Ebola efforts should focus on women and girls

Today from the World Economic Forum in Davos, the Bank of America published, "The secret to social change," which presents evidence that investing philanthropic dollars in organizations that benefit women and girls yields the greatest impact. They cite numerous studies that reflect both the greater relative impact of giving to groups that are disproportionately disadvantaged, as well as evidence that women are more likely to reinvest money gained through greater employment or education into activities that sustain and nurture families.

This study made me think of my recent mission in Sierra Leone to work on beneficiary communication with Ebola-impacted communities. During my mission, I was visiting with Winnie Romeril, a WHO spokesperson and overheard her discussion with an anthropologist preparing for a BBC interview. The topic was female genital mutilation, a practice that is still widespread in Sierra Leone. On its own, the practice has numerous negative effects on the lives of girls - culturally presenting them as marriageable even before puberty, inflicting painful and dangerous cutting in often non-sanitary conditions and often damaging their ability to conceive and bear children. Combining this with the presence of Ebola, a viral disease that is transmitted through touching bodily fluids, expands the deleterious impact. In the past few months a group of soweis, women who perform female genital mutilation ceremonies sequentially during the months of December and January, contracted Ebola and died. Huffington Post reported last week that the government of Sierra Leone has recently instituted a temporary ban on the practice.

Further, reports in August 2014 reflected that women formed a disproportionate percentage of Ebola deaths, reaching up to 75 per cent in Liberia and from 55 to 60 per cent in Sierra Leone and Guinea. This is due to traditional cultural practices in which women often pay a primary role. Ebola is contagious through bodily fluids - blood, vomit, faeces, semen, saliva - of a person who exhibits symptoms of the disease. In West African culture, women breastfeed and change children, care for the sick, and wash and prepare dead bodies prior to burial. Dead bodies carry the highest viral load for Ebola victims and are the most contagious.

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

---

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. Republished from IFRC.org

Finding hope in a community under Ebola quarantine

As we headed into a community in Freetown, Sierra Leone, on Christmas morning, I saw a blue wooden bench at the side of the road, labeled “Long Bench Brotherhood”. It seemed inviting, a perch from which one could see all of the neighbourhood’s activity, but it was empty. I took a photograph, wondering why it was empty on Christmas Day, a day of rest.

A uniformed policeman let the Sierra Leone Red Cross Society team with which I was travelling pass through a series of narrow alleyways into a community of several dozen people. We were in Kingston Bridge to engage with the community for several reasons. They were in quarantine, following several members having gotten Ebola. The Ministry of Health and partners recently scaled up holding centres, where one waits 24 hours for the results of a laboratory test while receiving care, and treatment centres in the Freetown area from 16 facilities to 90. The more recent cases in Kingston Bridge were uncovered quickly. The community had learned from the Red Cross social mobilization and contact tracing teams that sick people must not be touched and that they should call the emergency number, 117, as soon as they are sick in order to receive safe medical care.

Mamvana, an animated man, perhaps in his forties, who described himself as the right hand of village headman Suleiman, met us at the entrance of the community and gathered his family and neighbours. An inviting smell rose from the pot next to me, cooking over a woodstove as we spoke. As a special Christmas treat, his family was cooking a chicken to accompany the potato leaves the young women next to us were chopping. Mamvana, asked by the social mobilization team, described his understanding of Ebola and how the community should protect itself. Multiple discussions with Red Cross community engagement teams over the past few months of intermittent quarantines had helped him and others know what to do, especially now that more treatment centres are available to accommodate the sick, and more rapid pick-up is available to ensure a safe and dignified burial for the deceased.

To the contact tracing team, which comes to the community every day for 21 days after a case is discovered, he proudly announced that everyone in the community was still feeling well. This daily health check is essential to monitor the safety of the community itself, since the virus has an incubation period of three weeks, and to ensure people don’t spread the disease to others in this heavily populated area. Only six more days, he noted, and everyone would be free to leave the community when they wanted and, most importantly, resume gatherings of the Long Bench Brotherhood. Mystery solved!

While Mamvana disappeared into his corrugated tin home to find his favourite photograph of the bench, I spoke with a young woman who had been leaning against a concrete wall during our conversations. Mabinti is one of the strongest people in the world right now. Having come to Freetown to care for her sick auntie, she contracted Ebola. But she survived. Shyly, she described the experience. Mabinti, as a survivor, is now immune to the virus. Still, she is stigmatized by some. Her village would not allow her to return, a difficult challenge for the young woman. Though she has been welcomed into Kingston Bridge by Suleiman and his well-sensitized community members, the psychosocial support offered by the Red Cross will help her rediscover the self-assurance and happiness that is starting to peek through at moments.

Mamvana returned with his photograph, one of his most treasured possessions. The photograph shows the smiling men of the village beside the long blue bench. As we all smiled, thinking of the freedom that will be theirs in less than a week, he led the community in singing, “We wish you a merry Christmas”. Threading my way back through the narrow streets, escorted by the police officers, I hoped and sang again to myself, “and a happy, healthy New Year.”

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. Republished from IFRC.org