Betsy Small Campbell’s (Sierra Leone 1984-87) brilliant analysis of the impact of ebola on the people of Sierra Leone
Reflections of a former Peace Corps Volunteer in Sierra Leone
by Betsy Small Campbell (Sierra Leone 1984–87)
For the Concord, New Hampshire, Monitor
Friday, October 3, 2014
(Published in print: Friday, October 3, 2014)
(This is Part One in a two-part series. Look for the conclusion in tomorrow’s Forum.)
NO ONE WHO LIVED through the well-documented “blood diamond war” in Sierra Leone has forgotten the terrifying sound of an approaching automatic weapon. Still today, the loud noises of thunder, fireworks, a honking horn can cause panic. Millions of people in this mountainous West African country have fought to put the nightmare of 11 years of bloody civil chaos behind them. The conflict has been over for more than a decade, but the harrowing scars of war are everywhere. There are thousands of amputees, and the elders who should have been around to guide the next generation are dead.
People remember trying to escape the horror, running for their lives through rainforest and savanna, hiding in caves and evading road blocks manned by rebel soldiers. One indelible image: survivors arriving at road blocks that first appeared to be made of stacked cord wood. But it wasn’t wood; it was the decomposing bodies of the dead. And now Ebola, a new invisible army, is flourishing, an equal-opportunity threat making carbon copies of itself. And everyone in Sierra Leone now fears its swift and ruthless aim just as they feared those abducted boys holding AK-47s, whom we saw on the front pages of newspapers.
Last November, four months before the first reported cases of Ebola in Sierra Leone, I returned to the village of Tokpombu where 30 years before I’d lived as a Peace Corps agriculture volunteer. I introduced my son’s kindergarten teacher, Lisa Freeman, and my 15-year old daughter Lilly, to my friends from long ago, those who were lucky enough to survive the rebel attacks on their village. We spent 10 days in the country. It was a touching reunion, long overdue. I wish we’d had more time.
Ebola was not on anyone’s mind. The harvest season was beginning. A large crowd took time away from their farms to welcome us with drums, songs and dancing. We hugged, we sat holding hands, we ate from a common tray. Everything about this reunion revealed a culture of caring and sharing in the most poignant of ways. My friends from long ago greeted us the way I remembered, “Ow di bodi?” which literally means, “How is your body?” to determine whether your health is well enough for you to work. But what we also saw were men and women who had lost a decade of their lives, who were never able to attend school and who were exhausted from the exertion of each working day, trying with every cell in their bodies to rebuild their lives — to harvest their crops and process their food, or just to pull a sleeping baby off their backs and lay her down. Everyone spoke to us of their futures: of peace, renewal, and possibility.
During our visit less than a year ago, I didn’t feel fear or mistrust. Yes, there were seemingly insurmountable obstacles to rebuilding and maintaining an infrastructure, and health and education systems that lacked the basics. And it was clear that rampant corruption was sapping resources that should be used to build up this struggling post-colonial, post-conflict nation. But what took my breath away — what I easily found in the overcrowded cities and barely accessible rainforest villages — was a kind and disarming culture that welcomed us just as it had welcomed me 30 years ago.
A nation in shock
For the people of Sierra Leone, Ebola has arrived out of nowhere and in only five short months, it has preempted a way of life that no medicine man or woman, no juju, no pastor, no imam, no conspiracy theory can heal. Although the Ebola virus is not new to Africa — it was first identified in the Democratic Republic of Congo 1976 — the CDC has characterized this new Ebola strain as far more complex and virulent.
Its transmission is believed to have first taken place through the ingestion of fruitbats, a delicacy that some farm families rely on to pad their bellies during the Hungry Season when the rains are heaviest, before the rice harvest. But now it is spreading at exponential rates from human-to-human, through blood, body fluids, and even sweat.
This new Ebola virus which began at the geographic locus of Guinea, Liberia and Sierra Leone, has changed everything. An entire nation is in shock. No one knows the full scope of this virus or the havoc it might wreak. Like a chameleon, it keeps changing. No one knows for sure how it’s going to change the way Sierra Leoneans or any of us see the world.
The Ebola virus starts as a low-grade fever, the same as the flu, malaria or typhoid. But the fever slowly rises, a nightmare indicator: untreated, one may have as few as 21 days to live. Surviving your body’s immune response is now a game of roulette. Organs start to hemorrhage — bleed internally. Dehydration sets in, causing psychosis, and the patient starts to cough up blood. Agonizing pain follows as the patient excretes blood. And then dies.
Ma Sando, a village woman I knew during my Peace Corps days, called me two weeks ago from the top of a hill on the outskirts of Tokpombu — the place where people gather with their phones and SIM cards to access cell reception. She spoke frantically about what everyone in the village now believes, “Nar God ehn wi ancestors no more go help wi” (Only God and the ancestors can help us).
