To be in Freetown, you wouldn't necessarily know that this is a country with an Ebola epidemic. I have been here for 3 days and have yet to see a person dying or vomiting in the street. Our driver, who lives here, has never seen these things either. Some of Susan's Sierra Leonean friends don't know anyone who has died from Ebola. People still gather, albeit with caution. Yesterday there was a birthday party at the guest house where we're staying.
Nevertheless, there are messages about preventing Ebola everywhere. The messages include: wash your hands, don't touch others, and don't attend funerals. Here are some of the many signs I've seen:
We have interviewed a few people so far and everyone says that they understand that Ebola is real (in the beginning of the epidemic some people did not believe it was real or thought it was a conspiracy). People say that what convinced them that Ebola is real is knowing people who died. They also say they are convinced that engaging in prevention behaviors is a good thing: they wash their hands, they don't gather, and avoid touching people.
But.. if everyone is adhering to these prevention messages, then why are people still getting Ebola? Some people say that only rural people or health workers are getting it. Another person said that mostly poor people get it. These perceptions may be partially true. In Freetown, most of the people who have died of Ebola lived in a slum or a ward where people from the rural areas often stop on their way into Freetown. However, we don't really know the demographics of people who died of Ebola because we lack good data (see previous blog post).
We asked a few people whose family members died how their family members got Ebola. One person said that his mother contracted it while caring for her sick child and they both died. Another woman said that a traveler with Ebola came from a rural area to her parents' neighborhood. The traveler was taken into a house in the neighborhood and subsequently died of Ebola. Several people in that neighborhood also died, including 6 members of the woman's family. She doesn't know how her family members first contracted Ebola, other than that they may have been exposed to the traveler. However, she does know that at first her mother was inaccurately diagnosed with HIV which may have caused her to delay seeking care. She also knows that her brother slept in the bedroom of someone who had died of Ebola (even though people told him not to) and that's probably how he contracted Ebola and died.
One problem with tracing Ebola transmission is the time lag between infection and diagnosis. Currently, Ebola can only be tested once there is enough detectable virus in the blood, which usually accompanies a fever. It may take up to three days after symptoms start for someone to test positive for Ebola (http://www.cdc.gov/vhf/ebola/diagnosis/index.html). And people might attribute their fever not to Ebola but to malaria which is pretty common in Sierra Leone.
I'm not sure how people are being informed of the time lag for diagnosing Ebola. We heard from the woman who lost 6 members of her family that after her mother died, her brother went to get tested for Ebola. Apparently his symptoms were not severe enough and he was sent home without being tested (he probably did not meet the case definition). The family saw this as a slight and lost trust in the medical providers. Her brother later developed Ebola and died.
Tomorrow we meet with the CDC social mobilization team so I'm hoping we'll get some answers to these questions. Maybe we can also craft some research that will help them. Meanwhile, here is a picture of me at a Sierra Leonean buffet (the food was good!).
Nevertheless, there are messages about preventing Ebola everywhere. The messages include: wash your hands, don't touch others, and don't attend funerals. Here are some of the many signs I've seen:
We have interviewed a few people so far and everyone says that they understand that Ebola is real (in the beginning of the epidemic some people did not believe it was real or thought it was a conspiracy). People say that what convinced them that Ebola is real is knowing people who died. They also say they are convinced that engaging in prevention behaviors is a good thing: they wash their hands, they don't gather, and avoid touching people.
But.. if everyone is adhering to these prevention messages, then why are people still getting Ebola? Some people say that only rural people or health workers are getting it. Another person said that mostly poor people get it. These perceptions may be partially true. In Freetown, most of the people who have died of Ebola lived in a slum or a ward where people from the rural areas often stop on their way into Freetown. However, we don't really know the demographics of people who died of Ebola because we lack good data (see previous blog post).
We asked a few people whose family members died how their family members got Ebola. One person said that his mother contracted it while caring for her sick child and they both died. Another woman said that a traveler with Ebola came from a rural area to her parents' neighborhood. The traveler was taken into a house in the neighborhood and subsequently died of Ebola. Several people in that neighborhood also died, including 6 members of the woman's family. She doesn't know how her family members first contracted Ebola, other than that they may have been exposed to the traveler. However, she does know that at first her mother was inaccurately diagnosed with HIV which may have caused her to delay seeking care. She also knows that her brother slept in the bedroom of someone who had died of Ebola (even though people told him not to) and that's probably how he contracted Ebola and died.
One problem with tracing Ebola transmission is the time lag between infection and diagnosis. Currently, Ebola can only be tested once there is enough detectable virus in the blood, which usually accompanies a fever. It may take up to three days after symptoms start for someone to test positive for Ebola (http://www.cdc.gov/vhf/ebola/diagnosis/index.html). And people might attribute their fever not to Ebola but to malaria which is pretty common in Sierra Leone.
I'm not sure how people are being informed of the time lag for diagnosing Ebola. We heard from the woman who lost 6 members of her family that after her mother died, her brother went to get tested for Ebola. Apparently his symptoms were not severe enough and he was sent home without being tested (he probably did not meet the case definition). The family saw this as a slight and lost trust in the medical providers. Her brother later developed Ebola and died.
Tomorrow we meet with the CDC social mobilization team so I'm hoping we'll get some answers to these questions. Maybe we can also craft some research that will help them. Meanwhile, here is a picture of me at a Sierra Leonean buffet (the food was good!).
No comments:
Post a Comment