ALERT ON EBOLA:PHYSICAL SYMPTOMS AND PSYCHOLOGICAL EFFECTS-WHAT YOU NEED TO KNOW. (PART 3)
The Mental Health response since the outbreak of the deadly Ebola Virus Disease (EVD) has been absent or slow due to lack of established mental health services in most of the affected countries. Therefore, the psychological impact on victims, their family members and the health workers taking care of them as well is devastating. Although, the first priority of public-health experts is to contain the spread of virus, the psychological aftereffects of the EVD will become even more apparent once the spread is contained.There is the urgent need to address the situation.
Scientists today said that the most likely cause of the deadly outbreak of Ebola in West Africa was a young boy playing near a colony of virus-infected bats. The two-year-old boy - described as the index case, or patient zero - became infected and was the first to die in his village in Meliandou, Guinea in December 2013.
It is thought 'patient zero' was Emile Ouamouno, described as a playful toddler by his father Etienne. Before his death, on December 6, 2013, Emile had been near a tree harbouring the free-tailed bats.
The toddler came down with a sky-high fever, began vomiting and passing black stools. It took four days for the disease to claim Emile's life, and he passed away on December 6, 2013.
His sister Philomene fell ill on Christmas Day last year, and was dead before New Year. Their mother followed, along with their grandmother, Etienne said earlier this year. The disease then spread to other members of the community before spreading to other parts of Guinea.
The disease was only recognised as Ebola in March, and in the summer it began to spread across international borders, infecting people in Sierra Leone, Liberia and Nigeria, before patients were diagnosed in Spain, United States and most recently, Scotland, United Kingdom.
THE LATEST OUTBREAK OF EBOLA VIRUS DISEASE
Glasgow Scottish UK,December,30th,2014.The most recent case of the EVD surfaced today of a volunteer health worker Nurse Pauline Cafferkey, who fell ill in Glasgow after returning from Sierra Leone. Colleagues fear she may have contracted Ebola on Christmas Day. Even though she was screened for symptoms in Sierra Leone and London Airports respectively but nothing picked.
Hours after arriving home Pauline Cafferkey fell ill and soon afterwards became the first Briton to be diagnosed with Ebola on UK soil. She alerted the authorities and said she feared she had Ebola and was taken to a Glasgow hospital by special ambulance, immediately isolated and diagnosed with the virus. The authorities have been desperately trying to trace other 70 people who were on board. 63 of 70 people on flight from Heathrow to Glasgow have been contacted.
Pictured: This is Pauline Cafferkey, the Scottish NHS nurse from just outside Glasgow who is believed to have contracted Ebola while working for Save the Children treating the sick in Sierra Leone
Reported case incidence is fluctuating in Guinea and decreasing in Liberia.
-There are signs that the increase in incidence has slowed in Sierra Leone, although the country’s west is now experiencing the most intense transmission in the affected countries. Response efforts have been strengthened to curb the spread of disease in the area.
The challenge for most African communities in Guinea, Liberia, Sierra Leone, Senegal and Mali that are still struggling to contain the EVD, including Nigeria [has been declared (EVD) free by the WHO],The United states of America, Spain, United Kingdom and other parts of the world is how to effectively address this.
To drive home the urgency and need of effective diagnosis, treatment, management and prevention of the psychological impact of the (EVD); check out these Summary of the World Health Organization, (WHO) Highlights of cases/Deaths as at December,26,2014.
Number Of Ebola Cases In Countries With Widespread And Intense Transmission.
Table 1: Confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone
Table 1: Confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone
Number of cases | Number of deaths | ||||
Country | Data as of | Case definition | Cumulative cases | Cumulative deaths | |
Guinea | 24 December 2014 | Confirmed | 2342 | 1385 | |
Probable | 269 | 269 | |||
Suspected | 19 | 0 | |||
Total | 2630 | 1654 | |||
Liberia | 20 December 2014 | Confirmed | 3085 | Not available | |
Probable | 1757 | Not available | |||
Suspected | 3020 | Not available | |||
Total | 7862 | 3384 | |||
Sierra Leone | 24 December 2014 | Confirmed | 7160 | 2289 | |
Probable | 287 | 208 | |||
Suspected | 1786 | 158 | |||
Total | 9203 | 2665 | |||
All countries | 19 695 | 7693 | |||
Data are based on official information reported by ministries of health, through WHO country offices. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results. *Not reported due to the high proportion of probable and suspected cases that are reclassified. Data not available. Data are missing for 21 December.
