Aminata Kobie is a health promotion officer in WHO's Sierra Leone Country Office. When the first Ebola cases began to appear in May 2014 in Sierra Leone, Aminata travelled the country educating health workers and communities about the virus. As the outbreak spread throughout the country, Aminata spent months at a time educating her fellow Sierra Leoneans and visiting resistant communities where Ebola cases continued to occur.
"As a Health Promotion Officer, I work across all areas of health and mainly support the Ministry of Health. When we heard about the Ebola outbreak in Guinea, we immediately took action. The first thing we did was meeting with the Ministry of Health and partners to develop communications materials on how people could protect them from Ebola.
A health promotion colleague from WHO Uganda came to support us, as Uganda has previous experience with Ebola. We met with health workers and taught them about the signs and symptoms of Ebola virus disease and how transmission can be prevented. We told them to be cautious of anybody with the signs of Ebola. Every opportunity we had was used to educate the public about the disease. Even with World Malaria Day, we used this as an opportunity to teach the public about Ebola.
Misunderstandings and misconceptions about Ebola
There were many misunderstandings and misconceptions about Ebola. There was a lot of mistrust of the Ministry of Health, especially at the start. The issue was that they are used to having cholera, they are used to having diarrheal diseases, they are used to having fever, but these were not killing people like this. So Ebola was like a strange disease.
Looking back at how the disease started, the first confirmed case in Sierra Leone was a woman, a traditional healer who was going back and forth to and from Guinea. People living across the border are the same people. They don’t recognize international boundaries. This healer treated people, became sick and died. The community wondered what happened to her. And then, her husband died, too. There was this belief in the community that he had opened a secret pot, a snake came out, and scared him to death. People started to put ropes in their hands to beat off the evil spirits of snakes so that they would not die. I am just giving you one example, from one community, of people trying to make sense of the outbreak.
One of the success stories was that we used people from the various districts to talk with their own people. One of the section chiefs we worked with was particularly great, really hands-on. He used proverbs and words people were familiar with, explaining to them what Ebola was all about. For a lot of African cultures, if you are unable to explain things, people will attribute it to witchcraft or demons. We had a lot of dialogues, visited communities, set up meetings… It was difficult for people to understand this issue of Ebola, a disease that was killing a lot of people.
Building trust with the communities - the key for success
One day we met with a pregnant women, and I asked her why there was so much mistrust, why this great divide? She said, ‘You know, where Ebola has been treated, there are a lot of secrets about it. You go to treatment centers, and they are all covered. Because there are a lot of secret things happening, it doesn’t help us trust you.’
So we identified a number of key people, influencers within the community, such as chiefs and some health workers. We used them to build relationships with the communities, and built up that trust. But one thing that helped us a lot was the first survivors. We worked with those survivors, interviewed them, set up radio talks with them so that people could ask questions, and so on. All these things actually helped to start developing trust.
Youth making a difference
When I went to Moyamba district, we had so many cases from different chiefdoms. Some paramount chiefs were difficult to work with. They thought we were joking. Other chiefs managed to turn it around quickly and did a great job. The youth of the Moyamba Junction community played a key role in educating their community. They were very motivated to get Ebola out, because it was affecting their livelihoods. Moyamba Junction depends a lot on the sale of spare car parts, and with Ebola, the markets closed down.
Moyamba was one of the districts with a high number of Ebola cases. If they identified somebody – even if it was midnight – the youth would isolate the person, call you, and give you all the information. Nobody was paying them anything, they were just there, ready to work as volunteers. The community suffered from a high number of deaths, but they also had one of the highest numbers of survivors. With the help of their youth, they were able to identify cases early and take them to health centres. There was no treatment centre in Moyamba, so some patients were taken to Kailahun, others to Kenema which are on the other side of the country… can you imagine?
Seeing is believing
Another interesting community was Mothineh, where a lot of secret burials took place. We spoke to the paramount chief and he talked with the community, but the community denied conducting any secret burials. A social mobilization team, including myself, also met with the same community, and we finally got them to admit that there had been burials. We walked around and they showed us some graves in the bush. We realized they had truly had a lot of burials, and people were scared.
So we took five of Mothineh‘s key influencers to Moyamba. We showed them the Ebola response command centre, the treatment centres, the holding centre where patients were treated before going to Kenema or Kailahun. They started to realize that this thing was not a joke. They saw so many people working at the command centre and were impressed. We gave them a little money and told them they could use it to buy airtime to call us. The next day we started getting calls and cases reported.
Empowering the community to undertake action, I think this is the answer for Ebola. Because whatever you do, the answer is within the community. One community can be different than another, so you don’t treat all communities the same. You have to understand the dynamics, identify those who can be influenced in the community, and work with these people. We have to let them know that stopping Ebola depends on us."