It was a bit disconcerting to go to my Red Cross briefing in London and be given a full protective suit to bring with me, including gloves, a mask and goggles. I must admit I was very anxious. I have worked on public health crises before, notably in Sierra Leone and Haiti dealing with cholera; but Ebola is a different beast. Some of my friends were angry with me for agreeing to go, but this is what I do.
Ebola is such a contagious and deadly disease. This is the worst outbreak ever, both in terms of numbers affected and geographic region. It is the first time Ebola has appeared in Guinea, Sierra Leone and Liberia, so there's a lot of misunderstanding, which breeds fear, and it's that fear that presents the biggest challenge.
Rumours are rife, mostly because of lack of information. 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. There is even an unclear story going around - something about a snake being released from a box! And on top of that people are scared of the survivors so those rare few who do recover from the disease are stigmatised.
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.
Much has been said about the outbreak being out of control, but it can be stopped. The first thing we need to do is trace people who may have been exposed to the disease. We have to identify them when they get the symptoms and if it's Ebola they need to be taken to an Ebola treatment centre immediately. There is a slightly better chance of survival if supportive treatment is started early.
Unfortunately, tracing people isn't so simple. People get scared; when they're scared they run away. There were reports that relatives of people who had succumbed to the disease in Kambia fled their homes, leaving the infectious bodies behind. It's only when they display symptoms that they are infectious. If they have Ebola, they need to go straight to an Ebola treatment centre.
But again the rumours are a barrier. Some families believe that when their loved one goes into the ambulance they will be given an injection to kill them. The early symptoms of Ebola are similar to that of malaria, so often by the time they realise its Ebola it's already too late and whole families have been infected, including the children. The official death toll now stands at over 70, but the likelihood is its much higher as many families are simply not reporting the deaths.
The Ministry of Health and other actors are struggling to cope and the Red Cross has been working with religious and community leaders to spread the word on how to deal with Ebola. Many of them are angry that they haven't had information sooner. They are a trusted source of information so it's vital they are on board, armed with the right information, as quickly as possible. Overall, they are incredibly grateful that aid agencies are there trying to help and they are now cascading information to other leaders; we have even produced two radio programmes to give out information.
Red Cross volunteers have developed songs and theatre performances about Ebola. Last Friday, they walked all the way down the road to the market singing and performing their theatre. It is a highly effective way of getting messages across.
One of the biggest problems is dealing with dead bodies which are highly infectious. The Muslim and Christian communities have strict and elaborate burial rituals which involve working with the body to prepare it for burial. It is difficult to persuade people to change this practice, but religious leaders have a key role in doing this.
In many treatment centres victims are now being allowed to use mobile phones to talk to their loved ones, not only does this offer comfort but it is helping people to understand that they are not simply 'killed' there. And doctors are starting to allow one person to see the body being prepared for burial, be it a religious man or a member of the family, so families can be reassured that their loved one is being treated with respect. All this goes a long way to building trust.
People are incredibly scared. The disease is spreading fast. It has reached Kambia, the neighbouring district to Kalahun and where I was based with the Red Cross. I dread to think what might happen should it reach a high-density urban setting such as Freetown, which is home to around one million people.
People ask if Ebola came to Europe would a cure be found more quickly? The answer is 'maybe' but it is likely that ebola would be contained rapidly because Ebola would never spread here in the way it has there. 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. They deal with dead bodies in the communities, another primary source of infection, which doesn't happen here. And they are mistrustful of the health authorities, which again is not such a problem in Europe.
On top of all this are the challenges of disinfecting homes with chlorine and the management of people who die at home. While all partners will continue to do their best and contain the disease there is the very real fear that not enough funds will be raised and the health department and aid agencies will have to select what they are able to do, which could be catastrophic. It is a very blighted country indeed.
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Gwen Wilson is a health delegate with the British Red Cross, and has just returned from Sierra Leone where she has been for the last month to assess the needs and working with communities to increase public understanding of Ebola and how it is transmittedSuggest a correction