Table 2: Countries with an initial case or cases, or with localized transmission
Country | Case definition | Cases | Deaths |
Mali | Confirmed | 7 | 6 |
Probable | 1 | 0 | |
Suspected | 0 | 0 | |
Total | 8 | 6 |
Data are based on official information reported by the Ministry of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.
Country | Cases | Deaths |
Nigeria | 20 | 8 |
Spain | 1 | 0 |
Senegal | 1 | 0 |
United States of America | 4 | 1 |
Indeed, identifying the Psychological implications of the Ebola Virus Disease (EVD) is tantamount to diagnosing, treatment, management and prevention of the psychological consequences of the (EVD).
Fresh graves at a cemetery in Freetown, Sierra Leone- UN.org. |
There are a lot of psychological consequences that may arise, from the effects of the EVD ranging from acute stress reaction (at the beginning), depression, post-traumatic stress disorders to sleep problems, (consultant psychiatrist and senior lecturer, BABCOCK University, Ilishan-Remo, Ogun State,Nigeria) Dr. Increase Adeosun, also decried the enormous psycho-social burden placed on the survivors.
Stigmatisation has consequences on the survivors, family members of victims and community where the person lived.
The EVD could lead to mental disorders, depression and loss of life, for people who are not strong emotionally, because of feelings of worthlessness, hence, it should be seriously tackled (Ayobami Makanju, Psychologist and professor at the University Of Lagos, Nigeria).
Simple Insights On Some The Psychological Consequences Of The EVD
>FEAR >ANXIETY>STIGMATIZATION>ACUTE STRESS REACTION>DEPRESSION>POST TRAUMATIC STRESS>INSOMIA.
FEAR; The psychological impact of fear should not be underestimated because fear is a feeling of apprehension or alarm in response to an external source of danger. Fear about catastrophic incidents often originates from a feeling of lack of control and a perceived inability to prevent the problem or threat ((Dox & Melloni, 1998; The America Psychological Association, APA).
Fear is the number factor causing alarm and panic on both victims and the health workers taking care of them as well as the affected communities. The EVD creates serious fear stopping people are from travelling, some wearing masks on public transportation, and some people are afraid to have people from Africa visiting the schools where their children attend as no one wishes to get sick of other illnesses and be taken to hospital. In some areas schools are closed and children are not able to touch and play with others as they used to.
The fear of secondary infection by Health workers (HCWs) who are both overworked and exposed to the virus is also present. Of 666 HCWs known to have been infected with EVD up to the end of 21 December, 366 of whom have died. The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the USA (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas). Seven HCW infections were reported in the week to 21 December, 6 in Guinea (including 5 in Coyah and 1 in Kankan) and 1 in Montserrado in Liberia.
Nurse Pauline Cafferkey, Scottish volunteer health worker who have contracted the EVD yesterday while returning from Sierrialone (where she been caring for EVD victims)has sparked renewed fear among people. Health chiefs in the UK are disturbed about the spreading of the EVD because the Ebola victim came in contact with about 70 persons, who may have also came in contact with others as she was able to travel on a plane, go home to her family and use public parts of a hospital after developing symptoms.
New tests: The second Scottish patient who is being tested, pictured in orange, had been staying at a youth hostel in the Highlands and has also returned from West Africa.
There are also fears for passengers and staff who had close contact with the nurse, who flew from Freetown to London via Morocco before reaching Scotland late on Sunday night.
Dr Martin Deahl who sat next to Pauline Cafferkey on service to Heathrow from Casablanca said 'The precautions and checks at Heathrow were shambolic. They ran out of testing kits and didn't seem to know what they were doing. We were told that we were considered high risk but yet were told to make our own way home from Heathrow, either on the Tube, by bus or train or another flight like the one Pauline and others took. I was picked up. Public Health England told us we should avoid public transport or crowded places for 21 days, but only after we had got home. It defies common sense and we told them that’.
'Shambolic': Dr Martin Deahl, pictured, sat next to the nurse on their flight home to London and said the testing at Heathrow failed and Public Health England has put the public at risk.
Colleagues who volunteered with her in Sierra Leone believe she may have contracted the deadly disease after attending a church service without wearing her hazard suit on. Dr Deahl said that medical staff in Sierra Leone always wore hazard suits at work but some did not when they went out into the wider community.
