Mental Health and Psychosocial Support in the Face of Ebola in Liberia: the Personal and Professional Intersect

Cooper Personal reflection Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account

Janice L. Cooper

Thispersonalre£ectionisbasedontheauthor’sexperi- anti-stigmaprogramme that has apolicysup- ences,anativeLiberian,inhercountryatthebeginning port component, which has trained mental of the 2014 Ebola epidemic. It includes heraccount of healthcliniciansfromacrossthecountry.Inla- events as Ebola cases and related deaths began to rise teJune of 2014, I was asked to join the Ebola and the response appeared inadequate. Examples are National Taskforce, now called the Incident presented where a robust psychosocial and mental Management System, as the Co-Chair for health response was critically required, but most often the Psychosocial Pillar.1 Since joining the lacking.This re£ection focuses on the points where Ebola response, my o⁄ce is now at the Ebola the author’spersonal and the professional life met as Command Center in Sinkor, Monrovia. Ilive she co-led the psychosocial pillar of the national in my family home, located approximately 8 responseteamonEbola.It alsoexploresthechallenges kilometres from Monrovia. This house and of leading the mental health and psychosocial com- its yard has a long history, much of it rooted ponent of a complex emergency within a fragile, post in di⁄cult times, some in happier ones. In con£ictstate,wherethe medicaland infectiousdisease 1980, my mother was arrested here and taken component of the response often takes precedence. to jail. In 1988, friends and family attended Additionally, the author’s irnternal struggle that my wedding reception here and, in 1990, occurred when she was forced to evacuate at the out- this is where I £ed with my husband and tod- break’speak is explored. dler when ¢ghters came to my house. This is where we stayed, along with nearly 200 other Keywords: Ebola, Liberia, mental health, people, until caught in a ¢re¢ght between personal protective equipment, psychosocial the‘peacekeeping’forcesofTheEconomicCom- response, social reactions munity of West African States Monitoring Group (Ecomog) and the ‘freedom ¢ghters’ of Introduction Charles Taylor’s National Patriotic Front My job as support to mental health pro- of Liberia (NPFL). When forced to £ee gramme in Liberia is a dream job. Through again it was into what was then called‘Greater it,Ihavemetmanywonderfulpeopleandbeen Liberia’. involved in the training of nearly 145 clinicians. In that respect, my work has allowed First days me to substantially contribute to dealing with When Iand my team ¢rst heard about Ebola the threat of Ebola on both individual and in Lofa County in March 2014, the north of society levels. I work in a suburb of Monrovia the country, it was with no real alarm. called Congotown, less than 1.6 kilometres Within days we found out that a Me¤decins from the Ministry of Health, in a compound Sans Frontie' res (MSF) team was on the with other nongovernmental organisations way, and most people relaxed into the notion (NGOs). I lead a mental health training and that the Ebola Virus Disease (EVD) would

49 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account, Intervention 2015, Volume 13, Number 1, Page 45 - 84

Figure 1: Political map of Liberia (source: http://www.mapsofworld.com/liberia/maps/ liberia-political-map.jpg).

now be contained far away from us schools were still operating and although (Figure 1). she had notbeen in contact with her children During early April 2014 it seemed that the since becoming symptomatic, there was a outbreak was contained, but then it came move to keep her children from school. closer. We heard the story of a woman with Understanding the disease was new to every- EVD and her young baby, they had taken a one, and the natural reaction was panic taxi a long distance to meet her husband in and fear. As more education reached the Firestone, site of the famous rubber planta- public, there was clear vacillation between tion. On the way, they had stopped and the denial and over reaction. taxi driver found a place for her to sleep. She had been vomiting and the taxi driver Denial, mistakes and fear was her default caretaker, cleaning up after Ebola got my attention when, as part of the her. When she ¢nally reached her destina- continuing education component of our tion, the stigmawas immediate.The hospital mental health training, we held a workshop initially refused to treat her, even though on communications disorders in children at her husband was an employee. At this time the prestigious Cape Hotel in Monrovia on

