As death toll from latest outbreak of world’s deadliest virus climbs to 467, health workers battle misinformation and mistrust in effort to contain the disease
When ebola first struck Pujeh, a village deep in Sierra Leone’s forested interior region, residents did what they always do when a mysterious illness brings death: they consulted the traditional healer. But the elderly herbalist soon caught one of the world’s most contagious diseases, and then became a source for spreading it as visitors streamed in.
By the time officials had pinpointed Pujeh as a hotspot for the disease months later, dozens had died. “The people living in these areas said there’s no such thing as ebola,” said a district doctor who spoke on condition of anonymity. “They have their traditional beliefs and their traditional cures and they look up to their traditional leaders. Until we can bring the traditional leaders onside, it will be very difficult to convince them that ebola even exists.”
As the death toll from the latest outbreak of the world’s deadliest virus climbed to 467 – far exceeding the previous most lethal outbreak which killed 254 people in Congo – officials and health workers are battling a surge of infections propelled by misinformation and doubt about the disease’s existence on one side, and mistrust of scandal-hit governments on the other.
Following a World Health Organisation warning that the illness is “out of control” in Guinea, Liberia and Sierra Leone, west African health ministers on Wednesday began a two-day summit in Ghana’s capital of Accra to discuss ways to strengthen regional co-operation. The global health body has also warned four other west African countries – Ivory Coast, Senegal, Mali and Guinea Bissau – to prepare for the possible arrival of travellers carrying the virus.
Some government officials have disputed the WHO’s statement, saying the increasing death toll is a sign of better surveillance. “We are not saying everything is okay but there are fewer people dying in silence now, which is a good thing – the more we can identify when and where there are fatalities, the better we can prevent further cases,” health ministry official Sakouba Keita said from Guinea’s capital of Conakry.
The tiny nation has been the hardest hit by the virus, which first appeared there in February, before spreading through the tropical forests that sprawl into Liberia and Sierra Leone. More disturbingly, it has also jumped to all three countries’ densely-populated capitals.
“This is different from other cases just by the fact it’s a cross-border epidemic. Previous outbreaks have been very localised, which makes them easier to isolate and contain. Now for the first time, it’s also affecting urban areas,” said Dr Nestor Ndayimirije, Liberia’s WHO representative who has handled epidemics in several other countries.
Ebola was first identified in the Democratic Republic of Congo and Sudan in 1976, which suffered simultaneous outbreaks of different strains miles apart.
It was named after Congo’s Ebola river, where its most lethal mutation – the Zaire strain – infected 318 people and killed 280.
Described by virologists as a “molecular shark”, ebola is believed to be hosted by the fruit bat, a delicacy in Guinea and Liberia. The current strain is at least the fifth mutation since its discovery in 1976. Diagnosis is often complicated by the fact symptoms mirror those of malaria, common in the region, including fever, vomiting and diarrhoea. Victims sometimes have horrific internal and external bleeding and most die of shock or multiple organ failure, although chances of survival increase dramatically if adequate treatment is received early on. No cure exists for ebola but confirmed cases are first quarantined before undergoing intensive rehydration therapy. Due to its high contagion rate, medical workers should wear head-to-toe biohazard suits even when dealing with dead patients.
Weak public health systems have also undermined attempts to halt the disease. Sierra Leone and Liberia are both recovering from decades of back-to-back civil wars, while half a century of dictatorship in Guinea ended in 2010.
Daily reports from Liberia’s ministry of health provide a glimpse of just how big the hurdles are. On the eve of the regional summit, two suspected cases from Voinjama had travelled to the capital Monrovia – but specimens hadn’t been collected because “the county laboratory supervisor could not be found,” internal notes said.
The report also warned of an acute shortage of thermometers among a team dispatched to trace those who might have been in contact with suspects. Many of them feared taking temperatures in case they were exposed to the disease or attacked by locals, it added.
But an alarmingly wide spread is partly down to geography. “The deaths have been increasing because of traditional burial rites in that region,” said Tolbert Nyenswah, Liberia’s deputy chief medical officer. The Kissi ethnicity, found in all three countries, traditionally keep their dead at home for several days, and mourners touch the deceased’s head frequently before burial.
Ebola has a fatality rate of up to 90% and is transmitted through contact with fluids of infected people or animals, like urine, sweat, blood and saliva, even after death.
A doctor in Sierra Leone said patients’ families often attempted to break them out of treatment centres – often successfully. “Some of them are in denial and that it is something they can treat at home, and faith healers are one of the problems for us. When you have patients disappearing like that, you don’t know where the virus will appear next.”
When trader Fiya Lasana was diagnosed with suspected ebola in a clinic in Sierra Leone’s Kailahun district, he was put under quarantine. But convinced he had only malaria, he slipped out. Days later he returned, weak and dazed, for treatment. “My family tried prayers, but that didn’t work, so I returned,” said Lasana, who was declared ebola-free after eleven days.
Liberia’s president, Ellen Johnson Sirleaf, on Monday issued a warning on state radio that anyone suspected of holding ebola patients in homes or churches would be prosecuted.
The disease has also revealed alarming mistrust between citizens and public office holders in a region with shocking corruption levels.
Ebola was initially viewed as a government conspiracy to depopulate Sierra Leone’s Kailahun district, and fierce resistance to the arrival of health workers culminated in the stoning of a Doctors Without Borders vehicle. In Liberia, many remain adamant the outbreak is a hoax from government officials seeking to distract from a series of recent scandals, or for health officials to rake in public funds.
“I will say this loud, the government of Liberia has come up with a new strategy to divert the Liberian people’s mind,” student Alfred Randall said. “We understand the issue of ebola, ebola is real, we agree the virus is a very terrible virus, but ebola is not in Liberia,” he said.
Health workers at the frontline of the battle – often the first to die – face other challenges. Last week, riots broke out and an ambulance was attacked as family members fought to reclaim a victim’s corpse from a hospital in Kenema, Sierra Leone’s third largest city. On the same day, a three-man burial team was chased out of the Liberian town of Banjol where they went to bury a victim. “We need to find a special place to bury these corpses, if not, the bodies will keep piling up on us,” a member of the team said, adding that families often refused to come forward to identify dead relatives for fear of catching it.
Officials and several hundred researchers who have poured into all three countries have scrambled to disseminate public information, seen as key to containment.
But when the outbreak first began, popular text messages circulating in Guinea said an antidote could be found in a concoction of hot chocolate, coffee, milk, raw onions and sugar.
“Ebola, ebola, ebola. I hear it everywhere,” said Adama Sherry from behind her market stall in Sierra Leone’s Tombo, a fishing village as yet unaffected by the virus. Sherry admitted she couldn’t list the symptoms, causes or precautions.
Nearby, a local school had recently emptied out when word spread of routine blood tests being carried out – rumour had it that the needles would infect children with ebola.
Liberia’s health ministry has begun putting images of ebola-ravaged corpses in newspapers and on television. “They are very graphic but it is working – people are starting to see that ebola is not just a spiritual thing that you can cure through going to church,” Nyenswah, the deputy chief medical officer, said.
Ironically, survivors often face a “second disease” of stigmatisation. Aissata Bangoura’s family have refused to speak to her since her husband died in March, even though she has been declared virus-free.
“During my husband’s wake, I was left standing by myself. People I have known my whole life didn’t want to approach me. As far as they’re concerned, I’m a widow and a leper,” she said.
• Donal MacCrann in Tombo, Sierra Leone and Wade Williams in Monrovia, Liberia contributed to this report