Hit community reconsiders its traditions

Violently coughing up blood, the woman was close to collapse when brought to Kailahun hospital in eastern Sierra Leone from her village close to the Guinean border.

For nursing staff, the spectre of the killer Ebola virus had returned.

"My staff went into PTSD (post-traumatic stress disorder)," said Samuel Massaquoi, medical superintendent of the hospital. "People said that if she came from near Guinea she had Ebola."

Urging calm, the doctor immediately implemented the screening measures used at the outbreak's height, when Ebola cases arrived on a daily basis.

That was one month ago -- the patient was instead diagnosed with advanced tuberculosis -- but it is a clear example of how the the fear of Ebola still grips the heart of this community.

The district was the first in the country to record cases back in May 2014 after the initial outbreak in southern Guinea.

The virus killed around 230 people in Kailahun but its impact did not end when the area was declared Ebola-free a year ago: residents say entrenched attitudes to health and tradition have changed significantly.

"The outbreak started here. Every patient at that time was considered a suspected case," Massaquoi said, standing metres from the now empty triage building, where health workers in hazmat suits once worked in scenes resembling a horror film.

His hospital received a real boost, he said, with extra funding for equipment from the United Nations Population Fund (UNFPA), and targeted training for staff from Britain's Liverpool School of Tropical Medicine.

"It was not like this two years back. It has improved significantly," the general practitioner said. That was reflected by an uptick in the number of patients admitted post-Ebola, many of whom previously viewed the hospital as a place of death, not healing.

- Traditions upended -

Kailahun's first spate of cases is believed to have originated from the funeral of a traditional healer in a village close to where the Guinea, Liberia and Sierra Leone borders meet.

Ebola sufferers were crossing to see her from Guinea before she too succumbed to the virus. Many west Africans believed Ebola was a curse, and turned to their local witchdoctor rather than attempt the long distances and meet the elevated costs of government health facilities.

"Ebola came, but it came with lessons. Most of them who treated Ebola patients died," Massaquoi said.

"It was only when the powerful healers started dying that people started believing this is real. We lost quite a good amount of them," he said, with many no longer as convinced of their invincibility.

The Red Cross sought to engage the healers in the fight against the virus, persuading some to advise visitors that they could not cure Ebola, and pointing them to dedicated treatment centres.

Prevention in the form of better hygiene is highly visible in the proliferation of hand-washing stations at the string of villages that dot this rural district.

Another influential group has altered its activities post-Ebola in Kailahun: the female secret societies that dominate rural life in this part of west Africa, whose primary role is to initiate girls into womanhood.

Traditionally they would carry out female genital mutilation (FGM), a practice performed on 90 percent of girls in Sierra Leone, according to UNICEF.

But in 19-year-old Baindu Alie's village, they have stopped.

"(Families) are afraid, so there is less trust in the societies," she said.

The girls' loss of blood during the excision, usually performed with a razor, was now known to be a possible transmission point for Ebola, medical professionals in the community confirmed to AFP.

- Survivor communities -

Naima Morie, 20, lives down the road from the district hospital and is an Ebola survivor. Three of her family members were not so lucky, including a sister who died in her arms.

Morie had symptoms of fever, headache, vomiting and diarrhoea when she arrived at the Ebola treatment unit (ETU), and was driven there semi-conscious.

When she came round, "my whole system was very hot, boiling hot inside," she told AFP.

Morie made a full recovery, and in February gave birth to a baby boy named Joseph.

"When I was out of the ETU and went back home they were all rejoicing," she said, describing the reaction back in her village. "Now babies that are sick, they visit the hospital after seeing me survive."

Not everyone is so accepting. The stigma of Ebola remains a problem, and survivors have held protests in recent months against the government, claiming free follow-up treatment and scholarships for their children have not been delivered as promised.

According to Doctors Without Borders (MSF) there are more than 4,000 Ebola survivors living in Sierra Leone, and the virus killed many of country's already limited number of health workers.

Ebola is one in a long list of epidemics that have ravaged this community, each leaving its own generation of survivors and broken families.

Huge roadside signs in the district now proclaim: "It's not the end for Ebola survivors; it's the end for stigma", alongside more faded billboards that read "An HIV test saved my life".

Source: AFP