12 April 2014, led by a professor from Maker- conditions. On top of that, as the clinician ere University in Uganda. Sixty mental had said, there were not enough PPEs, in health clinicians attended. The anxiety of fact, many had not even seen a PPE. the clinicians in the room was palpable, as the initial update session featured an update The spread of Ebola and lack of on the epidemic from Lofa County. A clin- support of health care workers ician who was leading the mental health Shortly after that training, I joined the and psychosocial support (MHPSS) side of response programme to support the existing the response from Lofa county outlined her psychosocial committee.Wemet daily and on work with the county health and social wel- weekends. More and more people from the fare team and reassured us that all was well. international community seem to appear at Everything was under control, and there thesemeetings.Few wereemergency,letalone was su⁄cient personal protective equip- EVD, specialists.There were polite acknowl- ment, known locally by the acronym PPE. edgements that MHPSS was important to Her presentation triggered many responses, the response, but most of the support was mostly protestations that even if this was focusedonfood,meetingbasicneedsandiden- the case in Lofa, it would not be the same tifying contacts of cases that could be listed in other counties. Then I asked a clinician and passed on to the contact tracing team. (referred to here asJonathan)2 from the epi- One of our international faculty conducted centre of the epidemic, Foya in Lofa trainingon Ebolaanditspsychologicale¡ects County,tospeak.Asoft-spokenman,he withthe Ministryof Health & SocialWelfare. discredited all that had been said by the In the regular response meetings the stories clinician from Lofa county, saying that he started to come. A whole family wiped out had seen no evidence of widespread avail- because they attended a funeral. Cleric after ability of PPEs. Jonathan was stationed in cleric became infected, and infected others, the hospital where the MSF Ebola Treat- as they carried out burial rites. During this ment Unit was built. He informed the group time, we continued to have classes and my of a case of a health care worker who had students brought in stories of their own. been infected, went home and later became The number of cases rose and then the sick, exposing his family without contact- dreaded fear happened, Ebola hit Monrovia. ing the centre or the supervisor.The worker Elsewhere across the country, regular health died. This was a telling sign that our down- services started to shut down amidst claims fall would be a health care system pieced of insu⁄cient protective gear and health together with the best intentions, but lack- care workers fear.Within a matter of weeks, ing the basic elements of what we mean by cases were coming in from theWest, the East ‘system’. Apparently none of the nursing and the South. supervisors had received the message that In Monrovia, my students spoke of their own when someone does not come to work, or experiences. One was threatened with evic- calls in sick, they should physically seek tion from her house and community because out this person. This mistake has been she had called an ambulance when a woman repeated throughout the epidemic. Follow- who was sick died after exhibiting symptoms ing Jonathan’s presentation, there was an of Ebola. She hung around to make sure animated discussion among the clinicians the community would not bury the body on the ways that this virus might permeate on its own. The ambulance took most of the a frayed health care delivery system. Most day to come and the clinician, a new mother, clinicians had not been paid for months, was threatened throughout this period. She and their union was in a dispute with the stood her ground, but no longer felt safe in government on issues of pay and working her community.

51 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account, Intervention 2015, Volume 13, Number 1, Page 45 - 84

