The Anti Ebola Crusade In West Africa: How It Is Being Undermined

The campaign for the containment of the world's deadliest illness to date, the Ebola Virus Disease (EVD), is day by day becoming an up-hill task for heads of states and governments in West Africa. The rapid transmission of the disease since February of this year when it was first spotted in Guinea continues to stretch health authorities thin in an environment where media reports say there are no infection control measures.

An IRIN news report quoting Liberia's Assistant Minister of Health for Preventive Services, Tolbert Nyensuah described the pace at which the disease is spreading as overwhelming. “This has become a humanitarian crisis and Liberia alone cannot handle this now,” he said. Liberia is one of the four West African countries plagued by the Ebola virus. The others are Guinea, Sierra Leone, and Nigeria.

Medcins Sans Frontieres(MSF) West Africa Coordinator, Stephane Doyone remarked “we are reaching the breaking point of our capacity where today we can't guarantee to do more of what we are doing-particularly when it comes to human resources. We need more actors to get involved on the ground.” MSF shoulders a bulk of the case management burden in Liberia, Sierra Leone, and Guinea. The NGO has deployed 300 health workers, 80 of them expatriate staff and has spent $ 9.3 million on its Ebola response and does not know how much more it will take to contain the infection.

The health crisis is depleting experienced resources; claiming human lives, and at the same time multiplying the number of infected cases. The death toll and the number of confirmed cases are staggering; WHO on August 4, 2014 put the number of deaths at 887 in Guinea, Sierra Leone, Liberia, and Nigeria. Most of the newly reported deaths occurred in Liberia. According to WHO, there are 1,600 confirmed Ebola cases in the affected countries.

The fatalities include, Dr. Sheik Muar Khan, the 39 years old Sierra Leonean medical doctor, who led the fight against EVD in that country. Also, fallen prey to the infection are, a top notch Liberian medical doctor Samuel Brisbane and the Liberian Finance Ministry official Patrick O. Sawyer, who died on July 25, 2014 in Lagos, Nigeria while on an official mission. Before his tragic demise, Dr. Brisbane worked at the Liberian government owned John F. Kennedy Medical Center in Monrovia as Chief Medical Doctor.

Lethal Infection EVD is a fatal human disease caused by the Ebola virus. Symptoms typically start two to 21 days after contacting the virus with a fever, sore throat and muscle pains, and headaches. It is then followed by nausea, vomiting and diarrhea along with decreased functioning of the liver and kidney, which eventually leads to bleeding.

The disease is usually acquired when a person comes into contact with the blood or bodily fluids of an infected animal such as a monkey or fruit bat. Fruit bats are believed to carry and spread the virus without being affected by it. Once infection of a human occurs, the disease may be spread from one person to another. Men who survive may be able to transmit the disease sexually for nearly two months.

Ebola kills about 90 % of those infected, but patients have a better chance of survival if they receive early treatment. The virus for now has no cure, or vaccine. Ebola first emerged in 1976 in the Democratic Republic of Congo and Sudan. The infection is named after the Ebola River located in Yambuku, Democratic Republic of Congo.

Denial and Mistrust
More than five months ago, when the news about the presence of EVD in West Africa broke in the media, it sounded bizarre and incredible. Most West Africans including political and religious leaders greeted the news with contempt and denial. They were dismissive; blatant lie. In Liberia, a former Pro-Temp, who now represents Grand Kru County in the Liberian Senate, Cletus Wotorson in a response to the health crisis, opted to shame health authorities and the Liberian government.

Senator Wotorson, who is considered an opinion leader by most Liberians, sarcastically dubbed the government's nationwide anti-EVD campaign a scam to extort donor funding. “What kind of EBOLA? That thing your did to get donor funding. Your say EBOLA in Liberia”, he pontificated in Liberian parlance.

The Senator's distorted assertion was solidified by a self-proclaimed Liberian journalist Emmanuel Nagbe. Mr. Nagbe in a recent news interview in Monrovia argued “There is no Ebola in Liberia. The feeling amongst Liberians is that the government is broke. Apparently, this is a scam by the government to shake down the donor community.”

