A Different Perspective on Ebola

I am tired of reading American reports on Ebola talking about how it is actually a difficult disease to spread or how in reality it’s not very contagious. Which reality is that? Maybe it’s true in America, but Ebola is in Western Central Africa, not America. That’s the true reality. And in West Africa, where everything is unfolding, the reality is that the disease is very easy to spread. The proof is in the numbers. Would 6,263 people be infected, or would 2,917 people have died if this disease were hard to catch? The Peace Corps literally sent us an email several weeks ago saying that Ebola was so easy to kill, that a simple load of laundry—putting the infected clothes through the washer and dryer—would kill the virus. Well that’s great news for everyone in the First World, but what about my village? Am I supposed to go and tell everyone that they can put their clothes through the spin cycle and they’re safe? That is absolutely not the reality. That is almost the farthest thing from it. Let me assure you, Ebola is an incredibly easy disease to spread with this type of infrastructure, this culture, this life.

First, let us look at the health care system here. All of the articles say that gloves or masks or protective suits will prevent contamination. Again, that’s great news for the people who have access to those things, but what about the people who don’t? Levels of sanitation and hygiene for health centers here are not what they are in America. Don’t expect a white, shiny, sterile hospital. Picture a concrete room with dirt on the floors and chickens walking in and out freely. They don’t have enough supplies of alcohol or other disinfectants to regularly clean the facilities. There is no hand sanitizer. There is one set of tools. There is no running water, except for a tap out back (and that’s better off than many health centers). Nurses wear open-toe shoes. There is one pit latrine. That same latrine is used by all patients. There are very limited beds (6 to be exact). Beds are located in the same room in very close proximity. Patients and their families interact. There are no masks. There are no body suits. There are certainly no washing machines. There are no gloves. We recently had a vaccination campaign in which health care workers gave over 1,000 shots. Not a single glove was used. I have seen eye surgeries, again, no gloves. I have seen rapid malaria tests, in which blood is taken and put onto a screen, conducted without gloves. Part of this stems from the fact they do not see a necessity for gloves, part of this is because the health center literally does not have gloves because they are too expensive. Let me reiterate, health care workers do not have access to gloves. Are you still going to try to say this disease is hard to spread? Health care workers are also farmers and often have cuts and wounds of their own. Workers do not wash their hands before and after seeing each patient. Workers do not even regularly wash their hands after injecting an IV. This is not to belittle the nurses and staff. They simply have had different training in a different culture in different circumstances. But it does lead to very different standards, especially in regards to the spread of Ebola. Is it still difficult to transfer, in reality? Well let’s look at these workers in specific relation to Ebola. None of them have had any training with Ebola. The Cameroonian government has sent out some papers saying what the disease is and to make sure you sterilize your gloves and boots and aprons (of which the health center has none) after dealing with a patient. The government has not conducted any trainings or provided anything more than a three page document on the subject. If someone were to show up to the center tomorrow, the workers might not recognize the symptoms, they wouldn’t know how to treat it, and they would in all probability contaminate themselves. Sending an Ebola patient to my health center would be a death sentence to the workers there. That’s the reality.

The culture here also poses insurmountable challenges. People are close. The phrase “We are together” is more than just an expression, it is a true representation of life here. Everyone is your brother, your sister, your mother. You love everyone and care for everyone. You must greet every person you see by shaking their hand. Children hang all over their mothers and aunties. Little girls wipe their friends’ noses. Everyone sleeps in one large bed. Everyone shares food. You drink from the same cup, take pieces from the same ball of fufu with your hands, dip your forks into a single bowl of rice. When someone is sick, you take care of them. People were examining the culture in Central Africa where some of the Ebola cases have occurred in the Democratic Republic of the Congo. They found that children were able to live in households with parents who had contracted the disease but remained uninfected themselves. They knew not to touch their sick father. It is not the case here. They have never encountered Ebola before. They are used to malaria, which is not contagious. If a family member is sick, you must help them recover. You help them bathe, you clean their vomit, you throw out their bucket of urine. If a child throws up, the mother will be there to wipe it away. They don’t worry about contracting something themselves. Not touching someone is unheard of and inconceivable. Is Ebola contagious in this reality? You bet. Well, what if blood is involved? If there is blood in the vomit or stools, will that change people’s reaction? First of all, if you ask anyone what blood in vomit means, they will tell you it is indicative of witchcraft. It is a commonly known fact. When blood becomes involved in that way, someone has cursed you or poisoned you. Furthermore, unlike in the US, people do not fear blood. I have seen a little boy fall and cut his mouth, and an older girl on the street came running up and caught the blood flowing from his mouth with her bare hand. A stranger will have no problem coming up to someone in order to help, touching their arm, even if that arm is covered in blood. Is Ebola easily transferable yet? Families are living in small houses, sharing small rooms between many people. All of the women and children cook together and clean together and take care of one another. They hug each other and lean against one another and hold hands. People go to the bathroom in fields, in bushes, next to bars, or anywhere they get the urge to go. I have literally had a child pee less than a foot away from me while sitting on the grass. Her skirt was touching my leg and before I could even realize what was happening she stood up and pulled up her underwear. Urine can transmit Ebola. Right after she finished, other kids flocking to me ran through that spot. They walk around barefoot. Additionally, were someone to show the signs and symptoms of Ebola, and let’s say they somehow have access to a facility equipped to handle it, people often choose traditional healers over health centers. What’s the reality now? And what happens when somebody dies? Funerals are big events here. The tradition is taken very seriously in many areas. First you must prepare the body and dress them. Family members must touch it and hug it and weep over it. Then you must have an open casket where everyone in town comes inside the house to view the body, and possibly touch it as well. The truth is, if someone gets Ebola, their whole family will end up with it, and it likely won’t stop there either.  That’s the reality.

