• Bloomberg


Jamila got a cold reception when she returned home after 12 days in an isolation ward battling the Ebola virus in her hometown of Conakry, Guinea’s capital.

Though she survived, Jamila was fired from her job as a philosophy teacher because her school feared she would infect her students, the 24-year-old said in an interview on July 3. She spoke on condition that her surname wasn’t published because she doesn’t want to be recognized as someone who has had the disease.

“People looked at me like I’d come back from the dead, like I was a zombie,” said Jamila, who now does part-time work for Medecins Sans Frontieres, the Geneva-based medical charity. “Nobody except my relatives wanted anything to do with me anymore.”

The social stigma attached to Ebola, a hemorrhagic fever that kills as many as 90 percent of its victims, is complicating efforts to contain the worst-ever outbreak of the virus. The disease has claimed more than 600 lives in Guinea, Liberia and Sierra Leone since March, and will continue to spread for another four months, according to the World Health Organization.

Widespread misconceptions, denial and hostility to medical workers are slowing efforts to stop the virus from spreading, the United Nations Children’s Fund said this month. Some people hide when they fall sick, while others believe the disease isn’t real or that white researchers have introduced it to experiment on Africans. Those who survive are often treated as outcasts, Jamila said.

The outbreak has exposed weaknesses in the health systems of the affected countries, which are among the poorest in the world and whose crowded capitals lack tap water or sewage systems in all but the wealthy neighborhoods.

“Health systems, particularly on a rural level, aren’t working well,” said Guido Borghese, an adviser on child survival for Unicef in West and Central Africa. “They need to be strengthened, and not just to deal with an epidemic.”

The illness spreads through contact with bodily fluids of infected people, according to the WHO. It causes fever, diarrhea and vomiting, and can lead to bleeding from the eyes, ears and nose. There is no specific treatment or vaccine for the virus, which was first identified in what is now the Democratic Republic of Congo in 1976.

The latest outbreak began five months ago in small towns surrounded by dense forests in southeastern Guinea, near the border with Liberia. Since then, it has jumped across two borders and reached the three countries’ capitals. In Guinea, it was able to spread because medical staff ignored basic hygiene guidelines, Minister of Health Remy Lamah said in an interview. Some of the doctors and nurses who died in the first wave of the outbreak didn’t make a habit of washing their hands, he said.

“We paid a high price by not respecting basic standards of hygiene,” Lamah said.

At least 32 health workers have died in the current outbreak, according to the WHO. Medical staff in West Africa often ignore basic precautions, like using gloves for blood tests, Marie-Christine Ferir, emergency program coordinator for Medecins Sans Frontieres, said in an interview. Clinics in rural areas may lack running water or basic equipment like gloves and face masks, she said.

“Sometimes the staff are willing to do it but they don’t have the means, and sometimes they have the means but they don’t do it,” said Ferir, who helped set up isolation units to treat patients. “We still have colleagues — medical staff — dying from Ebola every week.”

There’s an acute lack of adequate health care and sanitation in the three affected countries. Guinea spends the equivalent of $32 per person on public and private health services, a third of Sierra Leone’s $96, according to World Bank data for 2012. That compares with $8,895 in the U.S.

Health care spending in Liberia amounted to $65 per person. Fewer than one in five people in the three countries has access to what the World Bank calls improved sanitation: flush toilets or pit latrines.

In Liberia, denial and fear are hindering the government’s efforts to contain the outbreak.

“There is high level of denial and there’s the stigma that goes with the disease,” Bernice Dahn, the country’s chief medical officer, told reporters last week. “They go to churches, they go to traditional healers, before they will go to a health facility.”

It’s been difficult to persuade relatives of Ebola victims that they can’t hold a traditional funeral, she said.

“Relatives do not want to see their loved ones buried in a thermic plastic bag,” Dahn said. “They want to touch the body, wash it, dress it.”

Persuading Sierra Leoneans that the disease exists has been difficult, Abubakar Fofanah, deputy minister of health and sanitation, said in an interview. Relatives have broken in to clinics to take patients diagnosed with Ebola home. Last month, youth in a village set fire to drugs they said were meant to kill Ebola patients.

“It’s worrying as more and more people are testing positive and more and more people are dying,” Fofanah said.

The nation’s health ministry has warned nurses and pharmacists that it’s illegal to treat suspected patients at home or at private clinics. Hiding relatives who may have Ebola is also considered a serious crime, the ministry said this month in a statement.

“We need the help and the trust of the population to fight Ebola,” MSF’s Ferir said. “Unfortunately, that’s not yet the case today.”

Health ministers from 11 countries agreed at an emergency meeting in Accra, Ghana, this month that campaigns must be leveraged to assuage fears and make sure unsafe cultural practices are avoided. Still, some people won’t believe Ebola exists until they see it with their own eyes.

“What we were shown on posters as the signs and symptoms of Ebola is not what I’m seeing,” Yayah Sesay, who runs a motorbike taxi business in Freetown, said in an interview. “Diarrhea has been affecting us, fever has been around, and cholera, too, has been affecting people. I think they’ve combined all these illnesses and called it Ebola.”

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