During daily re£ections students reported homes. In many cases, there were serious what they were hearing from their own com- concerns surrounding the absence of infec- munities across the country as they talked tion control procedures. constantly with family and co-workers about the epidemic. A group of clinicians from MHPSS not seen as an essential Gbarpolo County, north of Montserrado, component heard about colleagues at home that were Almost seamlessly our morning programme being instructed to conduct awareness-rais- had changed. Every day began with an ing sessions within the communities, but Ebola update that I delivered based on they were afraid because they had not been National Task Force meetings from the day given gloves nor any other basic protective before. At the emergency task force, things equipment, and most were unpaid. were changing too.There were lots of discus- Across the country health care workers were sions about which parts of the response were feeling unprotected. The few students from not working well. There were many heated Lofa would get daily reports about friends, exchanges about what should be driving mostly other health care workers, becoming the response: the epidemiology, case man- infected or dying. There were reports of a agement or contact tracing? At no time was friend’s child on one day, a student nurse on MHPSS seen as essential to the emergency another. In Monrovia, we knew of cases at response. There were no resources directed Redemption Hospital as health care workers at dealing with the impact of stress, trauma, were infected and moved to the JFK Hospi- grief and loss that were occurring, as the tal’s Ebola Treatment Unit (ETU), around health care system began to unravel and the corner from our classroom. Some of the the consequences of the epidemic became students spoke daily to their friends who clear. Consequently, the part of MHPSS that were in the ETU. got attention and funding related to provid- ing food to the a¡ected families, as contacts Role of religion and lack of infection of Ebola patients were more likely to control stay home. One day, the President declared a day of On 10 July 2014 something changed. The prayer, but did not declare it a holiday. Some head of case management brought to my of the students were angry. It should have attention the situation of a woman at the been holiday so people could‘reallypray’,some ETU who was really unwell. I called an said. As we debated, it became clear the role experienced clinician (Yolanda) who, with- that organised religion was playing in the out hesitation, agreed to accompany me to epidemic. One clinician talked about people the ETU. I had not been to one before. As in the community who believed that the I walked to the unit, seated outside was the ‘application of holy oil’ had protective powers, clinician (Jonathan) from Foya. Instin- and that the now standard hand washing ctively I went to him and gave him a hug. procedures being recommended could be He smiled sheepishly. What are you doing ignored.There were reports of ‘prayer women’ here, Iasked. He told me that he was in Mon- and other clerics who were ‘laying hands’on rovia for our upcoming workshop, led by those with Ebola, thereby spreading the an Emory University professor, on outcomes virus. Other issues started emerging. Some based management, but he had felt unwell clinicians were working at their regular jobs, and came to be tested. I am not sure if it even andthen in private clinics.These clinics were registered that I had just hugged someone among the ones identi¢ed as treating who was suspected of having Ebola. I moved patients with Ebola. Some were treating on with Yolanda, because we had a task at individuals intheir own homes or in patients’ hand. The woman we had come to see was

a health care worker who should have been but she chased him out with more abuse. discharged the night before, but was still Outside, he told me that he had treated her there as she had refused to have her blood seven years ago in his church to rid her of tested to con¢rm that she was negative for ‘her demons’ and that she had remained with the virus. She was not exhibiting any symp- him for many months. She had been toms of Ebola, but had been there for more shackled and bit him in the thigh. If there than 21days. Now she hadbecome aggressive had been a proper assessment with that and violent, and had set a small ¢re. She history when she was admitted, I thought was combative and verbally abusive. As this current crisis may have been avoided. Yolanda and I entered the ETU we were Outside the ETU, a truckload of policeman met with a surreal sight. The sun was (from the emergency response unit) was blistering hot. The sick health care worker, parked. They had been called as the Pamela, sat on the ground playing with a authorities feared the situation could esca- large plastic tub, methodically moving sand late.Their riot gear and armour were irrele- in and out of it. Her hair was loose and wild, vant here however, as if she charged at and her navy blue out¢t was covered with sa- them, they would simply £ee.This is the fear nd and clung to her body. She was mostly of mental illness. She is asymptomatic and talking to herself, but when we approached our knowledge tells us she is not infectious, her and introduced ourselves, we became but could it be that she is? Could it be she is the target of her rants and abuse. In between ‘strong’ and still has the virus? After several ranting, she told us what it was like in her unsuccessful attempts to talk her down, we head; she saw dead bodies. She wanted discussed the possibility of a more invasive water, so we got her water as most of the sta¡ procedure with the MSF doctor. had evacuated the area because they were In the end, four men approached her in full afraid. There were patients in the ETU that PPEs and struggled to physically restrain her needed attention and others waiting to be as another doctor give her a shot of 100 mgs admitted. There were a couple of bodies in ofThorazine.Wewaited for her to calm down the ETU that could not be moved. One of while the clinicians assess whether they have the only two ETUs in the city could not enoughThorazine in stock. She seems calmer admit any more patients because one patient by the time we left. The plan is to be back in was in the middle of a psychotic episode. the morning, and if things start getting lively The lackof mental health services hade¡ect- again to be in touch with the clinician. As we ively stopped the operation of this facility. waited for the car outside, Yolanda put her Wehad been called because she was deemed umbrelladownwhereourcolleaguefromFoya a danger to the ETU. The ETU sta¡ that hadbeen sitting.Dr.Zaizay,the leadclinician had remained threatened to walk out in the response, came to us and said; ‘your because they were afraid of what a person umbrella is where a suspect has been sitting’.On the su¡ering from psychosis might do to them. way home we do not talk much, we have Despite our best e¡orts at talking and entered the response rather dramatically. attempting to de-escalate the situation, Mental health is on the map. Pamela remained aggressive and combative. That evening Yolanda received calls every Inbetween her curses, with some choice ones hour, sometimes every half hour. At 11 pm addressed personally at me, she suddenly she sent me a text saying the facility man- remembered me and I her, from her clinic. ager had ‘called saying she is combative again’. She told us how impersonal she feels the She had augmented her initial drug order, PPEs are, and how inhuman the people but still this did not seem to calm the client who don them must be. She complained of for more than a couple of hours. At 3 am the lack of human touch. Her pastor arrived, she texted again, so I asked if they were able

