Sierra Leone has just reported one week of zero confirmed Ebola infections—the first time since the deadly virus reached its border in May 2014. If there are no more infections for 42 days after the country’s last Ebola patient was discharged, the outbreak will be declared over. But the race to end West Africa’s Ebola epidemic is not just about getting to zero infections. It’s also about how the three countries most affected can deal with the broad humanitarian crisis the virus has left, which impacted livelihoods and led to food shortages, loss of education, widespread fear and mistrust in communities.
Ebola has caused further limitations to an already poorly resourced health and social care system. In Sierra Leone, there is just one trained psychiatrist for a population over 6m people. Recent research I’ve worked on and visits to Sierra Leone to pilot a mental health intervention with nurses there have illuminated the severe lack of mental health services available—and the devastating impact that Ebola has had on those already scarce services.
Devastated Communities
A nurse in Makeni, Sierra Leone’s fourth largest city, was brought to tears as she described the vulnerability of orphans, especially young girls, who cannot afford to go to school and are left without family or community support. The charity Street Child estimates that over 12,000 children have lost at least a primary caregiver due to Ebola. Following training we delivered in April, this nurse is establishing connections in the local community to support these young girls to get back to education or find jobs.
The disease was particularly influenced by cultural and behavioral practices at household and community levels. Much of West Africa still relies heavily on traditional healthcare practices. The care for a sick relative is first done in the home by family members and further treatment is often sought from traditional healers rather than in the poorly resourced government health facilities. Fear and mistrust of modern health services have existed in Sierra Leone for some time. This stopped many people from seeking medical care for Ebola and caused them to instead flee or hide from authorities. One can imagine how distressing it might be to have people enter the village, fully covered in personal protective equipment and to recognize that when they took a family member he or she was not likely to return.
