One of the most critical aspects of any epidemic is how its casualties—the remains of those who die—are disposed of.
Such disposals, no matter the cause of death, are considered throughout the world as a medical and scientific, NOT a political function. This is where the pathologist comes in. A pathologist is a medical doctor who has specialized in the interpretation and diagnosis of the changes caused by disease in tissues and body fluids.
Medical doctors have a joke about pathologists: “They know everything, but can do nothing.” The reason is, by the time the patient reaches the pathologist, it is no longer a patient but a corpse, about which the pathologist can do nothing. He/she cannot bring the corpse back to life.
The only function left for the pathologist is to determine how, why and when the person died.
The medical doctor who treated the patient or announced him or her dead, determines whether or not the corpse can have a normal burial. If the person died of tuberculosis or some other highly contagious disease, the doctor will recommend immediate interment and the family may not have the body, for fear of spreading the disease.
That is why the Liberian government has decided that all Ebola patients cannot be returned to the families, but are to be immediately disposed of. This is NOT a political function, but a medical and scientific one, which a Ministry of Internal Affairs has little to do with. Logistics, such as transportation to convey the corpses to the burial or cremation site, and materials for spraying, etc., the MIA may be able to help with. But exactly where the highly contagious corpses should be buried is a decision for the medical doctor, NOT the MIA.
So it is with Ebola. When someone dies of Ebola, the government immediately steps in, receives the corpse, sprays it with the appropriate detergent, places it into a well layered body bag, then buries it in an appropriate place where it can contaminate no one, or nothing else—not even the terrain.
Over the past 48 hours there have been two very disturbing developments in Liberia, both occurring on Sunday, August 3. First, the Minister of Health and Social Welfare (MOH) told the Daily Observer that he was too “overwhelmed” with other Ebola issues and had asked President Ellen Johnson Sirleaf to authorize the Minister of Internal Affairs to bury the bodies of Ebola victims.
What is disturbing about Dr. Walter Gwenigale’s request is that the handling of Ebola fatalities has been deemed a political matter. We submit that is NOT! The question of where, when and how a corpse of Ebola or any other high contagious disease should be buried is a medical and scientific matter, NOT a political one, most especially when the issue at stake is a highly contagious disease such as TB or Ebola.
So no wonder the Minister of Internal Affairs did not understand where and how Ebola bodies handed over to him for disposal should buried. Accordingly, the MIA attendants, no medical or scientific people, buried many of the Ebola bodies in the wetlands, swamps and riverbanks of Johnsonville! The Johnsonville people were alarmed! And they protested, and rightly so, only to be mercilessly beaten by police. A woman interviewed by our reporter, C.Y. Kwanue, told him, “This is the only place we get our drinking water. We are poor and have no money to buy mineral water.”
We call on President Sirleaf to revoke her decision to place the MIA in charge of Ebola burials and place that responsibility for this delicate and dangerous assignment where it belongs, with the professionally trained personnel of the Ministry of Health and Social Welfare.
The idea of cremating Ebola bodies is a good one and we are pleased that GOL has decided to take up the offer of the Indian community to use their facilities for this purpose.
But the GOL should deal expeditiously with two other urgent matters: first, find vehicles to transport Ebola bodies from around the country to the cremation and appropriate burial sites.
Second, the MOH and the Environmental Protection Agency (EPA) should locate ALL inappropriate sites, such as the Johnsonville wetlands, swamps and river banks, and relocate the bodies buried there to more appropriate venues, where they can be buried six feet deep or cremated, and those areas effectively disinfected and chlorinated. This will hopefully restore the people’s source of drinking water and make their environment safer and more livable.