53 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account, Intervention 2015, Volume 13, Number 1, Page 45 - 84

to take the blood sample, she responded by again, I was devastated to learn he would text that ‘he said no because she was only calm not wait for me to come, and would not agree and did not sleep, so she refused’. A t 4 : 4 0 a m for her to be transferred to the mental health my request for help was answered via email hospital. Some ¢fteen minutes later, I was st- by our consultant psychiatrist at the other ill trying to convince the pastor, who took end of the continent who responded to the the phone next. I did not succeed. She went question what should we try next? She to the church. suggested changing the medication. Armed Buoyed by the partial success of the client in with this information, we stopped at the the ETU, I approached the next EVD task- only mental health hospital in the country force meeting with a sense that those sta⁄ng to pick up the recommended Haloperidol. the psychosocial subcommittee had gained On arrival, we learn that our client has credibility by our response. The importance scared the sta¡ into leaving the facility of MHPSS was clear. MHPSS was now on again. the map. Or so I thought. My high spirits Yolanda leaves instructions to administer the were short lived as news came of the con¢r- Haloperidol in the suggested dose before mation of Ebola for Jonathan. Back then, we go o¡ to the workshop. In the workshop, recovery rates were lower, there were fewer Yolanda makes many calls to ETU supervi- treatment units and people often got to them sor Nelson, checking on the status of the too late. We did all the normal things, pur- patient. She was doing much better. Later chased lots of juices and all the immune that day the patient will have her blood boosting foods we could get our hand on. I drawn for her Ebola test. called him. At ¢rst he didn’t answer, so I The workshop Jonathan had intended to texted him. When I did ¢nally speak with attend happens without him. His test results him, I reminded him about his training were indeterminate, so we have to wait for and what we know about mental health’s another test. At the workshop, 60 clinicians impact on the immune system, so it was sign up to help with individual, group and important for him to remain positive. It phone counselling sessions for persons with was the last time I spoke to him. The next Ebola. I am awestruck by their generosity. day a colleague called to break the news, The concern and near panic that surfaced at Jonathan didn’t make it. Two days later we the workshop in April, just three months ago, buried him. has now been replaced with a resolve to help, even in the face of the fear we all feel. The consequences of fear As I prepare to leave the following morning, At that stage of the epidemic, cremations I receive a text from Dr. Zaizay; ‘repeat test is were not being carried out. As we drove to negative! Plan is to move her to Grant tomorrow. the cemetery with the team, after having This calls for a celebration. One more survivor waited most of the day to receive the body, among health care workers! Thank you!’ (Grant we were also negotiating to have the same Hospital is the country’s only mental health team that did the burial disinfect the house hospital.) I called Yolanda and we are so forJonathan’s wife and children. At the cem- happy that the ETU is ready to discharge etery, there were lots of people commenting our client, but in a subsequent phone call, on how ‘Ebola was not real’, rather this was a Dr. Zaizay explains we have another pro- government e¡ort ‘to steal kidneys’.As the bur- blem. Her pastor wants to take her to his ial team went in, the immediate family and church instead of the hospital. I speak to I moved away from the site. What ensued her father who was there when we were was shocking. As the jeep with theJonathan’s working with her and I had spoken with body moved towards the open grave and him about her situation. Talking to him community folks recognised the Ministry

