Kategorie-Archiv: ethics

Sex as crime? – Criminalization of Ebola Survivors

Ebola survivors have a problem: At least three months after they are released as being cured, semen and vaginal excretions can contain the Ebola virus. That turns them into a risk factor in the fight against Ebola. They can cause a new outbreak of the virus anytime, even though the fight might seem to be won already. The recent new case in Liberia, after 28 days without new cases, might have been caused by unprotected sex with a survivor. That might or might not be the case. The fact remains that survivors are a real “danger”.

However, from my perspective, the attitude of the Sierra Leonean governments is not leading into the right direction. Last week the front page of the daily newspaper Awareness Times carried the headline: “Ernest Bai Koroma Warns Survivors to Delay Having Sex”. This is a message from his Excellency the president himself. In the article they say that hard measures are to be expected in case a survivor is causing another case of Ebola. And as far as I know at least one person was sentenced to one year in prison already, because he infected a sex worker.

150327 SurvivorSex

From my personal point of view that’s the wrong approach. First, I think it’s unrealistic that survivors abstain from sex for three months. My impression is that at least 2 factors are being overlooked here: 1. The strong human tendency to neglect. Ebola was long considered to be just a rumour sewn by the government to weaken the opposition, and according to my national colleagues, HIV is also being neglected. 2. Sex seems to be considered as an essential “human right”. That is a dangerous combination in times of Ebola.

On top of this, I’m sure that no wife will blackmail her husband if he has to go for one year to jail afterwards! In case the infected person is a sex worker I can imagine that he or she will report to the police. But the own wife or husband will surely not want to lose her or his spouse, especially after just having recovered from a severe illness and potentially being a main contributor to the family’s income. Being punished for sex with the own spouse is just not implementable. How on earth does any lawyer proof that the infection happened during sexual intercourse when the couple concerned is denying it?!

I think it would be better to distribute condoms in high quantities AND to explain how to use them. Best in pictures. Such information material is readily available from HIV campaigns. Of course, the acceptance of condoms is in most African societies not high and Sierra Leone is by no means an exception. But the pressure from Ebola could even being considered as the optimal point in time to raise this acceptance. In any case I believe that the people have to be mobilized, affected people should act, take up responsibility themselves instead of being punished or rewarded from a “higher power”. It doesn’t make sense to put draconian measures in place. Instead, try to seek the consent and voluntarily compliance of the population. But would do I humble aid worker know about politics…

This is a translation of my original article in German.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Ebola and handicapped people

I personally never really thought of this topic and I don’t know much about assistance to handicapped people. Nevertheless I want to write about two interesting events I heard of recently.

On TV I saw a news clip about a local organization for the blind and visually impaired. They had issued an Ebola information leaflet in braille. Even though by now many comics and picture explanations are available to reach the illiterate, doesn’t mean that really everybody is reached. And the blind have a very real risk of contracting Ebola: Many depend on body contact to other people, for instance when they use the services of a personal assistant. This hold true generally for many people with handicaps: They might need assistance in everyday life, and this assistance includes frequently body contact, for example getting assistance with dressing, visiting the bathroom, eating etc. Handicapped people are clearly at risk.

Thomas Alieu, Executive Director of the Educational Centre for the Blind and Visually Impaired in Sierra Leone, says:

“The visually impaired people were feeling very vulnerable in the fight against Ebola, and there was a real sense of loneliness. This was primarily because in the Ebola outbreak, people are encouraged not to touch each other, but for the visually impaired, this makes it very difficult to go about in daily life.”

(Source: http://www.actionaid.org/india/shared/challenges-faced-visually-impaired-fighting-ebola-sierra-leone)

A local caring home for Polio victims send an email to me and asked if Welthungerhilfe would be able to distribute food to the inhabitants. Due to the Ebola crisis the number of staff was reduced to a very minimum and everybody tries to avoid any contact to the outside world in order to keep the inhabitants safe. Therefore it would be of great help if food would not have to be acquired on the market, where it is crowded and body contact can happen accidently.

For me it’s clear now that handicapped people might suffer from lack of access to information and that the sometimes impaired mobility is also creating many different problems. People with handicaps need special attention during project implementation, no matter if it’s an emergency like Ebola or long-term development projects. Everybody should have a chance to participate.

For more information:

http://www.handicap-international.us/ensuring

This article is a translation of the original German article.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Fear of returning from Ebola affected regions back to Europe / Germany

It might be in the far future, but every now and then the thought pops up:

  • How will friends and family react when I return?
  • Will they avoid me?
  • Will they tell me made-up stories in order to prevent a meeting?
  • Will my family count-down the days and only welcome me after 21 have past?
  • And what is my own position?
  • Am I a risk for my family?
  • Should I avoid contact on my own initiative to protect my loved ones?
  • Should I put myself in quarantine for 21 days?

