The lasting shadow of Ebola: the virus that killed the carers
In 2014 Sierra Leone experienced a devastating outbreak of the Ebola virus. It killed almost 4,000 people. In March 2016, the outbreak was declared over, but the impact the virus had on the country’s fragile health system will be felt for years to come.
The virus that killed the carers
Ebola is the virus which killed the carers. The family members looking after sick loved ones; the health workers and doctors treating those who made it to hospital; the communities preparing bodies for burial.
In 2015, The World Heath Organisation (WHO) reported that 302 local health workers had been infected with Ebola (1). 11 of Sierra Leone's 136 trained doctors were killed by the virus (2).
In Sierra Leone, where resources were already inadequate, this had a devastating impact on the public health service.
While 0.06% of the general population died from Ebola in Sierra Leone, the country lost 5.6% of its health workers (3).
Fearing to leave home
After Ebola, many people were scared of attending clinics or hospitals, associating them with death. Health workers were also frightened to return to work, in case the virus returned.
The consequences were dire. Overall, visits to primary health facilities decreased by a third in June-December 2014 compared to the same period in 2013 (4).
Pregnant mothers were one of the most affected groups.
Mothers and newborns
Studies have shown that attending at least four antenatal care visits can significantly improve maternal and newborn health because complications can be detected at an early stage, and vitamins and other nutritional support can be provided (5).
In early 2014, the number of pregnant women in Sierra Leone attending at least four visits actually showed an increase over the year before. Sadly, the Ebola crisis reversed these fragile gains.
A Lancet study estimated that the reduction in health personnel, due to Ebola, could increase maternal mortality rate by up to 74% (6).
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By July 2014, the number of women receiving antenatal care began to decline to levels below the year before.
A UNICEF study found that by the end of the year, little more than half of pregnant women were coming to a primary healthcare facility for at least one antenatal visit, compared to 93% between 2008 and 2012 (7).
The number of women giving birth in a clinic or hospital setting also began to decrease.
By December 2014, only half of all pregnant women were receiving antenatal care in primary health facilities (ACAPS 2015).
These statistics are made even starker by the fact that Sierra Leone already held the dubious honour of being one of the worst place in the world to give birth.
A pregnant mother-to-be in Sierra Leone is 100 times more likely to die in childbirth than women the UK.
Leaving visits too late
Too many mothers only come to the health centres when it is too late. Often they are suffering from complications such as haemorrhaging, and pre-eclampsia.
Those that do go to health clinics, often face long journeys on bad roads only to reach clinics that often don’t have enough trained staff to attend them quickly.
Steps for recovery
Sierra Leone is a country with a unique culture and traditions. There is a strong practice of communicating through music and dance. At the height of the Ebola crisis, when the government and global health NGOs were struggling to raise awareness of the methods of preventing the spread of the disease, specially written songs and dances helped to engage communities and change behaviours.
Volunteers work within and alongside communities to increase awareness of health issues and engage with the most vulnerable in society to bring about better health outcomes for women and babies.
Trained doctors are volunteering in primary healthcare facilities in some of the regions worst affected by the virus. They are helping to reverse misunderstandings about health clinics and providing training where there is a dire shortage of skills and resources.
The aftermath of Ebola has left the Sierra Leone health system balanced on a knife edge. There is a real opportunity to maintain the world’s focus on the country’s health service and to ‘build back better’. But without the right investment this could be the decade that sees this vibrant and resourceful country slip backwards, with women and children paying the ultimate price.
- 1. WHO (2015)
- 2. Evans/World Bank 2015 via CSIS 2015
- 3. WHO (2015) "Ebola situation Report - 23 September 2015"
- 4. ACAPS Thematic Note March 2015
- 5. WHO 2006
- 6. Lancet 2015
- 7. UNICEF, 2013