Trust and 'bio-disaster units' needed to fight Ebola
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The medical charity MSF is calling on countries with capabilities to counter nuclear or biological attacks to come to the rescue of West Africa, where failure to win the confidence of local communities has hampered efforts to halt the epidemic.
Médecins Sans Frontières, also known as Doctors Without Borders, president Joanne Liu told UN officials at a high-level meeting on the epidemic on Tuesday that states with biological-disaster response capacity, including civilian and military medical teams, must immediately dispatch equipment and personnel to West Africa.
“Funding announcements and the deployment of a few experts do not suffice,” said Dr. Liu. “States with the required capacity have a political and humanitarian responsibility to come forward and offer a desperately needed, concrete response to the disaster unfolding in front of the world’s eyes,” said Dr. Liu.
MSF, which spearheads efforts to treat and contain the largest Ebola outbreak on record, has warned that UN agencies and non-governmental organisations alone cannot implement the World Health Organization’s (WHO) new roadmap to help African nations tackle the epidemic.
In an August 26 count, the WHO had recorded more than 3,000 cases and 1,500 deaths caused by the virus since the epidemic started at the beginning of the year, but estimated actual numbers to be two to four times higher. Guinea, Liberia and Sierra Leone have been most affected by the disease, with a small number of cases also signalled in Nigeria and Senegal.
The UN’s Food and Agriculture Organisation now fears that restrictions to farming and trade will spark food shortages in the region.
The death toll from a separate outbreak in an isolated area of the Democratic Republic of Congo now stands at 31, the health minister said on Tuesday.
Change of mindset
Last week’s WHO roadmap provides guidance for increased and better co-ordinated action to tackle the spread of Ebola, for which no vaccine or cure currently exists. In line with MSF’s appeal, it calls for additional resources totalling nearly $500 million – but also for a change of mindset, as inadequate responses at all levels have weakened efforts to tackle the disease.
At the international level, Dr. Liu criticised developed countries that “limit their response to the potential arrival of an infected patient in their countries” instead of contributing to tackling the epidemic in West Africa.
The region’s national governments, too, came under fire from aid agencies last month when they closed all borders, preventing medical organisations from moving equipment and staff and evacuating infected medics. According to the WHO, national authorities have now accepted to ease travel restrictions and access should resume “within two weeks”.
At the local level, too, the roadmap warns of the “deep-rooted fear and stigmatisation emerging in the affected areas” and calls for engagement with all strands of communities, from religious leaders to traditional healers.
There have been numerous reports of incomprehension from local people faced with the disease and the tough measures needed to tackle it, ranging from patients escaping quarantine to angry mobs attacking treatment centres and crooks selling miracle cures they say can heal Ebola.
Rumours have spread by SMS and on social networks, accusing Western laboratories of engineering and importing the virus and aid workers of causing the epidemic to make money.
“If the population in a particular area is to accept sanitary measures, it has to be done with the consensus of the community,” Liberian development worker Abdallah Jaleiba told FRANCE 24. The head of the Monrovia-based Community and Human Development Agency added: “At first, people have difficulty believing Ebola exists: there are many dimensions to it, and this is a gullible society. But if we place ourselves at the level of the people, it will work.”
'Scapegoating and denial'
Experts who have studied social behaviour in epidemics say such reactions are a regular occurrence – regardless of the location or disease involved. Alain Epelboin, a medical doctor and anthropologist at France’s National Centre for Scientific Research, told FRANCE 24 the scenario was always the same, involving “scapegoating, denial, insufficient consideration for local conditions, coercion and dehumanisation” – often stirred by local political or business interests.
“Many people have been trying to ‘negrify’ this problem, attributing it to the near-savage behaviour of the local populations,” he said. “But during the bird flu outbreak, there were cases detected in the Dombes lakes in France – and their owners denying it because it went against their financial interest.”
Epelboin said a worrying aspect of ill-informed popular reaction to epidemics was the stigmatisation of frontline health workers. “Many people do not tell their family they work with Ebola patients, and Red Cross volunteers who helped in the 2003 outbreak in the Democratic Republic of Congo were still regarded as witchdoctors three years later,” he said.
Following the rumours, the Paris-based Institute for Microbiology and Infectious Diseases decided to launch a study into their effects – but its head, Prof Jean-François Delfraissy, told FRANCE 24 this was not the main reason behind the difficulties in tackling the current Ebola outbreak.
“The scale of this epidemic has been underestimated. Previous outbreaks infected only a few hundred people and everyone thought it would unfold in the same way”, he said, adding that things were different this time. “The environment has changed in that part of Africa, with people travelling more – not only by air: villages are no longer isolated.”
In the absence of medical treatment, the only known method to curb the epidemic is generic hygiene measures – a fact Prof Delfraissy said weakened the response. “Basic prevention messages (‘wash your hands’, ‘don’t touch dead bodies’) have been too slow to spread,” he said. “When a cure is found, rumours and doubt are stopped: people believe there is a virus and take appropriate action.”
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