The current Ebola outbreak in the Democratic Republic of the Congo (DRC) is the fastest spreading and the second largest ever, with almost 6,200 confirmed cases and 3,000 confirmed deaths recorded so far. With such a quickly spreading and dangerous disease, education is vital. Healthcare staff and community health workers (CHWs) are doing their best to slow the spread of the disease by raising awareness of symptoms, combatting rumors and misinformation, and encouraging practices such as social distancing, handwashing and reporting suspicious cases.
One of the surest ways to slow the spread of Ebola is by conducting safe and dignified burials of deceased Ebola victims. Though it might seem counterintuitive, the virus continues to be extremely active and contagious in the body, even after death, and anyone who comes into contact with the body is at high risk of contracting the virus. In fact, WHO staff who worked in Sierra Leone during the 2014 Ebola outbreak estimated that as many as 80% of cases could be linked to unsafe burial and funeral practices.
Though we did do this work in Sierra Leone in 2014, our Water, Sanitation and Hygiene (WASH) team is not directly conducting safe and dignified burials in the DRC—the Red Cross and local government are handling burials during this outbreak. However, our WASH team is involved in preparing bodies for the morgue because of the dangers inherent in handling a body that contains the Ebola virus.
How It Works
After an Ebola patient dies in an Ebola treatment center (ETC), the WASH team decontaminates the body and the entire area around it with a 0.5% chlorine solution. They place absorbent pads with a 0.5% chlorine solution inside of the body bag so that bodily fluids won’t leak out.
There are many things to consider during the preparation of the body of a person who has died from Ebola. The team tries to be sensitive to the person’s religious and traditional practices and include them whenever possible. However, they must adhere to Ebola safety protocols.
For instance, loved ones are allowed to participate in any traditions that don’t involve touching or being near the body of their relative. When a Muslim passes away, for example, his or her body must be purified in a ritual called ghusl. Because non-Muslims are not permitted to partake in this ritual cleansing, only WASH team members who are Muslim (and of the same gender) are permitted to manipulate the body. Another example is when Christians want a pastor to lead mourners in prayer and singing before a burial. Gatherings like this can be allowed, but health workers encourage mourners to keep such services small and to socially distance, to prevent the spread of Ebola.
After cleansing and other burial preparations are finished, our WASH team members transfer the body to a table in the morgue, decontaminating their own bodies and hands at every step. A plexiglass barrier enables loved ones to safely view the body—even with the top of the bag unzipped to show the face—without fear of contracting the virus. Meanwhile, some WASH team members travel to the burial site to ensure that the grave is dug, and that the area is decontaminated to prevent community transmission.
“If the community is not prepared and community engagement is not done properly, you will have resistance,” says Global WASH Advisor Theodore Sie Scott. Ebola burial teams have been attacked in cemeteries when community members haven’t understood or been adequately included in the funeral process.
Accurate Information Is Key
This is an area where the role of CHWs is vitally important. Our CHWs talk to members of the community about many issues surrounding Ebola—including the importance of allowing loved ones to be buried in a safe but dignified manner. This is especially important because fears and misinformation surrounding ETCs—which CHWs are also working to combat—have led many people who develop Ebola to not seek medical care. Because of this, more than two-thirds of Ebola deaths have occurred at home.
“Deaths that occur at the community level are not being handled safely,” Scott explains.
However, since CHWs have started to engage with communities, people have begun to report at-home deaths. In response to these reports, the WASH team has set up outreach teams that deploy with psychosocial and health promotion teams to conduct community engagement and risk management before a body is taken from a house to the ETC where it can safely be prepared for burial.
Even as the outbreak grows, there are signs of hope. “With time and with the proper community engagement messaging, things are changing,” Scott says.