Ebola diaries: Psychological toll to endure

Francis Mulemba, logistician

A WHO logistician Francis Mulemba was first deployed to West Africa in March 2014 to respond to the fifth Ebola outbreak in his career. He took care of logistic and administrative tasks in Gueckedou, Guinea, the epicentre of the epidemic. Five months later, he was sent to Monrovia, Liberia, to support training of the national burial teams. He said that situation in Liberia was unlike any other Ebola outbreak he had experienced before.

Safe burial team at work in Bong Country during the Ebola outbreak, Liberia
Safe burial team at work in Bong Country during the Ebola outbreak, Liberia
WHO/R. Sorensen

"Monrovia is a major urban area with millions of people who have lots of opportunities to move around. When I arrived in August 2014, hundreds of people were falling ill and losing their lives to Ebola – a disease they still didn’t believe existed. There were so many deaths we didn’t have enough burial teams to cater for the increasing need, and a number of contacts we couldn’t even begin to count. It didn’t help our work or the situation that many people went into hiding due to fear of the virus and distrust of the international help.

Where do we start?

My primary task in Monrovia was to help recruit and train new burial teams. However, in a crisis like this, many other challenges arise. For instance, we had a lot of issues with body management teams – people who pick up the bodies and take them to burial sites and crematorium.

The biggest problem wasn’t only recruiting new team members, it was figuring out who was going to take the swabs for the laboratory. At the beginning of the outbreak, burial teams were not trained to do that. Many biological samples were simply buried or cremated with the dead. It took time and dedication to train people and obtain those precious specimens that could be used for research to save the lives of others.

Another major issue at the time was community resistance. We had to do everything we could to build trust and prevent people from hiding. When Ebola was declared an outbreak of an international concern, all deaths in West Africa were considered to be from Ebola unless laboratory results proved otherwise.

For this reason, families started requesting laboratory confirmations, but we simply didn’t have enough laboratory capacity to do that. Everyone’s priority was confirming cases not deaths, so, again, we scaled up activities. Work was overwhelming between August and September.

No time for a break

Francis Mulemba, a WHO logistician, has responded to five Ebola outbreaks. West Africa's was the most severe he's ever seen
Francis Mulemba, a WHO logistician, has responded to five Ebola outbreaks. West Africa's was the most severe he's ever seen
WHO/E. Longarini

For me, it is staggering how long this outbreak has lasted. When I look back at my previous experiences, other epidemics and outbreaks didn’t take more than 6 months to stop. The length of this outbreak has been physically and psychologically hard to endure. I say that as somebody who was deployed for a couple of months with time for breaks in between.

There were people from the Ministry of Health in Liberia and local communities who worked day and night for almost a year. They saw bodies and burial sites more than they saw their families. Ebola didn’t give them any time off.

However, thanks to hard work and dedication from all the response teams, this is also the first Ebola outbreak in my career where I have met someone who survived Ebola. I had heard there had been some survivors in the previous outbreaks, but I had never actually seen one. This time, some of my work entailed working with survivors as well, and I must say that hearing their experiences have left a huge impact on me.

Once the Ebola outbreak is over

Once the outbreak is over, I want to make a plea to not forget those people who stood on the frontline of the outbreak, risking their lives for the sake of others. From the first-hand experience, I can say that burial team workers and body management people endure some of the toughest psychological tolls. They have suffered a lot seeing things most people will never and should never see in their lives. It has deeply affected them.

If we could do something to support them and a follow-up to find out how they are coping, that would be the best thing we could do. I know exactly how it is to do this kind of job, and it is not easy."