When the war ended in 2002 Braima Moiwai, a Sierra Leonean friend now living in North Carolina, brought me an audio recording of Ma Sando. We sat at my kitchen table as he loaded a cassette into the player. For the first time since I left Tokpombu village in 1987, the mother of the family who “adopted” me when I lived there, would be sharing her story.
Braima pressed the recorder on and I heard the crackling sound of the machine and her breath. The steady breath of my friend, Ma Sando. At the time of the recording, Ma Sando was surviving in a refugee camp outside the capital city of Freetown, while I was sitting with Braima in my living room in Chapel Hill, 6,000 miles away from a place where war was once as unimaginable as Ebola is today.
I listened to Ma Sando inhale deeply, the sound we all make before we speak our truth.
“Ah Betsy! Ay still de alive! Ah tehl God tenki!” She described how relieved everyone was that the surviving members of her family would finally be able to return home to bury the bones of their loved ones. And then she slowly named all the people I knew who had died in Tokpombu village so I would remember them too.
Caring for the dead
During my Peace Corps years in Sierra Leone, I learned how the link between the dead and the living is crucial. Ma Sando once told me, “The buried treasure isn’t our diamonds but how we bury our people.” She was referring to how the dead are bathed, dressed and celebrated to prepare them for the next world. To a Sierra Leonean, the spirits of their loved ones are still very present and active in daily life. Paying them homage according to tradition, is what gave survivors some sense of closure about the war. There is even a word here that people say to remember the ones who have died but whose name they don’t remember and for which they apologize. “Nde-bla-sia.” For these ones, too, libation is poured.
I remember when Ma Sando’s father, Pa Sanusi, died. The entire village gathered and for over a month his passing was mourned and his life celebrated. The lengthy funeral was followed by a “seven-days ceremony” and then a “40-days ceremony” which marked the completion of the soul’s journey from the world of the living to the world of the dead. Both Christian and Muslim families took turns in these rituals, all of whom regarded one another as belonging to the same people, as they always have in this country. There was feasting, singing and dancing. People told stories of the life of this old man. He was revered and venerated.
Today, on the new battleground of Ebola, Sierra Leoneans must find new ways to observe these most fundamental and restorative rituals. The bodies of the dead are “hot zones” more contagious than living patients and must be carried away by men in spacesuits (protective gear) and buried in secure locations away from traditional burial grounds. Teams of young boys are signing up for a job that traditionally belongs to their elders. Even though they are risking their lives, their communities ostracize them, partly out of fear that they’re contagious and partly due to the fact that these new protocols ignore long-held traditions.
It’s difficult to accept the notion that people living in Sierra Leone are not supposed to touch or bury their dead or comfort surviving family members in the traditional way. Since the arrival of Ebola, you cannot share your bed with visitors, eat or drink from the same cup or bowl, put your neighbors’ children on your lap, greet elders by shaking hands and touching your heart. You cannot sit shoulder to shoulder sweating as you grieve the dead with your friends and family. I cannot imagine: no public gatherings now, no church, no mosque, no celebrations, no town meetings, no school, no way to conduct the joys and sorrows of life.
ABC’s of Ebola
People have been sequestered in Sierra Leone since the Ebola outbreak. President Ernest Bai Koroma has taken a drastic stand: establishing checkpoints to enforce “prevention and control” measures, and imposing a nationwide, three-day lockdown that ordered 6 million people of this country to stay in their homes while 30,000 recruits wearing latex gloves went house to house distributing bars of soap. He also instituted a public health campaign to raise awareness and educate people about the virus in order to quell misinformation, superstitions and conspiracy theories. Even now, a third of the country remains quarantined.
The message is clear: Wash hands with soap and chlorinated water, and “ABC” (Avoid Body Contact). If you or anyone you know has a fever, seek help at the nearest hospital. Do not touch a dead body. Call the authorities to collect it. This will save lives and “save their country.” This is the hope everyone is reaching for.
But there are critics and skeptics everywhere — of both the president and of the international community for acting too late. Although there are many heroes in this fight, some of the measures taken in desperation don’t fully consider the cultural logistics of this country. Without access to clean water, what is soap and chlorine to a family? And now Ebola lays bare the very real suffering that exists in post-colonial, post-conflict African nations. Many already inadequate health care facilities are closing down because of Ebola. The few that remain open are pre-occupied with admitting only Ebola patients.
Women with complicated labors, children with dysentery, people with malaria, HIV/AIDS, tuberculosis, typhoid, even Lassa Fever (another hemorrhagic disease) have nowhere to go or are afraid to mingle in the long lines where they might seek treatment. Simple everyday illnesses are going untreated. This collateral damage is also taking a toll.
Since late May, more than 838 people have died in Sierra Leone from Ebola, and the number of deaths is growing daily at an accelerating rate. And those are just the reported ones. More than a thousand more have also tested positive for Ebola and are sick. Those are just the ones who’ve been willing to be tested. There are still many more in hiding who are suffering its effects.
