“I don’t believe in Ebola,” Craig Manning’s local driver told him as he chauffeured the viral emergency specialist through Freetown, Sierra Leone, where infection rates are rising. The man came from a rural part of the country where people were already dying from the virus. He was adamant, like many others in his community, that “there is no such thing as Ebola.”
He is wrong. The epidemic, the deadliest on record, continues to batter Sierra Leone, Guinea and Liberia, with 85 new cases and 68 new deaths reported in only four days earlier this month, according to the World Health Organization (WHO). Sierra Leone bore the brunt of new infections and deaths, with 49 new cases and 52 deaths reported. The total number of cases stands at 982, with 613 deaths as of July 17.
Yet, as the Ebola virus continues to spread in West Africa, so do the rumors. Some say you can contract Ebola from a motorcycle helmet. Others say you can cure the deadly virus by drinking Nescafé mixed with cocoa and sugar — or with two large onions.
It’s Manning’s job to take onions out of the equation.
A health communications strategist with the Viral Special Pathogens Branch of the Centers for Disease Control and Prevention, Manning was sent to Guinea at the first outbreak of the Ebola crisis in March. When one of his colleagues, Pierre Roland, an expert on Ebola, gave a presentation at the U.S. Embassy in Conkary about mitigating risks of transmission, Manning recorded him. He then had the edited 30 second snippets translated into 10 local languages and broadcast over local radio stations and TV.
When the virus spread to Sierra Leone, Manning followed it, teaming up with BBC Media Action to bring together radio station managers from across the country to help spread the word.
Manning said aggressive intervention is necessary to prevent more people from becoming infected, but ensuring local populations understand Ebola first is essential. For instance, in areas where the virus has spread, relatives wash bodies by hand before funerals, putting families at risk of new infections.
“People do not easily accept the idea that teams will take their deceased loved one, put them in a bag and bury them somewhere different,” said Manning. “The challenge is to strike a balance.”
This balance demands communication, according to WHO spokesperson Daniel Epstein.
“There are a set of beliefs and myths that impede our messages about treatment – it is a huge challenge,” he said.
Doctors Without Borders has been unable to gain access to some affected areas due to hostility from the people there. Local communities fear outsiders are bringing the virus with them or want to exterminate the infected, since so few who get treatment return alive.
WHO is helping coordinate information sessions on Ebola to train local leaders how the virus is transmitted and how people can stop it.
“It is necessary for any group engaging in Ebola control to provide health education prior to initiating any other intervention,” said Rashid Ansumana, a researcher at Mercy Hospital Research Lab in the city of Bo, Sierra Leone, where 15 physicians treat a population of more than 150,000. Ansumana comes from the city of Kailahun, an epicenter of the outbreak, and said a large number of new infections are going undetected. His family lives in constant fear.
“One false rumor that is circulating is that health officials might inject suspected Ebola patients with lethal substances,” he said. He suggested HIV prevention protocols, which people are familiar with, can be used to explain how Ebola can be transmitted through blood or other body fluids.
In 2012, Mercy Hospital used the crowdsourcing platform Ushahidi to monitor an outbreak of the highly infectious Chikungunya virus, technology he believes could be employed to combat Ebola.
Crowdsourcing data during emergencies has become an important new way to quickly source information about people at risk and to locate the epicenters of the crisis, used to great effect during the earthquake in Haiti to aid a targeted, effective response.
“In West Africa, someone who has Ebola might not seek testing or treatment due to the monetary costs or the fear of getting a positive result for the virus, the impact and potential stigma that has for their family,” said Kathryn H. Jacobsen, associate professor for epidemiology at the Department of Global and Community Health at George Mason University. For diseases such as malaria, she said, people in this region will often go to a local pharmacy where medication is available without a prescription, rarely going to hospital.
“To have people reporting in cases through text messaging would be a very helpful system,” she said.
WHO has been operating emergency Ebola hotlines in the affected countries that get 200 to 300 calls a day. The organization is exploring text messaging, since 40 percent of affected populations use mobile phones.
Doctors Without Borders have brought anthropologists on board in an attempt to better understand the traditions and cultures of the people they are treating.
While expert advice is important, the key to getting the message through to communities in more isolated areas is building a network of local spokespersons and engaging religious and cultural leaders.
There have been small victories. Manning said his driver had come to trust him.
One day, his driver tugged on his sleeve at a gas station. Out of the blue, he said: “I want you to speak to these people about Ebola.”