A Game of Life and Death by Thomas from Liberia

Dear Friends, I would like to talk about how Ebola has changed me and many Liberians and our centuries old tradition in just over a period of a year and a half. An experience I call a “Game of Life and Death.”

In every society, there are ways of life and things that inescapably bind people and society together. For centuries, habits like greetings – the special Liberian handshake – traditional rites and ceremonies, were known to Liberia. Various other signs and practices portrayed harmony and approval; upon which our African cultures are built. When the Ebola virus struck, anybody could tell from the start that controlling such an epidemic would be a long battle of Life and Death.

Before Ebola, there was a bloody war here for more than 14 years, but Liberians have never been as scared as during the one and a half year period of Ebola. Due to the strange restrictions, most Liberians, even authorities, were caught unprepared, shocked and confused. They could not imagine the magnitude of death at the end from this strange disease. Because of the unexpected fear and panic, the majority of the population finally got it that Ebola was a real crisis. By then, thousands had already died, due to ignorance or not believing what was happening.

In Liberia, like most African countries, we do not just greet each other; we shake hands, stand, talk for a while, and hold hands. Sometimes we walk down the street together. People just don’t leave the sick or the dead; true grief is not considered real unless it is emotional and actively displayed. Bathing and kissing the dead in some traditions, hugging them, rolling, and crying on the ground, are all part of the cultural norms of our society. Sometimes, relatives and loved ones will be require to bath with the same water that was used to bath their dead, especially in the case of a wife or husband of the decease, to prove your love and sometime innocence.

Our people survived for decades on things like bush meat; they used dance and performances for important events that usually bring crowds together. Parents carry their children on their back and usually body to body contacts are most frequent because many African kids are carried barely naked. In our society, there is usually a lot of free time, due to lack of social infrastructure, jobs, or other clean learning opportunities. Therefore, children and youth spend much of their time in groups across communities, either playing hand and physical games, or sitting together in congested rooms, sharing stories (in rural areas) or watching sports games in crowded video clubs (in urban areas).

During these strange events of the Ebola crisis, the unthinkable happened: citizens were given straight orders: Don’t eat “bush meat,” primates and other wild animals. Don’t shake hands, don’t touch dead bodies. Avoid crowds and report anyone who has a fever or appears to be ill. On top of that, families will no longer sleep close to each other.

The nature of transmission is particularly influenced by cultural and behavioral practices that occur at the household and community level and also within a hospital setting, including patient care, family involvement, health-seeking behaviors and responses. The precautions relied on the changing of habits and good sanitation as key to curtailing the disease.

In Liberia, the Ebola virus appeared and reappeared over five times. But because the disease is strange to Liberia, authorities did not take it serious at first. There were a lot of doubts and confusion about the actual cause, transmission and control. Response was very slow and interventions were initially uncoordinated. These circumstances left many Liberians asking many questions. How do we go to church? How do we even bury our dead? How do I care for my sick brother, sister, and mother if I am asked not to touch sick patients in the midst of limited health facilities and emergency response? The overly challenged health system, limited facilities and logistics further impaired the situation, causing the epidemic to spread more speedily and uncontrollably, and increased the level of panic and deaths. As a result, in mostly rural affected communities, dwellers still relied on traditional healers and family members for advice and care, despite the inexperience of the people providing information. Traditional healers may have positions of influence within the community and, therefore, command a level of trust, and can also have a significant influence on health-seeking behavior and delivery of health messages, factors that can directly affect rapid spread of diseases.

So many Liberians who died, did so first because of denial of the disease, as it was confusing, with so many restrictions, ignorance, and limited information. It took almost three months for effective awareness to reach communities. There were low or limited response efforts by central authorities. When a family member was sick and they called for an ambulance, it would take two to three working days before it turned up. People had no choice but to cater to their sick relatives themselves. At the end, either both, or the entire family, would contract the disease or die. There were times when those who had been in contact with an infected person were requested to quarantine themselves, due to the limited capacities of the health centers. To think that people will easily change from washing their dead bodies by hand, dressing them, and holding elaborate ceremonies, to having a corpse in a body bag and no goodbye could not be that easy; it was an impossible call.

Christians, Muslim and other religions started turning toward their respective faiths for solution. Against the warnings of authorities, churches were still congregating, Muslims where attending prayers and pastor still laying hands. “God will not allow me to die from Ebola,” was a common statement. But do they understand that inasmuch as God wouldn’t allow it, the necessary precautions must be taken? As a result, both Muslim and Christian communities were affected due to religious beliefs and reliance.

I personally lost a lot of friends during this period, a situation which led me to courageously challenge myself and get into the field with my organization to carry out awareness and distribution of preventive resources. I wrote about my experiences in two blogs: “Circumstances for Change: Era of the Deadly Ebola Virus in Liberia” and “Journey to Klehn’s Town, an Isolated Village of Over 1,000 Inhabitants Amidst Ebola.” Despite the sorrows and anguish, the Ebola virus left Liberians with key lessons: effective social mobilization, strengthening of sanitation activities in all communities, places of worship and health care facilities. The government’s preparedness for logistical readiness, and also psycho-social support to patients and their families during such situations, became a matter of consideration for political and policy making.