KAILAHUN — It's late July in the south of Kailahun in Sierra Leone, and a small convoy of white four-wheel drives from Doctors Without Borders (DWB) and the World Health Organization (WHO), along with a local ambulance, slowly rolls towards the tiny village of Mendekema.

It takes more than an hour to drive just 20 kilometers (12.4 miles) on this road weaving deep into the bush, and soaked by heavy seasonal rains.

A death believed to have been caused by the Ebola virus has been reported by telephone, and this team is on its way to carry out a saliva test on the deceased. Several dozens of village residents have gathered around the vehicles and refuse to hand over the body. Tension is rising.

"Ebola isn't here," shouts Salomon, a 20-year-old man. "We don't want to have anything to do with all that."

The body is apparently in one of the village houses. But after an hour-long debate, the team has made no progress in gaining access. The convoy turns back, leaving the community to bury its deceased and risk infection. All the medical staff can do is pass on a few recommendations for minimizing the chances of the disease spreading. 

Not a word is spoken on the road back to Kailahun, where there is a DWB Ebola treatment center and a base camp for the international organizations.
 

DWB at work — Photo: EC/ECHO

The Ebola triangle

The doctors are on the front line in the war against this deadly epidemic, and we traveled with them hundreds of kilometers into the heart of the Ebola triangle, from the towns of Guéckédou (Guinea), Kailahun (Sierra Leone) and Foya (Liberia). We are in the area of the Kissi people, an ethnic group that lives on either side of the Makona River, a natural border to the south of forested Guinea that we cross in boats.

The Mendekema episode illustrates how this epidemic — which officially hit Guinea in March before moving on to Liberia and Sierra Leone — has killed so many people and, most of all, why it continues to spread. In just four months, the virus infected more than 1,300 people, and so far more than 880 people have died after suffering intense fever, diarrhea, vomiting and sometimes hemorrhages.

It is by far the most serious epidemic since the 1975 arrival of the virus to the Democratic Republic of Congo, near the Ebola River for which it is named. For 30 years, the number of victims — 1,570 deaths — had been relatively contained. But now the regional epidemic is considered out of control. The three West African capitals of Conakry, Freetown and Monrovia have all been hit. On July 26, Nigeria had its first confirmed case after an adult, who returned from Liberia via Togo, died in Lagos.

Mistrust of "white people"

The opposition we witnessed in Mendekema isn't isolated. In early July, more than 20 villages in Guinea refused intervention from medical staff. Exploiting the absence of treatment and mistrust towards "white people," opportunists are offering miracle cures based on onion potions. It is impossible to know the real health situation in these villages, and on the few occasions when medical teams gain access to them, unwelcome surprises inevitably await.

The most serious episode took place in Kolobengo, a small village to the north of Guéckédou, Guinea. In mid-July, local residents banned any access to the village. Two New York Times journalists were greeted with machetes, and young people even attacked a delegation of elderly people who came to talk with them. Police officers arrested 28 residents. 

The opposition is persistent, and rumors are wreaking havoc. Many of the villagers believe "white people" are here to kill the population by spreading the poison with the sprays that are used to disinfect the homes. Denial of the illness, which is rumored to be an invention of governments and NGOs, is mixed with fear of the virus.

Clashes with medical teams

"Many think that going to a treatment center means certain death, that they do lethal injections, cut off ears and burn the bodies," says one person who was previously infected with the virus.

Marc Poncin, a DWB coordinator for Guinea, says that fear breeds fear in a vicious cycle. "People are suspicious, refuse our services, call us when it's too late," he says. "And seeing as the people in the advanced states of the illness die in the centers, they say it's our fault." Attacks against NGO vehicles are frequent. Residents throw stones and make threats with sticks. 

"There is a clash between these different ways to handle the illness," explains Professor Cheikh Niang, a Senegalese anthropologist who travels around villages in Sierra Leone with a medical staff of 10 people. "When people say, ‘you’re taking our dead,’ it’s a metaphor for the absence of communication from the medical community." He says villagers reject the authority embodied by “doctors, power, the illness.”

He is working to implement processes and rituals that take community traditions into account. "In Uganda, when a person dies, the body is covered with a traditional cloth," he says. "So during a previous Ebola epidemic in this country, medical teams added a cloth around the bag that contained the body."

In Gueckedou, Guinea — Photo: IFRC

Avoid all contact

Funerals represent a high risk of contamination. Families gather, and neighbors come to bid farewell to the body, to kiss it and touch it — the perfect conditions for the virus to spread from one family to another, and from one village to another. Despite the apparent tranquility of these communities, which are spread out around this forest region that produces fruits, vegetables and rice in large quantities, it is now difficult to feel safe, facing this invisible enemy.

The teams are reminding the people they are able to reach that they must reconsider their habits. They should wash their hands frequently, with a chlorinated preparation and, most importantly, avoid shaking hands, using at most a fist bump instead. The learning process has been tough for the local medical staff, who are accustomed to warmer relations.

"They're not used to Ebola," explains the young doctor Keita Namory, a Guinean from Conakry who works with DWB. "It's the first time we've had to face this epidemic. We need to teach disinfection, security measures."

Like his colleagues from the other centers, he has accepted the risks, the concerns and sometimes rejection by family to fight the deadly threat.

To battle the epidemic, authorities have developed messages intended for the various populations. "Ebola is real," for example, is written on large billboards at the border between Liberia and Guinea. At the Conakry airport, travelers must pass through a sanitary control. Medical personnel take temperatures, and travelers are required to fill out a document certifying that they have not had diarrhea, vomiting, abnormal bleeding, fever or "felt unusual tiredness" in the 24 hours before departure.

In the end, the medical teams are the ones doing the heavy lifting to contain the virus. As Namory says, "In an epidemic: It's up to doctors to lead from the front."