An editorial in The Lancet: Ebola in west Africa: gaining community trust and confidence.
For many observers, the outbreak of Ebola in west Africa seemed to be in decline. However, Guinea reported eight new patients and three new deaths on May 23. Sierra Leone notified WHO of its first cases and deaths from the disease on May 28, and, as of May 29, Liberia registered one death from a new suspected case. Before that, no cases had been reported in Liberia since April 9.
In total, as of May 30, the region has reported more than 340 people with confirmed, probable, or suspected disease, including 200 deaths.
Control of this new strain of the Zaire Ebola subtype is proving difficult for several reasons. The geographical spread of cases and movement of people in and between the three countries presents a huge challenge in tracing those who might be infected. As epidemiologist Michel Van Herp from Médecins Sans Frontières told The Lancet, “even the dead are moving”, referring to the transport and burial of bodies by relatives. All three countries have weak health systems, including severe human resource constraints. Furthermore, the region's health workers have never dealt with Ebola before and need training in infection-control measures to protect themselves and to provide adequate care for patients.
Community misunderstanding is also a major issue. Speaking at a Geneva press briefing on May 28, WHO scientist Pierre Formenty admitted that cases had been missed because families did not want to cooperate with medical teams.
Worryingly, in Sierra Leone, patients, including some confirmed cases, have been removed from a health facility by families after they were told their relatives were being moved to a hospital 90 miles away. The health authorities are in discussions with the families and villages concerned, but as The Lancet went to press no resolution had been reached.
Also, in incidents in Sierra Leone and Guinea, community members have thrown stones at health workers investigating the outbreak.
Perhaps the biggest challenge for the concerned ministries of health and their international partners will be improving public awareness of the disease, and trust and confidence in the medical response. Good communication, transparency, and community engagement will be central to success.