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Ebola: No Graves, Cremation Leave Families With Trauma

Ebola: No Graves, Cremation Leave Families With Trauma

 

Monrovia - Jene Wonde – Momolu Stewart, 41, lost two sons and a daughter to Ebola in October 2014.

His two sons were buried in Amina, a village in Jene Wonde in Grand Cape Mount County’s Garwula District, but his daughter was taken to the Island Clinic outside Monrovia for treatment.

He visited her often until he received a call from healthcare workers to say that she had died.

Stewart has never found out where his daughter was buried.   

Three years on, Stewart still has nightmares and often wakes up in the middle of the night thinking about her.

“Week before last, I dreamed about her and she asked me: ‘What happened since they carried me you can’t find out about me?’ Stewart reveals.

“Sometimes when I dream about her I wake up and make sacrifice. That is the only thing I can do now.”

Stewart is one of the 250,000 people in Liberia estimated to be traumatized over the death of relatives from Ebola, according to Amos Gborie of the National Public Health Institute of Liberia (NPHIL).

That number, says Gborie, does not include healthcare workers. 

Jene Wonde was one of several towns hit hardest by the Ebola epidemic in Liberia. About 75 people died in the predominantly Muslim town, which has a population of 4,000 people.

Some of those bodies were secretly buried by relatives in local cemeteries but many were taken to a public cemetery at Disco Hill, cemetery records show.

Others were cremated at a crematorium in Boys Town in Margibi County.

Due to the nature of the emergency at the time, many did not receive death certificates, leaving dozens of families with no place to mourn their loved ones. 

Mourning the dead is an important element of the Liberian tradition. Families regularly perform rituals and pay respect to their dead.

The rituals are thought to have dual purpose: to appease the spirits of the dead relatives, and to bring fortune and comfort to the living.

Without proper burial or a place to mourn the dead, the spirit of the deceased is thought to wander forever and darken the path of the living.

Not having a place to mourn the dead, say mental health experts, is contributing to Liberia's mental health crisis. 

Cremation

The barrels of remains of cremated Ebola victims in Liberia being transferred to the Disco Hill cemetery in March 2015

The World Health Organization (WHO) declared Liberia Ebola-free in May 2015, just to see the killer disease resurge three more times before finally coming to an end in June 2016.

The virus killed more than more than 4,800 alone in Liberia, according to the WHO.

In September 2014, Ebola had its highest surge.

Nearly 5,000 cases were reported in Liberia, Sierra Leone and Guinea, with close to half of the cases confirmed dead.

In Liberia, sick people lay at the entrances of treatment units waiting for care.

Dead bodies littered the streets in places like Monrovia and Foya, reminiscent of the civil war years.

Then U.S. President Barrack Obama warned that the outbreak was “spiraling out of control” and sent U.S. soldiers into West Africa to assist with the response.   ­­

Records from the Ministry of Health show that 3,000 Ebola victims were cremated at Boys Town crematorium in Margibi County.    

“Cremation was a public health intervention that was necessary at the time of community resistance,” recalls Gborie at the National Public Health Institute.

“It became a security issue. The government of the day decided that we had to take care of the deceased in order to stop the infection from spreading.” 

But these enforced cremations meant that many people were taken from their homes and without their family's knowledge or consent.   

A total of 186 at Disco Hill cemetery have not been identified, according to the cemetery’s records, although not all of the number died from Ebola. 

These unidentified bodies  were marked “unknown” because they had no known relatives, were either dead when taken to the treatment unit or were too sick to speak, says Gborie.  

Just 200 families have come to obtain death certificates for their deceased relatives, says Gborie.

“I think it is also due to the trauma. Some people, especially for those who were cremated, it is still an issue for them,” he says.

NPHIL does not have death certificates for more than 1,800 Ebola victims. Stewart’s daughter is one of them.                                           

“Crazy” people

Still recovering from a bloody civil war that killed an estimated 300,000 people, Ebola deepened the country’s wounds. 

Liberia has one of the worst mental health profiles in the world, according to the WHO, where one in five Liberians suffers from mild to moderate mental illness and there is just one psychiatrist in the whole country.

There are no public rehabilitation homes and, until recently, there was no mental health policy. Mentally ill people—often called “crazy people” in Liberia—roam the streets of Monrovia and other cities.

No mental health program in the country goes as far as treating relatives of Ebola victims.

The Carter Center began running a mental health program in 2015 but works only in Montserrado and Margibi. ­­­The center works with psychosocial counselors but their training lasts only six weeks. 

A vaccine trial being carried out by the United States and Liberia, has enrolled thousands of Ebola survivors and their close contacts but does not look into mental health issues.

The Partnership for Research on Ebola Virus in Liberia (PREVAIL) only provides counseling for volunteers when being admitted into the program. 

Authorities at the Ministry of Health say Liberia is more prepared to contain a future outbreak of Ebola, but concede more needs to be done to address the psychosocial needs of people traumatized by the disease. 

Amanda Gbarmo Ndorbor, National Coordinator for the Ebola Disease Survivors Secretariat, says people like Stewart in Jene Wonde need help. 

Despite the secretariat being responsible for meeting the needs of Ebola survivors, including relatives of victims and healthcare workers, Ndorbor says support has been inadequate.

“There is no health without mental health. It should be prioritized; it should have [a] budget allocated to it and personnel must be paid well,” she says.

“Mental health does not have the level of attention and support that it should have, and mental health service provision is challenging.”

But Ndorbor says that Ebola only compounded a health crisis that already existed.

“Right now it is relatives of victims… but we had 14 years of civil crisis, which is a major factor for people to develop mental health conditions.”    

In 2014, the Liberian government announced that it would erect a monument to the memory of all victims of Ebola in Liberia.

However, that has yet to be done.

Instead, the bones and ashes of all cremated victims are being kept in barrels marked with the dates they were cremated at the Disco Hill cemetery.

In Jene Wonde, Stewart continues to mourn his 15-year-old daughter.

Later this month he and other residents of his village will offer sacrifices to those who died from Ebola in Jene Wonde.

He will have to offer his sacrifice without a grave.  

For now, a small monument sits in the middle of the grief-stricken Disco Hill to the memory of Ebola victims.

Its epitaph fades gradually: “In another home, in a better place, in a beautiful forever”.

By James Harding Giahyue, FPA Contributor

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