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Ms Cafferkey (seen centre, back) with a group of doctors and nurses in November, as they left Heathrow for Freetown, Sierra Leone
It has emerged the nurse could be offered plasma from patients who have survived the virus. It will come from a European network of recovered patients
A number of the 30 NHS staff out in Sierra Leone, including himself, worshipped at a local church on Christmas Day. He also said that at Freetown airport in Sierra Leone all the volunteers were 'kissing and hugging' as they left the country, including Miss Cafferkey.
Therefore, many people fear that the HCWs might act as carriers of the virus into the wider community. Their families are also a vulnerable group, fearing that these workers will catch the disease or inadvertently bring the pathogen home. HCWs and passengers returning from infected countries African have been put on isolation as soon as they return to their countries. And travel ban has also been imposed by some countries out of fear.
Table 5: Ebola virus disease infections in health-care workers in the three countries with intense transmission
Fear is causing unnecessary reactions and that overreaction is often counterproductive. Rationality disappears and irrational inclinations take over people. Despite the almost-zero probability of acquiring Ebola in the US for example, given the EVD terrifying symptoms, often does not register at a time of mass paranoia because of the case of Thomas Eric Duncan, who died Oct. 8 in a Dallas hospital after traveling to Liberia; two nurses who treated him are the only other CDC-confirmed cases in the U.S (Gene Beresin, a Harvard Medical School psychiatry professor).
For example, in Hazlehurst, Miss., parents pulled their children out of middle school after learning that the principal had recently visited southern Africa.
At Syracuse University, a Pulitzer Prize–winning photojournalist who had planned to speak about public health crises was banned from campus after working in Liberia.
An office building in Brecksville, Ohio, closed where almost 1000 people work over fears that an employee had been exposed to Ebola.
A high school in Oregon canceled a visit from nine African— even though none of them hailed from countries containing the deadly disease.
EVD can spread from person to person as a result of direct contact with skin or bodily fluids such as blood or sweat, the deadly virus is extremely infectious.
However the afflicted health worker's fellow passengers are unlikely to have contracted it because it is not airborne. They would not be at risk from breathing the same cabin air and it would be exceptionally unlucky to catch it from an armrest, a touch-screen television or a seat-back tray.
STIGMA; A stigmatised individual is deeply discredited, reduced in our minds from a whole and usual person to a tainted, discounted on [to the point where] we believe the person with the stigma is not quite human. Resulting in varieties of discrimination, through which we effectively, if often unthinkingly, reduce his/her life chances, (Goffman 1963).
Individuals and groups affected by the Ebola virus disease are being labeled and treated differently. Thus, reducing their life chances such as less power, a loss in status or some other form of discrimination may then follow whereby neighbors even refuse to buy from or make sales to those labeled. In some cases, neighbors threw stones at them, while others were chased from their houses.
Another vulnerable group is children made orphans by the EVD. They are facing deep stigma and isolation because nobody wants to take them in for of fear contacting the Ebola virus. These children will suffer adverse social and Psychological consequences for years to come unless this situation is urgently addressed. As a result of the increasingly widespread fear of infection, these children are being ostracized, stigmatized, and discriminated against, partially driven by the low level of knowledge of disease transmission in the affected countries.
Orphanages in Monrovia are starting to accept some children in response. Other groups are working to lessen stigma and reintegrate some of these children into their communities.
In Sierra Leone, the Ministry of Social Welfare is working with child protection specialists from UNICEF and Save the Children to register “unaccompanied and separated children,” as they are termed, and find care for them.
Stigmatisation has also psycho-social on consequences on the survivors, family members of victims and community where the person lived. And because this takes place at community level and workplace, there are also socio-economic consequences. They can lose their source of livelihood, friendships, relationships and connectedness to society. It can lead to isolation, humiliation, feelings of low self-esteem, adjustment problems, feelings of shock, numbness, denial, anger, confusion, and a host of negative emotions at the start before depression, anxiety and disorders set in (Dr. Increase Adeosun, consultant psychiatrist and senior lecturer, BABCOCK University, Ilishan-Remo, Ogun State, Nigeria).
Nigerians Turned Into Social Outcasts By The EVD
Nigerians are happy that the country has been declared Ebola-free but survivors of the virus and their families still face stigma from the society, reports Arukaino Umukoro (punchng.com).
For instance, eight weeks after the World Health Organisation, announced that Ebola had been eradicated from Nigeria, unknown to Dr. Kelechi Enemuo (whose husband Dr. Ikechukwu Enemuo died of EVD on August 22, 2014), her exit from 10 days in quarantine after being declared free of Ebola was only the entrance into a world of stigmatisation and uncertainties.
