Ebola in Sierra Leone – the ‘don’t touch!’ rule

‘Don’t touch’ has become a warning that most Sierra Leoneans live by, as communities across the country continue to battle the Ebola outbreak. While messages around reducing body contact as a way to prevent Ebola are now clear to most, when children are involved it can be a difficult rule to follow.

A child requires attention: they are needy and vulnerable and instinctively seek out affection. Equally, children, particularly babies and toddlers, can be the centre of adult attention – we are drawn to them, pick them up, tickle them, cuddle and hold them.

So what does this mean for children in a country that is being gripped by an infectious disease that can only be halted when people refrain from physical contact?

The vulnerability of children is most evident when they are ill. But when they are sick with a highly contagious virus, the adults caring for them also become acutely vulnerable to catching the disease. Ebola is spread through the transfer of bodily fluids of symptomatic patients. This means that when an infected child displays symptoms, their parents and carers can also become sick, their sisters and brothers are exposed, and children in close-knit communities are also at risk of catching the disease.

“For communities to fight this disease properly, they need to watch out for their children,” says UNICEF’s maternal and child health officer in Freetown, Margaret James. “They need to take a sick child straight to the health facilities, they need to keep their children away from other children in the community who may be sick – and if they themselves feel sick, they need to keep a distance from their children before reporting to health clinic.”

Health workers treating Ebola patients in the space-suit-like PPE outfits are trained to minimize contact with patients to avoid becoming infected and reduce the spread of infection in the ward. Applying this rule to children is heartbreaking for a health worker whose instinct is to comfort a sick child by picking them up – and confusing for the child who is desperate for attention and comfort.

“When I see sick children suffering in the ward, I feel terrible,” says Sister Aminata Sankah who is an Ebola nurse at the Macauley St. Clinic in Freetown. “Children are the most difficult patients when you treat Ebola because you need to touch them and they want to come close. This is difficult when you are an Ebola nurse, because it increases the risk of catching the disease but you just want to make them feel better.”

UNICEF Sierra Leone
Sister Aminata Sankah, a nurse at the Macauley St. Clinic in Freetown. (c) UNICEF Sierra Leone/2014/Dunlop

Nurses across all hospitals must also be mindful of infectious disease precautions. On a Friday morning at the under-5s clinic at the Macauley St. Clinic, mothers are lining up to have their young babies immunized. Maternal and Child health nurse Sister Miniratu King and her staff have just completed a training in infection control supported by UNICEF and are taking precautions to ensure they are protected when treating babies.

“We now have gloves, masks, aprons and chlorine for hand washing, this is what is needed in all health centres,” she said. “We pick up babies, we touch them. It is easy to catch something from a small baby because they are very close to you.”

Sister King is confident that sensitization has improved the way mothers are caring for their babies in the home. “We tell these mothers to not be afraid of Ebola but to take precautions, wash hands before feeding and changing and keep your baby close to you, do not let people you do not know touch your baby.”

“I think they are taking notice and they just have more knowledge and careful behavior than before Ebola started in this country,” said Sister King.

The issue of physical contact also affects children who are suspected Ebola cases or Ebola contacts. When someone is infected, their family members become ‘contacts’ and for 21 days they are often quarantined and monitored. Children who have been orphaned are either cared for by relatives or end up in care centres or orphanages.

According to Mary, a health promotion officer with Médecins Sans Frontières (MSF), this creates a difficult situation for both the child and the carers: “When children are suspected cases, they are vulnerable, they need support but we can’t really touch them because they may have Ebola”, she says.

“I heard one story of a toddler who was being taken care of in an interim care centre, he started developing a fever, he was tested and while we waited on the results nobody could touch him, all he wanted was to be picked up and held because he was scared and sick but the carers could go near him. It is painful to not be able to comfort a child when they cry,” said Mary.

Reports like this are common, and according to Ministry of Health and Sanitation statistics there are over 2,220 children in Sierra Leone affected by Ebola. This number continues to rise as the disease spreads and more children become infected or become orphaned.

Jo Dunlop is a UNICEF consultant based in Sierra Leone.

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