Kamiat and her seven children
Ebola is long gone, but for the survivors scarred by the disease, they are crushed by the daily trauma, grief, anxiety, distress, shame and suffering tied to multiple losses.
On January 11, 2023, Dr Jane Ruth Aceng, the minister of Health, triumphantly declared the end of Ebola in Uganda, four months after the first case was reported. The news did not only excite people in the central districts of Mubende and Kassanda, which were locked down to contain the spread of the highly infectious hemorrhagic fever.
The entire country and organizations on the front lines of the outbreak’s fight rejoiced. Before its containment, Ebola had spread to nine districts; so, its end was celebrated far afield from its epicenter.
Ebola, according to Wikipedia, the free online encyclopedia, is also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF). It is a viral hemorrhagic fever in humans and other primates, caused by ebolaviruses. Symptoms typically start anywhere between two days and three weeks after becoming infected with the virus.
The first symptoms are usually a fever, sore throat, muscle pain, and headaches. These are usually followed by vomiting, diarrhea, rash, and decreased liver and kidney function, at which point some people begin to bleed both internally and externally. The disease kills between 25% and 90% of those infected—about 50% on average.
SCARS STILL FRESH
But although many were happy that the spread of the virus had been contained, for the direct victims, the scars are still fresh. Interviews revealed Ebola is not yet over, and it will never be for the victims. In its wake, Ebola left behind a trail of destruction, grief, and disbelief. Families are still struggling to get back to their pre-Ebola lives. Those we spoke to confess that life will never be the same again.
Kamiat Nalunkuuma, a mother of seven from Kikandwa village, Kassanda sub-county, Kassanda district, has a moving story. Nalunkuuma was taken to the Mubende regional referral hospital isolation unit on November 1, 2022, after her husband Wahab Ssemakula tested positive for Ebola. He died two days later, on November 3, after his entire family was put in isolation. Ssemakula contracted the deadly virus after touching a dying man’s head while saying the last prayers for him.
Ssemakula was a Muslim religious leader in his area. When Ssemakula caught the virus, there was little information about Ebola in Kassanda district. Although there were confirmed cases in the neighboring Mubende district, many in Kassanda believed those who were in their area had been bewitched.
After seven days in isolation, Nalunkuuma and her three-year-old daughter also tested positive for Ebola. The rest of the children, including a three-month-old, tested negative, but nonetheless they had to complete the 21 days of quarantine. The news of her positive test result was very devastating to her and her family.
Throughout Nalunkuuma’s stay in isolation and quarantine, she never thought she would walk back home alive. Every single day, Nalunkuuma thought about her children and how they would survive if she died. Would they make it on their own? Her fears were not unfounded because there were families in Mubende that lost up to 10 members to the Ebola virus.
She was also afraid that if she lived, how was she going to look after her seven children without a husband? He was the sole breadwinner. Will they go back to school when the term begins? The ministry could have declared the outbreak over, but can the officials look into the nature of the destruction left behind?
With God’s mercy, Nalunkuuma and her child survived the virus and were subsequently discharged. For the time the family spent in isolation, the ministry picked up all their bills. They didn’t have to worry about where the food or the firewood would come from. But the day they were discharged, these realities hit like a tornado.
“My husband was everything for us. He not only brought the food but also the firewood used to prepare it. Now I have no money, yet I need to feed the children. Our house is almost collapsing on us. Before the death of my husband, we had started constructing a better house,” Nalunkuuma says.
COMPLEX GRIEF
Her story is not different from the stories of many Ebola survivors in the two districts. For the last two months, the World Health Organization, one of the many organizations and agencies that have been working hand in hand with the government to defeat the virus, has interacted with Ebola survivors, affected families, and communities, and many have reported experiences of complex grief, anxiety, distress, shame, and suffering associated with multiple losses.
The specific context of Ebola and the problems that come with it, such as the fear of infection, being unable to care for loved ones, the shock caused by transportation to treatment centers, and witnessing deaths, have heightened people’s experiences of bereavement and loss.
Distress, stigma, discrimination and anxiety, even now, are still affecting adult survivors and families who lost their loved ones or breadwinners. Much as WHO has offered grief and bereavement counseling, there is still more need for continuity of different approaches specifically for stress management to deal with acute anxiety, stigma, shock and stress.
Other than widespread stigma, some survivors have expressed complex relational difficulties in their marriage. Interpersonal conflicts tend to be rooted in distrust and blame associated with specific events during the Ebola outbreak rather than a person’s general status as a survivor.
In some communities, a person or household may blame a friend or neighbor for bringing Ebola into their community. This breakdown in relationships can be more complex than the concept of stigma. This, therefore, requires more focused approaches such as continuous home visits and follow-ups, couple counseling, group counseling, community dialogues and continuous psychosocial supportive counseling based on conflict resolution and mediation so that trust and relationships can be rebuilt.
WHO also noticed that a considerable proportion of children who survived Ebola and those who lost parents felt isolated and discriminated against in their communities or peer groups and tended to socialize with their family members only. This may also result in deterioration in their relationships as school resumes, which highlights the need for continued interventions in schools and peer group settings. Orphaned children and their guardians also shared their challenges adapting to new family structures.
For example, a family in Kirwanyi village, Kirwanyi parish, Kiruuma sub-county in Mubende district, lost eight family members to Ebola and is currently caring for between 10 and 12 additional children. Some children and their guardians further expressed their worries about a shortage of food and funds for school fees.
Some orphaned children feel they are treated differently compared to the way their biological parents used to treat them. Many complained of excessive housework and farm work in their new homes. This might result in an increase in school dropouts, child-headed households, and mental health related issues if appropriate measures are not taken.
In some communities, like Kirwanyi village, where nine households were put under institutional quarantine for 21 days, cases of robbery were reported. While away from home, thieves broke into their houses and shops and took away all their valuables.
Therefore, as the government and other agencies wrap up operations in the area, there is need for more targeted approaches such as economic support and long-term, continuous family-focused support to improve relationships and the psychosocial wellbeing of Ebola-affected communities, families, orphans, and survivors. For these communities, Ebola may be over, but the aftermath is proving to be so destructive.
The ministry of Health declared an outbreak of the Sudan Ebola virus on September 20, 2022, in Mubende district. This followed confirmation of a case treated at Mubende regional referral hospital in Mubende district. Subsequently, the EVD disease spread to nine districts: Mubende, Kassanda, Kyegegwa, Bunyangabu, Kagadi, Wakiso, Masaka, Kampala, and Jinja.
On December 7, the ministry of Health situation report showed the cumulative total of confirmed Ebola cases at 142, with 56 deaths and 86 recoveries.
wamalamusa531@gmail.com
The author is a social scientist/mental health and psychosocial support/counsellor (Mubende and Kassanda)
Source: The Observer
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