of Health’s insignia, a crowd assembled.The we did not know it. After mass, he and I burial team dressed in their full PPEs was had some words on the hospital’s responsibil- all business, while near the graveside there ity to take part in the response, attend meet- was a small crowd. However, at the ings and engage in the process as other entranced to the cemetery more and more hospital leaders were doing. So, on this day, people were gathering and they seemed the animated discussion I met was geared increasingly agitated and threatening.There towards me. One of the brothers was sick, were loud debates about an Ebola burial in he would not be in church today, but we were their cemetery. My colleague Mark urged told it was not Ebola. This religious order me to leave in one of the cars, while ran the hospital. The discussion was not Jonathan’s wife would follow with him. As about this, but about how quickly could I they and the burial team left, they were (everyone was aware I was part of the pelted with stones by a very angry mob. national response) get a team to the house of a family from Ghanawho had a dead body in their sitting room. I called the head of Situation report 37, 27 July 2014: 321 the psychosocial team (I was her co-lead) cases, 25 health care worker deaths,155 and she started begging and cajoling the total deaths already severely stretched burial team. It was Sunday, 27 July 2014 at 9:26, four minutes before we started mass. Sadly it took The personal and professional several days after that Sunday morning to intersect have the remains removed. In the meantime, It is Sunday 27 July and I am on my way to the family spent nights in their car and days church.The little chapel where I worship has on the phone to me and anyone else who a beautiful spirit. I started going there with a would listen. While I was instrumental in good friend. She liked it because it was multi- the removal, it was embarrassingly late. lingual and we worshipped sometimes with The Sunday that initiated my involvement hymns in Spanish and English. I liked it with that family would be a turning point because it was a good experience and was in my relationship as part of the response. usually over within an hour. It also allowed It would also change my relationship with metokilltwobirdswithonestone:Icouldmeet my church. I was now seen as the‘go to’person with family who lived in the compound that for one of our religious order when some- encompassed the Catholic Hospital, one of thing related to Ebola happened. Within the major faith based health institutions, and days, I was being called about sending one I could go to a service which still left enough of our leaders to Ghana for treatment. By time to take up my other passion, sitting on then, we had heard of the horrendous case thebeachandwatchingthewavesonaSunday. of Patrick Sawyer, where Liberia had This day, people were huddled outside the exported its ¢rst Ebola case to Nigeria. A chapel, deep in animated discussion. The clampdown had been put on travel of any week before, I had had a bit of a row with one who was sick, irrespective of their status. one of our faith leaders. He had reported, The hospital and faith leader could not after the service, but before we had left, that leave. As the days passed, he was not at the Catholic Hospital had experienced its church and he became sicker. There were ¢rst Ebola case. The message to the small rumours about the numbers of people who congregation was that Ebola was real, but were supporting him, but not adhering to it was also laced with strong criticism of the universal precautions. The brother who was government and their response. In retro- my link to our church leader denied that this spect, he was probably infected then, but was Ebola.

55 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account, Intervention 2015, Volume 13, Number 1, Page 45 - 84

