FrontPageAfrica (Monrovia)

30 June 2014

Liberia: Getting Rid of Ebola Dead Bodies a Daunting Task for Liberia

Photo: Boakai Fofana/AllAfrica
Redemption Hospital signboard in New Kru Town where a nurse reportedly died from the deadly Ebola virus.

"We need to find a special place to bury these corpses, if not, the bodies will keep piling up on us. If we don't bury them, they will begin to decompose and then that will be trouble for all of us." - A member of the burial team who spoke to FrontPageAfrica on condition of anonymity

Monrovia - On Saturday, June 27, 2014 four bodies of victims who died as a result of the deadly Ebola virus were buried but not without a hassle. Three of the bodies were near decay, as a burial team with one of the corpses was chased out of the Banjol community in lower Virginia in Montserrado County as they prepared to bury. At the ELWA Hospital Mortuary, another burial team displayed the face of a dead Ebola victim wrapped in a body bag to three members of their family.

The family is put outside and men in white plastic suits covered from head to toe deals with the corpse laid out on a stretcher, spraying it with high concentration of chlorine before lifting it into a white ambulance owned by the Montserrado County Health team. The vehicles are then sprayed and sealed and as the men spray themselves and get ready to pull off the suits beginning with the gloves a nurse yells:

"No, don't do that, don't take it off. You have to walk through our decontamination process. We have to make sure you are decontaminated and safe before you can take the suits off."

The three-man burial team listens and heeds the advice of the health practitioner and they emerge later with only their clothes on, leaving the protective gear behind and the car leaves with the corpse with the hope that the family has already secured burial ground.

"We are finding it very difficult to bury these people who die from Ebola. The community people when they see us in these white suits, they think we are some ghosts; the other day they chased some of our other friends and they had to bring the other body, they took to bury back to JFK," said a member of the burial team who spoke to FrontPageAfrica on condition of anonymity.

"We need to find a special place to bury these corpses, if not, the bodies will keep piling up on us. If we don't bury them, they will begin to decompose and then that will be trouble for all of us."

The head of the team seems very enthusiastic about his job and for him it is a duty to country, he said he and his boys cannot expose themselves to communities because of fear of reprisals. But he said they have a duty to get the consent of the family members of the dead Ebola victims before burying them, adding that some family members are not coming up to identify the bodies of their dead relatives because of some psychological fear.

"We give them maximum 24hours to come forward and identify their relatives and then we work with them and get their consent to bury; we have to do it to avoid problems," said the head of the burial team.

"When we get these people, it is important that we locate the families based on the locations they were brought in from and if no one comes forward, then we are given go-ahead by the ministry to bury. But the hospital keeps the bodies in a secured location and decontaminates them, so it is no problem."

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The Assistant Minister for Curative Services at the health ministry Mr. Tolbert Nyenswah said the ministry is aware of these difficulties posed to the burial teams and is doing all it can to alleviate it. "We met with the Montserrado County Superintendent and we are going to secure a place to bury people who die as a result of the disease," he said.

Margibi becomes new county of infection

Margibi County joins Montserrado and Lofa counties becoming the newest affected county as one death is reported there. Speaking to FrontPageAfrica on Saturday Minister Nyenswah said the number of deaths and confirmed cases has increased.

"On the 25th if you can recall, the cases were 35, it increased to 38. The confirmed, probable and suspected were 61 on the 25th it has increased to 70," he said.

"The probable confirmed and suspected cases in Lofa are 49, Margibi 3, Montserrado 18. The total number of people currently in treatment unit are 33; total number of deaths on the 25th was 37now it stands at 46; 25 in Lofa, 1 in Margibi, 20 in Montserrado. The new cases are coming from Lofa, Margibi and Montserrado."

The minister said Liberia has a testing center where specimens from the affected areas are taking for testing. "We have one Ebola testing center in the country; that's the only specialized lab we have in the country," he said.

"There are only two in the region the other one is in Guinea but it is mobile. These kinds of testing centers are sophisticated; they're level one labs that test for these kinds of high-level viruses."

Help from abroad

The World Health Organization (WHO) in a release issued on June 22, 2014 stated that it and its partners are providing the necessary technical support to the Ministries of Health of the three affected Mano River Union Countries, Liberia, Sierra Leone and Guinea to stop community and health facility transmission of the virus.

"This includes a high-level advocacy meeting with the governments of the three affected countries to enhance coordination, information management, and communication, among others," stated the United Nations organization.

The WHO stated that its Regional Director, in consultation with the Director General, has established a temporary function of WHO sub-regional EVD outbreak response Coordinator to directly support the affected countries with the Coordinator is based in Conakry, Guinea.

The organization stated that it is organizing a high-level meeting for the Ministers of Health in the sub-region, technical experts and key stakeholders to be held from 2-3 July 2014 in Accra, Ghana.

"The objective is to ensure increased political commitment and enhanced cross-border collaboration for EVD response activities among the countries in the sub-region," stated the WHO.

"WHO, GOARN, and other partners are also closely supporting the Ministries of Health in deploying additional experts in the various specialties (epidemiology, social mobilization, case management, data management, and logistics, among others) to support the EVD outbreak response efforts."

The next cross-border technical meeting among the three countries is planned for 23 June 2014 in Kailahun, Sierra Leone. Nyenswah disclosed that the government is getting huge assistance from its partners, including the WHO and the United States Agency for International Development.

