Angry residents are blocking access for health workers to dozens of remote villages in Guinea, in a sign of persistent mistrust that could threaten President Alpha Conde’s aim to eradicate Ebola from the country by early March.
The worst Ebola outbreak on record began deep in the forests of southeastern Guinea in December 2013 and has since spread to other countries in the impoverished region, killing more than 8,600 people.
Like its West African neighbours Liberia and Sierra Leone – the worst-affected nations – Guinea has recorded a sharp fall in infections in recent weeks, fuelling hope that the tide has turned against the epidemic.
But with some people still denying the incurable disease exists, experts say it could prove difficult to trace those who had been in contact with the infected and to change traditional behaviour such as burial rituals involving touching the dead. These steps are seen as vital to defeating the disease.
« We are at a turning point. However, we cannot say that we have completely defeated the disease until we know what is happening inside these reticent villages, » said Fode Tass Sylla, spokesman for the national committee for the fight against Ebola.
In a sign of the resistance and distrust, medical kits sent by the government to schoolchildren were destroyed by villagers in Ourekaba, southern Guinea. Sylla said that locals thought the kits had been sent to contaminate the children.
Two security officials who arrived to investigate reports of a secret Ebola burial were lynched last week by a crowd in Sinkine, in the Forecariah region about 100 km from the capital Conakry, a police source said.
While in Sierra Leone, some communities have been reluctant to change their behaviour, the problem in Guinea appears more acute, with health workers still being denied access altogether.
Health experts also worry that some of the southern areas lie dangerously close to the borders of Liberia and Sierra Leone and that imported cases could reverse some of the significant progress made in those two countries in recent weeks.
HIDING THE SICK
The haemorrhagic fever, which kills roughly two-thirds of people it infects, is endemic to central Africa and had never before struck in the west, taking communities by surprise.
About 1,800 people have died from Ebola in Guinea. But in the week to Jan. 18 there were 20 new cases, versus 45 the week before, World Health Organization data showed.
Sylla said the number of patients in treatment centres had fallen sharply in recent days: there were just five in the main unit at Donka, in Conakry, and three in Gueckedou, in the remote southeast, he said.
« But we need to be vigilant because there are 36 villages that are reticent about receiving our sensitisation and health agents, » Sylla said.
The epidemic in Guinea has taken an unpredictable course. Healthcare experts believed it was ending in May, only to see it return ferociously weeks later as it emerged that locals had hidden the sick away rather than take them to treatment centres that became regarded as « death traps ».
Many villagers were appalled by attempts by officials to change their behaviour – seeing it as an attack on their culture. In an effort to halt one of the main sources of transmission, authorities had banned traditional funerals.
Burials are important in West African culture, with mourners often touching the corpse in intimate, spiritual farewells to their loved ones. Ebola spreads via contact with bodily fluids of infected people or with corpses of someone killed by it.
In Guinea’s inaccessible southern forest region, far from the coastal capital and the heartland of President Conde’s Malinke ethnic group in Upper Guinea, the government is often viewed with mistrust.
Locals here have seen little benefit from the multi-billion dollar bauxite and iron ore mining contracts that have helped make the fortunes of a small elite in Conakry.
Tensions can spill over into violence. In September, a team of eight people trying to educate locals on the risks of Ebola were killed by a mob in southeastern Guinea.
While case numbers are falling in Guinea, the virus continues to spread geographically. The Boffa district reported cases last week for the first time since late June.
« We are going into a phase where they need delegate to the districts and trust people in the bush to get things done, » said Philippe Maughan, senior Ebola operations manager at ECHO, the European Commission’s humanitarian aid branch.
« The end game will be tough in Guinea. »