At an emergency meeting, I was in the unusual whether to keep their senior sta¡ in Liberia, or position of asking one of the response medical evacuate. At the same time, with the Inter- leads if it was possible to force members of my national Committee of the Red Cross (ICRC) church community into an Ebola treatment and the Ministry we began training social unit. They were not interested in going to the workersand mental healthclinicians inpsycho- ETU.The head of case management was in a logical ¢rst aid. It was very hard. I thought of dilemma: should they keep people who are resigning.Howcould Ibeaskedtoleaveat such semi-quarantined where they are, and take ot- avitaltime?Howdoyousaytoapopulationthat her people who are willing to go to the few bed ‘we are with you and good luck’asweleft?I had spaces that exist? Those in the church commu- dodgedthisquestionofwhenwoulditbeappro- nity’s compound were only ‘semi-quarantined’, priate to leave repeatedly. I was in good com- however,becauseastheygotsick,otherreligious pany. After an announcement that the US members were infected, and another brother Embassy would not evacuate, they were com- and hospital sta¡ were going in to help them. pelledto evacuate all non essential sta¡. So my The brother, who was my link, also got sick bosses made the decision that I should go. I andwe heard stories of him going tothe hospital wasdevastated.AsIannouncedtothepsychoso- grounds to buy telephone cards and vomiting cialcommitteethatIwouldbeleaving,Ipushed on or near the security post. back tears. For me, this was very di⁄cult. Then, we started getting news of death. The Duringthe1990war,withan18monthold,hav- hospital and religious leader died. Igot word ing survived abduction and detention in the that a favourite nun was infected. Tomy dis- military barracks by the ‘freedom ¢ghters’, we felt may, they had continued a planned pro- we had no choice but to leave. The 14 year old gramme to welcome a new nun, who had con£ict had many phases, and while many of returned from training. I called her the ¢rst my friends and colleagues who were nurses week in August, by then, she was sick.Three and physicians were able to return, without days later, I got word that she had passed clinical skills I had been unable to get ajob that and was buried behind the hospital. By this wouldallowmetoreturn.Thistime,whenmany time, several trips were made by case investi- were leaving, I did not have dependants in the gation teams that visited the hospital com- country.This time, I felt Icouldcontribute. pound in an attempt to persuade them to As the day for me to leave approached, I go to the ETU. In the end, on the compound rationalised about how much peace I was in addition to those in the religious order, giving my family who lived in the USA. themselves health care workers, were others My children, my mother, my siblings had who were assisting them.They ¢nally agreed all been sending messages that were increas- to be taken to the ETU. In all, nine individ- ingly desperate in tone. uals died from the outbreak at the com- By 11August 2014 I was out of Liberia. This pound. was the peak of the epidemic.Within a week I was reviewing situation reports from Mon- rovia and hearing how horrible the situation Situation Report 10 August, 662 cumu- was becoming. I was hearing more news of lative cases; 344 deaths; 35 health care people who had been infected that I knew workers’ deaths personally. Within two weeks I was itching to return home to Liberia, and was making As I dealt with the very personal side of the everyone in my o⁄ce miserable. Another epidemic, I was also internally battling with colleague raised money to support putting the decision made by my employer that I man- trained mental health clinicians into the datorily evacuate Liberia. Many international community to conduct dialogues and pro- organisations were grappling with decision of vide psychosocial support. We were grateful

to have them in the communities and Acknowledgement by then, many were being hired to work The author thanks the two reviewers and the in EbolaTreatment Units as well. By 18 Sep- editor who made comments and suggestions to tember 2014, I was on a plane back to strengthen the article. Liberia. 1 In Liberia there is a ¢ve pillar approach spelled out in an Ebola regional framework, comprising: Three days after I arrived back in (1)Bene¢ciary Communicationand Social Mobil- Liberia, the Situation Report for 21 isation; (2) Contact Tracing and Surveillance; (3) September 2014 indicated 3272 cases, Psychosocial Support; (4) Case Management; 1709 deaths and 85 health care workers and (5) Safeand Digni¢ed Burials (SDB) and Dis- deaths due to Ebola. infection. 2 All names are ¢ctitious.

Janice L. Cooper,PhD,wasseconded tothe Ministryof Health and SocialWelfare,byThe Carter Centre onOctober1.2014.SheistheActingChairofthePsychosocialPillarfortheIncidentManagementSystem of the National Ebola Response and holds academic posts at Emory University and at the University of Liberia. She leads the Carter Centre’sMental Health Program as its Country Representative for Health in Liberia. email: [email protected]

Personal reflection The travellers dance: how Ebola prevention measures affect day to day life

Te re s a G o n z a l ez

While the international community remains Landing in Sierra Leone concerned and focused on the potential spread of On arrival at the airport in Sierra Leone, Ebola out of Africa, the author states that they also you are invited to wash your hands with frequently ignore the deep psychological pain that a solution that smells strongly of chlorine. the measures implemented to combat the disease As you exit the plane onto the runway, are causing within impacted communities, as do people crowd around the arrivals door, like the national authorities. She provides a snapshot in many other African cities. However, in of this moment in the crisis and highlights the Sierra Leone, a man observes all travellers painful impacts, dehumanising measures and and inducts them into a new routine, makes a plea for international organisations to do one where the main message is: ‘DO NOT more to be mindful of this pain. TOUCH ’. Waiting for their luggage, some people are Keywords: burial,Ebola,everydaylife, already wearing gloves, masks or both. All prevention, quarantine, Sierra Leone, along the way from the airport to the city stigma, virus outbreak travellers seem to perform a strange dance,