(Formerly called IRIN) Journalism from the heart of crises

  • Post-Ebola Syndrome: It's not over for Ebola survivors

    West Africa’s Ebola outbreak might be winding down, but the struggles facing survivors in Guinea, Liberia and Sierra Leone are far from over.

    Beyond psycho-social problems related to stigma and post-traumatic stress disorder, more than half of survivors say they are suffering from debilitating joint pain, headaches, and fatigue. At least 25 percent have experienced some degree of change in vision, with many now close to being blind, according the World Health Organization (WHO).

    “I was cured from Ebola last October, but since then I have been suffering from severe pain in my joints,” 45-year-old Kebeh Jomah, who lives in Monrovia, told IRIN. “Sometimes it is so serious that I don’t walk around… I hardly visit people anymore. All day I am sitting home crying from joint pain.”

    Chris Tuan, 18, said his vision has been getting increasingly worse since he was discharged from an Ebola Treatment Unit (ETU) in Liberia in November.

    “I hardly see from a far distance anymore,” he said. “I am gradually losing my eyesight. I am worried. Sometimes I can’t walk alone. Someone has to help me to move around…This is no joke.”

    Medical mystery

    Doctors and other Ebola specialists say they are still unsure exactly why recovered Ebola patients, months later, are still suffering from these lingering side-effects, which many refer to as “post-Ebola syndrome." It is also unclear why the symptoms manifest themselves in so many ways in different people and to varying degrees.

    “We have very preliminary data – and I will again stress it is very preliminary – that suggests that patients who may have had more severe, acute disease may have more severe chronic disease after the initial recovery,” said Doctor Daniel Bausch, a clinical infection control specialist for WHO.

    But while studies from previous outbreaks have shown that the virus can survive in certain parts of the body, where the immune system does not reach, such as the eyes and testes, even for months after recovery, Bausch said nobody knows why patients are experiencing other physical problems, such as headaches and joint pains, in places where the immune system can reach.

    “That’s really one of the big knowledge gaps in which we need more research,” Bausch said.

    During past outbreaks, the number of people infected was always much smaller and so was the number of survivors, making it difficult to perform studies on a largescale.

    Now, there are more than 13,000 survivors across the three most-affected countries, giving experts a chance to have a more comprehensive look at the various long-lasting effects of Ebola.

    Even that, however, may be difficult, as the testing requires special biosafety facilities and can sometimes be invasive for the survivor.

    “It would be difficult… to really do studies that would measure, for example, cleaning the virus out of the eye, because that requires a relatively complicated procedure of tapping [and] putting a needle in someone’s eye – that’s [something] not too many of you would probably like to volunteer for,” Bausch explained.

    A need for care

    Beyond the need to better understand the long-lasting effects of Ebola, the more immediate need for these survivors is care.

    “When you say joint pain, it sounds like a minor thing, [but] it can be quite a major thing for many people,” Bausch said, explaining that many people in these three countries rely on farming and other manual labour for their survival, but are now unable to go back to work and provide for their families.

    For eye problems, in particular, if the inflammation, which causes vision problems, is left untreated, the person can go completely blind, according to WHO.

    There are no known treatments for any of these ailments, however, and trained eye specialists are rare. In Sierra Leone, for example, there are just two ophthalmologists for the entire country.

    Doctors say they are currently treating people’s symptoms on a case-to-case basis, using general medications, such as steroid eye drops or arthritis pain relievers.

    To reach survivors in other areas of the country, WHO is now working with local governments and organisations in all three countries to create mobile eye clinics, as well as offer other treatment for the various ailments facing survivors.

    In Liberia, the country’s first Ebola Survivor Clinic was opened earlier this year at the ELWA Hospital on the outskirts of Monrovia. A second recently became operational in Paynesville. The clinics offer free consultations, care and medications to survivors.

    According to Doctor John Fankhauser, the deputy medical director at the ELWA Hospital, they see more than two dozen patients each day.

    “We see a lot of muscular problems, people who come in with very severe pains in their hips, in their joints and in their knees,” Fankhauser said. “Some of them even have a hard time shuffling into clinic. And these are patients who have been suffering from this for months [without care].”

    Many people hope the clinic will finally offer some relief.

    “My little baby you see here is an Ebola survivor,” said Morris Kollie, inside the Survivor Clinic.“By the special grace of God, he survived and just turned five [years old] this year. But he continues to complain of severe headaches and pains. We have taken him all over the place, but no cure yet.”


    Ebola survivors still suffering
  • Ebola: Liberia's long road to recovery

    Liberia has lifted nationwide curfews and reopened its land borders with key trading partners Sierra Leone and Guinea, but a full recovery from the economic impact of the Ebola outbreak will take time, experts say.

    “The reopening of the border is going to have an impact immediately, both in terms of livelihoods and the availability of food, as well as informal trade,” said Errol Graham, the World Bank’s country economist for Liberia, who spoke to IRIN from Virginia. “But there is going to be a lot of asymmetry between the [speed of] recovery and the crisis. The crisis was an immediate thing because of fear and aversion. The recovery is going to take a little longer.”

