The problem with Ebola communication

A few days ago, an Ebola-infected patient from Guinea made his way to Senegal despite a travel ban imposed by the country to neighbors affected by the virus.

Health experts and aid agencies argue this proves the ban is ineffective in containing the epidemic. But governments are not listening and now there is concern some want to enforce even stricter travel restrictions in a desperate attempt to stem the spread of the disease across more countries in West Africa.

The issue can be seen as a communication failure but not because the message wasn’t loud and clear. Communication is a two-way process, but in the case of the Ebola epidemic, the receiver doesn’t always get the message nor the entire truth about it.

And misunderstandings like this are causing huge challenges to the response on the ground. For instance, the huge media attention given to the death toll has led affected communities to believe that contracting Ebola immediately means a death sentence. That’s why many of them decide to just stay in the company of loved ones at home, instead of seeking medical treatment in clinics.

The public perception is that the isolation centers are places where people enter, but never get out, said Ombretta Baggio, senior officer for health communications at the International Federation of Red Cross and Red Crescent Societies.

“They feel that if they go to the clinic they will die in any case and that there is no chance for them to recover from the disease. Whereas as soon as you recognize the symptoms and the sooner you go to the clinic, the higher the chances you have to survive this disease,” she told Devex from Dakar, where IFRC is co-hosting next week a forum aimed at improving communication related to the Ebola response.

The two-day event kicks off Monday and will be attended by representatives from Guinea, Liberia and Sierra Leone, the countries most affected by the outbreak, as well as from other nations in danger. The goal is to share lessons learned and debunk these public perceptions, which are not only misleading, but also greatly hampering the response. For example, closing borders has made it difficult for aid agency staff to travel to where they are needed, like when IFRC had to push through with a meeting in Ghana without one of its regional managers because she’s based in Guinea.

“This is something that we need to countercommunicate. We need to be able to reassure the people that closing the borders is not going to solve anything,” Baggio argued. In Liberia, for example, isolating people in an area only triggered protests and violence, she said.

The IFRC expert explained: “It’s like we’re leaving them alone to die. And this is not the message that we want to give out. Countries should work together rather than against each other.”

The forum would also like to send the message that the response needs more volunteers, Baggio pointed out.

One of the biggest challenges that the response faces is the lack of health personnel who are able and willing to participate. There are not enough health workers and volunteers on the ground, and most are exhausted after working practically nonstop since the epidemic was first reported in March.

Due to the global panic, few international volunteers are signing up, and those from local communities are also scared. Another job that many avoid is retrieving corpses.

“Dead body management is very tough, and contact tracing takes a long time. People are hiding or they don’t say the truth, so when they come to the facility they might not tell the health personnel their contact to protect [someone],” she explained. “Organizations are having a really hard time to find people who can boost the response now.”

To improve communication, Baggio said some agencies want to invest more resources in recruiting volunteers at the community level — those who are living with the people they want to reach and are seen as people’s “trusted sources.” They have the authority to debunk rumors that are untrue, like a religious leader in an area in Sierra Leone who was telling people that washing with water and salt at night would prevent them from contracting Ebola.

It’s wrong, though, to blame populations for not being sufficiently and properly informed.

“Of course there are a number of cultural barriers and it’s hard to tackle them in such a short time. And we shouldn’t blame populations for not being informed. This is not a matter of populations not being informed. It’s a matter of changing cultural practices that has been there for decades,” Baggio said.

“You can imagine telling a population not to bury their families and relatives, not touch the body of their relatives, is very hard for them because it is their tradition … not being able to bury them with dignity is really something that’s affecting them … it’s not about the population not understanding, they do understand, but they have to keep the local traditions as well.”

The IFRC official explained the communication approach in these circumstances should then be “less top-down and less giving orders,” and not just be limited to the agencies and their volunteers on the ground. It should be a multistakeholder effort, involving the corporate sector, the media and community leaders, with the government in a lead role.

“[We need to] give a sense of urgency to all the players and say we have to be there together. Otherwise, we won’t be able to scale the response up,” Baggio said.

This includes taking up other types of work not in their realm before. For example, IFRC may be focused right now on social mobilization and mass communication, but they are aware that clinical management must also be scaled up.

“[Everyone] has a role to play here. And over time we’re trying to divide up the responsibilities. The Red Cross is less engaged in clinical management than the local authorities and [Médecins Sans Frontières]. But now we’ve been asked to take that responsibility in Kenema because the health system is overstressed, and we’re asked to set up an Ebola treatment center there, which we are now doing,” Baggio said.

But she argued the aid community shouldn’t forget that there are other diseases present in the affected countries, not just Ebola. Most health facilities and personnel are so focused on the epidemic that patients coming to the centers and hospitals with other diseases like malaria may not be dealt with.

And that may lead to even bigger health problems for West Africa.

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