West Africans are key to fighting Ebola

Ebola doesn’t threaten you or me.

Despite the seriousness of the crisis, the virus hasn’t “gone airborne.” The disease spreads only through contact with Ebola-infected blood or bodily fluids, and there’s no indication this fundamental mode of transmission is changing. The threat, therefore, is to people on the ground in affected areas.

But that doesn’t mean Ebola is West Africa’s problem alone. West Africans have not been able to keep up with the disease, which means the West must be extensively involved. The challenge now is defining who should play what role on the ground.

Though medical relief workers from around the world, especially the physicians of Doctors Without Borders, have worked bravely to combat the disease, a series of blunders has intensified the suspicion West Africans feel toward Western medical professionals. The bodies piled up outside treatment centers, the family members hauled off in ambulances who are never seen again, the unwilling families thrust into quarantine: All these things intensify those suspicions.

To Westerners, local resistance looks stubborn, irrational and dangerously counterproductive. But there’s a terrible rationality to West African fear and distrust, and it’s something the world needs to understand before there’s a chance of halting this conflagration.

“Sierra Leone and Liberia are [among] the poorest countries in Africa,” says virologist Joseph Fair, who has worked in Sierra Leone extensively over the last 10 years and is now a consultant to the World Health Organization on the Ebola outbreak. “That’s saying something.” Both countries have crawled back from a series of devastating civil wars, but fissures remain.

And now, Ebola has come, sweeping through villages and cities, threatening to undo all the careful work of the last decade, destabilizing the political system, trashing the economy, leaving Sierra Leoneans and Liberians distrusting both their governments and the white people drifting among them, in Fair’s words, “like aliens in spacesuits.”

In the view of many Africans, the West has let native doctors and nurses die of Ebola, while evacuating afflicted Western volunteers for treatment in Europe and the United States. “In my mind,” says Dr. James Wilson, an expert in operational biosurveillance who has been tracking Ebola for 15 years, “the first people you want to save in these situations are the indigenous physicians. It’s a little bit of a double standard here — the Westerners take care of their own. That sends a bad message to the Africans.”

Fair’s close friend Dr. Sheik Humarr Khan, a 39-year-old Sierra Leonean physician, was one of the epidemic’s victims. A star in Sierra Leone’s medical establishment, Khan took care of more than 100 Ebola patients, including two nurses at the hospital in Kenema, before he contracted Ebola. An airplane stood on the tarmac for 72 hours waiting to fly him out of Sierra Leone, but layers of international bureaucracy kept him off the plane until it was too late.

Compounding the situation, it was decided, after a long argument, not to give Khan the first experimental dose of ZMapp, a drug being developed to treat Ebola. The decision grieved Fair and many others. But since there hadn’t been human trials, no one wanted to appear to be experimenting on an African. Still, shortly after his death, two American health workers in Liberia were flown to America and treated with ZMapp. Both survived.

To date, Fair says, more than 40 indigenous medical workers in Sierra Leone — doctors, nurses, drivers, attendants, hospital cleaners — have become infected, many fatally. The government of Sierra Leone begged the WHO for funds to evacuate another physician, Dr. Olivet Buck, but the organization denied the request, promising the best possible treatment in Sierra Leone instead, including a course of ZMapp. She died, the fourth Sierra Leonean doctor to die in the outbreak.

It’s not hard to see why people in Ebola-affected areas would mistrust the West. Yet the chains of transmission must be broken, or far more West Africans will die, as many as 1.4 million by year’s end, according to the Centers for Disease Control and Prevention.

The only way to combat the virus effectively is for Westerners to recognize the critical value of the indigenous physicians and healthcare workers, to protect them, and to earn back the confidence of the peoples of West Africa. “It would have been such a good thing if Khan had been saved, because it would have shown people that there is a path forward,” says virologist and Ebola expert Thomas W. Geisbert of the University of Texas medical branch in Galveston, Texas.

Sierra Leoneans and Liberians must be persuaded to stop washing the dead and hiding the infected, practices that are driving the outbreak. But this can’t be done in a high-handed manner by people from the West.

The recent three-day “lockdown” by the Sierra Leonean government — or “sensitization,” as Fair prefers to call it — was controversial in the West. But he thinks the strategy was valuable. As indigenous volunteers walked door to door throughout every town, city, village in the country, they were able to explain to people in their own languages what the disease is, how it is transmitted and how people can protect themselves and still care for their loved ones.

West Africa needs massive help from the West — beds, treatment centers, medical volunteers, funding. But it also needs the West to understand that the people most necessary to stop the fires of Ebola are West Africans themselves.

Wendy Orent is the author of Plague: The Mysterious Past and Terrifying Future of the World’s Most Dangerous Disease and Ticked: The Battle Over Lyme Disease in the South.

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