16
