As Epidemic In Liberia Slows, Burying Bodies Remains A Challenge

By NPR Staff

Published November 1, 2014 at 5:51 PM EDT

A burial team carries the body of woman suspected to have died from the Ebola virus in Monrovia, Liberia. Most of the organized burial teams in the country are assisted by the aid group Global Communities, which, among other things, trains workers to properly wear personal protective equipment, like the gear this team is wearing.

In West Africa, the Ebola virus has killed more than 5,000 people, but there have been far fewer funerals. The bodies of Ebola victims are so infectious that they can only be handled safely by special burial teams. They wear head-to-toe protective gear and use special body bags and chlorinated water to disinfect the area where the person died.

In Liberia, many of those teams are organized by the aid group Global Communities. Since March, the group has been trying to spread awareness about the dangers of burying Ebola victims without proper protection.

The group's head of Liberian operations, Piet deVries, spoke with NPR's Arun Rath about the challenges families and communities still face when it comes to safely saying goodbye to the deceased. Rath asked deVries about the news that the epidemic is slowing, as well as the reasons why safe burial remains a challenge.

Give us a sense of the scale of the task at hand right now. The latest report from the World Health Organization estimates the epidemic is growing more slowly [in Liberia]. Did you see evidence to suggest that during your most recent trip?

Yes. I live in Liberia and have been there for a little over a year and a half so I'm very familiar with the context. We became involved in response to Ebola in March, and it has increased significantly over the time period, obviously, but there has been a flattening off in some of the most high-infection areas, and a significant decrease in areas where Ebola first came into the country in Lofa County.

Can you talk about the challenges [of burial]? I have to imagine that in general it's a different set of challenges in rural areas than in the cities.

We have walk-in teams where a team leader will ride a motorcycle out as far as he can get, where there is a trained burial team that will then walk five to seven hours to reach remote communities ... conduct safe burials there and then walk back out again.

The urban areas have their own challenges, but in the rural environment the roads are terrible often. You know, there are places where there aren't even roads. There are places where we have walk-in teams, where a team leader will ride a motorcycle out as far as he can get, where there is a trained burial team that will then walk five to seven hours to reach remote communities that have been infected by the disease, and conduct safe burials there and then walk back out again. There's one area that we work in where people have to canoe across a river and then do a walk-in.

So it's very complicated logistics, and we have a lot of dedicated people who are making an enormous effort.

How have people changed the way they say goodbye to the deceased?

In the early days of the response, there was an enormous amount of fear and resistance, actually, to safe burial teams engaging with burial, with taking deceased from families. So we engaged community in a lot of dialogue and awareness, and once that's happened people have opened up and engaged with the county health teams and with us to assist them with removing deceased.

So they have very much embraced our activity and we have then in turn, turned around to them and invited them back into the process — not in a hands-on way, but allowing them to be a part of the service at a distance, so they feel a connection to the burial of their loved ones. ... They want to know where their loved ones are buried, they want to feel a part of that [process of] saying goodbye, and we're trying to facilitate that and make them a part of it so there's greater acceptance of this safe burial procedure.

The [Liberian] Ministry of Health has ordered that, in Monrovia at least, people must now cremate their dead, and there was a huge outcry among the public. Is there any concern that that could lead to people hiding the sick and those that have died, not wanting them to be disposed of that way?

That is a huge current issue ... there are people who have been avoiding cremation for their loved ones, and there's been a lot of resistance.

We have been working actively with the Ministry of Health and other agencies within the Liberian government to find appropriate land for safe burial for Monrovia. I would say we are within seven to 10 days of being able to make the shift from cremation to safe burial, which is highly supported by the cultural and traditional leaders of Liberia. And I think it will really curtail any illegal burials and undermining of the Ebola response effort.

This interview has been edited for length and clarity.