Another Grand Kru County Senator and former Health Minister, Peter Coleman in a recent BBC news interview proposed that health authorities approach religious leaders to spread the anti Ebola message as “people don't seem to believe anything the government now says.”

In Sierra Leone, Nigeria, and Guinea, the denial and mistrust about the non-existence of the disease are the same. A Sierra Leone based newspaper, the Independent quoting the Sierra Leone National Police Assistant Inspector General, Alfred Karrow-Kamara in a current news article, reported the police was recently constrained to deploy officers at the main Ebola Hospital where dozens are receiving treatment for the virus in Kenema to prevent the facility from being set ablaze. Inspector Kamara said a group of angry protester gathered at the hospital and threatened to forcefully take away EVD patients and burn the facility because a former nurse had reportedly told a crowd at a local market that “Ebola was unreal and a gimmick aimed at carrying out cannibalistic rituals.”

For some Nigerians, they are yet to come to term with the reality of the disease. They believe EVD is either a Western invention to exploit Africa through drug sales, or a fictitious disease being popularized through the media.

Ignorance and Illiteracy
Superstition as a result of ignorance and illiteracy on the African continent, where no one dies a natural death, appears to be another key hurdle to the West African regional fight against EVD. Most Guineans, Sierra Leoneans, Liberians, and Nigerians erroneously believe the disease is Satan's wrath on mankind, or sorcery. In Liberia, the notable Liberia Council of Churches (LCC) at a recent meeting of church leaders described the disease as a curse on the nation. “God is angry with Liberia. Liberians have to pray and seek God's forgiveness over the corruption and immoral acts such as homosexualism that continue to penetrate our society. As Christians, we must repent and seek God's forgiveness.”

According to the Medical Director of the Phebe Hospital in Liberia, Dr. Jefferson Sibley, some Liberians think Ebola is an evil spell cast by a witch. Because of the misconception, some people who are in affected communities and countries are refusing to adhere to medical advice from health authorities. Those, who have contracted the disease, or had contact with EVD patients, are refusing to seek medical treatment or declare themselves to health authorities.

Last month, the relatives of a Sierra Leonean Ebola patient sparked a nationwide hunt in that country when they forcefully removed her from an EVD treatment center and took her to a traditional healer. Days following her removal, health authorities and the police located the lady in the home of a traditional healer. After a stand-off between her family and the police, the patient was removed from the healer's home. Unfortunately, she died in an ambulance while en-route to another hospital.

Despite persistent warnings by health authorities in West Africa cautioning people not to touch the body or bodily fluid of anyone alive or dead, who is suspected of having the Ebola virus, many West African families continue to ignore the warnings by caring for their relatives, and washing and burying the dead without safety precautions.

In July of this year, pandemonium broke out the at the JFK hospital when the family of a deceased pregnant Liberian woman, who reportedly died of EVD at the hospital, stormed the hospital's compound to demand the release of her remains. According to Front Page Africa (FPA), as the Ebola Response Team was preparing to take delivery of the body for burial, the family resisted. They contended their relative did not die as a result of the virus and therefore wanted the body to give her a befitting burial. The Governor of Kogi State in Nigeria, Idris Wada in a statement issued on the transmission of EVD in is his country said "ignorance and disbelief are the leading cause of the spread of Ebola…”

Rumors and Misinformation
The resistance by most West Africans, especially the traditionalists to adhere to medical advice against EVD is also, strengthened by the rapid spread of rumors and misinformation about the disease. There continue to be the propagation of half truths about the non-existence of EVD and its cures. In Guinea, it is widely believed that health workers of the medical charity Medicines San Frontiers (MSF) are responsible for caring the virus to the country.

According to Reuters news reports, an angry mob in the Guinean town of Macenta recently attacked an MSF clinic, forcing it to shut down. There are also reports in Guinea about the circulation of text messages that a medical researcher in Senegal has reportedly found the cure for Ebola-hot chocolate, Nescafe, and raw onions taken once a day for three days.

