To combat Ebola, first build back trust in healthcare workers

By Celine Gounder
July 30, 2014

Medical staff working with Medecins sans Frontieres prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in Kailahun

The worst-ever outbreak of Ebola is spreading out of control in Guinea, Liberia, Sierra Leone, and now Nigeria, where almost 700 people have already died from the virus. Healthcare workers caring for Ebola patients have themselves fallen victim to the disease, including two American physicians.

And, at its root, the size of this outbreak can be blamed on a lack of trust in healthcare workers.

Ebola is spread through direct contact with an infected person or their body fluids, which may include sweat, blood, urine, feces or vomit, making it difficult to contain outside of proper medical facilities.

There is no cure for Ebola, though supportive measures like intravenous fluids and antibiotics may be helpful in treating some of the complications of the disease. There is no vaccine to halt the spread of the virus. The only way to stop the transmission of Ebola is to identify and quarantine infected persons.

But people aren’t likely to come forward with a deadly, stigmatized infectious disease when there’s an absence of trust.

In the African nations currently experiencing the outbreak, patients don’t trust their local healthcare systems – sometimes with good reason. Their clinics and hospitals are understaffed and have inadequate stocks of drugs and other supplies. Healthcare workers suffer from poor morale in difficult working conditions. In such settings, people turn to traditional healers. These healers may not be able to cure their illnesses, but they offer care and empathy that healthcare workers may not.

Affected communities don’t trust the foreign doctors who have come to help treat patients with Ebola, sometimes because they believe they are the very source of the disease. They conflate healthcare workers’ arrival to help treat Ebola with the coming of the illness itself.

Ebola’s harsh outcomes do nothing to inspire trust. Those who are hospitalized for Ebola — often too late in the course of disease, when mortality rates may be as high as 90 percent — are more likely to come out in a body bag than alive.

Families have been told not to care for sick relatives or to engage in traditional burial practices because of fears of contagion, but lack of trust leads communities to hide the sick from medical attention,. When they come to help, Doctors Without Borders and Red Cross workers have been threatened and attacked by locals suspicious of their activities.

Of course, it’s not just the healthcare system people don’t trust. Ebola is spreading in countries that have suffered from poor governance and civil war, where people don’t trust their own public officials, adding to the chaos.

The question is, how do you create trust?

Efforts to fight other stigmatized infectious diseases, like HIV and tuberculosis, have taught us that advocates from affected communities have an important role to play. Public health workers need to enlist the help of recovered patients and their families to speak about their experiences with medical treatment for the disease. Religious leaders and traditional healers should also be recruited and trained to educate communities about Ebola.

In the absence of trusted spokespersons, Ebola will continue to spread. Halting transmission of the Ebola virus will require isolation of infected persons. And no one will submit to quarantine if they believe that foreign aid workers are spreading the virus or that they are being doomed to die horribly and alone without their families at their bedsides.

PHOTO: Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in Kailahun July 20, 2014. REUTERS/Tommy Trenchard

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