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Life in an infected Ebolacountry EtC: Could you explain how the ebola outbreak started and evolved in Sierra Leone? The crisis itself started in Guinea. And as you may know Sierra Leone and Guinea share a very porous border. Porous in the sense that these borders do not lend themselves to conventional means of crossing. So people just crisscross between each other and most of the people living in the border region have relatives on the other side of the border. At some point someone from the far eastern town of Kailahun came back from a burial in Guinea and got ill. That is how it started spreading. of the ebola disease. First of all, we don’t have modern facilities of attending to burials. From a western perspective, you would expect that when somebody dies, he will be taken to a mortuary, cleaned-up and prepared for burial. Here, in most parts of the country, except the capital city where you have more modern facilities, relatives take the responsibility to wash the body and prepare them for the afterlife. Sometimes this involves rituals in which family members wash themselves with water that they have used to wash the deceased. In Guinea and Liberia the burials are very similar because the three affected countries in this region have similar cultures, practices and ethnic groups. EtC: Do you think these funeral practices have contributed to the spread of ebola? Which challenges have you encountered in your daily life since the outbreak? “Poverty and deprivation make this kind of disease thrive” Certainly. That is the major source of the spread For this article, the Exchange to Change team interviewed Henry Mbawa who obtained his Master’s degree in Governance and Development at IOB in 2007 and the Province of Antwerp Prize in the same year. Since his graduation he obtained his PhD at the University of Leeds and is now working for the Ministry of Justice in Sierra Leone. He paints a vivid but nuanced picture of how he and his fellow citizens are experiencing the Ebola epidemic. I have encountered different challenges. You get, for instance, restrictions on the social interactions you have with other family members. You are advised not to touch and have intimate contact with people and that affects the relationship with close family members. We no longer socialize in gatherings and events. I used to exercise on Sundays along the beach with friends and we play football together, but that has been banned as well. These days you even need special permission to organize a wedding. Professionally, it has affected our work as certain activities could not be implemented due to travel restrictions and a ban on gatherings. These are ways in which ebola has affected me, but the wider population might have to deal with more serious challenges. EtC: Could you explain why? This disease is serious and intense because poverty and deprivation make this kind of disease thrive. This is a region where over 70% of the people live in poverty. They share communal facilities like toilets, go to overcrowded markets and have a poor health and sanitation infrastructure. Whole districts have been in quarantine and these are the same districts where you have these very bad health facilities. Additionally, agriculture remains restricted, while tourism and businesses continue to stagnate with a consequential effect on the economy. These are all areas where employment opportunities are created for people of the lower brackets of society. Thus, this disease has genocidal effects on the poor. It is more severe on people who are poor and illiterate. Middle class people and others may be able to protect themselves. They share their house with fewer people, have better health and sanitation facilities and have a good understanding and capacity to navigate their way in the health system. EtC: Do you think ebola will have a long lasting impact on your country? Yes, I think so, but these long term effects could be both positive and negative. On the negative side, ebola has torn apart social interactions which will have long term impact on cultural and social interactions. Our cultural practices have been unravelled and questioned. The outbreak has also set the country back for many years of developmental efforts that were meant to improve the lives of its people. Funding for road construction or schools is very tight as a lot of funds are now being diverted to ebola. Another long term effect is the impact on the image of the country. Ebola will also leave a stigma, just like what happened after the release of the ‘Blood Diamond’ movie. During my period in Antwerp there was a lot of stigmatization and people thought that I was just coming from a war zone. This pessimistic view of Sierra Leone and the whole of Africa is now being reinforced and will have a negative impact on investment in the long run. On the positive side, it is good that more questions are being asked about practices that do not lend themselves well to modern forms of hygiene and 18 sanitation. As such, the most striking effect of ebola is that it has shone a light on the weak health infrastructure within these countries and the wider issue of strengthening governance institutions to deliver services to its citizens. “Ebola’s long term effects could be both positive and negative” The Liberian President Sirleaf said that it is no coincidence that ebola has taken hold in three fragile states, all battling to overcome the effect of interconnected wars. Do you agree? She has captured the very nature of the disease. These three states are former failed states, but they remain very fragile. In a region where people are coming out of long periods of war and instability, government institutions remain weak to respond to these crises. However, what we cannot excuse is the failure of leadership. Leaders should take more responsibility to push for effective governance and rebuild these institutions in their countries. Thus, the excuse of state fragility should not be overstretched. EtC: What do you expect from the international community? I am more of a skeptic than a fan when it comes to the expectations we heap on the international community, simply because there is no single international community. Most people accuse them of coming quite late, but that is because go vernments react based on the local public opinion. As long as they don’t see trucks of refugees coming towards Europe, people won’t have the sympathy to act and the media won’t pay attention to these countries. By now, public opinion changed in most European countries and they are coming with all their sympathy to help ‘poverty-stricken Africans’. But I do not have too much faith in the international community when it comes to things like this. Indeed, their interventions have helped to some extent to coordinate the response, but it took long before anyone noticed us. EtC: Do you have any message you want to send to the IOB community? Ebola is a serious disease. This can happen to any country, although we might be more vulnerable because of our weak systems. Much as we all feel terrified and frightened about this serious disease, we hope and pray that at the end, this disease will not serve to stigmatise Sierra Leone or Africa in general. Lisa Popelier The Ministry of Health declared a 90-day alert on August 11, 2014, which was later extended for a few more months. In August, it also deployed medical teams to check people suspected of carrying the virus in 25 ports. The airport is currently checking temperatures with a hand-held thermal scanner capable of measuring temperature without touching the body. There is no direct flight service between Bangladesh and the major Ebola-affected countries – Liberia, Sierra Leone and Guinea. Most of the travelers from these countries arrive in Bangladesh via the Middle East or other countries. Nowadays, the urban educated people are a little concerned about Ebola and it is not perceived among citizens as a ‘threat’ for Bangladesh. Though the media and some health experts are vocal about the issue. For example, the Daily Star on October 13 published a report by referring to the remarks of Dr Saif Ullah Munshi, associate professor of Virology at Bangabandhu Sheikh Mujib Medical University, who said, “There must be very rigorous monitoring at the ports. A single mistake can cause disaster.” Sensible preventive measures: there is an ongoing campaign to sensitize people about the disease and some elementary measures that can be adopted to prevent the disease from spreading (for example, regular hand washing with detergent soap) and efforts have been carried out to track and record potential Ebola cases among passengers coming to Burundi once they arrive at the Bujumbura International Airport. There is, however, still a long way to go in terms of putting in place a real health unit, well-staffed and equipped enough to deal with probable cases and I’m afraid that any single case would be a very big challenge to our weak health system. There is apparently a weak awareness among the general public about Ebola as people continue to think that those affected countries in West Africa are relatively far away from Burundi. Life goes on normally, which is somehow good because it’s not productive to create an unjustified panic, but I think there is a need for a constant alertness by the population in general and the government in particular to make sure that any case is managed efficiently if and when it occurs. 19