Ebola is exotic, and exotic means unfamiliar. There is a reason for this: Until this year Ebola outbreaks had only happened in a handful of Central African countries, and had been controlled relatively quickly with comparatively few cases. It was a little known virus named after a distant Congolese river, seldom encountered but renown for its lethality. Outbreaks cropped up in distant villages where few westerners ventured and the world authority on its treatment was (and I think it would be fair to say still is) a global charity that specialises in providing health care to those with the least access to it.
Despite its severity once contracted, Ebola is relatively difficult to catch. Compared to some it’s a pathetic woos of a virus. Consider measles, now there’s a virus. Measles spreads through the air silently, leaving the respiratory tract of its host days before revealing itself through the classic rash. It floats in the air and can be breathed in to infect a new person hours after it left its original source. A single case of measles can lead to up to 18 new cases.
Ebola on the other hand needs direct contact to spread. Virus contained in blood or other bodily fluids needs to come into contact with broken skin or a mucous membrane such as those on the eye, lips or mouth. Ebola can’t survive for long out of the body and is killed quickly by ultraviolet light. Importantly for its control, it can only be spread after the onset of symptoms.
That is why previous outbreaks have been controlled quickly. They have started (as this one did) in remote areas, been recognised promptly, and controlled by isolating cases and tracking the close contacts of those who became unwell.
But this time its been different. As this long but very interesting article explains, it started in an unexpected place. Ebola had never been encountered in the west of the continent before and its symptoms mimic those of many other illnesses (such as cholera and Lassa fever) that are well known in these parts. There is speculation that deforestation or climate change might have contributed to the presence near settlements of the animals (often bats) that harbour the illness, but the truth is it could have been simple bad luck that lead to the first Guinean toddler getting infected. Whatever the cause, what really put Ebola onto the world stage wasn’t the age of the victims or where they lived so much as it was West African economics and culture.
This is a very poor part of the world. What little heath system there ever has been here was largely destroyed by the war that ended only 10 years ago. Before the epidemic there were 30,000 people per doctor (many of these Sierra Leonean doctors have since died of Ebola). Roads are poor and travel takes a long time. This means that care for the sick is mainly done by family members with little help from professionals.
But more than lack of healthcare access, what made Ebola gain a foothold in this epidemic is the cultural practices around caring for the dead. Proper care and preparation of a dead person prior to burial is of paramount importance in West African culture. Bodies are washed and funerals include traditions such as hand washing with a communal bowl and kissing the body. These are vital traditions to the mourners, many of whom are uneducated and do not even have basic literacy or any kind of an understanding of germ theory. Crucially, people with Ebola are most infectious after death.
With this is mind it can be no wonder Ebola has found a foothold in Sierra Leone, and it’s a massive public health exercise to get it out.