In Sierra Leone, Ebola continues its spread via denial and ignorance

Freetown, Sierra Leone – Standing in line at a small, street side pharmacy just off this port city’s main drag, a well-clad woman is buying a crate of hand sanitizer. After the pharmacist informs her that this is the last of his stock, she buys up the lot and leaves wearing a disgruntled expression, disappointed that she couldn’t purchase any more.

Seconds after she walks out the door, a young man in a stained cotton t-shirt and torn jeans take a wad of gum out of his mouth to give to his friend before approaching the counter. His friend happily begins chewing the used, saliva-covered treat. An excellent disease transmission strategy if there ever was one.

So goes the fight here against one of the world’s most frightening infectious diseases – Ebola.

This is an unusual outbreak of Ebola – unusual because of its size, nearly 700 dead so far, and its West African epicenter. Ebola, a viral disease that causes massive bleeding and usually death, was discovered in DR Congo in 1976 and erupts on occasion in parts of East Africa. But this outbreak has gained wider international attention for its strength, for its continued spread throughout the region and because of the toll it is taking on health care workers.

Yet, here at ground zero, the problem is that many of those most at risk don’t think it’s a real threat.

“If I was to judge the main cause of death, it would have to be denial – that it doesn’t exist at all,” said Sheik Bawoh, editor of the Freetown newspaper Global Times.

Since the outbreak started, Bawoh has spent more time in the Ebola-ridden east than any other local journalist, desperate to understand the plague that has decimated the areas surrounding his childhood home.

Up until now, Ebola has been virtually unheard of in West Africa, with all other outbreaks taking place in the central parts of the continent. So when reports started flooding in of cases sprouting up in Guinea and Liberia, disbelief on the part of both the people on the ground and the central government created a wide-spread disregard for the problem that would eventually establish the perfect conditions for the virus’s breach into Sierra Leone. In fact, it took over six weeks for President Ernest BaiKoroma to even address the issue publicly.

“The government was ill prepared – very ill prepared,” Bawoh said.“Imagine: we have an Ebola outbreak in Guinea and Liberia. If the government had carried out preparations as it is doing now on the ground then, we probably wouldn’t have gotten to the point where somebody would speculate things like ‘Oh if you go to the health center, they will inject you and you’ll die.’”

I was taken aback when I first started hearing such theories floating around, but even in Freetown rumors of conspiracy are more common
than you’d think.

Because people with the virus don’t often develop visible symptoms until around 20 days after initial infection, some patients have died in treatment centres after leaving their homes with little other than a headache. This spawned the shockingly prevalent rumor among the nation’s less-educated that, in effort to combat the disease, “death squads” have been rounding up all sick people in the east to bring them to treatment centers and administer lethal injections, just on the off chance that they would be killing an Ebola-carrying individual.

Others have even suggested that the country’s ruling political party, the All People’s Congress, has been orchestrating these “death squads” in an effort to take a chunk out of the opposition’s voter base before the country’s upcoming 2014 census.

“These are strong opposition areas so the moment people started spreading rumors like that, they became militant,” said Yayah Tunis, Information Communication Technology Director for the Ministry of Health Services. “So to even allow health workers to go in was difficult. We had ambulances being attacked, we’ve had instances where people have broken into medical stores and burned all the drugs and medical equipment in Kailahun district, thinking ‘Oh these are Ebola drugs that are meant to kill our people.’”

As the epicenter of the outbreak in Sierra Leone, the Kailahun district along the border with Guinea has by far been the hardest hit, with over 220 confirmed cases and at least 65 dead. Due to Ebola’s sharing of many of identifying symptoms with other more common illnesses in the area – like malaria and typhoid fever – the early spread in the area was overwhelming, without anyone considering that Ebola could be the root of epidemic.

“The official figures that we now have may be far less than the actual number of people who have died,” Bawoh said. “Initially when we went to Kailahun with the Ministry, the death rate was around 60, country wide. There it was in a meeting that the chief of the NjalaJawi village actually said that his village has recorded more than 50 alone.”

Now, over three months into Ebola’s emergence in Sierra Leone, the number of confirmed cases is just over 350, with the official death toll currently standing at 118.

But just as prevalent as the phenomenon of denial and baseless speculation is the issue of fearful people deciding to take matters into their own hands. Due to the virus’s high fatality rate, many people are under the belief that seeking official treatment is useless, or even a death sentence. This has led to many individuals privately treating relatives within the confines of their own homes, or even hiding infected friends and family members from government contact tracers.

In fact, one of the primary causes of Ebola’s swift spread across the country has been from people actually fleeing treatment to hide relatives in neighboring towns and cities. But it isn’t only concerned family members that are contributing to the spread.

“Another thing that has become very worrisome is that you have a lot of private clinics and pharmacies with some of their health workers treating people at home,” Tunis said.  “The risky part is that you never know the person you are treating, whether he’s positive or not for Ebola. If you treat an Ebola patient at home you will not take the precautions that a health worker in a hospital certainly would take.

“You are exposing yourself and so many members of your community to Ebola.”

Sadly, this practice has endangered health workers all across the country and since the dawn of the outbreak, and not just Western aid workers. At least 16 local health workers – doctors and nurses – have lost their lives to it.

To an outsider like me, it’s nothing short of astounding that such denial still runs rampant throughout Sierra Leone, especially given that the progress of the virus’s spread dominates all forms of local media.

In fact, the local publication I work for last week ran an issue in which only three stories weren’t Ebola related, and any radio station you turn the dial to is sure to be attempting further sensitization efforts. But in Freetown, where the only physical evidence of the virus are large chlorine hand-washing tanks sitting in front of the entrances to major buildings, people still speak as if Ebola is nothing other than a word in the dictionary.

“In areas that have been effected doubt is slowing down, but in areas that haven’t been affected that doubt is still pretty high, and that is the scary part.” Tunis said. “If you come to an urban setting like Freetown where you’d expect people to be well informed, where so many radio stations are talking about Ebola, the national television talking about Ebola, and then you still have people denying that it exists, that is scary.”

But people like Tunis have even more to worry about than figures and death tolls. In fact, some of the more complicated issues facing workers on the ground don’t have anything to do with treatment or sensitization at all.

“Ebola seems to have taken over all the health issues now,” Bawoh said. “The maternal mortality rate here is still so high, but the east also has a high amount of Lassa fever, which isn’t being tackled. It’s all Ebola now.”

Even those who have escaped the virus’s deadly grip face challenges, as dozens of children orphaned by the disease as well as those who have survived it face stigmatization and all-out rejection by their home communities. The government has recruited the help of anthropologists and sociologists to try to uncover a solution to the problem, but as of now all efforts have come up short. Ebola has done more than just kill people; it’s continuously ripping apart entire
communities.

“Ebola took hold of our lives like the war,” Bawoh said.“The war took us by surprise, and that’s what Ebola is doing to us this time. We were completely unprepared. When the deaths started coming we just couldn’t cope.”

And now, as the virus continues to crawl west, the impending threat of Ebola hitting the densely populated capital is becoming a grim reality. But even as I sit in a crowded internet café typing up this story, the clerk walks over to me and asks a very sincere question:

“So Ebola, do you think it’s real?”

Cooper Inveen is a Seattle-based journalist, a student at the University of Washington and currently a reporter for the Awoko newspaper in Freetown, the capital city of Sierra Leone. Raised in Gig Harbor, WA, Cooper also writes of his exploits at his blog Rain Enthusiast.