Health workers struggle to separate myth from reality of Ebola as residents say abandoning tradition is out of the question

Medical teams struggling to curb Ebola in west Africa have been discouraging bush meat consumption, believed to have caused the outbreak, but some rural communities dependent on the meat for protein are determined to continue their traditional hunting practices.

While meat from wild animals such as fruit bats, rodents and forest antelopes has largely disappeared from market stalls in main towns such as Guéckédou in southern Guinea – the epicentre of the disease, and the capital Conakry following campaigns to avoid contamination, it is still being eaten in remote villages despite the risks.

"Life is not easy here in the village. They [authorities and aid groups] want to ban our traditions that we have observed for generations. Animal husbandry is not widespread here because bush meat is easily available. Banning bush meat means a new way of life, which is unrealistic," said Sâa Fela Léno, who lives in Nongoha village in Guéckédou.

The disease, which erupted in Guinea's southern forest region and was diagnosed in March as Ebola, is west Africa's first outbreak, and the worst known to date globally with more than 700 deaths. Infections continue to spread in Guinea and neighbouring Liberia and Sierra Leone.

Poor knowledge and superstition especially in rural communities, as well as cross-border movement, a poor public health infrastructure and other epidemiological causes have contributed to its spread.

The immediate concern is to halt human-to-human transmission. Discouraging bush meat consumption and introducing livestock as an alternative to hunting are part of long-term solutions against the risks of contracting Ebola from the wild, said Juan Lubroth, chief veterinary officer with the Food and Agriculture Organisation (FAO) in Rome.

"We recognise the importance that bush meat has to quality nutrition that you may not get from only crop-based diets. We do not say that you should stop wild meat … but can we replace the need to go to the forest and hunt wildlife with having a source of livestock and livelihood that can be safer?" Lubroth said.

"Can we have a more development agenda where we could have poultry production, sheep, goats, pigs … so that there is no undue encroachment into the forest for hunting?"

Getting the message across

Promoting hygienic practices to avoid contracting Ebola is a protracted endeavour. Urging new norms for diet is far harder. Lubroth said: "It becomes very difficult to convey to an individual about a threat that cannot be seen, in this particular case a virus.

"One of the major aspects is to build trust with communities or villages. The sociology, the anthropology, the communication is so important, not like the veterinary or the wildlife or medical sciences," he told IRIN, explaining that epidemiological facts have to be translated in simple ways for ordinary people to understand, by using local allegories for instance.

Yet promoters of health messages, such as Mariame Bayo in Guinea, have been threatened with death in villages where residents strongly oppose aid workers. "In Nongoha we were told that if we don't leave we would be cut into pieces and our flesh thrown into the water," she said.

"There are those who go even as far as saying that the government and the president have invented Ebola, and that it is meant to avoid holding elections," said the health minister, Colonel Rémy Lamah. The presidential election is due next year.

"It is difficult to change a society's way of life, but when it comes to saving lives I think no efforts should be spared. We didn't say that people will no longer eat meat. [Discouraging bush meat] is just an interim measure," he added.

Because Ebola had not previously broken out in west Africa, many rural communities have been perplexed and grown wary of health workers who have been accused of introducing the virus. Some believe it is witchcraft or an evil spell. Moustapha Diallo of the International Federation of Red Cross and Red Crescent Societies, however, said fewer villages across the three west African countries remained hostile to aid groups, following public education campaigns.

"The main behaviour change needed is at funerals where a lot of cases are being contracted. That and good protective measures at health structures are the most important targets," said Stéphane Doyone, west Africa coordinator of Médecins sans Frontières.

Virus spillover risks

Exposure to infected people as families care for sick relatives at home, touching bodies during burials or even hospital-acquired infections continue to account for the high death toll. However, rural communities still hunting for bush meat risk further spillover of the virus from infected wild animals, according to the FAO.

"We will die if we must, but abandoning our traditions is out of the question. It is true that we have lost many relatives. That's fate," said Guéckédou resident Mamadi Diawara.

Guinea's communication minister, Alhousseine Makanera Kaké, said bringing the outbreak under control is fraught with challenges. "Obstacles will remain until the outbreak is over. It goes without saying that we will not overcome this easily," he said.

It is still unclear why the Ebola virus crossed from its animal hosts this time in west Africa while communities have consumed bush meat for generations without infection. "We do not know enough about Ebola's natural cycle in the jungle. I'm sure it ticks away every year or every season, but it only makes it into the news when we have human mortality," said Lubroth.

While warning against consuming bats or handling sick or dead animals, Lubroth said an outright ban on bush meat "will likely see it go underground and that is actually worse. So we talk more about management than prohibition."

Providing alternatives to bush meat may solve only part of the problem. In the long run, better equipped and resourced public health systems remain crucial to curbing outbreaks.

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