Photo Essay: A Safe and Dignified Burial at Disco Hill

Photo Essay: A Safe and Dignified Burial at Disco Hill
By Natalie Sarles, Global Communities
After months of preparation and anticipation, the safe burial site at Disco Hill opened on December 24 for the first burials. All told, ten burials happened throughout the course of the day with five Christian and five Muslim burials taking place.
The first Muslim burial was presided over by a local Imam who ensured traditions were adhered to while the family witnessed the ceremony from the designated pavala hut at a safe distance away. The newly formed burial and disinfection teams were observed carefully by a seasoned team of trainers and the OFDA-funded ALERT Burial Team Advisor to ensure all protocols were strictly followed.
The below is a photo essay showing what happens during a safe and dignified burial at Disco Hill.
Trained burial and disinfection teams assemble ahead of the first burials; four new burial and disinfection teams were trained in anticipation of activities at Disco Hill. The teams are made up of local community members from the area near to the safe burial site.

Calls from burial teams and Ebola Treatment Units (ETU) come in, alerting the operator and site management team of impending burials. All cases are logged in the data base to ensure accurate record keeping. When a new case is called in, the operator logs the organization who will bring the body to the site, the name and other pertinent details to ensure a complete record is kept for each case. 

Graves are marked with tarps to show where grave diggers should begin their process. All told, it can take up to five hours to dig a grave in the midday heat. As much as possible, the team will try to anticipate burials and dig graves early in the morning or evening to avoid working during the hottest parts of the day.

Grave diggers dig graves ahead of burials; each grave takes an average of five hours to dig by teams of four. The six teams are comprised of local labor from the surrounding community. For Muslim Graves, teams dig in a specific manner as instructed by religious leaders. Bodies will be placed facing west while on the Christian side bodies are placed so they face in an eastwardly direction.  The team above digs a grave in anticipation of a Muslim burial scheduled for the next day.

A grave site with Christian marker ready for first burial; markers at the Christian site are crosses while on the Muslim site the graves are not decorated. Each grave is also marked by a letter and number to designate row and the specific spot which is cross referenced in the database.

Prior to burial, disinfection teams mix chlorine solution to put in backpack sprayers. The body bag and grave will be completely sprayed with the solution for decontamination.

Burial and disinfection teams dress with direct supervision by burial team trainers and team leaders. The supervisors remind the team members to take their time and ensure the PPE is properly donned. In the picture above, the burial team supervisor helps a team member tape his second layer of protective glove to the outside of the PPE suit.  The suits are the most important infection control measure for the teams who handle the bodies. 

A standard burial team consists of six people to carry the body and lower it into the designated grave. A member of the disinfection team follows the burial team to spray the body bag and the grave after the body is lowered. There is also a team leader for each burial and disinfection team to help oversee and manage activities. Here, fully dressed burial team members show off their PPE.

The burial team removes the body from the Medicins Sans Frontieres (MSF) vehicle. The body was transported from the ELWA Ebola Treatment Unit in Monrovia. The team brings the body out of the truck and into the temporary morgue through the “hot zone” while those not in PPE stay behind the orange fence that separates the “blue” and “red” areas of the cemetery.

The team enters the temporary morgue with the cadaver. The identification card is placed on the table under the body as well as on top of the body bag. A third copy is given to the drop off team to ensure complete records are kept at every level. The laminated identification card signifies which grave the body will be buried in and will be attached to the grave marker for future reference. 

The burial team carries the body on a tarp to the designated grave site. The tarp is outfitted with grommets and sturdy rope to slowly lower the body into the grave. This process honors Liberian customs and traditions. Burial teams practice transporting bodies and the specific manner in which they must lower the body into the grave prior to the actual burial to ensure they know exactly how to carry out the process. 

The burial team lowers the body slowly into the ground, observing the Liberian customs they practiced prior to the burial. The burial team advisor stands near by observing the first burial to ensure the proper techniques are practiced and providing instruction when necessary.

After the team lowers the body into the grave they walk back out, through the designated “hot zone” to a waiting vehicle that will take them to the disinfection area. When they arrive at the disinfection area, the team will carefully remove their PPE and travel back down through the “non-hot,” or “blue” area of the safe burial site.

After the burial team leaves the site, the trained disinfection team member comes in with a backpack sprayer filled with the chlorine solution. The disinfection team member sprays the entire area, disinfecting the grave ahead of the dig team who will come back to the fill in the plot with the removed dirt.

As the burial team and sprayer leave the site for the disinfection area, the grave diggers return to fill in the plot. They work quickly to refill the freshly dug grave with the dirt that was removed just hours before.
 
Reusable PPE is sprayed down by high-pressured sprayers filled with chlorine solution and left to dry in the designated disinfection area, away from the rest of the safe burial site. The non-reusable PPE is burned in the incinerator run by incineration teams trained on site and as well as through trainings at nearby Ebola Treatment Units.