A community’s experience during and after the Ebola epidemic of 2014—2016 in Sierra Leone: A qualitative study

Background: The 2014–2016 Ebola epidemic devastated families and communities throughout West Africa. Due to its high mortality rate and infectious nature, most Ebola research to date has focused on healthcare response and interventions; however, little is known about the experiences of Ebola survivors and communities. This qualitative study aimed to better understand the lived experiences of community members, including children, during and after the Ebola epidemic in Sierra Leone. Methods: During June 2016 and June 2017, we conducted four focus groups comprised of primary school students, female caretakers, male caretakers, and teachers, and two individual in-depth interviews with local nurses in Calaba Town, a small village outside of Freetown. Interviews were recorded, transcribed verbatim, and coded using a modified grounded theory methodology. Findings: All participants shared that they experienced significant challenges during and after the Ebola epidemic. During the epidemic, participants endured daily life challenges pertaining to fear, financial distress, and school closures. They also experienced suffering, loss, isolation, grief, and compromised culture. Confusion and distrust were also prevalent during the epidemic, with participants reporting confusion around Ebola transmission and distrust in the government and healthcare services. We also found that the struggle for food and grief stemming from the loss of loved ones continued more than a year after the epidemic ended. Despite Sierra Leone being declared Ebola-free, stigma and fear persisted and community members shared their continuing distrust of the government due to their actions during and after the epidemic. Conclusions: The findings of this qualitative study reveal that the Ebola epidemic was a traumatizing period for the Calaba Town community, and that confusion and distrust toward the government health care system have continued. Future studies should explore the extended impact of the epidemic on communities, including long-term psychological, social, and economic consequences of this outbreak. Author summary: The Ebola epidemic of 2014–2016 in West Africa was the largest in history, resulting in over 28,000 infections and more than 11,300 deaths across Sierra Leone, Liberia, and Guinea. Little is known about the lived experiences of communities, families, and children during and after the epidemic, and this qualitative study sought to better understand these experiences in a community in Sierra Leone. Through focus groups and individual interviews, we discovered that participants endured daily life challenges pertaining to fear, financial distress, and school closures. They also experienced suffering, loss, isolation, grief, and compromised culture, especially regarding funeral traditions. Children expressed being unhappy while schools were closed due to their inability to learn and interact with their classmates. Healthcare workers reported the stigmatization that they experienced, along with fear of an unfamiliar disease that led to the deaths of their colleagues. Distrust in the government, particularly due to their epidemic response, fueled feelings of confusion about Ebola transmission and treatment, and an overall lack of trust in healthcare services. Despite Sierra Leone being declared Ebola-free in March 2016, stigma and fear persisted and community members shared their continuing distrust of the government.