Ebola victims are most infectious right after death—which means that West African burial practices, where families touch the bodies, are spreading the disease like wildfire.
From 8 a.m. to midnight, wearing three pairs of gloves, the young men of Sierra Leone bury Ebola casualities. An activity that’s earned the Red Cross recruits an unwelcome designation: The Dead Body Management Team.
Some days, just one call to collect a newly deceased victim comes in from the Kailahun district. Some days, the team receives nine. The calls from medical professionals at isolation centers are met with relief.
These bodies have been quarantined. The infection can—with copious amounts of disinfectant (bleach) and meticulous attention to detail—end there. Once cleaned and sealed in two body bags, the corpse will be driven to a fresh row of graves. In gowns, boots, goggles, and masks, the men will lower the body into a 6-foot grave below. In these burials, safety trumps tradition.
The harder phone calls that the Dead Body Management Team receives, and the more dangerous burials they perform, take place in the communities themselves. Here, they must walk a delicate line between allowing the family to perform goodbye rituals and safeguarding the living from infecting themselves.
The washing, touching, and kissing of these bodies—typical in many West African burials—can be deadly. But prohibiting communities from properly honoring their dead ones—and thereby worsening their distrust in medical professionals—can be deadly, too.
Insufficient medical care, shortage of supplies, and lack of money are undoubtedly contributing to an epidemic the World Health Organization has a deemed a “national disaster.” But with a death toll now topping 1,000 in four countries, it’s the battle over dead bodies that is fueling it.
In the remains of a deceased victim, Ebola lives on. Tears, saliva, urine, blood—all are inundated with a lethal viral load that threatens to steal any life it touches. Fluids outside the body (and in death, there are many) are highly contagious. According to the World Health Organization, they remain so for at least three days.
Dr. Terry O’Sullivan, director of the Center for Emergency Management and Homeland Security Policy Research, spent three years volunteering in Sierra Leone. He tells me in vivid detail what it’s like to watch a hemorrhagic fever overtake the body. “Those that have just died are teeming with virus, in all their fluids,” says O’Sullivan.
“That is in fact the worst point because their immune systems are failed…they are leaking out of every orifice. They are extremely dangerous.” A passage in the 2004 paper Containing a Haemorrhagic Fever Epidemic published in the International Journal of Infectious Diseases paints an even bleaker picture. Citing two specific studies, the authors suggest that a “high concentration of the virus is secreted on the skin of the dead.”
With fluids seeping out of every body opening, and potentially every pore, it’s no mystery why the burial rituals of West Africa pose such a danger. In a pamphlet on safety methods for treating victims of Ebola, The World Health Organization outlines proper procedures to prevent infection from spreading outward from a deceased Ebola victim.
“Be aware of the family’s cultural practices and religious beliefs,” the WHO document reads. “Help the family understand why some practices cannot be done because they place the family or others at risk for exposure…explain to the family that viewing the body is not possible.”
Telling this to the families of deceased is one thing—making sure they understand is entirely another. In Sierra Leone, a country whose literacy rate in 2013 was just over 35 percent, it’s particularly challenging. In neighboring Guinea and Liberia, two places with similar levels of poverty and illiteracy, education alone isn’t a viable solution either.
It’s a phenomenon O’Sullivan witnessed firsthand in Sierra Leone. “People have no idea how infectious diseases work. They see people go into the hospital sick and come out dead—or never come out at all,” he says. “They think if they can avoid the hospital they can survive.” This mistrust of the medical world seems to be validated when a family is prohibited from honoring the dead, participating in the funeral, or even seeing the body.
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