Irish burial experts help control Ebola outbreak in Sierra Leone

It may be a long way from the carefully tended plots of Glasnevin Cemetery to the chaos of burial in Ebola-ravaged Sierra Leone, but Ireland's expertise in interment is being put to good use in fighting the spread of the virus in West Africa.

The aid agency Concern Worldwide have teamed up with Glasnevin Trust in an unusual partnership to manage the burial records and grave locations of the epidemic's victims. It's an attempt to put some order and human dignity on the ravages of a disease that has caused up to 85 deaths a day in Sierra Leone alone.

Safe burial is a key element of the fight against Ebola, which is highly contagious at death. At this point, the virus takes over the entire body, and can often force it to release infected blood, vomit and diarrhoea. At times during the current epidemic, burials and the management of dead bodies contributed to up to 70 per cent of the transmission of the disease.

Some bodies were left on the street for days; others were taken back to their communities for traditional burial. Both scenarios involved huge risks to those in contact with corpses. Yet families still want to mourn loved ones. Mass graves or hastily dug unmarked plots deny the bereaved this opportunity.

“You had a situation where dead bodies were being dug up because people felt rituals were not being honoured and the spirits of the dead were not being put to rest,” says Anne O’Mahony, Concern’s director of international programmes.

Burial with dignity

And so, with the aim of providing burial with dignity, the agency made contact with the trust running Glasnevin Cemetery. The historic north-Dublin burial ground is home to One Million Dubliners, as the documentary aired last week on RTÉ television so beautifully illustrated.

Glasnevin has developed its own cemetery records management system to keep track of burials and the use of plots. The system, which records detailed information on the deceased, including names, addresses, causes of death and grave location, is transferable.

"Glasnevin Trust was established to bury those of all religions, and none, with dignity and respect, and by offering our assistance to Concern we are continuing to fulfil our mission," says Mervyn Colville, deputy chief executive of the trust.

Concern became involved in the job of burying the dead in Sierra Leone after the existing government-led system broke down. O’Mahony says there was a huge backlog of burials, and families often didn’t know where their relatives had been taken for burial. Compounding the problem was an adherence to traditional funeral rites, which often include touching and washing the bodies of the dead. This helped to speed transmission of the disease.

Although Concern is an experienced agency with almost four decades of experience in international disaster relief, this is the first time it has specialised in burials during an emergency. Burial and inspection teams are at the same heightened risk of infection as frontline medical teams because of their exposure to bodily fluids from infected corpses. The risk to direct agency staff is a little lower because their job is to supervise the burial teams inherited from the ministry of health in Sierra Leone.

Minimising risk

The teams are trained to minimise risk. They wear full personal protective equipment as well as using disinfectant and chlorine to keep themselves safe. Before burial, corpses are placed in two body bags to ensure there is no opportunity for the virus to survive. Contaminated personal items, such as clothes, pillows and blankets, are either burned or buried along with the body.

Concern now manages 10 burial teams and two cemeteries in the capital, Freetown. To date, fortunately, none of those in the burial team have been infected.

“The partnership has already proven transformational in terms of public support, as it preserves the dignity of the deceased and respects the relatives, with whom communications have been hugely improved,” says O’Mahony.“Most importantly, we have already seen a significant drop in the number of secret burials, which are a huge risk to public health.”

Under the new system, graves are marked with a small white cross and families are given a map to find it. Some have already begun to put concrete on their graves.

Recent reports from West Africa have suggested a levelling off of cases, but O'Mahony says the numbers in both Liberia and Sierra Leone have started to rise again in the last few weeks.

“Sadly, rumours of the demise of this outbreak have been greatly exaggerated,” she says.