Apart from being criticised for being married to the doctor that treated an Ebola patient, (Olubukun Koye, a Nigerian diplomat with the Economic Community of West African States, who contracted Ebola after coming in contact with Sawyer allegedly escaped surveillance in Lagos to a hotel in Portharcourt, Nigeria) the young widow has also been accused of killing her husband by her in-laws and some members of the public.
For Dr. Ada Igonor, another Ebola survivor, months after being certified free after spending 14 days in isolation, some people still refuse to have physical contact with her. Igonor worked closely with the late Consultant Physician and Endocrinologist, Ameyo Adadevoh in treating the index case (Patrick Sawyer) at First Consultants Medical Centre, (FCMC), Obalende, Lagos, Nigeria. She said, “Some people still avoid body contact with me even though I am now free of Ebola. They would tell me, ‘Oh! Sorry, we can’t hug you or shake hands with you. How are we sure you don’t have Ebola on your skin?’ Some of the people that treat me in this manner are quite educated.”
Amara, who worked at Good Heart Medical Consultants, the hospital where Dr. Ikechukwu Enemuo was diagnosed of Ebola, said that the stigmatization she had been experiencing was unbearable so have had to deny that she work at the hospital. Amara’s roommate suffered stigmatisation even after moving out of the apartment they shared. she was immediately sacked from work.
For 32-year-old Dennis Akagha, whose fiancée, Justina Ejelonu, a nurse with FCMC, was one of the health workers who attended to the late Sawyer. Akagha also lost his job as a marketer in an oil and gas firm. Recounting the pains of the stigma he faced, he said, “I couldn’t buy food outside, because people were not willing to sell to me. I had to walk five kilometres just to find food to buy and then come back home to eat and sleep. I couldn’t have a haircut, some people didn’t and still do not want to shake my hands.”
Abiola and Akagha
| credits: Arukaino Umukoro
Akagha is now seeing a psychologist to help him deal with the post-Ebola problems and recover from psychological trauma and stigma.
Newly-wed Chinyere left her job as a secretary due to the stigma and would-be employers have refused to employ her. It almost consumed her wedding plans because everybody was running away from her causing her husband difficulties and stigmatisation.
Now not only has the clinic been deserted by its loyal patients, only 14 of its 53 workers are left. The 25-bed hospital with its empty wards and scant equipment looked desolate.
Good Heart Medical Consultants, cardiac centre at GRA, a high brow area in Port Harcourt,where late Enemuo died have lost over 70 per cent of their regular patients because of the EVD according to Dr. Eze Nwuafor, a cardiologist at the hospital. “At a point, it got so bad that when cheques were presented in the bank, some bank workers were scared of touching them. In fact, some banks had to tell their staff who had been to Good heart in the last three months to stay away. It was that disturbing,” Nwuafor added.
A psychologist and a professor at the University of Lagos, Nigeria, Ayobami Makanju, expressed disbelief at the cases of stigmatisation.
He said, “I’m taken aback. I never expected that such a thing would still be happening in this country. They already have immunity against the disease. It is ignorance on the part of Nigerians. It’s a pity because such persons could be going through hell because they are not wanted by people living close to them, and it’s a terrible situation to pass through. Government needs to take urgent action, educate the people and legislate a law criminalising stigmatisation in such cases.”
DEPRESSION; Ebola does not directly cause depression. But depression is a mental health condition that can arise due to factors like stigmatization or labeling of survivals and uninfected family members by others in the community.
Depression is a serious medical illness that is more than just a feeling of being “down” or "blue" for a few days. Depression is a disorder of the brain can range from mild to severe. The symptoms and treatment will b discussed in future articles on BabySteps-PsychMag.
STRESS; Report indicates that quarantine conditions for patients with the EVD is producing severe psychological stress due to separation from normal support from friends and relatives, along with natural apprehension over contracting Ebola; fear they would infect their family and witnessing deaths.
Health workers on the other hand, are facing extremely long shifts attending to too many patients, with a lack of resources[In Sierra Leone,]. while witnessing their colleagues’ deaths and working under lots of fear and stress because of emotional losses and constant reminders of the risk they themselves are taking. (Carmen Valle, Ph.D., project coordinator and Mental Health specialist for the Enabling Access to Mental Health (EAMH) program in Freetown, Sierra Leone).
UNICEF reports children account for 22 percent of Ebola cases which is having a devastating psychological and social impact on children. As children see their family members and relatives die of the Ebola disease, the affect have deeply distressing for children. Many children have lost one or two parents,in some cases entire family members to this disease.
