When fear can be a killer…
As Sierra Leone goes into a four-day Ebola ‘lockdown’ from today (Friday19th) Breda Gahan of Concern Worldwide says there are echoes of the early days of HIV and AIDS in the Ebola Outbreak in West Africa, but there are also lessons to be learned.
The causes of Ebola and AIDS are viruses, insidious viruses that we have come to know more about in recent years.
Both can kill. Without treatment, both kill quicker.
This happens especially in the poorest places in developing countries on the African continent. Health service responses are inadequate and under-resourced.
But fear, denial, stigma, myths and misunderstanding - as with HIV and AIDS - in the early days is impeding an effective response in worst affected countries.
I first visited Liberia and Sierra Leone in 2004. The impact of years of war was visible in the poor state of all infrastructures, including health and school buildings. Many had been damaged beyond repair. Lack of teachers and health workers was a problem.
In both countries, people mistrusted government health services and preferred to go to traditional healers or missionary hospitals when they were sick. I remember during my first visits, most people in both urban and rural locations refused to believe that HIV and AIDS existed. There were a number of conspiracy theories about, among them that it was western propaganda to reduce population numbers in Africa.
After discreet discussions, I came across people who were dying of AIDS in under-resourced hospices in the capital cities of both Liberia and Sierra Leone. The brave health staff and carers in the health centres provided whatever comfort they could, but in 2004 everyone died from the HIV virus causing AIDS in their centres. Anti-retroviral medication to reduce HIV virus was not easily available. Staff at the hospices reported fear, denial, stigma and discrimination towards people living with HIV. Stones were thrown over the front gates of a health clinic. The distressing state of people inside, most abandoned and barely conscious was heartrending.
I remember clearly, still, the sad, frightened and gaunt faces of the men, women and young people inside.
Only one person had a visitor, a woman who was trying to take some food by spoon from her sister. Staff told me that they never told anyone outside the hospices that they were caring for people with HIV and AIDS as they feared that they would be ostracised. They told me of the myths and misunderstanding they were hearing in their communities.
A decade later, the health workers caring for people with Ebola are also sometimes remaining silent. Staff in some Ebola centres are stigmatised by association. It is a big setback that just when the health systems in Liberia and Sierra Leone were becoming more robust, Ebola surreptitiously struck for the first time in these two countries, and more viciously than in previous African outbreaks. Ebola is negatively impacting on every aspect of life in Sierra Leone. People living with HIV are not going to collect their medicines and AIDS support groups are not meeting. Many of the health centres are closed as staff have abandoned their posts.
This is resulting in deteriorating health for people living with HIV. Mothers’ lives are in jeopardy as many are now delivering new babies at home, a negative turnaround given that it is only in the past few years that they have taken up going to health facilities for safer delivery with trained midwives. Concern’s Child Survival Programme in Sierra Leone reported an increase in facility deliveries last year as a result of efforts to improve the quality of mother and child services health facilities along with education for mothers on birth planning and safer delivery.
Lessons from managing HIV and AIDS can be applied to the Ebola outbreak. People need clear accurate information in their own language, delivered by people who they trust and believe in; then they can act on advice given if basic resources are provided. Just as with HIV, people need to know how Ebola is transmitted, how it is not transmitted and how they can protect themselves. Education is the best vaccine to stop the spread of Ebola.
This outbreak needs to be contained and fear reduced so that health workers can return to provide routine services including children’s vaccinations, safe delivery of babies, treatment of other infections including malaria, TB and diarrhoea, and anti-retroviral medicine for people living with HIV. People are still getting sick from these illnesses every day, and some are dying as no treatment is available. Health workers need to be respected, protected, well trained, supported and paid commensurately for their difficult work.
In the response to Ebola, health workers are our medical soldiers and they must be trained and armoured with the best equipment to track, contain and treat people infected with this virus. Outreach workers are needed for education and they need training to reduce fear, denial, myths, stigma and misunderstanding. They must trust that they can be protected from Ebola if they practice safe behaviours in the community.
Concern Worldwide teams are supporting on the ground with education of outreach workers, health staff training and logistical support for contact tracing and burial groups.
Committed leadership in support of the Ebola response at all levels is paramount, from the President and government to community levels.
Liberia and Sierra Leone have been able to reduce HIV infections in difficult circumstances by strengthening health systems. Let’s not allow gains made to be reversed. Both countries can use the lessons of AIDS to reverse the spread of Ebola.
Breda Gahan is Global HIV & AIDS Programme Adviser with Concern Worldwide.