Waging battle on Ebola, and an outbreak of fear and confusion

Eliza Cheung says the outbreak of the deadly Ebola virus in West Africa is being worsened by a lack of knowledge and the spread of inaccurate information, hampering the medical response

PUBLISHED : Saturday, 09 August, 2014, 4:08am
UPDATED : Saturday, 09 August, 2014, 4:08am

Not long after I arrived in Monrovia, the capital city of Liberia, one expatriate working here told me: "I am in a panic now. I just found out that I shook hands with someone last week who had contact with a confirmed Ebola patient. What should I do?"

In the three weeks I've been here, as part of a Red Cross mission seeking to contain an outbreak of Ebola in West Africa, I've come across many such stories about fear, as well as those of grief and despair.

This fear is understandable.

The Ebola virus is deadly. In previous outbreaks, as many as 90 per cent of those infected have died, though early intervention can dramatically improve the chances of survival. Once infected, patients developed symptoms such as fever, vomiting, diarrhoea and internal bleeding. There is no proven vaccine or cure, and treatment involves giving the patient supportive care - replacing lost fluids and controlling fever - to help the immune system fight off the virus.

Transmission is relatively difficult, however, and only occurs through direct contact with bodily fluids of an infected patient.

So far, the current outbreak in Liberia, Guinea and Sierra Leone has infected more than 1,700 people and killed over 900, and the World Health Organisation has warned that it could get worse.

Signs of the disease spreading in West Africa emerged early this year when more and more cases were reported. But it did not catch international news headlines until March when Guinea declared an outbreak. And when three doctors battling the outbreak on the front lines were infected - one in Sierra Leone, who later died, and two American volunteer medics in Liberia, who are now reportedly recovering - the world really sat up and took notice.

In many parts of the world, including Hong Kong, there was alarm about the virus spreading further through flights or other means of public transportation.

Again, this is understandable.

Information, both accurate and inaccurate, spreads quickly with little verification, causing confusion and fear. When faced with uncertainty and clouded by anxiety, many people choose to believe the worst.

It is the same in West Africa. Thus, part of my work here as a clinical psychologist is to help people cope with their fear.

This is the first time the people and governments of Liberia and other affected parts of the region are dealing with an Ebola outbreak. They have witnessed the sudden death of their family members in extreme though short-lived suffering. They see medical personnel in masks and protective gear entering their neighbourhoods, spraying unknown liquids. And they have been told by their governments, the WHO and relief agencies not to eat bush meat, which, for generations, they had been eating without any problem at all. Police and heavily armed soldiers now guard borders that had been loosely guarded for years.

All these are changes local people witness, but do not yet understand. Fear, out of lack of knowledge, caused some of them to strongly resist earlier measures to prevent a major outbreak.

Rumours about the cause of death also led to stigmatisation of recovered patients and their families. In some of these once closely knit communities, mistrust and conflicts have emerged.

On the other hand, frontline government officials, medical personnel and volunteers working around the clock are facing frustration on the ground. Along with the news of the outbreak, unfortunate stories have been heard on a daily basis, such as corpses being seen unattended on roadsides due to fear of those handling them being infected, and clinics declining to deal with common injuries out of fear, causing delay in treatment. For many people here, the death toll is not a mere figure, but a representation of lost loved ones.

The intense internal and international atmosphere contributes to low morale that could hinder our work.

It is vital that we deal with the epidemic promptly, and I am glad the local governments, WHO, the Red Cross and other international agencies are joining hands in the fight.

In any such effort, an important part is combating fear, ignorance, stigma and rumours via timely public health education.

As a clinical psychologist, and probably one of the few that are now in Liberia, I am surprised to find that many people see psychological support as an integral part of the action plan against the epidemic. People are generally willing to admit they are stressed and actively seek psychosocial support.

Psychologists in the field have been working non-stop to assist local partners to adapt psychological first aid training. We also help provide psychological support to frontline workers, including those who need to work in the communities; those who work on dead body management; those who conduct contact tracing of suspected infected cases; and those who need to face families denying the existence of Ebola or refusing to have their loved ones' bodies taken away, or communities hostile to responders.

In nearly every meeting, officials are discussing the importance of mental health, its shorter-term impact and longer-term needs.

Although the number of Ebola cases is still going up, with concerted efforts and hopefully more support from the international community, I am hopeful we can put a stop to the outbreak in West Africa soon.

Eliza Cheung is a clinical psychologist on Red Cross Hong Kong mission to fight the Ebola outbreak in Liberia