Fr. Aris Miranda, the General Consultor for Ministry and the central coordinator of the Camillian Task Force (CTF), has just come back from Makeni in Sierra Leone where he had a series of meetings with exponents of the local ecclesial,

P.Aris Miranda

civil and health-care world, but above all else he encountered the dramatic situation that has been caused by the emergency of the Ebola virus.

Here he offers a vision of this in very personal and involving tones. He is sharing it with us so that in us as well, and in the context in which we live, the ‘tension’, and also sensitivity towards this humanitarian crisis, can remain high.

We will share his testimony in the form of a ‘ship’s log’ in three stages over three days: basic information, the impact of the epidemic, and the initial plan of the Camillian Task Force. Some of the photographs that accompany the report are the result of a service by Anita Ennis, the Vice-President of the Lay Camillian Family, that she is doing on the ground.

Makeni (Sierra Leone), 19 -26 October 2014

The CTF carried out a rapid assessment of the diocese of Makeni and in particular of the district  of Bombali.

After an analysis of the situation, steps were taken to think about and plan the initial initiative of the following six weeks. All of this was done thanks to the help of Mrs Anita Ennis, the Vice-President of the Lay Camillian Family, the members of the diocesan Task Force, the health-care personnel of the district, surveillance teams, families in quarantine, and the gathering of the testimonies of some survivors.

Basic Information on the Context

On 5 May 2014 the mysterious Ebola virus appeared in Sierra Leone: its first appearance was noted in a young expectant woman who had been admitted to the government hospital of Kenema following a miscarriage. The young woman had certain symptoms which were subsequently confirmed as produced by the Ebola virus. An attempt was made to understand the source of the infection. This woman provided an account of a previous event which had taken place during a funeral ceremony and the burial of a famous holy man who was a ‘healer’, on the border with Guinea Conakry, in which she had taken part, together with hundreds of other people who had come from nearby villages to honour the memory of the dead man.

A subsequent investigation found that taking part in this funeral might have been linked to 365 deaths caused by Ebola.

Distribuzione di cibo per le famiglie in quarantena

On 29 July Dr. Sheik Humarr Kahn, a virologist and expert of international fame on viral haemorrhage fevers, who was head of the Lassa Fever Programme for the area, died of Ebola at the age of only thirty-nine (cf. the data of the World Health Organisation, WHO, 23 September 2014). Since them confirmed cases have risen to 3,717, above all in the principal districts: Kailahun (551), Bombali (529), Port Loko (514), Kenema (481), Tonkolili (193) and Bo (174). Deaths have also occurred in other districts.

The total of ascertained deaths caused by Ebola has risen to 1,049 (as of 18 October). At the moment only 346 hospital beds are available compared to the 2,050 that are needed. The situation continues to grow worse, with a strong increase in the number of new cases of infection. Five of the fifteen districts of Sierra Leone are isolated. Our of a total of six million inhabitants, more than a third suffer gross restrictions on their movement (less movement, less contagion).

Who us to blame for this rapid escalation in this infection in Sierra Leone? For some people this is still a mystery. Various kinds of explanations have been proffered: from ones based on superstition to a scientific explanation, and from culture to politics.

One of the principal channels of infection is connected with the traditional practices of burial – for example washing the corpse and touching the body. Funeral rites are a very important event for the inhabitants of Sierra Leone. Indeed, membership of a specific ethnic group is primarily indicated by having a death and a funeral of greater dignity. Many of the people attending these funeral rites have been infected. Recently the government declared that all burials – independently of the cause of death – will be managed by a specific team which is dealing with the Ebola contagion.

Another element which accelerates the spread of this disease is the situations brought about by the milieus of wider families where there are twenty or more people in a home who live in a very small space. The structure of the wider family is customary in Sierra Leone in all the tribes. In every home on average seventeen people share the same milieu together. This practice is typical above all of very prestigious families and is connected with respect and the level of authority within a village: the greater the number of members of a home, the greater the respect, the power and the security that they all have within the village.

Another factor is the violent denial of the reality of Ebola: many people who have been contaminated do not admit the fact and do not report contagion by Ebola because they are afraid that they will be put in quarantine for twenty-one days or more, or because they are afraid that they will be taken to a centre with strong restrictions on their actions for a week or admitted to an institution for treatment until there are completely cured or die.

For example, a secretary of one of the Catholic schools of Lunsar lost four members of her family in three days but she opposed a policy of quarantine because she was convinced that her relatives had died because of another disease that was not Ebola. It often happens that men and women are afraid of reporting symptoms of other viral fevers our of a fear that they would be seen as Ebola patients. In such a case fear takes over and dominates the attitudes of people. Some people believe that in villages where mass deaths took place in the space of a week, an angel of death (witchcraft) dwelt near to these villages killing these people.

Amongst the principal factors responsible for the current situation, there is certainly the weak health-care system and its governance. Sierra Leone is still one of the worst- off countries in the world in terms of welfare, the supply of respectable conditions of health,

Famiglia in quarantena sorvegliata dai militari

and prevention and treatment. It is a country where the level of infant and maternal mortality remains amongst the highest in the world. Average life expectancy is 57. One woman in every eight runs the risk of dying during pregnancy or childbirth. The population suffers from epidemic outbreaks of endemic diseases such as cholera, Lassa fever or meningitis. Sierra Leone should not have been surprised by the Ebola pandemic and its atrocious impact on people, given that Guinea Conakry, a neighbouring country, had been previously struck by the disease. The alarm increased but it was simply ignored.

In Bombali (the primary objective of the assessment), the third district with a high number of confirmed cases (497), the victims have to struggle with each other to obtain a hospital bed at the Ebola Treatment Centres. This district has only three holding centres with a total of fifty beds and cannot take in all the suspected cases of Ebola that are indicated during the day. In the villages about 130 families (1,661 individuals) have been put in quarantine for twenty-one days or more because of a suspected case amongst family members. From 21 October onwards the suspected cases of Ebola have not been easily managed above all in the most distant villages and for this reason they have been put immediately into the holding centres because the medical team is hyper-busy with the daily cases of contagion. When a suspected case (according to the symptoms) is not isolated, the person concerned can easily contaminate the other members of the family because they have the same living conditions in a family context where there are many people and they have very little living space.

To be continued ….

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