    Within hours of the reopening of the border, people and merchandise began to flow from one side to the other. Local markets, once again stocked with fresh produce, meat and home goods, buzzed with activity, for the first time in more than six months.  

    In the interior of Liberia, Graham said, “We are also seeing, with the abatement of the crisis, people starting to go back to work and we expect to see more of that over time. And as foreigners who were involved in concessions in the natural resource sector come back, we expect to see more improvements in the employment situation.”

    But even for those back at work, business remains sluggish.

    “Before Ebola, I used to make 50 US dollars in profits every day from my sales,” said Emily Kennedy, a beverage seller in Margibi County. “But since Ebola came, I only make about 10 US dollars a day. People are afraid to come out and buy. They still think they will get Ebola.”

    The borders were closed in late July as one of several measures to contain the further spread of the virus. The closures brought cross-border trade to a virtual standstill in Liberia. Unable to sell their goods, many people lost their sole means of income.

    “When the border was closed, we had a closed economy,” said Jimmy Keyann, an economist in Liberia. “Nothing was going in and nothing was coming out. The country was losing [revenue] and people were suffering.”

    Very little data is available on the volume or value of local cross-border imports and exports, as much of the border trade is informal and goes unreported. 

    “The borders with Guinea, Cote d’Ivoire and Sierra Leone are quite important to Liberia, largely because of the amount of informal trade that takes place between these countries at the border,” Graham said. “It’s much easier for Liberians [living along the border] to go across into Sierra Leone, for example, than it is to go to other [Liberian] cities, such as Monrovia,” he explained. “Food and goods are also cheaper because the cost of transporting them to the market is less.”

    Economic impact

    Due in large part to the closed borders, curfews and pervasive fear over catching Ebola, nearly half of people who had been employed before the outbreak say they had lost their jobs by December, according to a series of nationwide mobile phone surveys conducted by the World Bank between October 2014 and January 2015.

    This figure has since dropped to 41 percent, but self-employed workers, who make up the informal sector, such as traders and farmers, remain the worst hit. 

    The Liberian economy is expected to grow by three percent this year – less than half the pre-Ebola projection. This equates to a loss of forgone income of around $200 million, according to the World Bank. In 2014, the growth rate was expected to be 5.9 percent; this plummeted to 2.2 percent, after Ebola hit. 

    “We depend on business at the border to survive, said Musu Freeman, a seller at the Bo-Waterside Market in Liberia’s Grand Cape Mount County, which borders Sierra Leone. “But during Ebola, everything was at a standstill. No business, no money. Things became very hard on us. There was no food to even eat. Our kids were suffering,” she said. 

    Now that the border has reopened, Freeman said she can once again buy and sell her wares in Sierra Leone and has started to earn money for the first time in months. 

    “I am a happy woman today,” she told IRIN. “When the border was closed, we never had any other options. But now we are going back to business as usual and our lives are improving. Things are getting better for us once again.”

    While wages fell, food prices went up, particularly in the border communities, where people were forced to travel further to get food from big-city markets. The price of rice, for example, was 35 percent higher in January this year than it was a year earlier, according to the latest figures from the World Bank. 

    Sixty-five percent of surveyed households told the World Bank in late January that they were not able to buy enough rice to meet their needs during the previous two weeks. A lack of money was the main reason cited by more than 88 percent of respondents.

    “When Ebola hit Liberia, my boss asked all of us to stay home,” said 38-year-old Tina Cooper, who works for the Ministry of Education. “I went out of money completely. I never had a cent to feed my family. Things were very rough [because] I had no income at all.”

    Trying to cope

    As a result of lost wages, high unemployment and higher prices, more than 85 percent of families say were forced to use negative coping strategies since the outbreak began, according to survey data released by the World Bank on 24 February. This includes things such as selling assets, slaughtering livestock and borrowing money, in order to feed themselves and their families.

    “Ebola affected me so much to the extent that I sold all of my living-room furniture,including my children’s television, our radio and dining room sets,” said John Tamba, who lives in Goborchop Community, a suburb east of Monrovia. “I had to do this because I needed money to feed my family when things were hard during the Ebola war. It was the only way me and my kids could survive the crisis.”

    More than 80 percent of families living in rural areas and three-quarters of households in urban areas now report being food insecure, the World Bank says. Many households say they have had to reduce portion sizes during the past few months and cut down on the number of meals they eat each day. 

    Gradual recovery

    Economists say that in order for people to get back into the working sector, it is vital that they have access to credit and capital, to restart their businesses. Graham said that this should be a key component of the post-Ebola recovery plan that the government is now working on.

    According to Liberia’s acting Minister of Information, Isaac Jackson: “Bit by bit we are working to revitalize the economy.” 

    This has included things such reopening the airports and ports to allow tourists and business people to come in, trying to attract both new and old investment partners into the country, resuming the salaries of civil servant employees and reassuring Liberians that they can return to work, as proper safety and health measures are in place. 

    Liberians say they hope these initiatives will be as quick and helpful as the reopening of the borders. 

    “We don’t blame the government for closing the border,” said Lain Trawalley, a trader in Bo-Waterside Market. “But we felt the pinch of it. We were stranded. We really suffered. So thank God it is all over. We feel like we are finally out of prison.”


    Ebola's lasting economic impact

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