Ebola Emergency: ‘Ebola is real’
It's been nine months since a catastrophic outbreak of Ebola officially took hold in the West African nations of Guinea, Liberia, and Sierra Leone. Agnes Varraine-Leca, Action Against Hunger’s Communications Officer in Liberia, reports from Monrovia, Liberia.
Dec 13 2014
In Montserrado county, home to the capital city Monrovia, no one can avoid the awareness campaigns on the city walls. “Ebola is real,” “Stop Ebola,” “Don’t be the next victim.” More than six months after the epidemic started in Liberia, the rumors about the virus and the true intentions behind the interventions of international aid agencies are as virulent as ever. In a climate of irrational fears and delusions, the humanitarian community is working on perception issues and information campaigns to win the fight against the epidemic.
Sitting on one of two wooden benches at the Banjo health center (North of Monrovia), Georges is frowning. The team of ‘contact tracers’ he is supervising – a team which tracks people who might have been in contact with an Ebola sufferer - has just reported a new death potentially linked to Ebola. The deceased, an old man, has already been buried by his family following Muslim rites.
This case is worrisome because the community hid the death from the contact tracers’ teams. Although it is not rare, such a reaction calls into question how families perceive the virus and creates a huge challenge in the epidemic control process.
Dr. Fallah, an epidemiologist and infectious disease specialist, works for Action Against Hunger. He explains that “[a] lot of them have seen their loved ones taken away in ambulances to die in Ebola treatment centres, with no way of knowing what happened. Moreover, in this context, we need to cremate the bodies, which prevents the families from organising a proper funeral.” Some people go so far as falsifying death certificates to deny any link to the virus so they can bury their loved ones according to local traditions.
Georges has good reasons to be worried. If this case is indeed linked to Ebola, it raises dozens of questions: what was the man’s schedule before he died? Who was he in contact with while he was contagious? Who washed his body before he was buried? Which rites were carried out during the funeral and by how many people?
Georges is already at work on a chart of individuals potentially at risk. The convoluted chart presages a Herculean task for the team that will be investigating the case. Informing local communities is made even harder by the immaterial aspect of Ebola.
Without any physical representation, it is difficult to spread prevention messages that will be heard and understood by the community, especially since the virus targets everything that makes us human. How do you get people to understand that the sick should be neither touched nor comforted, that you cannot pay your respects to the deceased?
The very first campaign messages did not help either. Focused on the lack of treatment, amplified by the media, and combined with the lack of transparency about the fate of patients in treatment centers, they contributed to the most irrational fears and rumors. There were speculations that patients’ organs and blood were being stolen in treatment centers, conspiracy theories involving Western countries and international NGOs, among others.
According to a Monrovia anthropologist, who works on the perception of Ebola in Guinea and Liberia, “[t]here are two opposing models, and they cause a growing reluctance in local communities.
On the one hand, the official model explains that there is a hemorrhagic fever epidemic, with high contamination risks and a high mortality rate. On the other, an alternative model explains that the epidemic is not real but rather is a conspiracy of Western countries against the Liberian population.”
And these models diverge at all stages of the control process. For instance, the PPE suit worn by health personel can be perceived as a way for foreigners to protect themselves from the virus they themselves spread, although it has officially been presented as a protection to reduce transmission risks. As the anthropologist points out, “information matters little, no logical reasoning can change this interpretation.” Beyond prevention, the key issue is therefore one of trust in the institutions that are dealing with the epidemic. And trust can only be established if community members are fully included in the Ebola response system.