The Ebola out break 2014 ; why was this one different?
‘There was no trust in the community. When they see people in space suits coming in to their village to take away their loved ones they were very scared… and they hide their sick relatives at home. They hide dead bodies at home. And these are extremely, extremely dangerous in terms of spreading the disease…. We must bring the community on our side to fight the Ebola outbreak.’
Historical and Cultural Factors
‘This government has been a failure to the Liberian people. They sit in their offices and just make decisions against us. The government feel they’re in a secure position where they can’t get easily infected with the virus and the common people are getting infected, so they don’t care.’
‘Because the districts in the East, especially Kenema and Kailahun are opposition strongholds, the people felt that, they didn’t expect much from the government. And there were a lot of complaints that the government was not providing the PPEs [personal protective equipment] to the nurses who worked in the districts, they were not providing funds for sensitisation [awareness-raising], in those districts. So those people felt very much that they were on their own.’
I know from speaking to family members in Kailahun District, that there was a widespread feeling amongst people that, there was a lot of denial. They felt, in Kailahun, young people and old people, that this was a ruse by the government, to try and prevent them from being counted in the national census. In other parts of the country later on, some people felt that it was being exaggerated, so that, I’m not quite sure how, that somebody could make money out of it. […] People didn’t understand and see that it was something very serious. They felt that somewhere along the lines someone was not telling them the truth.
Barriers to seeking health care
‘[F]or most rural Sierra Leoneans, getting to hospital involves long, uncomfortable, and expensive journeys, navigating Kafka-esque bureaucracies. Repeated payments are required and long waits are interspersed with inconclusive interactions with medical personnel. After all this, one often returns home as one had left or dies from the journey’s hardships and lack of care.’
The fear of Ebola has caused hospitals to turn sick people away, even if those who present at hospitals do not have Ebola symptoms. The daughter of a member of parliament in Liberia, died of an asthma attack after the hospital refused to admit her due to fears over Ebola. He states,6 ‘They killed my daughter. The institution killed my daughter. The government killed my daughter. The Ebola crisis has exposed how bankrupt our health system is’. (The impact of Ebola on treatment of other diseases is discussed further in a later step.) Traditional explanations of disease form another barrier to seeking health care, and give rise to rumours and myths about Ebola. One myth is that Ebola is due to witchcraft. Attributing sickness to witchcraft is prevalent in parts of West Africa, particularly isolated rural areas.11 Jusu-Sheriff notes that the belief in witchcraft is particularly strong in the Port Loko and Tonkolili Districts. According to Bolten,12 there is a belief in northern Sierra Leone that people become infected via invisible witches with guns who ‘shoot’ their victims with Ebola. Conspiracy theories about the treatment of victims’ bodies by the health staff at treatment centres create another barrier to seeking care. For example, stories have circulated that organs are being harvested from the dying in order to sell them in the international market, and that the reason the public cannot view the bodies of victims is because body parts have been removed for witchcraft. Further issues around using Ebola care centres, including stigma and infection risk, are discussed in week 2. It is important to recognize that not all citizens of the countries most affected by Ebola give credence to myths and conspiracy theories on the origins and treatment of Ebola. Speaking in December 2014, Jusu-Sheriff states,7 ‘People do understand that there really is an illness which is different to cholera and malaria, and these other things, in many parts of the country’.‘That’s my brother so I have to be by his side. No one could be allowed to go near him, helping him to eat, feeding him. Taking care of him, that is brother love. There was no one else to console him, so I had to be by his side.’
Ebola in Context: Understanding Transmission, Response and Control
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