ANXIETY; Since the outbreak of the Ebola virus disease, (EVD) we are in an extremely difficult time right now psychologically and what we are dealing with is how to separate rational, productive worry from irrational unproductive worry.
The difference?
Productive worry is anxiety that you use to take action to help keep you safe. Unproductive worry is worrying without taking action and, therefore, driving more anxiety (Josh Klapo w,associate professor in the University of Alabama at Birmingham School of Public Health).
There is also this exaggerated stigma and hyper anxiety about casual exposure EVD in the US. As of October 27, there were 13,703 cases of Ebola reported worldwide. Liberia and Sierra Leone are the most heavily affected, and the disease has also claimed victims in neighboring Guinea.
At that time, the United States had nine reported Ebola cases. Amid hysteria breaking out in the United States concerning EVD, there is a very small chance that Americans who have not been to West Africa or taken care of patients with the Ebola virus will contract it.
George Rutherford, M.D., head of the Division of Infectious Disease Epidemiology at the University of California, San Francisco, advised psychiatrists to reach out to their local hospitals to become part of Ebola preparation teams—which are being formed in hospitals throughout the nation—to provide an adequate mental health resource for hospital workers who treat Ebola patients.
“Mental health workers are definitely needed,” he emphasized.
“Being prepared in the U.S. is prudent and appropriate, but what is more appropriate is to be concerned about West Africa. ... If we don’t stop the epidemic in West Africa, it will definitely spread.” “What is important is the epidemic in West Africa, where we need to concentrate our resources,” stressed Rutherford during an interview with Psychiatric News.
SUBMISSION; After the evaluation of the Psychological impact of the Ebola virus disease outbreak above, it is now more apparent that there is an urgent need for governments, organizations as well as volunteer Mental Health workers to put the mental health needs of survivors, families, and health workers as a matter of priority despite limited resources. There is need to give urgent mental health attention to the psychological consequences (fear, stigmatization, anxiety, stress, depression, post traumatic stress, e.t.c.) of the Ebola virus disease highlighted in part three of this article.
The concluding article on another update on BabySteps-PsychMag will present the early stages of efforts to deal with the inevitable psychological consequences of this major Ebola outbreak worldwide despite low/shortage or absence of mental health workers and how psychological first aid can bring relieve to survivors, families, health workers, and communities.
You do not have to be a health care expert, government official, to join in this fight to contain the Ebola virus disease world wide. You can start by getting, sharing/communicating accurate information on how the symptoms, management and most importantly, prevention of this Ebola outbreak. BabySteps-PsychMag has created this platform for you to do so. You never can tell how many lives you may save at the press of the SEND BUTTON by LIKING, SHARING THIS PAGE with your friends, family or acquaintance by any means possible through Facebook, twitter, Google plus, Pin interest, subscribe through E-mail, e.t.c.
REFERENCES
The American Psychological Association, APA American Psychiatric Association, APA .
Psychology Today
Punchng.com, Arukaino umukoro
Reuters
World Health Organisation, WHO
The EVD could lead to mental disorders, depression and loss of life, for people who are not strong emotionally, because of feelings of worthlessness, hence, it should be seriously tackled (Ayobami Makanju, Psychologist and professor at the University Of Lagos, Nigeria).
Simple Insights On Some The Psychological Consequences Of The EVD
>FEAR >ANXIETY>STIGMATIZATION>ACUTE STRESS REACTION>DEPRESSION>POST TRAUMATIC STRESS>INSOMIA.
FEAR; The psychological impact of fear should not be underestimated because fear is a feeling of apprehension or alarm in response to an external source of danger. Fear about catastrophic incidents often originates from a feeling of lack of control and a perceived inability to prevent the problem or threat ((Dox & Melloni, 1998; The America Psychological Association, APA).
Fear is the number factor causing alarm and panic on both victims and the health workers taking care of them as well as the affected communities. The EVD creates serious fear stopping people are from travelling, some wearing masks on public transportation, and some people are afraid to have people from Africa visiting the schools where their children attend as no one wishes to get sick of other illnesses and be taken to hospital. In some areas schools are closed and children are not able to touch and play with others as they used to.
The fear of secondary infection by Health workers (HCWs) who are both overworked and exposed to the virus is also present. Of 666 HCWs known to have been infected with EVD up to the end of 21 December, 366 of whom have died. The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the USA (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas). Seven HCW infections were reported in the week to 21 December, 6 in Guinea (including 5 in Coyah and 1 in Kankan) and 1 in Montserrado in Liberia.
