When villagers in some of the most remote corners of West Africa began to show symptoms of a deadly, unknown virus, locals tried traditional cures, begged local healers for help, fed the afflicted nourishing meat and buried the dead with care, manually washing the bodies. But these acts have only hastened the spread of the Ebola epidemic currently gripping the region.
Rural communities in Sierra Leone, Guinea and Liberia now face the sudden arrival of strange foreign health workers, clad in spaceman suits. For many the equation is simple - before the arrival of these green-suited and helmeted bods, there was no disease. And now there is.
Deteriorating victims, sick from internal hemorrhaging, are taken from local witch doctors to make-shift hospitals while still-infectious, festering bodies are whisked away before traditional rites can be administered.
A member of Doctors Without Borders (MSF) putting on protective gear at the isolation ward of the Donka Hospital in Conakry, Guinea
The intense fear and anger which surrounds not only the horrifying and mysterious disease, but also the aid workers who come to help, is breeding an atmosphere of mutiny.
The Red Cross in Guinea said it had been forced to suspend operations after staff there were threatened by a knife-wielding gang in the southern town of Gueckedou. In Macenta, in southeastern Guinea, an angry mob attacked an MSF clinic, accusing the aidworkers of bringing in Ebola.
"We've suspended operations for safety reasons," a Red Cross official in West Africa told Reuters, asking not to be named. "I imagine this won't be the last time this happens."
Sheffield-born Gwen Wilson, a health delegate with the British Red Cross (BRC), has just returned from Sierra Leone. "There’s a lot of misunderstanding, which breeds fear, and it’s that fear that presents the biggest challenge," she told HuffPost UK.
"There are a lot of myths, some think the government has planted it in opposition areas; others believe the disease is a punishment, or a result of witchcraft.
"Some families believe that when their loved one goes into the ambulance they will be given an injection to kill them."
The rural diet is also causing the spread of disease, Wilson said. "In West Africa life is very basic; people are dealing with bushmeat, one of the primary sources of infection. Even though cooked meat is fine, traces of the virus on the hands from preparation can be enough to cause infection."
Of those who do survive, their recovery is rarely greeted with delight. "People are scared of the survivors so those rare few who do recover from the disease are stigmatised," Wilson said.
Fieldworkers from MSF and the Red Cross, who have been threatened and attacked, report that villagers often refuse to believe that Ebola exists, because all information is gleaned from local leaders and witchdoctors, who have had no proper briefing from government on the disease.
"They are a trusted source of information so it’s vital they are on board, armed with the right information, as quickly as possible," Wilson said.
'OUT OF CONTROL'
Ebola is one of the world’s most deadly diseases, highly infectious and likely to kill 90% of those who catch it. Victims suffer high temperature, vomiting and diarrhoea, followed by internal bleeding and multiple organ failure.
Described as "out of control” by Dr Bart Janssens, director of operations for MSF, the current epidemic is already the worst in history, with 467 people dead and almost 300 other suspected or confirmed cases.
And no cure exists. Health workers that are able to treat victims can only attempt to keep the victims comfortable and their temperatures down - and they must dress from head-to-toe in protective suits.
The World Health Organisation has also warned that four other West African countries – Ivory Coast, Senegal, Mali and Guinea Bissau – could be at risk as populations cross borders, meaning millions of people lie in the path of the virus.
"People are very mobile, they cross borders, and they hide the sick people and do not always report suspected cases. This creates a heightened risk of contamination," an MSF spokesperson told HuffPost UK.
"People sometimes come to care for those infected before returning to their respective villages, taking the virus with them to new locations."
Even if relatives and locals do not specifically confront health workers, it has been widely reported that victims or their families have secreted the afflicted out of hospitals, taking them for treatment to local healers. Liberian authorities have promised those suspected of hiding Ebola patients will face arrest.
Local TV channels have also started broadcasting images of the corpses of Ebola victims, in an effort to shock the population into understanding the epidemic cannot be cured by traditional means.
Mack Lahai, a 26-year-old lab technician at the Government Hospital in Sierra Leone's Kenema region has been working to shift his community's attitude toward the Ebola outbreak since it spread into the north eastern area over a month ago, as well as countering fears that the health workers themselves are deliberately spreading the disease.
"What health worker would inject a colleague to death just because of Ebola? No one has been doing that here," he said. But terror is thick in the hospital's air, as the afflicted watch fellow patients die everyday. Attitudes are changing slowly, he said, but the fight is by no means over - Lahai added: "Pray for the nation and ask God to see the country through the Ebola crisis."
Members of the Guinean Red Cross walk during an awareness campaign on the Ebola virus
"We need a lot of communication and sensitisation in a community to help break through the fear and mistrust that people have about Ebola," an MSF representative told HuffPost UK.
"We are using a box of images illustrating the origin of the disease, its symptoms, transmission chains and prevention measures. We also use plays that are shown in villages and radio information slots."
Scaremongering has not been effective, said BRC's Wilson. "Unfortunately some of the early messages simply said 'Ebola Kills' so it has been difficult to encourage people to go for treatment and into isolation - instead many hide at home and ultimately infect other people.
"Some villages have refused to allow anyone in - including Ministry of Health officials. In one tragic case a family brought three bodies home that had been prepared for burial by the Ministry of Health. They opened one of the body bags to check no body parts had been removed: all the family now have Ebola."
More often, misinformation is spreading faster than the health workers can counter it. Text messages have circulated in Guinea, according to Reuters, which claimed Senegalese researchers had found the cure for Ebola - a mixture of hot chocolate, Nescafe, milk, sugar and raw onions taken once a day for three days.
The risk does not stop after death. Traditional methods of burial, involving the manual washing of the body, has been identified as one of the key factors in passing on the disease. One specific ethnicity at risk is the Kissi - who live across all three countries. Bodies of the dead are traditionally kept at home before burial, and mourners touch the head of the corpse.
WITCH DOCTORS NOT THE ANSWER
In Kenema, Sierra Leone, rioting broke out as relatives attempted to force their way into an ambulance to retrieve a victim's body, to give him the traditional burial.
Though Western aid organisations and governments want to convince the afflicted populations that witch doctors and traditional healers are not the answer to the epidemic, the reality is that Western medicine has no cure either.
Jeremy Farrar of biomedical research charity the Welcome Trust said that radical action was now needed. "We have more than 450 deaths so far - and not a single individual has been offered anything beyond tepid sponging and 'we'll bury you nicely,'" Farrar told Reuters. "It's just unacceptable."
The World Health Organisation has advised that medical staff isolate victims, control their temperatures and promote vigorous hygiene. That is the only medical strategy available - though it at least ensures the disease does not spread further.
Several global Pharmaceutical companies are in the early stages of drug development to treat ebola, including GlaxoSmithKline, Inovio and Vaxart, as well as Tekmira Pharmaceuticals, in collaboration with the US Department of Defence.
"There are candidate vaccines out there, and candidate drugs, and whilst I absolutely agree that the most important things are infection control and making sure people can't pass it on, ultimately you do have to move these things out and start offering them to people," Farrar said.
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