Thursday, April 30, 2015

The Superstitous Ebola Fear

As the Ebola epidemic was advancing on Guinea’s capital Conakry in April 2014 a powerful rumour started to spread among the people living on the outskirts. Onions and coffee, so the saying went, could protect against the disease. Within hours, onions were completely sold out at the stalls of the city’s main market. Of course, the rumour was false. Despite the health authorities’ immediate efforts to discredit the rumour on social media and through radio, it spread rapidly, becoming one of many examples of misinformation.

False information took many forms during the epidemic. Some people did not believe in Ebola at all. Others believed it existed but had wrong ideas about how and why it was spreading.
“Even until now, part of the population still doesn’t believe in the existence of Ebola,” says Sakoba Keita, the national coordinator of the Guinean health ministry’s response team. “They believe it was invented by the authorities.” Other strategies to combat the virus, such as spraying houses to disinfect them, were sometimes perceived as doing exactly the opposite. Keita says many people believed that the spray, which was laced with chlorine for disinfection, also contained the Ebola virus. They believed “that the spray was a propagation factor”, Keita says. Similar rumours soon spread about the thermometers used to measure body temperatures. The health staff who took away the sick and gathered dead bodies had to work quickly, with little time to communicate what they were doing, or why. Often, their actions clashed with communities’ religious beliefs and traditions. Relatives were not allowed to touch the deceased and go through traditional funeral rites. This gave rise to conspiracy theories. Keita explains that many people began to strongly oppose the Guinean government’s strategy to manage corpses. “They thought we collected organs from the bodies for sale,” he says. Some people saw the disease as a plague sent by God only on atheists, so they came to treat the exercise as a religious purification ritual rather than a hygiene measure. Stressing the need for better communication, Keita adds that his response teams persuaded religious and community leaders to speak to the population “so they understand the ins and outs of the disease”.

At the height of the epidemic, when hundreds of people died every day, panic spread. In radio broadcasts and stories spread by word of mouth, Ebola was portrayed as an inescapable, apocalyptic threat. Jérôme Mouton, head of the Médecins Sans Frontières response team in Guinea, says Ebola was used as a source of horror in literature and movies across West Africa “The first messages that were broadcast portrayed Ebola as a disease that kills almost every time and one that has no cure,” he says. “With such messages, to obtain a rational and thoughtful response from the population was obviously not easy. Instead of appeasing, rescue teams, in some situations, reinforced fear.”

Misinformation was also spreading over the internet. From the onset of the crisis, health authorities tried to use social networks such as Twitter and Facebook to distribute information on Ebola and gather hints on where their response teams might be needed next. But although social networks reach many people, it soon became clear they were not always an appropriate forum in which to discuss complex issues. Information about Ebola’s spread and prevention got muddled, warped and hyped. Social media users spread half-truths and rumours in an environment already gripped by a general panic, propagating misinformation quickly. This was exacerbated by the lack of reliable conventional media channels to broadcast reliable information.

 In fact, in the rush for sensational news, some traditional media outlets repeated ridiculous rumours that Ebola was a ‘Zombie disease’ sent by God to punish atheists. One of the things that people clung to was witchcraft. Supernatural forces are still a reality in the minds of many African societies, even those with advanced education and social development. In West Africa, many people responded to mystical explanations of the disease by seeking out traditional healing, despite government efforts to discourage such practices. And sometimes, the witchcraft remedies would appear to work, potentially reinforcing such beliefs. The idea that Ebola was a supernatural evil also meant that those who got infected often doubted their ability to recover. SaaSabasse Tèmèsadouno, a health worker at Guéckédou hospital in Guinea, was infected with Ebola whilst caring for other victims. As a medical assistant, Tèmèsadouno had some basic knowledge about the virus. But he still doubted his own ability to recover due to persistent rumours that Ebola was caused by witchcraft.  “After I got infected many people kept saying I had no chance of surviving because there was no cure for Ebola,”

Some news channels blatantly harnessed misconceptions to further their own goals, for example by playing on existing political and ethnic rivalries in the country, says Charles Vieira Sanches, the senior programme manager for West Africa’s branch of Article 19, an NGO working to defend freedom of speech. For instance, in Guinea the leader of the opposition party claimed that the ruling party were selectively spreading Ebola to the forested regions of the nation. Sanches and his team initiated a number of awareness campaigns on social networks, and tried to limit the political damage and social unrest this rumour and others like it were doing.

It was not until the height of the epidemic, around July 2014, that response teams realised how the social constraints generated by misinformation prevented them from stopping the epidemic. “We therefore had to take these parameters into consideration,” adds Keita.

To address rumours, health authorities called in social anthropologists for advice, and used information relays such as radio and newspapers, artists, and religious and community leaders.

One essential part of the strategy, according to MSF’s Jérôme Mouton, was to make treatment centres and what goes on inside them more transparent to the general population. From the start, health workers had experienced problems related to these centres. Since Ebola patients need to be strictly isolated and will, for a time, only come in contact with people in strange-looking protection coats, the experience of being taken away to a centre is traumatising both for patients and their relatives. Mouton said that this “isolation aspect” of the disease fed the rumours. “When people do not know what's going on, they imagine all sorts of terrible things,” he says. “For instance, there were rumours that the centres were used for organ trafficking. No one, under such circumstances, would want to be treated in our centres.” MSF became more transparent “When we inaugurated new centres, we’d ask the population to visit them and understand what they were all about,” Mouton explains. “Once people are convinced of the value for their communities to temporarily suspend certain traditions in the interest of public health, communication with the population becomes much easier,” he says.

“Fear is an important part of all problems we had to face while dealing with the Ebola epidemic,” says Mouton, adding that the panic caused by the epidemic explains why even the most outlandish Ebola rumours were so easily believed. “Fear has never helped people to think in a sensible manner. When we are scared, we no longer act rationally.”

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