Nurse Pauline Cafferkey, Scottish volunteer health worker who have contracted the EVD yesterday while returning from Sierrialone (where she been caring for EVD victims)has sparked renewed fear among people. Health chiefs in the UK are disturbed about the spreading of the EVD because the Ebola victim came in contact with about 70 persons, who may have also came in contact with others as she was able to travel on a plane, go home to her family and use public parts of a hospital after developing symptoms.
There are also fears for passengers and staff who had close contact with the nurse, who flew from Freetown to London via Morocco before reaching Scotland late on Sunday night.
Dr Martin Deahl who sat next to Pauline Cafferkey on service to Heathrow from Casablanca said 'The precautions and checks at Heathrow were shambolic. They ran out of testing kits and didn't seem to know what they were doing. We were told that we were considered high risk but yet were told to make our own way home from Heathrow, either on the Tube, by bus or train or another flight like the one Pauline and others took. I was picked up. Public Health England told us we should avoid public transport or crowded places for 21 days, but only after we had got home. It defies common sense and we told them that’.
'Shambolic': Dr Martin Deahl, pictured, sat next to the nurse on their flight home to London and said the testing at Heathrow failed and Public Health England has put the public at risk.Colleagues who volunteered with her in Sierra Leone believe she may have contracted the deadly disease after attending a church service without wearing her hazard suit on. Dr Deahl said that medical staff in Sierra Leone always wore hazard suits at work but some did not when they went out into the wider community.
SHARE PAGE
Ms Cafferkey (seen centre, back) with a group of doctors and nurses in November, as they left Heathrow for Freetown, Sierra Leone
It has emerged the nurse could be offered plasma from patients who have survived the virus. It will come from a European network of recovered patients
A number of the 30 NHS staff out in Sierra Leone, including himself, worshipped at a local church on Christmas Day. He also said that at Freetown airport in Sierra Leone all the volunteers were 'kissing and hugging' as they left the country, including Miss Cafferkey.
Therefore, many people fear that the HCWs might act as carriers of the virus into the wider community. Their families are also a vulnerable group, fearing that these workers will catch the disease or inadvertently bring the pathogen home. HCWs and passengers returning from infected countries African have been put on isolation as soon as they return to their countries. And travel ban has also been imposed by some countries out of fear.
Table 5: Ebola virus disease infections in health-care workers in the three countries with intense transmission
Country | Cases | Deaths |
Guinea | 139 | 72 |
Liberia* | 367 | 177 |
Sierra Leone | 143 | 110 |
Total | 649 | 359 |
Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.*Data are missing for 21 December.
A protester stands outside the White House asking President Barack Obama to ban flights in effort to stop Ebola on Oct. 17, 2014 in Washington, DC.Olivier Douliery—dpa/Corbis
For example, in Hazlehurst, Miss., parents pulled their children out of middle school after learning that the principal had recently visited southern Africa.
At Syracuse University, a Pulitzer Prize–winning photojournalist who had planned to speak about public health crises was banned from campus after working in Liberia.
An office building in Brecksville, Ohio, closed where almost 1000 people work over fears that an employee had been exposed to Ebola.
A high school in Oregon canceled a visit from nine African— even though none of them hailed from countries containing the deadly disease.
EVD can spread from person to person as a result of direct contact with skin or bodily fluids such as blood or sweat, the deadly virus is extremely infectious.
However the afflicted health worker's fellow passengers are unlikely to have contracted it because it is not airborne. They would not be at risk from breathing the same cabin air and it would be exceptionally unlucky to catch it from an armrest, a touch-screen television or a seat-back tray.
STIGMA; A stigmatised individual is deeply discredited, reduced in our minds from a whole and usual person to a tainted, discounted on [to the point where] we believe the person with the stigma is not quite human. Resulting in varieties of discrimination, through which we effectively, if often unthinkingly, reduce his/her life chances, (Goffman 1963).
Individuals and groups affected by the Ebola virus disease are being labeled and treated differently. Thus, reducing their life chances such as less power, a loss in status or some other form of discrimination may then follow whereby neighbors even refuse to buy from or make sales to those labeled. In some cases, neighbors threw stones at them, while others were chased from their houses.
Another vulnerable group is children made orphans by the EVD. They are facing deep stigma and isolation because nobody wants to take them in for of fear contacting the Ebola virus. These children will suffer adverse social and Psychological consequences for years to come unless this situation is urgently addressed. As a result of the increasingly widespread fear of infection, these children are being ostracized, stigmatized, and discriminated against, partially driven by the low level of knowledge of disease transmission in the affected countries.