Just the way of life threatens the population. People here do not get the same type of health education growing up. The average person in America has a better understanding of germs and contagions than someone living in a village here. (Please do not misinterpret what I am saying. In no way do I believe Americans are overall smarter than people here, nor that most Americans have an advanced understanding of pathogens. I am simply stating that, in general, the American culture is germaphobic and parents emphasize to their children to “not touch that, it’s dirty,” or “that will make you sick,” and public schools teach about the transmission of diseases, and people commonly know the meaning of “airborne,” and can identify bodily fluids—more so than the average person who grew up in my village here). People do not understand how things are transferred, and thus do not understand how to prevent it or interrupt the chain of events. When recently talking to man about Ebola and trying to provide him with information, he told me, “I don’t believe in it.” Will that make it harder for him to contract it? No, in fact, total ignorance will make Ebola much easier to get, surprise surprise. I pressed him on why he didn’t “believe in it,” and he said, “I haven’t ever seen it. Many of us here don’t believe something until we see it for ourselves.” By the time he sees it, it will be too late for him. And in all likelihood he was being stubborn and just trying to make things difficult for me, but still, by having that attitude—one of indifference, lack of concern, and apathy—he neglects the chance to be educated about the disease. So even if he does in fact believe Ebola is out there, he is refusing to learn about symptoms, prevention techniques, or causes—which in turn increases his chances of contracting the disease. Does that reality sound like a difficult place to spread Ebola? Let’s also not forget the source of bush meat as a cause. That’s the only type of meat they eat in my village. Chicken is incredibly expensive, beef isn’t available, and if you want to eat meat (and you do because it is considered such a luxury), your only option is bush meat. Porcupine is incredibly common, monkey can be readily found, and bats are a delicacy. So what about now? Still a mildly contagious disease? People are going to continue to sell these things because it is their livelihood. Their family, their existence depends on the catching, selling, and preparing of bush meat. And people are not going to stop eating it because it has a status. Not eating meat means you are poor. I was eating a meal in village yesterday without meat and someone came by and offered to buy some for me. I said I didn’t want any. He moved a little closer and told me, “In our culture, not eating meat shows you are too poor, can I at least give you some fish?” The stigma of not eating meat will have people continuing to consume it for a long time to come, Ebola or no Ebola. I took a car the other day from the side of the road, put my luggage in the hatchback and had another man follow me into the car. He also put his luggage in the back. Two giant, 100kg sacks of raw meat, still bloody. Others got into the car and put their purses directly on top of his bags. He shook hands with the driver. He shared the front seat with another man who had to sit on top of him. Does that reality sound inhibiting towards the expansion of the disease? That’s the reality.

One woman asked me, so what can we do? If someone in our family shows the signs of Ebola, what should we do? Well, the immediate reaction is to take them to the nearest health center. But already we run into problems. First, how do they get to the health center? In their state they probably won’t be able to walk. There aren’t cars up here. They could take a motorcycle, but then there’s the risk of infecting the driver. There’s also the larger issue that once they get to the health center the health staff are totally and utterly unequipped to deal with the case. The family doesn’t have the proper methods of dealing with the person either. So then they should go to the nearest health center that is capable of dealing with an Ebola patient. That health center is probably over three hours away. They will have to take a motorcycle for two hours, then public transportation for an hour (and that’s assuming that the city in mind has a proper facility). That’s not a very good solution either. So then what? Contact someone and ask for a government official to be sent here to collect the person? Maybe the best option but highly unlikely due to financial resources, conditions of the roads, and the time it would take to reach this village. There is no correct solution for this situation. That’s the reality.

Cameroon is not prepared. West Africa is not prepared. A new facility with a few more beds is not going to solve this problem. It is going to get a lot worse before it gets any better. That is for sure. Right now, the main strategy is just to hope it doesn’t come here. It’s true they’ve closed borders, but we already know from Senegal that those borders are not foolproof. We can hope that it doesn’t make it here, but we are lucky to be able to have that hope. What about the other countries that are already being devastated by the disease? The count continues to go up and it doesn’t look like it’s about to steady out or drop off any time soon. Are you really going to tell them it’s difficult to spread? Ebola, whatever it might look like on paper, or whatever it seems like from an American perspective, is easy enough to spread here. It should not be downplayed. Numbers are going to continue to rise. The way of life here and the state of things guarantees it. This is the reality.