Reports from others show, the reactions are mixed. And this is also what I expect to encounter in my own environment. Initially I had planned to participate in a yoga retreat in March. But could I do so now? Could I carry the responsibility? Body contact, after sweat drenching exercise, is unavoidable. Should I keep my duty station secret? Even lie?

I say it straight forward: I haven’t done my decision yet. You might think I’m a bad person and that I’m knowingly put others at risk. But the facts are on my side: Only after developing signs of a sickness, an Ebola patient becomes contagious. As long as you keep certain procedures and keep up regular monitoring, measure your temperature and observe suspicious symptoms, there is practically no risk for your contact group.

However, doubts remain. How can I act responsible and avoid spending my annual leave in self-made quarantine at the same time?

This article is my translation of the original German post.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Who are our beneficiaries: the people sick with Ebola or the people still healthy?

Recently I had an interesting discussion with one of my colleagues: Who are the beneficiaries of our intervention? Of course you’re first thinking of the sick. People who contracted Ebola have to be treated and – if possible – cured. You think of the families in quarantine that anxiously expect the end of their incubation period, hoping not to show symptoms themselves. This way of thinking is expressed as well by the Time Magazine, announcing Ebola fighters as the TIME person of the year 2014, emphasizing the achievements of the medical personnel. They are the ones with a real an eminent danger of contracting Ebola themselves.

On the other hand contracted less than 7,000 Sierra Leoneans EVD so far. With a total population of approximately 5 million. A target group of 7,000 people can be called manageable. But unfortunately, the opposite is the case: The 4,993,000 Sierra Leoneans that stayed uninfected until now are our target group. To protect the healthy from infection is the main objective. And that is not the task of doctors or nurses. Other things are needed here:

  • Creating awareness
  • Education
  • Changing behavioural habits
  • Coordination and logistics

Prevention is the key. That is a message being distributed by the government as well:

Stop Ebola Campaign by Sierra Leona government. von User:JuliaBroska [CC BY-SA 4.0], via Wikimedia Commons

But of course it is less attractive to walk from house to house distributing leaflets than caring for the sick and the needy, dressed up like an astronaut. The same concept was found valid in the fight against HIV: Donor prefer investment in HIV drugs over simply distributing condoms. The Gates Foundation makes the following statement:

Our largest investment is in efforts to discover and develop an HIV vaccine.

Without knowledge of the figures, my impression is the following: The majority of donors, UN bodies and NGOs focussed on the medical sector in the Ebola Response. Treatment centre are being built almost overnight, there is heavy investment in vaccines and treatment research, physicians from all over the world are being recruited. That fits to the UN Mission for Ebola Emergency Response (UNMEER) (UN Resolution 2177 of the UN Security Council).

Their main task is the logistical distribution of treatment centres, vehicles and telecommunication equipment in the countries affected the hardest by Ebola.

Those activities involve high costs. But they will not change the fact that the probability of survival of the 7,000 infected are highly dependent on chance and on their general health condition. On top of that, most activities are implemented extremely slowly and their results will not impact the current crisis, it is rather a provision for future ones.

What is needed on a much bigger scale is social mobilization, well planned and organised. The people have to wake up. Social control is needed. Certain behaviours have to stop. Each and every Sierra Leonean, who refuses an invitation to a burial, is a hero. Each and every one who keeps her door shot to visitors, is a hero. Everybody avoiding body contact even to close friends, is a hero.

I see many parallels to the HIV epidemic for example in South Africa. There I heard people saying: “Our traditions are older than HIV. We will not change our behaviour.” But new infectious diseases can kill the holder of the tradition. The other way around is certainly less common.

This article is a translation from the original German version.

Julia Broska

Julia arbeitet für die Welthungerhilfe im Projektmanagement in Sierra Leone. Sie beschreibt in diesem Blog ihre persönlichen Eindrücke. Ihre Meinung muss sich nicht mit der der Welthungerhilfe decken. Bevor Julia nach Sierra Leone kam war sie in Nord Korea im Einsatz. Sie schreibt auch Artikel für den offiziellen Blog der Welthungerhilfe

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Safe and dignified burials

Much is heard these days in Sierra Leone of so-called safe and dignified burials for Ebola victims. But what exactly is it?