“Rumors can be harmful, if they think for example that eating onions can protect them,” declared the WHO Assistant Director General for Health Security, Dr. Keiji Fukuda. In Liberia, it is also, rumored that the government's anti EVD campaign is a scheme by the government and some international organizations to extract human kidneys for transplant purposes.

In a recent publication, the Daily Observer Newspaper in Liberia reported “This publication received reports from families whose loved ones' organs were missing upon return of the bodies to the families. Families suspect an organ trafficking operation is capitalizing on the outbreak of the Ebola virus in Liberia.” In Sierra Leone, few weeks ago, the police arrested a man, who allegedly assaulted a nurse, accusing her of having the illness. Some Sierra Leoneans believe nurses carry the disease or inject the illness into people.

Consequences
The current outbreak is the largest since the disease first emerged in Africa more than 38 years ago. It has claimed scores of human lives and millions of dollars in materials resources. On August 1, 2014, leaders of the Mano River Union (MRU) convened in Conakry, Guinea and signed a communique, which imposes a cross-border isolation zone at the epicenter of the EVD outbreak. The MRU comprises Liberia, Guinea, and Sierra Leone. At the meeting, the MRU leaders and WHO launched an appeal for US $100 million for the anti-Ebola campaign.

EVD has stalled economic, social, and political activities in the affected West African countries. In Nigeria and Liberia, the sale and consumption of bush meat has been banned due to the rising spread of the Ebola virus which scientists say is transmitted through handling of infected wild animals.

The movement of people in affected communities has been restricted; they have been quarantined and international borders have been closed. Airlines have suspended international flights to the affected West African nations as means of minimizing the spread of the disease.

The situation is further exacerbated by the rise in the death toll of medical doctors, nurses and aid workers, who through their work contracted the disease from EVD patients and passed. As precautionary measures, some health workers have stopped attending to the sick and deserted their places of assignment while some hospitals and EVD treatment centers have closed temporarily.

In Liberia, all schools have been temporarily closed while some public offices have suspended full scale work. On August 6, 2014, President Ellen Johnson-Sirleaf declared a 90 day state of emergency in the country as part of strategies taken by the government to put a lid on the infection. President Sirleaf said the government will institute extraordinary measures, including, if need be the suspension of certain rights and privileges as mandated by the constitution.

The President said the Ebola virus outbreak poses serious risk to the health, safety, security and welfare of Liberia. She said besides the public health risk EVD poses; the disease is now undermining the economic stability of the country in the tune of millions of dollars in lost revenues, productivity, and economic activities.

Conclusion
EVD is real; it is not a scam or curse as wrongly propagated by some people. There are empirical evidences which show that the infection has nothing to do with witch craft, curse, homosexuality, and corruption as erroneously claimed by the LCC in Liberia. The infection goes beyond traditional beliefs, taboos, and politics. It is a regional and global health crisis that requires collective support for its containment. Ebola has nothing to do with kidneys extraction, or cannibalism for financial gain or ritualistic purpose as rumored in West Africa.

Recommendation
To stop the spread of EVD in West Africa, everyone including EVD patients must adhere to safety measures put in place by health authorities for the inhibition of the epidemic. Political and religious leaders, journalists, community and opinion leaders, students, and traditionalists must forge a united front in standing up against Ebola. The international community and heads of states and governments must work in unison for the mobilization of financial and material resources for the anti EVD fight.

Affected individuals must seek medical treatment and desist from going to traditional healers and churches for cure. Additionally, health authorities must support the work of medical doctors and nurses, who are risking their lives in attending to the sick by ensuring that they are paid well and given all logistical support.

About the Author: Moses D. Sandy is a prolific writer and former Editor-in-Chief of the Liberia Broadcasting System (LBS). He currently works as social work manager in the City of Philadelphia, Pennsylvania. Mr. Holds an MSW in Social Work from Temple University in Philadelphia.

Moses D. Sandy