Via MSF: Struggling to Contain the Ebola Epidemic in West Africa. Excerpt from a long, must-read article:
An Ebola hemorrhagic fever epidemic is currently plaguing Guinea, Liberia, and Sierra Leone on an unprecedented scale. Since March 2014, Doctors Without Borders/Médecins Sans Frontières (MSF) has treated more than 250 confirmed cases of the deadly disease, for which there is no known cure.
MSF’s Dr. Hilde de Clerck and MSF epidemiologist Dr. Michel Van Herp both have extensive experience in containing hemorrhagic fever outbreaks. They have helped respond to six Ebola outbreaks, notably in Democratic Republic of Congo, Uganda, and, most recently, Guinea. Here, they discuss the current outbreak and the challenges facing MSF teams as they fight to contain the spread of the disease.
We are currently seeing a resurgence of the Ebola epidemic in West Africa, in Guinea in particular. What is the current situation?
Hilde de Clerck: Just a few weeks ago, there were only two villages left in Guinea that MSF still had to monitor for "contact" people—anyone who had been in contact with confirmed or suspected cases of Ebola. As a result, we were quite hopeful that we were witnessing the end of the epidemic.
But then, all at once, we received calls from three different sites in Guinea. Within five minutes, everything changed. It emerged that several cases had also appeared in villages in neighboring Sierra Leone that are very close to the Guinean border. For the people here, the border doesn’t exist in the way that many might imagine a border would. Here, the border is porous, and people regularly cross back and forth. They have family on both sides and they frequently cross the border to travel to markets—or to funerals.
In addition to the alert for those villages in Sierra Leone, there were also new alerts inside Guinea—in Télimélé, a mountainous region 200 kilometers [about 125 miles] north of the capital, Conakry, and also in the capital itself.
All these new alerts together meant that in the Guéckédou region alone, one of the most affected areas in the south of Guinea, MSF went from monitoring only two villages to needing to monitor 40 villages and more than 500 "contact" people.
When you carry out epidemiological analysis using records of the "contact" people you can see where cases are likely to appear. There are many villages affected. This has now become the largest epidemic we have ever faced, in terms of its duration and the numbers of cases.
Why is the epidemic so difficult to control?
Michel Van Herp: Lack of knowledge amongst the population about Ebola, the high mobility of people in this area of the world, and the wide geographic spread of cases all combine together to make it difficult to control this epidemic.
It is the first time that Guinea, Sierra Leone, and Liberia have had to deal with the Ebola virus. People are afraid and find it difficult to believe that the disease even exists. Certain villagers close to Guéckédou in Guinea have even accused MSF of bringing the disease into their area. One villager asked us, “Our ancestors never spoke about this disease, so why would this have changed today?”
The communities here are not familiar with this disease, so we work with anthropologists as part of our outbreak response. These anthropologists work to help us better understand the populations here, and to facilitate our relationships with patients and communities.
With a mortality rate as high as 90 percent, when people hear of Ebola, they immediately think of death. This generates intense levels of fear, and for some people here, Ebola is perceived as something akin to magic.
They believe that to say "Ebola" aloud is to make it appear, but the reverse also believed to be true—denying that Ebola exists would mean that it won’t be able to affect you. This fear and superstition is understandable if you think about how patients with cancer in western societies sometimes cope. For example, sometimes cancer patients refuse to accept their diagnosis in order to try to avoid the consequences of what that diagnosis means.