THE BLOG
13/02/2016 18:36 GMT | Updated 12/02/2017 05:12 GMT

Ebola's Legacy Is Still Deadly for Mums and Babies in West Africa

Ebola no longer makes the headlines, driven out by news of Zika virus and the crisis in Syria. But the terrible legacy of Ebola persists in West Africa, for the survivors who suffer stigma and fear long-term complications, and for all of those who are vulnerable and in need of healthcare at a time when the health system has been brought to its knees.

While Ebola is hopefully now contained, the legacy continues for pregnant women and their newborns.

Sierra Leone's initial Ebola-free declaration last November was a moment of sombre remembrance as well as sober celebration; everyone knew the fight wasn't over and last month, hours after the World Health Organization declared the outbreak in West Africa over, Sierra Leone officials reported another Ebola death.

I was there with WaterAid and saw how Ebola's toll -- on Sierra Leone's doctors, nurses, health clinics and the families who depend upon them -- continues to grow.

The legacy in Kenema

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WaterAid/Monique Jaques

The Kenema Government Hospital was a major centre for Ebola treatment at the height of the crisis and continues to receive complicated medical referrals, usually by motorbike.

Kenema Government Hospital, more than four hours' drive southeast of Freetown, is a major regional centre which already had expertise in handling Lassa fever, another haemorrhagic fever, when Ebola surfaced in the region in summer 2014. However it too was overwhelmed by Ebola, and lost 37 of its own medical workers to the deadly virus. The fight was made all the more difficult because the hospital did not have reliable, regular access to clean water and good sanitation, without which it's nearly impossible to control infection.

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WaterAid/Monique Jaques

A memorial outside the hospital for the health workers that died during the Ebola epidemic, at Kenema Government Hospital in Kenema, Sierra Leone.

Just five doctors are now left at the hospital to treat a population of more than 500,000. A small white memorial, decorated with flowers, sits outside to mark the loss of their colleagues.

During the week I spent in Kenema hospital, I saw midwives doing their utmost to save young women in labour as well as their tiny newborns despite basic facilities, intermittent access to running water and few functioning toilets.

But infection control is a constant struggle and photographer Monique Jaques and I saw many women who lost their babies to largely preventable causes. A woman giving birth in the UK faces a one in 7,518 likelihood of losing a baby to sepsis or other infection in her lifetime; in Sierra Leone, it's one in 21. And unless the Sierra Leone government and foreign donors urgently address the dearth of water and sanitation in the country's healthcare facilities, the risk is likely to grow.

Ebola's other deadly legacy

During the epidemic, many women in labour shunned the hospitals, terrified that they would catch Ebola. The consequences were stark.

A recent WaterAid-VSO study found a 30% increase in maternal deaths and a 24% increase in newborn deaths in Sierra Leone between May 2014 and April 2015, in part because women were so afraid to go to hospital that they tried to deliver their babies at home, without skilled care and in unhygienic conditions.

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WaterAid/Monique Jaques

Christiana Dassama, 17 (back to camera), waits to give birth at Kenema Government Hospital as another woman who has just given birth rests. The maternity ward has no running water and no functioning toilets; women bring their own birth supplies including bed sheets.

"At the height of the Ebola outbreak, hospitals were seen as a place for the dead," Dr Amadu Sesay, the medical superintendent at Kingharman Road Government hospital in Freetown, had told me earlier in the week. "Going forward we have to rebuild confidence in the healthcare system in Sierra Leone, especially with regards to maternal health.

"Having access to clean water, good sanitation and hygiene practices is pivotal in bringing mothers back [to our hospitals]. You cannot have infection prevention where you lack water supply. Ebola taught us that, and the government must recognise that too."

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WaterAid/Monique Jaques

Midwives, nurses and doctors deliver the baby of Christiana Dassana at Kenema Government Hospital. Medical staff continue to take careful precautions for fear Ebola has been undetected.

The road ahead

As donor countries and national governments work to rebuild healthcare systems in West Africa, water, sanitation and hygiene training will be a crucial part of this effort.

The impact of a lack of water and sanitation is not limited to Sierra Leone's hospitals. Some 87% of homes in the country do not have toilets and 37% do not have access to clean water.

As much as 50% of malnutrition and stunting can be attributed to chronic infection linked to dirty water and poor sanitation, and women who had their physical development stunted as children are more likely to experience obstructed labour, making such difficult deliveries tragically common.

The results are devastating, and I saw this first-hand, as young women arrived on motorbikes in agonising pain from obstructed labour. Many came to hospital too late. Some hadn't had any prenatal care. Under these conditions, the midwives did the best they could but the odds were stacked against them.

Afraid of hospital

Kenema Government Hospital's lead midwife Sando Kamara said they are struggling to draw pregnant women back to medical clinics, and they are contracting infection from poor hygiene practices at home.

"The problem we find with young mothers is that they're afraid to access prenatal care," she said.

None of us here in the UK could even imagine attending a hospital with no running water coming from the taps.

Safe, clean water must be at the heart of healthcare - it's true in the UK and everywhere in the world.

WaterAid is working in Sierra Leone and in other countries around the world to improve water, sanitation and hygiene in healthcare facilities. This winter's Deliver Life appeal is to bring safe water and good hygiene to 130,000 women and their families.

As Sierra Leone, Liberia and Guinea rebuild their health systems, water, sanitation and hygiene will be critical if they are to cope with the next pandemic.

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WaterAid/Monique Jaques

Kema James, 18, rests after delivering her baby at Kenema Government Hospital. Kema arrived at the hospital on a motorbike after a 30-minute journey over bumpy roads while in labour, after midwives at the provincial health centre became concerned at her labour's lack of progress. Midwives said her baby contracted an infection in utero.

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WaterAid/Monique Jaques

Kema James watches over her baby son at Kenema Government Hospital, Sierra Leone. Tragically, the baby boy succumbs to sepsis when he is just five days old.

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WaterAid/Monique Jaques

Hawa Kallon, 35, waits outside before being given a bed at the Kenema Government Hospital. Pregnant, she arrived at hospital with a fever and waited in quarantine until both Ebola and Lassa fever could be ruled out.

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WaterAid/Monique Jaques

A maternity ward worker takes a breather after an 18-year-old died in childbirth, one of many to die in a crisis in maternal health in the country.

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WaterAid/Monique Jaques

Jeneba Sandy, 22, sleeps next to her healthy newborn at Kenema Government Hospital, Sierra Leone. Medical workers are struggling to convince pregnant women to return to clinics for prenatal care after the Ebola crisis.

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WaterAid/Monique Jaques

A burial team member carries a cardboard box containing a baby who has died after obstructed labour and infection. Burial teams still wear full protective gear in Sierra Leone out of concern Ebola virus may have been undetected.