Ebola in Guinea: changing entire cultures in 12 months

Loma Proverb: What you don’t know looks older than you

Why is it taking so long? Why are people still resistant after months of explaining and explaining about Ebola prevention? The people of Guinea, fatigued international responders, tired doctors, and weary communities grow impatient as the outbreak drags into its twelfth month. My colleagues in UNICEF Guinea have been working 16-20 hour days, no weekends, traveling on impossible, impassable roads, trying new ideas, new methods, breaking down resistance one house at a time.

But still the outbreak persists and the resistance grows and shrinks, or pops up in completely new places. Not wanting to pile more work onto my exhausted colleagues, I accepted their request to go myself and find the answers to these questions. I left Geneva and travelled to Conakry, then a quick flight to Nzérékoré, one of the epicentres of the outbreak.

I was asked to spend time in the Forest region and bring my perspective from years of working in emergencies to this response. When I arrived in Nzérékoré, I was met by the UNICEF Chief of the Field Office in Guinea Forestière, Dr. Thierno Bah. He looked tired. He told me the story of how he sent the first email, last February, about a mysterious disease that was killing people. He quickly distributed chlorine and soap that he had on hand knowing that it probably wasn’t cholera but hygiene always helps. One of UNICEF’s major focuses in combating this outbreak is the mobilization of communities to protect themselves and prevent further spread. I asked him what his challenges were in stopping the outbreak.

‘There are many factors,’ he explained, “contributing to the difficulty of response. In a region where there are no less than 30 languages, deeply rooted traditions, ancient grudges, and general suspicion of outsiders and authorities, we have to go village to village, house to house, listening and explaining. Many times we have gained the trust of communities, only to find resistance crop up again and the whole process has to be restarted. And then there is the violence. People are afraid. They believe that there is manipulation. People are taken to the treatment centres, sometimes they don’t come back. How would you feel if someone came into your house in Personal Protective Equipment (PPE), took your mother and you never saw her again? And, understandably, fear of the disease itself. The answer is in the communities themselves and that’s what we are working towards. You should see for yourself.”

I agreed. That’s why I came to Guinea. Thierno assigned me a driver, Mary, and gave me a choice. Did I want to see a village that was already cooperating with health officials or one that was, after many visits and discussions, just about to open its doors to the Ebola response? I chose the latter—-the village of Bokoulouma in Balizia. Mary and I set off. I noticed as we got closer to the village, Mary, normally quite animated, grew very quiet. It was only later that she confided in me that she was afraid. She was supposed to be a driver for the ill-fated mission to Womey ending in the brutal deaths of several sensitizers and journalists. Just a few weeks ago she had been threatened in Beyla and her car was pelted with stones. Mary was well aware of the risks of her job and the realities of ebola sensitization on the ground.

Upon arriving at Bokoulouma, there was a welcoming sign—compulsory hand washing at the entrance to the village. This meant that the messages were getting across. We were greeted by the community and members of the local administration and the social mobilization team including UNICEF, the NGO Association d’Action Communautaire en Guinée (AACG) and the local Pastor.

When you visit a small village in Guinea, like most places in Africa, you should respect the protocol and meet with the local leaders first. In this situation, it is vital to the success of the mission. These are people who are confronting a new and deadly disease in their country. They are mostly cut off from mass media; they’ve seen and heard terrible things. Without showing respect and understanding, sensitization teams won’t make much progress.

The UNICEF social mobilization teams know that the most important thing to do is to listen. Oftentimes, people just want to be heard. So we met the elders and listened carefully to the people. Dalla, 52, a mother of three told the team, “We were afraid. The first time a team came, we refused to receive them. Then a woman in a neighboring village died from Ebola. Shortly after, the disease took her son and three others. We were forbidden to visit the village.”

“Because of our resistance, our own Chief was not permitted to attend a prefecture meeting. That’s when we decided to listen to the teams that came here. We used to eat from the same bowl, now we use our own bowls, even within our families.

“Still, Ebola creates anxiety. It is always on our minds. When we go work in the field, we can’t work because of this anxiety.”

This struck me. UNICEF has been working with families and affected children for a long time to reduce trauma through psycho-social support. However, these people had no cases and lost no members of their community, but their trauma was visible.

