Working with communities in Gueckedou for better understanding of Ebola

July 2014

WHO anthropologist Sylvain Landry Faye talking to a resident of Kolobengu village.
WHO/T. Jasarevic

“When we first arrived at the village, things started well. We told people we’d come to explain about Ebola and to learn why they didn’t want medical teams to come to the village and help their families,” says Hina Teguiano, a young local volunteer who was part of the nine-person team that visited the village of Kolobengu on 14 July. “As we were talking with them, a car drove up, and that’s when things changed.”

Kolobengu is situated 12km east of Gueckedou, a Guinean city close to the borders with Liberia and Sierra Leone. Already this year, more than 1000 people have been infected with Ebola in the three countries and more than 600 have died. About one third of those deaths have been around Gueckedou.

Kolobengu is one of the communities where there is an urgent need to increase public awareness about the causes of Ebola and what people need to do to protect themselves from the disease.

Some residents believe that humanitarian agencies are the source of the disease. The other widespread misunderstanding is that being taken away by medical teams to “treatment centres” means certain death. People in these villages would rather keep their sick loved ones at home so that they can die surrounded by family.

“This is a very encouraging development as previous attempts to access these villages have failed.”

Professor Sylvain Landry Faye, an anthropologist deployed by WHO

Teguiano volunteered to help local health authorities because he was from the same area but this did not help. “We were attacked with anything they could get hold of. Our motorcycles were thrown in ditches and we had to run for our lives,” he recalls. He and a few others left with minor injuries but this further fuelled the sense of frustration among Ebola response teams.

It was not the first time this kind of incident has occurred when representatives of local, national or international medical teams try to help people in these remote forest villages. The day after the incident in Kolobengu, the authorities detained 18 people who had participated in the attack. But the challenge of working out how to help the sick and prevent more infections remained.

Positive outcome

Soon afterwards, however, the Minister of Health and the President of the National Assembly paid a visit to Gueckedou and negotiated the removal of roadblocks leading to Kolobengu.

On 20 July, a delegation from local authorities, the Ministry of Health, WHO and the Red Cross did preliminary investigations of 4 reported deaths. Three days later, Ebola response teams arrived in Kolobengu to fully assess the epidemiological situation. They were able to take 2 people with Ebola symptoms to Gueckedou and identify contacts of 7 suspected deaths.

Ebola patients do survive

“This is a very encouraging development as previous attempts to access these villages have failed,” says Professor Sylvain Landry Faye, an anthropologist deployed by WHO and one of the delegation that went to Kolobengu.

Faye recognizes the root of the resistance may stem from the initial approach of the medical teams. “At the beginning, medical teams were working fast and did not take the time to properly explain what Ebola is, and did not pay enough attention to local practices,” he says.

Most importantly, there was not enough emphasis on the fact that patients can recover from Ebola and, that the sooner they receive supportive care, the more likely they are to survive.

“You can understand their thinking,” he says. “The first message they heard was that there was no vaccine and no treatment for Ebola.”

When Ebola was first detected in the area, the villagers were suddenly faced with a disease that they did not know anything about. Some refused to believe that the disease existed, others were reluctant to change cultural practices, such as burial ceremonies.

Rapid response

International partners are supporting Gueckedou health authorities to implement response actions. Médecins Sans Frontières has established a treatment centre and ensures the transport of suspected cases. The Red Cross is working on infection control and safe burial. The US Centers for Disease Control and Prevention is helping to manage epidemiological data. WHO has assisted with the deployment of a European Mobile Laboratory and is working on contact tracing and overall coordination.

But the serious problem remains the reluctance of ‘contacts’— people who have been in close contact with a confirmed case — to be followed by medical teams for 21 days until after the incubation period of the disease. Sometimes they go missing and some develop symptoms and die in their communities.

Teguiano is not discouraged. Because he lives here, he feels a personal determination to do what he can to save the lives of his friends and neighbours.

“We are ready to continue working with those communities until they understand what to do to prevent being infected and the importance of medical interventions for Ebola in our region,” he says.