15 August 2014

West Africa: Ebola - Voices On the Ground

Photo: Vanguard
A doctor prepares to treat patients diagnosed with Ebola.

The Ebola outbreak that started in February has killed more than 1,000 people across West Africa — in Guinea, Liberia, Nigeria and Sierra Leone — triggering an international emergency response and even a review of the ethics of using promising Ebola drugs, despite them not yet having been evaluated for safety and efficiency.

To better understand the challenges faced by health workers and people in West Africa, SciDev.Net has put together these interactive stories, which gather the voices of experts working on the ground in Guinea and Sierra Leone. They explain how doctors and health promoters are working with local people to curb the disease's spread, which improvements have been achieved and what capacity and infrastructure are still missing.

Stories from the field: on location with Ebola

[WEST AFRICA] The lack of any treatment or vaccine for Ebola has increased the panic among people in the region, which is dealing with the most deadly outbreak of this form of haemorrhagic fever ever recorded.

In February, the outbreak caught the affected countries unprepared. Their health systems were unequipped to care for infected patients efficiently and safely and were unable to stop its spread.

Today, aid agencies and health workers recognise the crucial role that local communities play in tackling the outbreak, as cooperation with doctors allows people to receive care as soon as symptoms appear.

'Two actions can stop an outbreak'

Awareness about how Ebola spreads is another key factor to prevent transmission among local communities.

David Heymann, chair of Public Health England, which is supporting global efforts to stop the Ebola outbreak, tells SciDev.Net: “The first crucial step is addressing the situation of healthcare infrastructure, improving the supply of basic needs such as gloves and sterile syringes. The second is helping people understand how Ebola is transmitted, for example during the traditional preparation of bodies for burial. Those two actions in themselves can stop an outbreak if they are enacted early enough.”

Two days to save a life

[TELIMELE] Saverio Bellizzi is an epidemiologist with medical charity Médecins Sans Frontières (MSF), who travelled to Guinea in April and June. He worked for a few weeks in the village of Telimele, where he cared for patients and helped track down the path of contagion in nearby villages. “In Telimele, we achieved a significant reduction in mortality, down to 25 per cent, thanks to our relations of trust and dialogue with the local community,” he says. “People would come to us within 48 hours from the first appearance of symptoms and we could provide them with the best assistance.”

Despite no approved treatment yet being available for Ebola, doctors offer psychological and physical support, helping many patients to pull through.

“I think the situation is improving in Guinea, because the outbreak started earlier than in other countries and people are by now more aware of the risks and ready to cooperate with doctors,” says Bellizzi.

Hospitals are not for everybody

[GUECKEDOU] Maria Cristina Manca, an Italian anthropologist who worked for MSF as a health promoter in Guinea, tells SciDev.Net that “in Gueckedou, like in many other villages in Guinea, healthcare is private. Most of the people are not familiar with hospitals as we are in Europe.

“People were uncomfortable with the idea of abandoning their loved ones in a structure that felt a bit like a prison. Local hospitals don’t provide meals or bedsheets, so relatives play an important role in the patient’s care.”

The role of traditional healers

[FREETOWN] Haja Ramatulai Wurie, a researcher and lecturer in health system development based in Freetown, Sierra Leone, believes that a lack of equal access to healthcare services is exacerbating the outbreak. “If [people] had equitable access to healthcare services they would be familiar with going to health facilities and would have more faith in health workers,” she says. “What we are experiencing is them preferring to go to traditional healers as they are more accustomed to them.”

I am not a ghost, I am fine

[GUECKEDOU] “In the bigger centres, we used to organise theatre shows in public spaces or screen documentaries about the Ebola response,” Maria Cristina Manca recalls. “The events were always followed by public debate where people could ask questions about what to do in an emergency.”

The idea was to overcome fear and dispel myths around Ebola by addressing the issue openly. Sometimes survivors are invited to tell their stories, but health promoters have to be careful when introducing them. “People may be very suspicious when meeting someone who won the battle against a disease that kills so many people,” says Manca. “I remember accompanying a young survivor back to what remained of his family, after his parents, wife and son had been killed by Ebola. While the others were celebrating, a young girl kept staring at him in silence. She would get close, touch him and run away. She couldn’t believe he was alive. So I hugged him tightly to show her that he wasn’t a ghost and he was fine.”

‘Kick Ebola Out’

[FREETOWN] Medical students in Sierra Leone have decided to help fight Ebola. Haja Ramatulai Wurie says: “One day, my third year students told me that they were raising funds for an education campaign called Kick Ebola Out.”

From August to October, three student associations will work to raise awareness and educate people in Freetown, mainly targeting deprived communities. The project will partly be funded by the Sierra Leone Medical Students’ Association, with additional funds raised by the students. Asking for donations from members of staff, family members and the public, the students have so far raised 800,000 leones (around US$180).

Isolation

[NONGOA] “Ebola is a unique disease for its symbolic impact on local communities,” says Maria Cristina Manca. “My experience in the rural villages of Guinea taught me how people value company and physical contact as a way of caring for their loved ones. Many people sleep together in the same room. No one ever spends time alone, especially when they are ill. To them, Ebola is especially cruel because it forces patients to be kept in isolation when they most need their family.”

We don't shake hands anymore

[FREETOWN] Since Sierra Leone declared a state of national emergency on 31 July, the capital’s streets have been deserted. Haja Ramatulai Wurie says that everyday life has changed not only for healthcare workers and infected people, but for everyone. “You see buckets of chlorine everywhere. People in the streets wear gloves. Taxi drivers wear masks. I wash my hands every half an hour, even when I am in the office, just sitting at my desk. Many people don’t shake hands any more.”

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