"We are getting a lot of help; we got a consignment of dozens of PPEs from USAID just yesterday, we're also getting support from our international partners including the government itself. There is high spirit in fighting the disease right now," he said. "WHO has stepped up international efforts to support these three countries because they believe it is the first time they have seen these many deaths and had had a toll on the population."

Nyenswah called on all health workers across the country to take universal precaution to protect themselves against the disease. "We call it the barrier netting methods; that is you must wear gloves during examination of a patient, even if they were not Ebola," he said.

"What we call infection control in health facilities should be adhered to. So we are calling on health workers across the country, including private and public facilities; clinics and everywhere, to ensure at the highest standard and level to protect themselves."

Following the reported death of eight persons including a health worker at the Redemption Hospital in New Kru Town in Monrovia, two weeks ago, the ministry of health and social welfare is reporting more than a dozen confirmed Ebola deaths as of June 26.

Deaths at JFK, Catholic Hospitals

At the John F. Kennedy Medical Center, Liberia's biggest referral hospital, the Cholera Unit at the facility has been turned into a center for Ebola and was seen busy all day on Wednesday with patients being brought in. The ELWA and the St. Joseph Catholic Hospital are the latest recipient of Ebola cases, both reporting deaths. FrontPageAfrica has also learned that another patient succumbed to Ebola Saturday at the Catholic Hospital. Authorities at the ministry of health told FrontPageAfrica last week that the disease is a national emergency and the government is taking it with a high degree of seriousness.

"The Ebola situation is critical. We are concerned; the reason it's critical is that we are confirming lot of cases, including health workers; so we're concerned right now that we are not seeing a downward trend of this disease yet," said Nyenswah. Mr. Nyenswah disclosed that last Wednesday another health worker died and it is suspected that he might have been infected with the deadly virus.

"The proprietor of that clinic whom I understand is a physician assistant died this morning upon admission in the emergency room," he said."Healthcare facilities; hospital clinics, health centers across the country; every health worker needs to take universal precaution on dealing with the situation so that we don't get more health workers being infected."

Denials hampers awareness

Though the ministry of health has made several announcements about the disease and created radio messages about the prevention of the disease, educating the general public seems to be slow. Many continue to doubt that the disease actually exists.

Outbreak in Guinea, Liberia, and Sierra Leone

The Center for Disease Control (CDC) states that as of June 20, 2014, the total number of confirmed and suspect Ebola hemorrhagic fever (EHF) cases as stated by the Ministry of Health (MoH) of Guinea was 390, including 270 fatal cases and 260 laboratory confirmed cases. Active surveillance continues in Conakry, Guéckédou, Macenta, Télimélé, Dubreka, and Boffa districts.

The World Health Organization has stated that as of June 20, 2014, the Ministry of Health and Sanitation of Sierra Leone reported a cumulative total of 158 clinical cases of EHF (including 147 laboratory confirmations, 34 of these being fatal cases). Districts reporting clinical EHF patients include Kailahun, Kenema, Kambia, Port Loko, and Western. Reports and investigations of suspect cases continue across the country. Laboratory testing is being conducted in Kenema city. The CDC states that the Government of Sierra Leone, WHO, and CDC have sent experts to aid in the response and investigation.

"As of June 22, 2014, the Ministry of Health and Social Welfare of Liberia had reported 51 overall clinical cases of EHF, including 34 laboratory confirmations, and 34 fatal cases. All cases reported in June have been from Lofa and Montserado districts. Laboratory testing is being conducted in Monrovia," states the CDC in its update on the disease, which continues to spread out of control in the region.

"CDC is in regular communication with its international partners, WHO, and MSF regarding the outbreak. Currently CDC has a 4 person team in Guinea and a staff member in Sierra Leone assisting the respective MOHs and the WHO-led international response to this Ebola outbreak."

The CDC states that genetic analysis of the virus indicates that it is closely related (97% identical) to variants of Ebola virus (species Zaire ebolavirus) identified earlier in the Democratic Republic of the Congo and Gabon.

Prevention methods

The CDC states that the prevention of Ebola presents many challenges because it is still unknown how people are exactly infected with the disease and there are few established primary prevention measures.

"When cases of the disease do appear, there is increased risk of transmission within health care settings," states the CDC. "Therefore, health care workers must be able to recognize a case of Ebola HF and be ready to employ practical viral hemorrhagic fever isolation precautions or barrier nursing techniques. They should also have the capability to request diagnostic tests or prepare samples for shipping and testing elsewhere."

Barrier nursing techniques include:

Wearing of protective clothing (such as masks, gloves, gowns, and goggles)

The use of infection-control measures (such as complete equipment sterilization and routine use of disinfectant) Isolation of Ebola HF patients from contact with unprotected persons. The CDC states that the aim of these techniques is to avoid contact with the blood or secretions of an infected patient.

"If a patient with Ebola HF dies, it is equally important that direct contact with the body of the deceased patient be prevented," states the CDC.

Ebola in Liberia, Sierra Leone and Guinea at a Glance:

Suspected and Confirmed Case Count: 390

Suspected Case Deaths: 270

Laboratory Confirmed Cases: 260

Liberia at a Glance

Suspected and Confirmed Case Count: 51

Suspected Case Deaths: 34

Laboratory Confirmed Cases: 34

Sierra Leone at a Glance

Suspected and Confirmed Case Count: 158

Suspected Case Deaths: 58

Laboratory Confirmed Cases: 147

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