(c) UNICEF Guinea/2014/Christophe Boulierac
On 21 November a sensitization meeting was held with the community in Bokoulouma. (c) UNICEF Guinea/2014/Christophe Boulierac

We asked a young man, maybe 28 years old, “what did Ebola change for you?” He looked away for a minute and then responded, “Lots of people died…other people won’t buy our crops. Our students are idle and restless with no school. Ebola robbed us of our incentive. We believed that the first sensitization team was here to mislead us. We heard ‘spraying equals death’.”

I’ve heard this rumor before. People were naturally quite put off by men and women in full protective gear spraying the homes of Ebola victims with chlorine. To facilitate a better understanding, spraying teams conduct demonstrations for communities. They show them how they suit up, load the sprayer and invite them to participate in spraying non-contaminated, demonstration homes.

We listened and discussed and listened again for over four hours. It was here that I finally started to really understand the challenges facing social mobilization teams throughout Guinea. The fear that exists, the patience required, the trauma that people face is daunting.

As the conversations ended, I was given a live chicken and, despite my feeling that I was really just observing, the community gave me a new name, Christophe Guilavogui—-a common family name in Bokoulouma.

When I left the village, I passed several other villages on the way back to Nzérékoré. Considering the vastness of this land, the difficulty in reaching communities, and the diversity of cultures, I could clearly see the challenges that lie ahead for this region. Tomorrow would be another day, another village, oftentimes another culture—many teams and many communities are working in many places. Maybe they would be lucky again tomorrow. Maybe not.

A few days later I learned that UNICEF and partners had successfully set up a Community Watch Committee (CWC) in Bokoulouma. CWCs are made of community members who act as liaisons between the population and Ebola services available to them. The truth is only the communities and a community response will end this outbreak.

Next stop: Kourémalé to visit another community on the Mali border.

Christophe Boulierac is a UNICEF Spokesperson based in Geneva. He recently traveled to Guinea to witness the response to the Ebola outbreak. Timothy La Rose is a Communication Specialist with UNICEF Guinea.

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Comments:

  1. there is only so much information campaigns can do, even with “perfect” information, you can get Ebola (see ratio of infections among medical staff – ok they are more exposed, but take international journalists and other highly educated persons). Better livelihoods, access to clean water, and more efficient cures should also be urgently aimed. Am a bit tired of seeing all officials put all the responsibility on awareness rising, how convenient… ok people are informed / lectured, they still live in a shantytown where eveything can be a risk for Ebola, Cholera, Typhoid […]. Also please, please give more information on the outbreak and a bit less of UNICEF promotion (every two sentences).

  2. @Wily I tought it was a well written article with lots of information. Also, do you realize you’re reading the unicef blog? I agree with you there needs to be structural changes as well, awareness can only go so far.

  3. Thank you for your work and your articles. If I had not joined the Scientology Sea org in ’77 I would have been with you guys. Too bad the Scien goals are the same but the actions are much much different. It is a bit of relief to know there are groups true to their purpose.

  4. Wily,

    Thank you for your comment. I take your point that oftentimes awareness raising is tossed at problems that require more complex and profound solutions. However comparing our community mobilization and sensitization work to awareness raising is like comparing a band aid to open heart surgery. Our work is not simply telling people not to eat fruit bats. It is a very complex response aimed at clear concrete goals such as: convince a family to turn over a sick child to medical workers for treatment. Or let us remove the body of your loved one so the rest of your family doesn’t become infected. We install community watch groups through an election process who help keep the villages safe. We provide medical training to traditional healers. We trained tens of thousands of teachers on Ebola prevention and detection so that schools can open and children can learn in a safe environment. These are just some examples. Sensitization is only one component of our response that we chose to highlight in this piece. But it is essential as prevention and rapid response is the only way to stop this outbreak.

    Access to clean water—as you rightly mention–is a perfect example of another one of our activities. We have been working on increasing handwashing in Guinea for decades and in the last few months we have seen. We are providing 500,000 hygiene kits and hand washing stations to schools, medical facilities and families throughout the country. We drill wells both with traditional methods and with a new innovative manual drilling programme that is cheaper and easier—and we’ve trained teams here to be able—not only to drill themselves but to produce the equipment locally. All of the materials for these hand washing stations and hygiene kits are produced locally which supports the Guinean economy. Handwashing, formally a major challenge in Guinea is practiced regularly.

    These are just two of our many activities aimed at stopping Ebola.

    And yes like any organization dependent on fundraising and goodwill of our partners and the people we serve, we do have to mention UNICEF from time to time so people know what their support is going.

    Your comment is very much appreciated as it furthers the discussion on how best to end this devastating outbreak. Thank you.
    Timothy