Orphanages in Monrovia are starting to accept some children in response. Other groups are working to lessen stigma and reintegrate some of these children into their communities.
In Sierra Leone, the Ministry of Social Welfare is working with child protection specialists from UNICEF and Save the Children to register “unaccompanied and separated children,” as they are termed, and find care for them.
Stigmatisation has also psycho-social on consequences on the survivors, family members of victims and community where the person lived. And because this takes place at community level and workplace, there are also socio-economic consequences. They can lose their source of livelihood, friendships, relationships and connectedness to society. It can lead to isolation, humiliation, feelings of low self-esteem, adjustment problems, feelings of shock, numbness, denial, anger, confusion, and a host of negative emotions at the start before depression, anxiety and disorders set in (Dr. Increase Adeosun, consultant psychiatrist and senior lecturer, BABCOCK University, Ilishan-Remo, Ogun State, Nigeria).
Nigerians Turned Into Social Outcasts By The EVD
Nigerians are happy that the country has been declared Ebola-free but survivors of the virus and their families still face stigma from the society, reports Arukaino Umukoro (punchng.com).
For instance, eight weeks after the World Health Organisation, announced that Ebola had been eradicated from Nigeria, unknown to Dr. Kelechi Enemuo (whose husband Dr. Ikechukwu Enemuo died of EVD on August 22, 2014), her exit from 10 days in quarantine after being declared free of Ebola was only the entrance into a world of stigmatisation and uncertainties.
Apart from being criticised for being married to the doctor that treated an Ebola patient, (Olubukun Koye, a Nigerian diplomat with the Economic Community of West African States, who contracted Ebola after coming in contact with Sawyer allegedly escaped surveillance in Lagos to a hotel in Portharcourt, Nigeria) the young widow has also been accused of killing her husband by her in-laws and some members of the public.
For Dr. Ada Igonor, another Ebola survivor, months after being certified free after spending 14 days in isolation, some people still refuse to have physical contact with her. Igonor worked closely with the late Consultant Physician and Endocrinologist, Ameyo Adadevoh in treating the index case (Patrick Sawyer) at First Consultants Medical Centre, (FCMC), Obalende, Lagos, Nigeria. She said, “Some people still avoid body contact with me even though I am now free of Ebola. They would tell me, ‘Oh! Sorry, we can’t hug you or shake hands with you. How are we sure you don’t have Ebola on your skin?’ Some of the people that treat me in this manner are quite educated.”
Amara, who worked at Good Heart Medical Consultants, the hospital where Dr. Ikechukwu Enemuo was diagnosed of Ebola, said that the stigmatization she had been experiencing was unbearable so have had to deny that she work at the hospital. Amara’s roommate suffered stigmatisation even after moving out of the apartment they shared. she was immediately sacked from work.
For 32-year-old Dennis Akagha, whose fiancée, Justina Ejelonu, a nurse with FCMC, was one of the health workers who attended to the late Sawyer. Akagha also lost his job as a marketer in an oil and gas firm. Recounting the pains of the stigma he faced, he said, “I couldn’t buy food outside, because people were not willing to sell to me. I had to walk five kilometres just to find food to buy and then come back home to eat and sleep. I couldn’t have a haircut, some people didn’t and still do not want to shake my hands.”
Abiola and Akagha
| credits: Arukaino Umukoro
Akagha is now seeing a psychologist to help him deal with the post-Ebola problems and recover from psychological trauma and stigma.
Newly-wed Chinyere left her job as a secretary due to the stigma and would-be employers have refused to employ her. It almost consumed her wedding plans because everybody was running away from her causing her husband difficulties and stigmatisation.
Now not only has the clinic been deserted by its loyal patients, only 14 of its 53 workers are left. The 25-bed hospital with its empty wards and scant equipment looked desolate.
Good Heart Medical Consultants, cardiac centre at GRA, a high brow area in Port Harcourt,where late Enemuo died have lost over 70 per cent of their regular patients because of the EVD according to Dr. Eze Nwuafor, a cardiologist at the hospital. “At a point, it got so bad that when cheques were presented in the bank, some bank workers were scared of touching them. In fact, some banks had to tell their staff who had been to Good heart in the last three months to stay away. It was that disturbing,” Nwuafor added.
A psychologist and a professor at the University of Lagos, Nigeria, Ayobami Makanju, expressed disbelief at the cases of stigmatisation.