People are afraid to get tested — and with good reason. When 30 nurses and four of Sierra Leone’s most respected medical doctors died from the dreaded disease, it raised everyone’s fears. When the premier experts in the country, who know the necessary precautions perhaps better than anyone else, die of the disease, it sinks in that this is a formidable public health crisis, a microbial tsunami, or worse because no one knows when its waters will recede.
Even the CDC has projected worse-case-scenario death counts in the millions by January 2015. It’s hard to have faith in the way medicine and new public health protocols might work together to save lives. Thousands of pounds of protective gear have been delivered with the assumption that people know how to use them properly. Many people don’t. Nor do they have time to learn how to wear them. Even if they did, they risk heat-exhaustion in this climate where temperatures can easily climb beyond 100 degrees.
Last November, I spent a few days in Freetown, the nation’s capital, with Lilly and Lisa to “acclimate” before making the 10-hour drive to where I once lived and farmed in Tokpombu village.
Freetown has a population that exploded by 300 percent after refugees refused to go back to their ancestral villages at the war’s end. It was difficult to tell the ruins of war from the non-ruins. Its narrow streets teem with buses, automobile and motorbike taxis, wall-to-wall pedestrians, and wall-to-wall markets. And not only Freetown, but Koidu, Makeni, Kenema and Bo, the other provincial headquarter towns.
Piles of seeping garbage, and people excavating what they could from its mounds were a common sight, accompanied by the smells of burning plastic and raw sewage emptying into rivers and into the coastal capital marshland. There are many structurally unsound places to live and work in this country where the climate fluctuates between completely dry and completely wet. These extreme conditions create breeding grounds for parasitic or viral life to encroach.
Everywhere, but especially in the city, people live packed together in small spaces, sharing everything — it’s impossible not to touch. Even inside the hospitals, patients are heaped on dirty, thin, uncovered foam mats that lie on rickety pipe metal frames, some the same “beds” that were used before the war. It’s troubling to think about a health care system in such disrepair.
Sierra Leone’s largest city once had leafy foliage climbing from its coastline into arching hills where houses stood beveled like rough jewels, but it’s now so deforested and exposed, so densely crowded, there seems to be hardly enough room for the living or the dead.
Sierra Leoneans are their own best resource in their country. Crises and hard times are a way of life, so they know best how to be innovative and resilient. I know they will find a way through this. It’s just that now, as this country transitions from one of the harshest rainy seasons on record into Harmattan, when the Saharan winds push cool air and dust from the North in its direction, the view ahead is more obscured than ever. Sierra Leoneans often make the comment, “Nar di same dawty dehm get foh bury wi all.” (It is the same earth we are all buried in.) They know that the failure of one person is the failure of all, a missed opportunity for understanding.
I introduced Lisa and Lilly to Ma Sando in the rural village where I had lived. Lisa taught the children the same clapping, singing, hand-holding games she taught my now-13-year-old son on the clean foundation where my house once stood, burned down in the war. Ma Sando pointed to the crumbled back steps where we used to sit in the evenings.
I remembered sitting there with Sahr Kondeh, Ma Sando’s only son, when he was a 13-year-old school boy looking up into the night sky on the back stoop between our houses. “Nar America dehm make stars?” (Did America make those stars?) he asked, referring to the satellites he’d seen passing overhead. With his intimate knowledge of the night sky, a satellite was an easy mark, just as a plane was. Sahr Kondeh was trying to distinguish what was old from what was new in his world. He was seeing something he’d never seen before, and trying to understand.
It’s hard to understand things for which we have no reference point, like Ebola.
Before we left, we hugged. We held hands. We touched hope. We promised to return.
Betsy Small Campbell of Milford, NH was a Peace Corps agriculture volunteer in Sierra Leone from 1984 to 1987. She is the former director of War Child USA, a nonprofit that was founded in Peterborough that is devoted to helping children marginalized by war, and is now working on a book about her time in Sierra Leone. She is also a board member of the Mariposa Museum and World Culture Center in Peterborough.
If you would like to make a donation to help efforts to contain Ebola, consider making a donation to:
Village Medical Project for Sierra Leone Society
c/o Africa Yes
2308 Sprunt Ave.
Durham, NC 27705
Visit AfricaYes.org for more information.
Thank you to Betsy Small Campbell for this beautifully written and incredibly important story of the people of her community in Sierra Leon and the impact of Ebola, the health mandates and their culture. It should be required reading for every health worker.
I believed that Campbell’s analysis is an excellent example of what the Third Goal truly means.
Reminds me a bit of the Haitian people, another place where I have lived. How can such friendly, lovely people be subjected to so much misery? Why are such kind souls the victims of so much trauma?
That question, Leo, is one that humans have pondered for eons. I think that culture and religion help to answer that question and give some protection against the onslaught of what appears to be a cruel universe. The tragedy of Sierra Leon is when the very rituals that are designed to give peace and perhaps protection are in absolute conflict with the scientifically derived practices that would give such protection.