It was a dramatic breakout. Muscle-bound thugs forced their way into a building in Sierra Leone’s capital of Freetown last week, assaulting and threatening staff and making off with a pregnant woman who escaped on the back of a motorcycle in the midst of a summer downpour. But the woman wasn’t a criminal, and the place she fled wasn’t a prison. She was, according to local news reports, a potential victim of the massive Ebola outbreak that has hit West Africa, and she was fleeing the hospital where she had been brought for treatment.
That episode is emblematic of a growing problem fueling the epidemic racing through Liberia, Guinea, and Sierra Leone: a widespread fear and mistrust by locals of the doctors and health care workers trying to save them.
Health care workers are being assaulted and threatened by people who believe the disease doesn’t exist, or that the doctors themselves are causing it. In Liberia, doctors trying to screen for the virus were chased away by villagers armed with knives, swords, and stones. In Guinea, locals have blocked roads and destroyed bridges to keep out health workers. Doctors Without Borders believes that dozens of infected people are hiding out in villages around Guinea’s capital of Conakry, refusing treatment at local hospitals. In Sierra Leone, according to a public health official, people are accusing doctors of administering lethal injections to the Ebola patients or harvesting their organs for sale in Europe. “As a result,” Inter Press Service reports, “doctors and nurses in the hospitals have been attacked and many nurses are not wearing their uniforms on the way to work for fear of being attacked in the streets.” That many people who choose to accept help die anyway has only fueled the fear.
Most people in this part of Africa associate hospitals with death, not prolonged life, so the sight of huge teams of Western doctors and researchers garbed in white cloaks and wearing masks and gloves can be terrifying.
“You can’t just walk in and say, ‘Hey, it’s a virus. We’ll take care of it,’ ” says Ronald St. John, an infectious diseases specialist who has worked on Ebola for the World Health Organization in various parts of Africa. In earlier outbreaks, he says, “we realized that part of the team had to include people like anthropologists and sociologists who were familiar with local practices and could explain things to people. You come roaring in with a team dressed in white suits and masks…you’ll have problems.”
The latest outbreak is the worst the world has ever seen. More than 600 people have died across Sierra Leone, Guinea, and Liberia. One of the most recent victims is the very doctor who was leading Sierra Leone’s anti-Ebola campaign. The disease causes diarrhea, vomiting, and intense bleeding and is fatal for upwards of 90 percent of those infected. Some early-stage cases have been successfully treated, but once the disease is established, there is no known cure.
Since Ebola’s discovery in 1976, outbreaks have hit Uganda, the Democratic Republic of Congo, and other parts of Central Africa, killing about 1,500. Those early episodes gave doctors and researchers a chance to learn the importance of sensitizing the public to the dangers of the disease, and also the most effective treatment, which includes hospital care and drug therapy. This is the first outbreak in West Africa, posing a new set of challenges.
Doctors are now focusing on a massive public information campaign targeting local chiefs and tribal elders in an effort to change perceptions quickly. St. John says gaining public trust is essential, citing his experience in Canada during the SARS outbreak. His team advised some 25,000 Canadians at risk of transmission to stay inside; only two citations were given out for failure to comply. West Africa is a different story. It’s a place where cultural practices and lack of access to modern health care fuel Ebola’s transmission. Local burial traditions, for instance, entail women washing the bodies of the dead before burial, which doctors say virtually guarantees transmission.
“This disease is easily containable. We know how to do it,” says St. John. “The issue is the cooperation of the public.” But that will only happen if people like the pregnant escapee come to believe that the white-gowned men and women are there to help.