He said, “I’m taken aback. I never expected that such a thing would still be happening in this country. They already have immunity against the disease. It is ignorance on the part of Nigerians. It’s a pity because such persons could be going through hell because they are not wanted by people living close to them, and it’s a terrible situation to pass through. Government needs to take urgent action, educate the people and legislate a law criminalising stigmatisation in such cases.”
DEPRESSION; Ebola does not directly cause depression. But depression is a mental health condition that can arise due to factors like stigmatization or labeling of survivals and uninfected family members by others in the community.
Depression is a serious medical illness that is more than just a feeling of being “down” or "blue" for a few days. Depression is a disorder of the brain can range from mild to severe. The symptoms and treatment will b discussed in future articles on BabySteps-PsychMag.
STRESS; Report indicates that quarantine conditions for patients with the EVD is producing severe psychological stress due to separation from normal support from friends and relatives, along with natural apprehension over contracting Ebola; fear they would infect their family and witnessing deaths.
Health workers on the other hand, are facing extremely long shifts attending to too many patients, with a lack of resources[In Sierra Leone,]. while witnessing their colleagues’ deaths and working under lots of fear and stress because of emotional losses and constant reminders of the risk they themselves are taking. (Carmen Valle, Ph.D., project coordinator and Mental Health specialist for the Enabling Access to Mental Health (EAMH) program in Freetown, Sierra Leone).
UNICEF reports children account for 22 percent of Ebola cases which is having a devastating psychological and social impact on children. As children see their family members and relatives die of the Ebola disease, the affect have deeply distressing for children. Many children have lost one or two parents,in some cases entire family members to this disease.
ANXIETY; Since the outbreak of the Ebola virus disease, (EVD) we are in an extremely difficult time right now psychologically and what we are dealing with is how to separate rational, productive worry from irrational unproductive worry.
The difference?
Productive worry is anxiety that you use to take action to help keep you safe. Unproductive worry is worrying without taking action and, therefore, driving more anxiety (Josh Klapo w,associate professor in the University of Alabama at Birmingham School of Public Health).
There is also this exaggerated stigma and hyper anxiety about casual exposure EVD in the US. As of October 27, there were 13,703 cases of Ebola reported worldwide. Liberia and Sierra Leone are the most heavily affected, and the disease has also claimed victims in neighboring Guinea.
At that time, the United States had nine reported Ebola cases. Amid hysteria breaking out in the United States concerning EVD, there is a very small chance that Americans who have not been to West Africa or taken care of patients with the Ebola virus will contract it.
George Rutherford, M.D., head of the Division of Infectious Disease Epidemiology at the University of California, San Francisco, advised psychiatrists to reach out to their local hospitals to become part of Ebola preparation teams—which are being formed in hospitals throughout the nation—to provide an adequate mental health resource for hospital workers who treat Ebola patients.
“Mental health workers are definitely needed,” he emphasized.
“Being prepared in the U.S. is prudent and appropriate, but what is more appropriate is to be concerned about West Africa. ... If we don’t stop the epidemic in West Africa, it will definitely spread.” “What is important is the epidemic in West Africa, where we need to concentrate our resources,” stressed Rutherford during an interview with Psychiatric News.
SUBMISSION; After the evaluation of the Psychological impact of the Ebola virus disease outbreak above, it is now more apparent that there is an urgent need for governments, organizations as well as volunteer Mental Health workers to put the mental health needs of survivors, families, and health workers as a matter of priority despite limited resources. There is need to give urgent mental health attention to the psychological consequences (fear, stigmatization, anxiety, stress, depression, post traumatic stress, e.t.c.) of the Ebola virus disease highlighted in part three of this article.
The concluding article on another update on BabySteps-PsychMag will present the early stages of efforts to deal with the inevitable psychological consequences of this major Ebola outbreak worldwide despite low/shortage or absence of mental health workers and how psychological first aid can bring relieve to survivors, families, health workers, and communities.
You do not have to be a health care expert, government official, to join in this fight to contain the Ebola virus disease world wide. You can start by getting, sharing/communicating accurate information on how the symptoms, management and most importantly, prevention of this Ebola outbreak. BabySteps-PsychMag has created this platform for you to do so. You never can tell how many lives you may save at the press of the SEND BUTTON by LIKING, SHARING THIS PAGE with your friends, family or acquaintance by any means possible through Facebook, twitter, Google plus, Pin interest, subscribe through E-mail, e.t.c.
REFERENCES
The American Psychological Association, APA American Psychiatric Association, APA .
Psychology Today
Punchng.com, Arukaino umukoro
Reuters
World Health Organisation, WHO
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