Throughout the epidemic the practice of safe burial practices have been a major player in the transmission of the Ebola virus disease (EVD). In fact, safe burial practices are so important that, when not performed, we see a jump in the number of confirmed cases in the entire prefecture the burial was performed; in September up to sixty-percent of transmissions were due to funerals (United Nations, 2014). So why aren't they happening? There are a multitude of reasons for unsafe burial practices to take place but from what we are seeing, the main reasons are: lack of knowledge and cultural norms. We'll delve into why the traditional burial practices of the West African nations matter and then we get into the "how to."
Like most cultures, citizens of the countries affected by EVD have their own burial rituals. Here in the United States when someone dies we often have a traditional style funeral. A body is placed in a casket, family and friends have a visitation period, there's funeral service, followed by the burial service and sometimes a luncheon or gathering to mourn the dead. We often wear black and greet each other and offer help- it's just part of the culture. Just like the ones here in the United States, the citizens of Sierra Leone have rituals to mourn the dead. Family and friends gather and the body is often wash, touch, and kiss the dead. This is where tradition is challenged by instance.
Ebola is a highly contagious, viral, hemorrhagic fever spread from person to person through blood, urine, sweat, spit, vomit, semen, and even breast milk (a reason why we are seeing infants infected with the virus). When a person is infected with Ebola, the infected does not see the symptoms for about seven days. That leaves a week for any one of those channels of transmission to pass on unnoticed. After the initial symptoms like headaches, fevers, fatigue, and muscle soreness, the infected will experience a high fever and vomit blood. (You can probably already see the problems here). At the beginning of the second week the infected may suffer brain damage, bruising on the skin from blisters, and will being bleeding from his/her orifices. By the middle of the second week the victim will begin to go in and out of consciousness, experience seizures and massive internal hemorrhaging, and eventually pass away. The lack of education given to the people of Sierra Leone coupled with the traditional burial practices make the country very susceptible to the transmission of the virus.
So amidst all of this, how do are the healthcare workers safely burying the dead? The challenge lies in giving a safe but dignified funeral for the deceased. The World Health Organization (WHO) has partnered with various other health-related and religious organizations to create an effective yet respectful burial protocol.
To being with, the health worker teams must assemble their long list of equipment including: disposable gloves, goggles, masks, outer gloves, rubber boots, a coverall suit, a plastic apron, disinfectant spray made up of chlorine, leak and puncture proof containers, leak proof disposable bags, and a body bag. Its a cornucopia of equipment, which only makes sense. After, they head to the victim's house. Respectfully the healthcare workers are instructed to offer condolences before doing anything with the body or putting on the gear. This humanizes the situation, just imagine a group of 4-6 people coming to your house in disinfectant gear, it wouldn't be the most pleasant feeling. Only after paying respects the team will move in to clear the body.
Two people are then sent into the house to retrieve the body. The body is placed into the body bag which is then sprayed with disinfectant and taken outside of the house or building. Once the body is outside the rest of the team is moves into the building and has to spray the entire house down. Every room, every object the victim touched, and every item the victim may have had contact with is sprayed. Of course special attention is paid to the area the body was initially removed from and anything the victim touched.
Once the house is sprayed down an material the victim's body is placed in a coffin and the family is given time to grieve,. During this time the team must gather any belongings that were soiled by the victim and take them to be burned elsewhere (this shows just how contagious the virus is). Now that the body is safely in a coffin and any infected object burned, the team may remove their protective gear, disinfecting the the reusable gear and burning the disposable gear. The process is quite tedious. Imagine going to and from a house with a grieving family with a deadly virus floating around, all the while burning the very clothes on your back.
After this step, the coffin is taken to the burial site and the funeral procession can begin. When the body is in the coffin the team no longer has to wear the protective gear because the channels in which the virus spreads are not blocked, though everyone must exercise caution. This allows the healthcare workers to add more of a humanitarian aspect to the funeral, rather than burying the dead in the gear seen above.
After the funeral session the healthcare workers may finally leave the sight and return to the headquarters or a hospital. The process takes hours. Any reusable equipment must be once again disinfected and any equipment that was not initially burned, must then be burned. The car that was used to transport the workers and the victim must be completely disinfected. It's a tedious, yet vital, process. So there you have it, a safe burial.
Hands for Africa
Hands for Africa is a non-profit organization working to restore lost hope to those devastated by the civil war in Sierra Leone. We support amputee victims by developing and implementing self-reliance programs and providing the necessary aid for the advancement of these programs.