Ebola: Facing Death Without Spreading Disease

ebolatruckFREETOWN, Sierra Leone — The most “intense” Ebola epidemic in the world, as the World Health Organization puts it, can now be found in Sierra Leone, which is witnessing more than 500 laboratory-confirmed new cases per week, and hundreds more suspected and uncounted infections. The virus is spreading all over the country, but about half of new cases are arising in the capital city of Freetown and neighboring districts. When I was in Freetown three weeks ago the epidemic situation felt dire, but the latest statistics reveal catastrophe.

Worse, the WHO data lags a few days behind the outbreak — by as much as eight days, depending on the country and district — and only reflects cases and deaths officially reported to the Geneva-based organization by the Sierra Leone Ministry of Health. Which means of course that the situation on the ground is certainly significantly worse than even these grim findings reveal. For the first time, on Dec. 8, the WHO reported that the officially reported cumulative total number of cases in Sierra Leone (7,798) exceeds Liberia’s cumulative caseload (7,719).

There are many reasons why Sierra Leone’s epidemic is far worse than those in Guinea and Liberia: governance, corruption, the process of international assistance, lack of hospital beds, and burial procedures, to name a few. In the first installment of this series I addressed the governance and corruption issues. For the other points, consider the story of 38-year-old Musu Esther Massaquoi, a resident of Freetown.

In late October, Massaquoi’s adult sister came down with Ebola, and the entire Massaquoi household was placed under quarantine. Since late October there have been consistently more Ebola cases in Freetown than treatment beds, so Massaquoi cared for her sister in the family home. At the end of the month the sister died, and Massaquoi and her family prepared to carry out a series of traditional rituals and the burial of their loved one. But a government burial team and police arrived to not only remove the deceased from the home, but also to block all funeral services in order to prevent transmission of the virus from the cadaver to mourners.

According to court and local news accounts, a distraught Massaquoi allegedly tried to block the burial team and hit one of the officers. She was charged with three counts of violating the Public Emergency Regulations, under which the nation has been ruled since late July due to Ebola, and on Nov. 6 she was found guilty. Despite pleas from her attorney for mercy, the judge sentenced Massaquoi to either serve a year in prison or pay a fine that is the equivalent of more than 10 percent of the per capita GDP — 500,000 leones, or $115. At the time of this reporting, Massaquoi was in jail in lieu of being able to pay the fine.

Anyone who has lost a loved one can sympathize with Massaquoi’s anguished misbehavior and pity her imprisonment. But epidemics call for drastic actions, and Massaquoi not only apparently violated safe burial procedures but, as a potential carrier of the virus herself, could have spread the disease to the people she attacked. Emotions may weigh on Massaquoi’s side, but ethics and disease control exigencies lean heavily against her. (read more)



ebola, ebola health, Sierra Leone, West Africa