‘We are not here for ceremony’: The indignity of a coronavirus burial

Uganda Letter: In a country that dealt with Ebola 20 years ago, many healthcare workers risk going too far implementing controls during burials

A team in protective gear carry out the burial of a coronavirus victim in Gulu, northern Uganda. Photograph: Sally Hayden

A team in protective gear carry out the burial of a coronavirus victim in Gulu, northern Uganda. Photograph: Sally Hayden

 

The funeral started like any other. Plastic chairs were spaced out under marquees. Steam rose as women cooked big vats of food on charcoal fires beside grass huts. Mourners trickled in, greeting each other with a few kind words.

It was hours before the coffin arrived, driven from the hospital in the back of an open truck marked with Chinese lettering. Two white jeeps drove up alongside it – the assigned burial team, who proceeded to dress in protective gear: white wellies, full plastic coverings, goggles, face shields, and long gloves.

“We are not here for ceremony,” the official in charge told the rest of his men. “Let’s do what we have to do.”

In the tradition of the Acholi tribe, who live between northern Uganda and South Sudan, deceased people are buried beside their family homes, their graves dug on the land their relatives live on.

This is continuing in the time of coronavirus, though the pandemic is upsetting other norms, causing discomfort and even anger among mourners.

Gulu, a small city in northern Uganda, dealt with an Ebola outbreak 20 years ago, and many of the regional coronavirus task force worked on that response. Now that Covid-19 has reached Uganda’s north, healthcare workers are trying to implement the same controls during burials. They risk going too far while coming up against the same challenges: combining safety with respect for the dead.

In the recent Ebola outbreak in neighbouring Democratic Republic of Congo, burial teams were attacked by upset families, who couldn’t understand why they weren’t allowed to follow traditions that have existed for generations.

“It’s about balancing everything and not causing undue suffering,” Stephen Fonseca, the International Committee of the Red Cross’s regional forensic manager for Africa, tells me by phone. “That dead person is someone special to the community.. .This is a time when the community’s mourning. This is a very sensitive time.”

Burying someone who died from Covid-19 does not pose the same risks as involved in the case of an Ebola death, he says, and this needs to be recognised. “We’re not talking Ebola where everyone has to show up in astronaut suits, in crime scene suits ... The last thing we want to do is treat a case as an Ebola case and then have the family ostracised.”

Fonseca also highlights the fact that many regions don’t have an “endless” supply of personal protective gear. It may be better used by healthcare workers dealing with the living than someone carrying the already disinfected coffin of a coronavirus victim. “We have to be judicious in terms of where do you use it, where is it necessary, where will it cause undue fear and panic?”

Despite the relatively slow spread of the coronavirus, northern Uganda’s hospitals are already at capacity and healthcare teams are calling out for more funding, resources, and protective gear. There are still only 6,468 confirmed coronavirus confirmed cases, and 63 deaths, in this country of more than 40 million people.

A policy of isolating people who are asymptomatic in treatment centres has increased the pressure. Last week, the head of Gulu’s coronavirus task force told me they were “overwhelmed”.

Big gatherings

This burial was one of the first of a Covid-19 victim in the city. About 150 mourners were present – not all of them masked – as the burial team dressed themselves and poured out disinfectant. A religious minister stood by the graveside. One relative collapsed, wailing, and was taken away by friends.

When the coffin was lifted out of the truck, the family of the deceased asked if the minister could say a prayer. “This is Covid-19, this is not a joke,” snapped back one of the burial team.

They sprayed disinfectant on the ground around the grave, tied ropes under the coffin, and lowered it in. Mourners stepped forward to throw some soil on top, before being forced back by the health team who shouted, “it’s enough”.

Though Uganda’s ministry of health advises that a maximum of 50 mourners can be present at a burial, big gatherings have continued throughout the pandemic, with up to 1,000 showing up to pay their respects when a person dies of other causes. Senior military figures and politicians even attended a recent burial in Gulu en masse, after the wife of the president’s brother died.

But coronavirus burials are new, and the way they’re conducted is a work in progress. While officials and government health teams have been vocal about the need to reduce stigma, it remains to be seen whether a victim’s family or their land might be seen as tainted. And still, a people will mourn.