Fatima Kamara survived Ebola. Now she cares for children as a nurse at an Ebola treatment centre in Kenema, Sierra Leone. But Kamara’s neighbours are wary of her, despite her bill of good health. Some call her home the ‘Ebola compound’ and avoid taking water from her well.

Kamara’s story is not unusual. Across Sierra Leone, Ebola survivors are working as nurses, caregivers, counsellors, organizers and outreach workers, seeking to halt the spread of the disease that threatened their lives. But they also fight discrimination and stigma, lingering health problems and poverty — a legacy of the ongoing Ebola epidemic that is only now beginning to be addressed, seven months after the virus emerged in the country.

A November survey commissioned by the United Nations Children’s Fund (UNICEF) found that 14% of respondents in Sierra Leone would not welcome back a neighbour who had recovered from the disease, and 31% said that they would not buy vegetables from a shopkeeper who had survived an Ebola infection. Overall, 46% of those polled admitted to some form of bias against Ebola survivors.

That is an improvement from a survey conducted in August, when 94% of respondents held negative attitudes.

Now Sierra Leonean officials are organizing three conferences, with support from UNICEF, to help survivors working to reintegrate into their communities. The first begins on 18 December.

The idea is to provide a forum where people who have lived through Ebola can share their experiences. At a similar meeting in Kenema in October, many survivors said that they had not been able to replace possessions, such as clothes and bedding, that were destroyed while they were in treatment. As a result, organizations began giving survivors ‘release packages’ containing items such as mattresses, says Matthew Dalling, chief of child protection for UNICEF Sierra Leone.

Surviving stigma

Some of the prejudice in Sierra Leone stems from the fact that Ebola had never been reported in the country before this year. Few people here expect anyone to walk out of an Ebola ward alive.

Bintu Massaquoi counsels patients with Ebola at a treatment centre in Bo run by Médecins Sans Frontières (MSF, also known as Doctors Without Borders). When Massaquoi tells patients that she has survived the virus, they often do not believe her — until she shows them her certificate of discharge from a different MSF facility, where she was treated.

“There are some patients here who have lost almost all of their family members,” she says. “They may be thinking, ‘I will die soon, because I have lost everyone.’”

But even for patients who pull through, life after Ebola can be difficult. Employment is scarce in Sierra Leone, and many survivors have lost their jobs or their family breadwinners to the virus.

Massaquoi says that her neighbours gossip about her, and her landlord pesters her so much that she is trying to move to a new house. Kamara is on sick leave from her job as a nurse treating Lassa fever — like Ebola, a viral haemorrhagic illness — at Kenema Government Hospital.

She and her colleagues were enlisted to fight Ebola when it spread into Sierra Leone in May. Many became infected and died owing to shortages of staff and protective equipment at the hospital.

Questions about immunity

Kamara now cares for children under age seven at a treatment centre in Kenema run by the International Federation of Red Cross and Red Crescent Societies.

On a recent day, she and her colleagues cared for a five-year-old boy and his three-year-old sister. The children sang to themselves and played behind layers of fencing, tossing rocks in the air. They showed no symptoms of Ebola, but they had just been orphaned by the virus. Their mother had died in the treatment centre the previous day.

Kamara and other survivors are thought to be immune from re-infection, because of the antibodies to Ebola that their bodies developed as they fought off the disease. Thus, nurses who have survived the virus are thought to be well suited to caring for children who have been exposed. The workers still take precautions, donning ‘light’ personal protective equipment — yellow surgical gowns instead of the white, waterproof Tyvek suits that workers usually wear around people who have Ebola.

But Bailor Barrie, a physician with the non-profit group Partners in Health, based in Boston, Massachusetts, says that there are still questions about how long survivors are protected from re-infection. “Nobody knows how long they will be immune,” says Barrie, who also works with the non-profit Wellbody Alliance in Sierra Leone. “You just don’t want to put those people at risk.”

Nadia Wauquier, a virologist and immunologist who works with the company Metabiota at Kenema Government Hospital, is more optimistic. “We believe that once you get a memory immune response [such as antibody development], that response lasts and seems to be protective against infection for the same virus,” she says.

But this idea has been difficult to test outside the lab, and very few survivors of previous Ebola outbreaks have been studied.

With that in mind, Partners in Health is hiring survivors both inside and outside treatment centres, in jobs that do not involve contact with potentially infectious patients. The organization has already hired more than 100 such people as cooks, cleaners and community health workers.

The resilience of these survivors is obvious. Massaquoi, for example, says that working with patients who have Ebola gives her a strong sense of purpose that blunts the impact of criticism and discrimination from her neighbours.

“I don’t even look at them,” she says. “I’m doing what I thought was right — not only for me, but for others.”