Ebola: Fixing the Fear Factor

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Dr. Wilhemina Jallah, Founder and Executive Director of the Hope for Women (HFW) Clinic, was baffled when she called the Daily Observer on Monday in an effort to dispel rumors that she was Ebola-positive. 

“I can’t see how anyone could have carried such a rumor,” she said, with recollections of the rumor rousing her ire.  “Some people even thought I was dead, but I am healthy and moving around.  As a medical professional, if I feel I have it, I would report, not spread it around.  But the main problem is that this rumor is scaring the families of the nurses who work here.  People are telling the family members of our nurses to stay home for 21 days because they claim our nurses are ‘exposed to Ebola patients’.”

As the rumor went viral over the Independence Day weekend and shocked most who heard it, many were caught between feelings of fear and surprise, especially following the death of Dr. Samuel Brisbane, who practiced general medicine for nearly 50 years and succumbed to the Ebola virus.  Then there is the American doctor working with Samaritan’s Purse as head of the ELWA Hospital ebola unit, Kent Brant, who tested positive and is currently in isolation and undergoing treatment. 

“Dr. Jallah, too?” a woman who subscribes to the HFW Clinic commented in a bewildered tone, but then retorted a defiant “You damn lie!” to the man who conveyed the rumor. 

The news of many health workers including senior medical personnel working in Liberia who have tested positive for, or become casualties of the Ebola virus, is no doubt alarming to the Liberian public and contributing to widespread fear.  Many patients who would otherwise seek treatment from a health center of any scale, now find themselves wary of professional medical treatment and health workers in Lofa, Montserrado, Bong and Bomi counties where, according to statistics from the Ministry of Health, the infection rates – in that order – are highest. 

In Montserrado County, the Redemption Hospital has been overwhelmed with numerous suspected Ebola cases, which include patients, nurses and doctors.  Last week, the hospital was the scene of an angry mob of hundreds of people demanding the body of a pregnant woman who had died there showing symptoms of Ebola. Authorities at the facility were forced to lock themselves in and request police backup.  

In Bong County, the Phebe and C. B. Dunbar Maternity Hospitals have been abandoned by health workers who say they will not return to work without protective equipment, Daily Observer Bong County correspondent Marcus Malayea reported. Up to Tuesday, July 29, security officers at Dunbar Maternity were seen turning away pregnant women who showed up expecting neonatal care.

Also, the government hospital in Tubmanburg, Bomi County was reported abandoned in the wake of the Ebola-positive diagnosis of the entire family of Mr. Sando Sirleaf, a top healthcare official of that county.  Health workers and patients alike have since abandoned that hospital in fear and for lack of protective gear.  Sirleaf’s son, Sando, Jr., who is also a health worker and heads the Gayah Hill Health Center, tested positive.   

Sick, scared, skeptical

This is not good news.  The Daily Observer fielded a question on Facebook about whether anyone in Liberia in need of medical help would seek treatment at any hospital here, given the prevailing situation.  The general consensus was a resounding ‘NO’, because of safety concerns, or who to trust. 

One respondent aptly said: “When healthcare workers and disease control experts cannot protect themselves, it is not reasonable to expect the public to have confidence in seeking relief from health care facilities.”

Another with a dissenting view asked, “If you fell victim to Ebola would you have a choice of hospital?”

Rev. John Sumo, Director for Health Promotion at the Ministry of Health and Social Welfare, believes the fear and skepticism comes from misconceptions about the Ebola virus and how suspected and positive cases should be handled. 

According to him, if it isn’t the fearsome perception of certain death that keeps suspected ebola patients away, it might also be the stigma behind the very terminology such as ‘isolation’ or ‘quarantine’, used by health workers in their treatment of ebola related cases.  “So we have renamed the isolation areas as ‘treatment units’,” Sumo explains, “because even though we have to contain the ebola cases, they are still getting the proper care from doctors and health workers.”

Another major challenge in responding to ebola cases is the burial of infected persons who have expired. “Someone who has died from Ebola must be buried immediately,” Sumo says.  “Yet some families are defiant and make away with the infected corpse and before we can find them, they have washed and dressed it for a traditional burial.  We know that bagging the body goes against our normal way of burying the dead in Liberia, but a traditional burial is also a key way to spread the virus, especially since washing the corpse puts people in contact with the contaminated fluids that come from it.”  

And as if that weren’t enough, Sumo agrees one cannot ignore the allegations of ebola infected corpses being stripped of kidneys, hearts and other organs before burial. 

Dr. Bernice Dahn, Liberia’s Chief Medical Officer, asserted earlier this week that “people are just afraid” and are “making the wrong decisions by refusing to go to the health facilities.”

Granted, but where else should sick people go?

Managing the message

The National Task Force on Ebola set up by President Ellen Johnson Sirleaf over the weekend has mandated the Ministry of Information, Cultural Affairs and Tourism (MICAT) to create the awareness strategy to educate the public on what Ebola is; the window of opportunity to treat infected patients; and how to prevent contact with the virus altogether.

Many Liberians are still poorly informed about the pre-symptom window of opportunity through which an infection can be successfully treated. The general understanding among ordinary people is that, “if you have Ebola, you will die.”   

But according to the latest Situation Report (July 28, 2014) released by the Ministry of Health, out of 40 cases that were quarantined in treatment units, 4 have been discharged –a survival rate of 10%, which resonates with established Ebola research data.  And out of 352 cumulative (suspected, probable and confirmed) cases, 95 were actually confirmed Ebola positive.  Therefore, if more suspected and probable cases get tested early enough, the survival rate could increase.  Sadly enough, however, these numbers do not include the countless unreported cases that result in deaths which in turn perpetuate contamination among families and communities.

In a meeting with media executives at MICAT on Tuesday, July 29, there was a general consensus from the media to partner with government regarding public awareness toward fighting Ebola.  And though Ministry officials took technical suggestions on the way forward, the challenge is to craft messages that can address the psychological effects of the current public perceptions (and misperceptions) about Ebola. 

For the messages to be effective, the hospitals and health centers that were shut down or abandoned will have to be sanitized, re-opened re-staffed with doctors and nurses; and replenished with sufficient protective equipment.  These measures would to prove to patients that the Government of Liberia, in all its efforts to address this dreadful Ebola outbreak, means business.

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