Ebola Outbreak Reveals Challenges of Battling Disease in the Developing World
Sunday’s news that a group of young men armed with clubs attacked an Ebola treatment center in Liberia’s capital of Monrovia sent shockwaves around the world and illustrated the gulf of distrust, ignorance, and poverty that separates West Africans and international observers. The men forced out all of the approximately 30 patients who were being treated for the deadly (and extremely contagious) Ebola virus that has so far killed more than a thousand in a matter of months in Sierra Leone, Guinea, and Liberia, many of those coming in the last several weeks. At least 20 patients have since been recovered and transferred to local hospitals, but several remain missing. In a follow-up attack, the men stole soiled bedsheets, mattresses, and other medical items, which were later seen around West Point, one of the poorest slums in Monrovia and a prime network for disease transmission.
While medical experts now fear that the attacks will have dire consequences for efforts to contain the ongoing Ebola outbreak, many locals feel quite differently. “There is denial among the people about the Ebola virus,” said Amara Jambai, director of disease prevention and control at Sierra Leone’s ministry of health after a similar attack on aid workers there in May. Despite the efforts of international health groups and charitable organizations, most of the region’s inhabitants lack the education necessary to properly understand the nature of the threat they face. Villagers have expressed a mystical understanding of the disease, with some attributing its effects to witchcraft and the work of sorcerers. According to Dr. Benjamin Black, volunteering in Sierre Leone with Doctors Without Borders, “There is a section of population here who simply don’t believe Ebola is real, they think it is witchcraft and so they don’t come to the treatment centres.” Similarly, patients have told Dr. Michel Van Herp (another volunteer for Doctors Without Borders) that “to say ‘Ebola’ aloud is to make it appear.” Most dangerously, he says it is widely believed that the reverse is true: “denying that Ebola exists would mean that it won’t be able to affect you.” The men who stormed the treatment center in Monrovia on Sunday were heard shouting “There’s no Ebola!” as they released dozens of highly contagious victims into the dense slums and removed contaminated materials from the facility, according to witnesses.
By and large, the local populations don’t believe that Ebola is a real threat and have ignored warnings against eating so-called bushmeat, or the meat of wild animals whose carcasses are often found lying next to a road rather than hunted. Due to its low price and relative abundance (even as all three countries in the region have attempted to ban it), bushmeat composes a large portion of the protein consumed in West Africa. With no other realistic options for maintaining a balanced diet in the marketplace, many people feel that eating bushmeat is both safe and necessary – even though it is likely the primary vector for Ebola transmission. Traditional burial practices may also be helping spread the disease as the Kissi, an ethnic group present in all three afflicted countries, keep the bodies of family members in their homes for a few days after death and frequently touch the head of the deceased in mourning. Since the disease is spread through contact with bodily fluids and the virus does not die with the host, Ebola can be transmitted from its victims’ corpses to their surviving relatives.
Perhaps of even greater concern is the intense distrust that people throughout West Africa have displayed towards international aid workers and government leaders in the region. Popular rumors and conspiracy theories include that local government officials are perpetrating a hoax (either to cover up other scandals or to profit from medical supply sales), that Western doctors are deliberately spreading Ebola from village to village, and that aid workers are harvesting African organs for sale in the West in a form of medical neocolonialism. One particularly nasty rumor suggests that the current president of Sierra Leone (its first of the Temne ethnicity) is involved in a conspiracy to depopulate the Kailahun district, home to many Mende (Sierra Leone’s other principal ethnic group and the Temne’s rival in national politics) and the site of the greatest number of deaths in the country. Local police chief Alfred Karrow-Kamara suggested that the attack on the treatment center was triggered by a former health worker who allegedly told customers at a nearby fish market that news of the Ebola outbreak was a cover for “carrying out cannibalistic rituals.”The long-term causes of this deep-seated distrust of the West, of medicine, and of local politicians are numerous, but such concerns will need to be eased if authorities hope to control disease outbreaks like Ebola. Without the respect and support of the local population, international aid organizations cannot effectively carry out their missions to administer medical care and educate about a burgeoning epidemic.
As with other disease outbreaks, the populace has been hesitant to listen to foreign medical experts, but there is hope yet. The Liberian health ministry has begun a series of print and television advertisements depicting the disfigured corpses of Ebola victims accompanied by information about the disease. According to Liberia’s deputy chief medical officer Tolbert Nyenswah, “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.” Perhaps by broadcasting these disturbing images, health officials can raise awareness and understanding of the disease while allaying unfounded rumors of elaborate conspiracies and sorcery to bring the outbreak back under control – at least for now.