Last year, Ebola in West Africa claimed more than 10,000 lives, destroyed many communities, and tore countless families apart.
But in Sierra Leone, it did so much more than that. Ebola broke down all social norms and community habits, leaving nothing but confusion and distrust in its wake. Before Ebola, it used to be impossible to conceive of a mother who is not allowed to hug her child, a wife stigmatised for caring for her husband, or of old friends who are prohibited from shaking hands. But a year on stigma remains, and is proving one of the most difficult challenges to overcome.
As Sierra Leone passes the 42-day milestone with zero new Ebola cases, Bob Bongomin Jr, International Medical Corps' WASH Coordinator in Sierra Leone, reflects on the challenges faced and lessons learned from the most deadly Ebola outbreak in history.
"Still recovering from a decade-long civil war, Sierra Leone was already suffering from a diminished capacity of households to prevent and recover from the impact of conflict and disaster", says Bob. "Water, Sanitation and Hygiene (WASH) facilities were lacking; open defecation was widely practiced; and insufficient structures prevented safe hygiene and sanitation practices.
"When the Ebola (EVD) outbreak hit Sierra Leone in 2014, the situation in the country went from bad to worse.
"At the start of the crisis, dying patients were taken to hospitals which never had enough water to maintain sufficient hygiene standards, or isolation for infectious fluids...The epidemic pushed the already weak system to breaking point."
Ebola requires access to clean water - for disinfection, for hygiene, for cleaning, for laundry, but most importantly for rehydration. When the outbreak hit Sierra Leone, the situation deteriorated even further because of the 'fear factor' that literally influenced all activities, and WASH was no exception.
"At the initial stages of the outbreak, people resisted the fact that it was an EVD outbreak and were unwilling to change their behaviour", Bob explains. "This resistance exposed many community members as well as health-care workers to EVD.
"At the response level, skilled personnel were lacking and many of those present were unwilling to take the risk of exposure by becoming responders. Stigma against both Ebola response workers and survivors was also there. Some of our national staff got evicted from where they rented houses while others had to deal with separation as their spouses were unwilling to share a house with an Ebola worker."
Overcoming local customs and traditions also proved a challenge. "An Ebola corpse is more contagious than an Ebola patient", Bob explains. "In some traditional burials, the body is washed, and that same water is used to bless those in attendance, which is extremely dangerous. Needless to say, safe burials became a crucial priority for us."
In addition, many community members refused medicine, preferring traditional healing, and remained skeptical of Ebola Treatment Centres (ETC's), believing that the food and water provided there was what made people sick.
Osmaen Thulla, an Ebola survivor who reported himself to the ETC as soon as he started showing signs of Ebola explains how he received phone calls from my family, telling him not to take the medication, drink the water or eat the food that was being provided to him.
"Many people believed that the ETC was actually giving people Ebola and killing them, but I did not listen to these ideas", he says. "Instead I took the medicine, drank the water and ate the food. That is how I survived. When I recovered and returned home, I assured everyone that the ETC is only here to help people and to keep them alive. I am living proof of that, and so they listened to me."
With the outbreak finally under control, and as the Government of Sierra Leone is getting ready to take over their own Ebola response, International Medical Corps has begun the decommissioning process. But the community outreach work continues, with the hope that improved WASH practices can combat many other contagious diseases in the community, and prevent future outbreaks by reinforcing simple hygiene practices.
"Our challenge was really to educate the communities when it comes to hygiene practices, to help prevent further spread of Ebola", says Bob. "I think it was a real eye-opener for everybody involved.
"The hope now is that, following the guidelines established, a similar kind of situation can be avoided in the future."