Guinean authorities are in a race against time to limit the spread of an Ebola outbreak after several infections of the deadly disease were detected in the country’s far southern region last week.
The West African country declared an Ebola epidemic on February 14, two weeks after the sick attended the funeral of a nurse in the city of Gouecke and later showed symptoms of the disease including a fever, diarrhoea and vomiting.
Among the confirmed and suspected cases – the nurse, five of her family members and a traditional healer she had consulted – five have died and two are currently being treated in isolation.
Despite a ban on gatherings of more than five people, including weddings and weekly markets, people in Gouecke appeared sceptical of government directives and the resurgence of a disease, which killed some 2,500 Guineans during an earlier epidemic that ripped through West Africa between 2014 and 2016.
“We are not afraid and we are not worried,” said Paul Lamah, who was among the residents who defied the ban and turned out at Gouecke’s weekly market on Saturday.
“We know that God is with us. If authorities want to lie to get their partners’ money [aid organisations], they shouldn’t say that. But as far as we’re concerned, there is no Ebola.”
Echoing his sentiments, Fatoumata Diabate, a red oil seller from N’Zerekore, said containment measures announced by the government posed a threat to people already struggling to survive.
“Our husbands finished their studies but have not found any jobs. We are responsible for our families, which is why we came to sell our produce, to find something to eat,” Diabate said at the market.
“We have to stop tiring ourselves with this Ebola outbreak story. Besides, we do not believe in this disease. These are just rumours because we have never seen a patient or a person who died of this disease.”
Community engagement ‘vital’
Against this background, Guinean authorities in partnership with international experts are trying to establish the full scale of the outbreak.
The efforts include tracking down people who potentially came in contact with Ebola patients in order to monitor their health and stop the chain of transmission. Security forces have also set up checkpoints to take temperatures and isolate those who appear ill.
Neighbouring countries are also on high alert to avoid a repeat of the previous outbreak that killed more than 11,300 people across Guinea, Sierra Leone and Liberia.
Authorities in Sierra Leone deployed workers to entry points across its border with Guinea to assist border patrols and health workers while Liberia raised its threat level and “increased surveillance and preventive activities”.
A resurgence of Ebola could cripple the already strained healthcare systems of the countries in the region at a time when they are also battling the coronavirus pandemic.
Health experts stress that passing good and clear health education information is key at the start of an Ebola response, but in Gouecke some residents argued that the apparent confusing messaging has played a role in people’s reluctance to heed the authorities’ directives.
“Why do they want to stop the market when kids are still in school, three or four sitting on the same bench all week long,” said Foromo, a resident of Gouecke.
An official at the prefecture speaking on the condition of anonymity told Al Jazeera that authorities weighed sending in security forces to enforce the ban, but in the end, they decided against the move.
The source said a major factor in the decision was the fear of an escalation in tensions and potential clashes between security forces and marketgoers, something that had happened in 2014.
This was corroborated by a commander in the gendarmerie who said security forces did not receive any order to enforce the ban.
“Community engagement is particularly vital,” said Anja Wolz, the Ebola Emergency Coordinator overseeing the response of Doctors Without Borders, also known as Medecins Sans Frontieres (MSF). “You need to invest time and energy in talking – and listening – to the communities in affected areas. You need to adapt the response according to what they say, and you need them to adapt to the risks of Ebola. It has to be a two-way conversation.”
Listening to and engaging with locals is also key in the success of rolling out a successful vaccination drive to help combat the epidemic of the haemorrhagic fever, experts say, citing the current existence of Ebola vaccines as one of the main differences from the last outbreak.
The expected arrival in the country of some 11,000 doses of the vaccine developed by Merck was delayed due to bad weather on Sunday, with vaccinations now set to begin on Tuesday, instead of Monday.
But even then, authorities fear the local population might not sign up for the inoculation programme.
“People don’t want to believe [in Ebola] and associate the disease with something else. Nobody intends on taking the vaccines,” an official at the prefecture was quoted as saying by local media.
“The citizens don’t want to hear anything from us and this worries us for the vaccination.”
Health Minister Remy Lamah, who is a native of Gouecke, arrived in his hometown on Saturday to convince people of the merits of taking the vaccine, the source said.
“It all comes back again to community engagement,” said the MSF’s Wolz. “We have seen this many times in the past. If a community feels involved, heard and empowered, then an Ebola response will likely go well, with or without vaccines. But if a community feels side-lined, unheard and becomes nervous or distrustful, then an Ebola response will likely face multiple difficulties, with or without vaccines.