As Ebola threat abates, Sierra Leone turns attention to survivors

For Fonti Kargbo, Ebola fills up his waking hours. 

During the day, he is an expert patient facilitator at the Ebola Academy, a training center for health workers. At night, he works as a superintendent at the Ola During Children’s Hospital, Freetown’s main pediatric hospital. And in his free time, he is second-in-command of the Sierra Leone Association of Ebola Survivors, a national support group. 

The 42-year-old nurse sees his roles in the Ebola fight as a kind of vengeance against a disease that nearly killed him and claimed the lives of five out of seven family members, including his wife, also a nurse. She fell ill last September. Soon after, everyone in his family except his five-year-old daughter tested positive for Ebola. He was the only one who survived.

Then came the next struggle. “Getting the community to accept me after surviving Ebola has been my biggest challenge,” he says.

Since the start of the outbreak, Sierra Leone has had 8,353 confirmed cases of Ebola, according to the National Ebola Response Center. Of these, 3,086 individuals, or 37 percent, survived, yet now face social discrimination, neglect, and possible life-long health problems. 

The government is now turning its attention towards this population and their needs, while it continues to work towards zero new Ebola cases. There is no specific plan in place, but the rollout of support groups and free access for survivors to healthcare could be key indicators of how well the country can rebound from the disease. 

The initial government support comes in the form of reintegration packages, worth $200, that provide each survivor with items like food, a mattress, and condoms. It provides a first step for many who have lost everything in a nation that barely a decade ago emerged from a decades-long civil war. 

“During the war, victims ended up begging in the streets. So my target is no Ebola survivor must go on the street to beg,” says Moijueh Kaikai, Minister of Social Welfare, Gender and Children’s Affairs says.

Everyday indignities

Mr. Kargbo describes facing discrimination in all areas of his life after his release from a treatment clinic last October. Most troubling was when he went to seek refuge at his mosque – and its members avoided him.

“I had to take my certificate ... to the mosque and asked the clerk to read it out loudly for them to know that I no longer pose a threat to the community,” he says.

Suspicion of Ebola survivors runs deep here. To combat discrimination, the government now issues certificates as proof that a survivor no longer has the virus, Kaikai says. In some cases, medical personnel accompany them home in order to tell community leaders that the survivors have been cured.

But most devastating for many survivors is the loneliness they feel, especially with the loss of their own family members.

Marie Kamara survived Ebola, though her husband died last October. When she was discharged from a Red Cross Treatment Center to take care of her three children, she was disowned by her late husband’s family.

She has been attending the meetings held by the Sierra Leone Association of Ebola Survivors, where Kargbo works in his spare team. The government-funded group was set up in January to fight stigma, offer support and advocate for survivors, and help their reentry into civilian life. It plans to open a branch in each district, Mr. Kaikai says.

The association also provides psychosocial counseling in members' homes and promotes entrepreneurship for survivors who lost their jobs, says Yusuf Kabba, the national chairman.

Ms. Kamara’s late husband was a mechanic for the Freetown City Council. But she is still waiting to get access to his benefits. A trader selling plastic items, she had former customers refuse to pay her, and taunt her by calling her “Ebola.”

She then fled with her children to her sister’s house in Lungi, 18 km (11 miles) from the capital. There, no one knows her status. “I have no money to start a business now and my only hope is my elder sister who asked me to go to Lungi and stay in her house,” she says.

Sierra Leone's government has limited resources and pressing needs. Kaikai's ministry is tasked with returning child survivors to their communities or to orphanages and providing food for survivors, as well as caring for the health of survivors. 

Healthcare needs

Ebola survivors also have to deal with unexpected side effects from the virus.

“When the virus enters the system it affects the organs and causes severe damage,” says Dr. Foday Robert Sesay. Though some effects are temporary, others can be long-term.

Dr. Sesay heads the Ebola survivors’ clinic at 34 Military Hospital, the only medical facility in Freetown with such a mandate. The clinic opened in January to provide free treatment to survivors and has so far treated about 40, with half returning continuously. Funding comes from the Defense Ministry. 

“When they go to other doctors or to other hospitals, they don’t treat them. They are afraid of them even though they are survivors,” says Dr. Sesay.

Dr. Brima Kargbo, chief medical officer in the Ministry of Health and Sanitation, says the ministry's goal is for survivors to be treated at normal medical facilities rather than dedicated clinics. The only other survivors' clinic in the country is the federally-funded Kenema Government Hospital, about a five-hour drive east of Freetown.

For now, Sesay says healthcare for survivors is not yet a crisis, but as more survivors look for care, it will become impossible to ignore. 

“It will only be a crisis if it is not handled now. There should be effort to set up more survivors’ clinics to treat cases,” he says.