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Sierra Leone is declared Ebola-free – but the legacy of the virus continues

This week, Sierra Leone was declared Ebola-free. It was a cause for celebration, but as our Media Officer Jo Lehmann explains, the country is still living in the shadow of the virus – particularly in its shattered clinics and hospitals.

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9 Nov 2015 | UK

29-year-old Song strolls through the streets of Sierra Leone’s capital Freetown as loud music blares out from local street vendors.

"This time last year we were putting thousands of people in body bags, people were scared, unable to go out. Today we are free,” he says.

After 42 days with no new cases, the World Health Organisation officially declared Sierra Leone free from Ebola on Saturday. 

However reminders of this deadly virus are everywhere across this chaotic city. Roadside billboards remind residents to stay vigilant, and guards at security checkpoints are armed with thermometers and bottles of hand sanitiser. 

A virus that did not discriminate

Just outside Freetown, in the suburb of Waterloo, is Ebola’s Ground Zero – a cemetery filled with those who died from the virus. The grave of a 99-year-old woman sits beside that of a three-year-old boy, a stark reminder that this deadly virus did not discriminate.

The Ebola cemetery in Freetown, the King Tom Cemetery.
The Ebola cemetery in Freetown, Sierra Leone.

At the cemetery a young mother arrives for a burial service. She explains that her two-year-old daughter Nancy contracted an infection and passed away a few days ago.

Nancy is to be buried in the children’s cemetery next to hundreds of other tiny graves on the rain-soaked hillside. These children did not die from Ebola but from other – mainly preventable – causes, causes which Sierra Leone has been fighting since long before the outbreak of Ebola.

In 2013, more than 4,500 children under five in Sierra Leone are estimated to have died of diarrhoeal illnesses, common in a country where nearly 87% of the population do not have access to a safe, private toilet and more than 37% do not have clean water.

What is most shocking is the number of graves of babies under a month old.

One of the most dangerous places to give birth

Even before the Ebola outbreak, Sierra Leone was one of the most dangerous places in the world to give birth.

On average, one woman in every 21 will lose a child to infection in the first month of life. The equivalent risk in the UK is one woman in 7,518.

The Ebola outbreak made this alarming statistic even worse. New research by WaterAid, in partnership with VSO, found that during the crisis there was a 30% increase in maternal deaths and a 24% increase in newborn deaths.

With the healthcare system crippled by Ebola and struggling with even basic access to water and sanitation, many mothers were too afraid to go to hospital to give birth. 17-year-old Musu Monsoray was one of them.

“I didn’t go to hospital for any check-ups when I was pregnant, as I was too scared of catching Ebola,” she explains. “I only managed to see the midwife twice.”

Musu near her home in New Englandville, Freetown.
Musu, pictured right, near her home in New Englandville, Freetown.

Musu lives in a tiny hut in Freetown’s New Englandville neighbourhood. As in many homes here, there is no access to safe water and the toilet is in the same place as the kitchen, making good hygiene difficult.

Musu explains that she went into labour, and only at the last minute was rushed to hospital by a neighbour. Tragically, her baby was stillborn.

‘If Ebola was not here maybe things would have been different’

It is impossible to say for sure what caused Musu’s baby to die. But we know that women whose growth and development in childhood were stunted by chronic diarrhoea, caused by dirty water and poor sanitation and hygiene, are more likely to have complications in pregnancy, including obstructed labour.

Women who are ill during their pregnancies are also more susceptible to complications, and infections can set in during long labours if women give birth in unhygienic conditions, assisted by midwives unable to wash their hands properly with soap.

“If Ebola was not here maybe things would have been different,” Musu says. "I would have gone for regular check-ups. Instead my baby died.”

Rebuilding confidence in the healthcare system

There is still a huge legacy of fear surrounding the healthcare system in Sierra Leone, with mothers reluctant to go to hospital.

“At the height of the Ebola outbreak hospitals were seen as a place for the dead,” says Dr Amadu Sesay, the medical superintendent at King Harman Road Government Hospital.

“Going forward we have to rebuild confidence in the healthcare system in Sierra Leone, especially with regards to maternal health.”

Baby Sarah, who was born at King Harman Road Government Hospital, Tanzania.
Baby Sarah, who was born at King Harman Road Government Hospital.

Next door a woman in labour lets out a loud scream. Dr Sesay goes to tend to her. Minutes later, baby Sarah is born.

Both mother and baby are fine and in good health. But for Sarah the next 28 days of her life will be her most vulnerable.

For Sierra Leone to move past the Ebola outbreak and give newborn children a fighting chance at life, ‘clean’ must be put at the heart of healthcare.

No longer can hospitals lack access to water, sanitation and hygiene. Sarah’s life depends upon it.