Bringing safer burial rituals to Ebola outbreak countries

In Liberia when a loved one dies, the family washes the body and the mourners lay their hands on the departed. These are dearly held burial rituals, but they also contributed to the spread of the Ebola virus before health authorities brought an end to the practice.

Alain Epelboin is one of the anthropologists helping the World Health Organization come up with safer burial practices that still take into consideration the traditions of the communities of West Africa, where Ebola has taken a deadly toll.

West Africa could see up to 10,000 more Ebola cases per week within two months, Bruce Aylward, the World Health Organization’s head of emergency operations, said Tuesday at a press conference in Geneva. As of Tuesday, there were 8,914 confirmed Ebola cases and 4,447 deaths — mainly in West Africa — in this year’s outbreak, he said.

Epelboin, a French native, has worked as a consultant to the WHO since 2003 and currently is helping the international agency in Guinea with its Ebola operations by learning about local life, listening to people’s complaints and fears, and making recommendations to the agency.

“I would say that we are helping to humanize interventions,” to find a balance between authoritarian sanitary operations, and safe and empathic approaches, he said through an interpreter.

In places such as Guinea, Liberia and Sierra Leone — the countries hardest hit by Ebola, treatment of the sick includes personal care by relatives, such as wiping, massaging, kissing and embracing. After the person dies, the bodily contact continues as bereaved people come by to express their grief and offer condolences, said Epelboin. The body is wrapped in a shroud, mat or coffin and placed in the ground by several people, where more contamination is possible.

It’s necessary to thoroughly explain the reasoning behind any burial changes and get the local population on board, he said. And the family should have time to be with their loved one, even separately when the body is enveloped in disinfectant.

“We must allow the family to look for the last time on the face and body of the deceased before the final closure of the body bag,” and photograph him or her if they want, he said.

The funeral procession and burial — including time for prayer and speeches — are still allowed, just with the help of burial teams in protective gear. The ritual washing of the body is replaced by the more symbolic disinfectant sprays of chlorinated water, Epelboin said.

One of the positive trends among the bleak news about Ebola is an increase in the number and effectiveness of the burial teams, who are paid for their services, said Aylward in Geneva.

In Liberia’s capital Monrovia, where new sanitary burial practices angered locals who felt they were authoritarian, impersonal and sacrilegious, the number of burial teams has jumped from six to 64, achieving an 80 percent safe burial rate, he said.