Peter Wonacott, Wall Street Journal, November 17, 2014
When a Red Cross volunteer visited this impoverished border district in mid-May to warn about the spread of Ebola, he faced a formidable adversary: the village healer.
Surbeh Alpha, the 25-year-old youth chairman of the Red Cross chapter in Kailahun, was advising residents to avoid contact with the sick and dead when the healer approached him. She had been treating patients coming from Guinea, rubbing tree-leaf mud packs on feverish bodies. Villagers, he learned, feared he and his colleagues had come to steal internal organs–a rumor health workers suspected she had cooked up to protect her business. Staring hard at Mr. Alpha, she challenged why he had come to the village.
“We’re doing Ebola sensitization,” he replied.
“That’s what I’m doing,” she retorted, Mr. Alpha recounted. “You are just telling lies.”
Weeks later, the village healer was dead and the government of Sierra Leone–where a surgeon contracted the disease and became the U.S.’s second fatality on Monday–had announced its own Ebola outbreak that stemmed from her funeral, according to local health workers and a paper later published in Science. The death of the healer, whom another local health worker identified as Finda Mendenor, created a viral trail that spilled into Kenema, the country’s third-largest city, before moving into the crowded capital of Freetown.
Kailahun became a microcosm for all that can go wrong in trying to contain Ebola, but it has since become a template for what can also go right, after officials and health workers got residents to change behavior, accept modern medicine and break a chain of deadly infections.
In Guinea, where the most recent epidemic originated, the 61-year-old doctor who heads the country’s Ebola response recently had to dissuade a delegation of traditional healers against using their formula for fighting the lethal virus: plants, roots and tree bark. Six healers have caught Ebola treating patients there, and three have died. In a compromise, Sakoba Keita told the delegation his agency would clear the delivery of traditional medications to Ebola treatment centers as long as he and his cohort allowed regular doctors to decide whether the products could be administered safely.
In Liberia’s capital Monrovia, another Ebola hot spot, healers offer their herbal-based remedies at so-called pharmacies, although in a nod to the epidemic there are now jugs of chlorinated water outside their doors. Meanwhile, Ebola has torn through the country’s Pentecostal churches, after pastors tried to heal by laying their hands on the ill.
In one church just outside the capital of Monrovia, Ebola killed a pastor, his wife, an assistant pastor, his wife, and a prayer leader, as well as a pastor from a neighboring church who stopped by to try and heal them, said Rev. Kortu Koilor, the church’s only surviving leader, and a part-time health worker, who put a stop to the laying of hands on the sick.
In Kailahun, the Sierra Leone district bordering Guinea, locals blamed a rising death toll on witchcraft and organ harvesting, but spread risk by secretly cleaning and burying diseased corpses at night to usher them into the afterlife.
In October, the World Health Organization said it hoped to begin testing Ebola vaccines this year in a step toward rolling out mass inoculations. But the success of any vaccination campaign will hinge on local communities accepting how the disease surfaced in the first place. That has proved tough in places like Kailahun–where literacy is low, poverty high and ancient rituals bind together generations.
“It’s a virus–not witchcraft, not a conspiracy. All those things halted our progress,” said Joseph Bresee, head of the Sierra Leone Ebola response team for the U.S. Centers for Disease Control and Prevention. “It’s hard to allay fear.”
Sierra Leone isn’t the only place where culture and conspiracy have clashed with efforts to fight disease.
Scientists scoured the villages of Papua New Guinea to teach cannibals the links between Kuru, a neurological disorder, and the consumption of human brains. Muslims who believe antipolio vaccines are a plot to sterilize them have stymied global vaccination campaigns. And Ebola spread in Sierra Leone in part because of common burial practices with its neighbors, Guinea and Liberia.
After the Guinea outbreak, Eric Moosa, health superintendent for the Kailahun district, scoured the Internet to understand how the disease was transmitted. He and other officials held cross-border meetings to learn how it spread. They also implored the district’s chiefs to tell villagers not to touch the sick or dead who may carry the virus.
Disseminating information turned out to be the easy part. Far harder was getting locals to accept it.
Soon after Mr. Alpha and his team from the district capital of Kailahun arrived in mid-May with their police escort, the local chief asked them to leave. The health workers were rumored to be peddling blood and body organs to foreigners.
“You want to kill my people,” the chief told the health workers, said Mr. Alpha, the Red Cross youth leader.
Beside the chief, said Mr. Alpha, was a woman of high standing in the community, the healer, Ms. Mendenor. Sulaiman Kanneh Saidu, a community health officer in nearby Koindu who knew Ms. Mendenor, said he suspects she spread rumors about organ-harvesting health workers to boost her healing business. Soon she developed a high fever, but died before being tested for Ebola.
Health workers now say her funeral served as ground zero for Sierra Leone’s epidemic.
Local women washed her body and some lay on top of the corpse in the hope “that her power would transfer to them,” said Mr. Moosa, the Kailahun health official.
Women who attended the funeral later showed up sick at the local clinic in Koindu, staffed by Mr. Saidu. His nurse, Messah Kone, fell ill and died on May 23. Two days later, a lab in Kenema confirmed she had tested positive for Ebola. The government of Sierra Leone notified the World Health Organization of an Ebola outbreak centered in Kailahun district.
When Mr. Moosa and health workers returned to the area to warn locals, villagers threw rocks at their vehicles, shattering windshields of two cars, he said. Fresh rumors had surfaced of an invisible plane full of witches that had crashed in the area, allowing a deadly disease to seep from the wreckage. Parents and grandparents fled with sick children to other villages, spreading the contagion.