First, which procedure was customary in Sierra Leone before Ebola? According to religious affiliation this may vary. The majority of people belong to the Islam, the second largest group are Christians. Common is that the farewell of deceased takes place within the family circle and includes the ceremony of washing the dead. The washing ceremony is perceived as an essential part of a proper burial.

At the beginning of the Ebola crisis, safety issues were taken radically more serious than the sentience of the local population. If Ebola patients died in treatment centers they were enfolded with two layers of plastic and buried quickly. The family was informed by phone after everything had been done. The relatives had no chance to see their loved ones. A traumatic experience.

By now this approach has been reconsidered. Notably the IFRC developed the concept of the safe and dignified burial and organizes burials in many parts of the country. After the death of a patient or if a person is found dead at home, s/he will be, unfortunately there is no other way, still be wrapped in two layers of plastic. But then follows a funeral rite in which a priest / Iman and the relatives can participate. There is a safety zone of 5m and the family will see the deceased only covered. But at least they can take part. The German website Gemeinsam für Afrika wrote the following about it:

Even a few months ago chaotic scenes took place in Sierra Leone on such occasions. Many relatives wanted their Ebola-dead not to be put into plastic bags and been taken away. Again and again the police came with tear gas. Meanwhile, the widespread education about Ebola via radio, street theater, house-to-house visits and poster campaigns shows more and more impact. People are increasingly willing to seek help. Auxiliary services such as grief assistants give them the opportunity to tie in traditions without putting themselves at risk. Information on this service are spread amongst others through the district administrations and their healthcare teams.

Nevertheless opinions are divided whether these are dignified burial conditions or not. There is a great social pressure in the communities: If a wife does not mourn loudly over her deceased husband or her deceased children, hugging and washing them, people may start talking bad about her. Grief must be publicly celebrated, if one does not want to lose his reputation as loyal family member.

Such deep-seated behaviors can not be changed overnight, no matter how long one appeals to sanity. Meanwhile, even the country’s president has called the population via television to suspend traditions and reintegrate them into everyday life not before the Ebola epidemic is gone. Unfortunately, I still hear almost on a daily basis of cases in which the dead were washed.

This article is a translation of Julias original article in German language.

Philippe

Philippe translates Julias articles to English language so that more people can have access to her reports and information.

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Ebola triggers teenage pregnancy and child abuse in Port Loko District Sierra Leone

Last weeks‘ Friday I stumbled upon the cover of the Standard Times – a local newspaper from Sierra Leone. It read: „Teenage pregnancy ruins Port Loko district“. In the first glimps I thought this was not related to the Ebola outbreak, but then to my surprise I read the following lines:

It is a truism that the outbreak of the Ebola pestilence in the country has not only ravaged the socio-economic fabric, nook and cranny of our settlements, but it has also left a host of the population of the girl child in the rural communities in a fit of child rights abuses and violations and as a result 80% of those children that are holidaying in the Ebola menace are presently been affected with teenage pregnancy whilst a greater % of them are in the family way.

Here is the original news paper article about teenager pregnancy. Click to enlarge
Here is the original news paper article about teenager pregnancy. Click to enlarge.

If you read further you will find that almost all girls of the village have been victims of sexual abuse by the inhabitants. This happened partly with the consent of their parents which are in need of help by the perpetrators (farmers, traders, colleagues,…) in order to work on the fields. According to the article, education of the girls is not highly appreciated by their parents who are trying to bring workers inside the family by offering their daughters.

I am honestly shocked by this article. I have been wondering for a long time how big the socioeconomic consequences of the Ebola outbreak would be since over the last months schools and universities are closed down. But it never came to my mind that a virus like Ebola would lead to a rapid increase in child abuse. All kids have to stay at home nowadays. They have no occupation. Parents and relatives have  to continue to make a living. So, often the kids are without protection. At least, over the last couple of weeks, there was a educational radio station created.

One thing is very obvious to me. The Ebola outbreak will have severe long term consequences for Liberia and Sierra Leone. I think no one can currently foresee how deeply the countries will be affected in the long-run. My organization has already released a report about the non-medical impacts of the Ebola outbreak which mainly focuses on economical topics like food supply. The large scale of the social impacts can in my opinion currently not be predicted, but should not be forgotten.

This article is a translation of Julia’s original article in German language.

Rene

Rene ist PhD Student und blogger. Er setzt sich fuer freies Wissen und freie Bildung ein. Dadurch ist er auf wikiversity, wikimedia commons und gelegentlich auf der Wikipedia aktiv. Er unterstuetzt Julia ihre Erfahrungen aus Sierra Leone zu verbreiten.

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