Four weeks ago, OB Sisay, a political and economic risk analyst specializing in Africa, returned to London from Sierra Leone. While in Kenema, the West African country’s southeastern province, he had witnessed the anxiety among locals emotionally devastated by the unfolding news of the deadly Ebola outbreak.
‘There’s plenty of fear and confusion on the streets,’ he says. ‘The level of understanding among the public is not great.’
The outbreak is said to be the deadliest since 1976. There have been nearly 900 deaths and at least 1,200 reported cases across Guinea, Sierra Leone and Liberia.
As he boarded his flight to London, Sisay was concerned about the lack of screening at airport entry, particularly in view of the fact that he was boarding an international flight leaving an area with such a high death toll. Similarly, on arrival in London, there was a dearth of spot symptom check-ups at Heathrow.
Sisay wrote to the UK’s Chief Medical Officer, Dame Sally Davies, pointing out the lack of safety procedures in both countries. He received a response two weeks later (in mid-July) reassuring him that there had been no reports of cases having been ‘exported’ to countries outside of West Africa. Airport screenings, the letter implied, were ‘costly’ and could be expected to have ‘limited impact’ given that the virus has an incubation period of 21 days.
But last week, after learning of the death of a US citizen in Nigeria who had travelled from Liberia, Foreign Secretary Philip Hammond called for an emergency Cobra meeting (named Cobra after the Cabinet Office Briefing Rooms, where the crisis response committee meets). It suddenly became clear that Ebola could travel to another country. Thanks to globalization and air travel, the virus is not restricted to West Africa.
Citizen journalists in Sierra Leone and Liberia have blamed the government’s poor awareness campaigns and the public’s lack of understanding for the low hospital admission rates
Contrary to the response from the Chief Medical Officer’s office, Immigration Service Union (ISU) General Secretary Lucy Moreton admitted that her members were not adequately equipped and said that more information was needed to bring the staff up to speed about the deadly virus.
Recently, the death of a 70-year-old Gambian woman at Gatwick sparked fears the disease had spread to Britain, but tests from the Department of Health proved negative.
Sisay’s testimony reflects the growing anguish among medical and foreign policy professionals regarding the inertia of local governments to respond to affected areas, in addition to the inept security measures at London’s airports.
‘There has been some slowness,’ says Mike Noyes, head of humanitarian response at ActionAid. ‘Mostly out of a valid wish to not create a level of fear and panic which would make the situation even harder to handle than it already is. We’re now seeing a few panic measures being introduced, with talk of enforced isolation of communities where there are cases.’
Since the first reported incident in Guinea in March, national governments and international organizations such as World Health Organization (WHO) have underestimated the problem, according to Sisay. Only in the last week of July did Liberian President Ellen Johnson Sirleaf announce the closing of borders and Sierra Leone’s President Ernest Bai Koroma call for a public state of emergency.
‘ActionAid doesn’t believe it is appropriate to stigmatize and criminalize people for being sick,’ says Noyes, ‘so care has to be taken that people’s rights are respected, even at this time.’
Citizen journalists in Sierra Leone and Liberia have blamed the government’s poor awareness campaigns and the public’s lack of understanding (Ebola has similar symptoms to cholera and diarrhoea) for the low hospital admission rates. Sisay says that people were cynical and reluctant to be admitted to hospital, for fear they would contract the virus there. Others were deeply suspicious and initially thought the virus was a hoax.
Tolbert Nyenswah, Assistant Minister for Health and Disease Prevention in Liberia, doesn’t believe that lack of awareness is the problem. ‘Based on the [high numbers] of people infected, we [understand] the gravity of the situation. If you tune into any radio station in Liberia, awareness is not a problem, but this has created fear among many people.’
There is a huge challenge in getting the message out to affected communities, and those at risk that Ebola is real and is a threat
According to Sisay, things could have been done differently: ‘Our people believe traditional medicine works where Western medicine fails, so to lead [awareness-raising campaigns] with the almost certain fatality of Ebola was a mistake. Emphasizing the increased survival rates associated with early diagnosis and treatment and using initial survivors as “poster boys” for the campaign would have been more effective.’
‘The WHO and national governments seem to have assumed that the outbreak would follow patterns similar to previous outbreaks and end after just a few months with little major spread outside the initial focal points. This ignored the relative geographical isolation of previous outbreaks, which is not the case in West Africa, where cross-border travel from outbreak locations is much higher,’ he adds.
Two respected doctors – Samuel Brisbane from Liberia and Sheik Humarr Khan from Sierra Leone – have died in the outbreak. Two Americans, Kent Brantly, a doctor, and Nancy Writebol, from Christian aid group Samaritan’s Purse, continue to fight for their lives.
Citing health education as a top priority, Noyes believes there is a huge challenge in getting the message out to affected communities, and those at risk that Ebola is real and is a threat, and in channelling advice on how to prevent the spread and deal with suspected cases. But he acknowledges it is hard: ‘Emotionally, some of the messages needed can be hard to accept,’ he says.
Meanwhile, local governments are doing what they can to contain the spread. Aid agencies continue to appeal for funds and the World Bank announced this week that it is allocating $200 million in emergency assistance. But with no sign of the death toll levelling off, many fear that the virus is spreading too fast, not only in Africa, but in other parts of the world, too. It will be a while before the people of West Africa can rid themselves of the deadly virus and start to live again.