FREETOWN,
Sierra Leone — The gravedigger hacked at the cemetery’s dense
undergrowth, clearing space for the day’s Ebola victims. A burial team,
in protective suits torn with gaping holes, arrived with fresh bodies.
The
backs of the battered secondhand vans carrying the dead were closed
with twisted, rusting wire. Bodies were dumped in new graves, and a
worker in a short-sleeve shirt carried away the stretcher, wearing only
plastic bags over his hands as protection. The outlook for the day at
King Tom Cemetery was busy.
“We
will need much more space,” said James C. O. Hamilton, the chief
gravedigger, as a colleague cleared the bush with his machete.
The
Ebola epidemic is spreading rapidly in Sierra Leone’s densely packed
capital — and it may already be far worse than the authorities
acknowledge.
Since
the beginning of the outbreak more than six months ago, the Sierra
Leone Health Ministry reported only 10 confirmed Ebola deaths here in
Freetown, the capital of more than one million people, and its suburbs
as of Sunday — a hopeful sign that this city, unlike the capital of
neighboring Liberia, had been relatively spared the ravages of the
outbreak.
Burial Boys of Ebola
In Sierra Leone, a group of young men take on the dirtiest work of the Ebola outbreak: finding and burying the dead.
Video Credit By Ben C. Solomon on
Publish Date August 23, 2014.
But
the bodies pouring in to the graveyard tell a different story. In the
last eight days alone, 110 Ebola victims have been buried at King Tom
Cemetery, according to the supervisor, Abdul Rahman Parker, suggesting
an outbreak that is much more deadly than either the government or
international health officials have announced.
“I’m
working with the burial team, and the first question I ask them is,
‘Are they Ebola-positive?’ ” said Mr. Parker, adding that the figures
were based on medical certificates that he had seen himself. The deaths
are carefully recorded by name and date in a notebook headed “Ebola
Burials.”
A
burial team supervisor who drove up with fresh bodies echoed Mr.
Parker’s assertion. “Any body we collect is a positive case,” said Sorie
Kessebeh. “All the bodies that we are bringing in are positive.”
Beyond
the many worrisome trends in the Ebola epidemic seizing parts of West
Africa — the overflowing hospitals, the presence of the disease in
crowded cities, the deaths of scores of health workers trying to help —
another basic problem has stymied attempts to contain the disease: No
one seems to know how bad the outbreak really is.
The World Health Organization acknowledged
weeks ago that despite its efforts to tally the thousands of cases in
the region, the official statistics probably “vastly underestimate the
magnitude of the outbreak.”
Here in Sierra Leone, the government just finished an aggressive national lockdown
to get a handle on the epidemic, ordering the entire country to stay
indoors for three days as an army of volunteers went door to door,
explaining the dangers of the virus and trying to root out hidden
pockets of illness.
Still, the Health Ministry spokesman insisted that the epidemic was not as bad as the flow of bodies at the cemetery suggested.
“It
is not possible that all of them are Ebola-related deaths,” said Sidie
Yahya Tunis, the Health Ministry spokesman, saying the corpses included
people who died of other causes.
But as the cemetery records show, the challenge facing the government might be of a different magnitude than previously thought.
The
majority of the recent deaths recorded at the cemetery were young
people — young adults, people in early middle age, or children — with
very few elderly people on the list. Several of the deaths also occurred
in a concentrated area, sometimes in the same house, suggesting that a
virulent infection had struck.
King Tom Cemetery
1 Mile
Kolleh Town
Kroo Bay
SIERRA
LEONE
Freetown
Atlantic
Ocean
Freetown
At
the house of Marion Seisay — the third name on the list — her son
acknowledged she was a secretary at Wilberforce Hospital, had died of
Ebola and was buried on Sept. 14. The house was now under quarantine,
with some of its eight residents lingering on the cinder-block porch.
“The
way my Mummy died was pathetic,” said the son, Michael Foday, clearly
frustrated by the quarantine. “How do you expect us to get food?”
Other
houses in Wilberforce Barracks, the village-like compound surrounding
the hospital, were on the list of the dead and placed under quarantine,
marked off from the surrounding jumble of shacks and cinder-block houses
by a thin line of red or blue string.
In
one of them, the house of Momoh Lomeh, the residents said that a total
of five people who lived there had died of Ebola — yet four of them did
not even appear on the cemetery list. At another, the house of Andrew
Mansoray, a family member said that the disease had been ruthless and
unrelenting.
“It
wouldn’t stop,” Abdul R. Kallon said of the diarrhea that Mr. Mansoray,
his brother-in-law, had endured before dying. “They took him to the
hospital, and they wouldn’t let him out.”
At
another six households on the cemetery supervisor’s list of the dead,
residents gave similar accounts. One family said the victim had
definitely died of Ebola, while five others described Ebola-like
symptoms — vomiting, diarrhea, fever — though none had been given an
official cause of death.
International
health experts here had no explanation for the striking discrepancy
between the government’s tally of the dead in the capital and the
cemetery crew’s statistics. Several of them noted the general confusion
surrounding official statistics here from the beginning, with one
leading international health official saying: “We don’t know exactly
what is going on.”
But
nobody disputed that things appear to be getting worse. The W.H.O. has
shown a sharp increase in new cases in Freetown in recent weeks, rising
from almost none early in the summer to more than 50 during the week of
Sept. 14.
Various
models of the growth of the epidemic here “all show an exponential
increase,” said Peter H. Kilmarx, the head of the Centers for Disease
Control and Prevention team in Sierra Leone. “The conditions are
amenable to Ebola spread.”
The
goal of the government’s national lockdown was to reach every household
in the country, and officials claimed success in doing so on Monday,
saying that progress had been made in the fight against the disease.
But
the exhaustion of the Ebola gravediggers at King Tom Cemetery, who dig
as many as 16 graves a day, indicated that the disease was far from
being contained.
“It’s a herculean task,” said Mr. Hamilton, the chief gravedigger. “It’s only out of patriotism that we are doing it.”
The
Ebola victims were buried in an expanding stretch of fresh muddy graves
under a giant cotton tree, and the makeshift arrangements are seen as a
looming threat by the residents of the slum next to it. No barrier
stops the pigs rooting in the adjoining trash field from digging in the
fresh Ebola graves, which residents say they often do.
“We
have creatures in the community, and they dig in the graves,” said
Henry S. Momoh, who lives in the adjoining slum, which residents call
Kolleh Town. “They are burying the Ebola patients in there, but not in
the proper manner.”
Five
yards from where the new graves begin, a well-used path connects the
slum to the main road. Residents all use it, passing close to the
freshly dug graves, and are frightened by the intensifying activity in
the cemetery.
“Since
last month, it’s every day, any minute and hour, and often, they are
coming” to bury the Ebola dead, said Desmond Kamara, a police officer.
A cloudy stream drains from the area of the new graves into the slum, further frightening the residents.
“We are at risk, big risk,” said Ousman Kamara, a resident. “We have made many complaints.”
But the bodies, he said, keep coming.
“Even at night,” he said. “You stand here, and you see them coming.”
Correction: September 22, 2014
An earlier version of a picture caption with this article referred incorrectly to a possible victim of Ebola whose body is shown being removed from a house in Freetown, Sierra Leone. The body is that of a man, not a woman. http://www.nytimes.com/2014/09/23/world/africa/23ebola.html?_r=1
An earlier version of a picture caption with this article referred incorrectly to a possible victim of Ebola whose body is shown being removed from a house in Freetown, Sierra Leone. The body is that of a man, not a woman. http://www.nytimes.com/2014/09/23/world/africa/23ebola.html?_r=1