Communication about diseases must be adapted to the local culture to stop epidemics, WHO official says

By Misha Hussain

MACENTA, Guinea, March 2 (Thomson Reuters Foundation) - In a land where witchcraft is sought after more than science for curing illness, medicine men in Guinea say the Ebola epidemic would be over by now if they had been properly included in the outbreak response.

From broken bones to impotence to madness, these traditional healers say they have a potion, spell or touch for many ailments Western doctors can't treat. But there's only one cure for Ebola they say: knowledge.

In the forest region of southeastern Guinea, where the virus was detected last March, disseminating information using modern technology has proved challenging, resulting in the disease outstaying its welcome.

Karamoko Ibrahima Fofana, president of the association of traditional healers in the town of Macenta, said guérisseurs, as they are known, have unique access to remote villages.

"Guérisseurs are often the first port of call for the sick," said Fofana, 69, who is also an imam at the central mosque in Macenta, a hot, dusty town carved out of the forest.

"We could have spread information on how to protect against Ebola or told people with symptoms to seek help in the treatment centres."

Instead, the traditional healers were sometimes accused of spreading the deadly virus. After all, it was the claim of a guérisseur in Sierra Leone that she could cure Ebola that drew the first Guinean victims across the border, Fofana recalled.

Ebola has infected more than 23,500 people in West Africa and killed over 9,500, nearly all in the three worst-affected countries of Guinea, Liberia and Sierra Leone. It is transmitted through blood, vomit, diarrhoea and other bodily fluids.

Health officials are exploring ways to prevent similar disease outbreaks around the world, with epidemics expected to be a focus at a global conference on disaster risk reduction in Japan later this month.

Fofana admits the guérisseurs in his association didn't know what Ebola was at first, but after training from United Nations staff they're keen to spread information - and not the virus.

"If a guérisseur has been trained on Ebola and is then caught treating a suspected case, they are fined 50,000 GNF ($7), stripped of their membership and reported to the police," he told the Thomson Reuters Foundation.

WORD OF MOUTH

Jean Marie Dangou, head of the World Health Organisation (WHO) in Guinea, said the "Stop Ebola" campaign based on modern communication technology, had all but failed.

"For about one year the main communication strategy was built around media, mainly radio and TV, but it wasn't successful. The country is still dealing with tough and repetitive resistance," Dangou said.

West Africa has recorded some weekly declines in new confirmed cases of Ebola since the start of 2015, but resistance in some communities has undermined efforts to end the epidemic.

The main message from this outbreak is that communication must be adapted to fit the local culture, Dangou said.

Word of mouth may be a better way of getting information out than modern methods in parts of the world where broadcast signals are weak and power for electrical appliances is scarce.

"Lessons learned from Ebola in Guinea can be applied to cholera, malaria or any other infectious disease in other parts of the world that rely on an oral tradition," Dangou added.

At the start of the outbreak, traditional healers were viewed as part of the problem, rather than being recruited to help halt the disease.

"Our communication was top down and the way we delivered the messages was wrong. We told people to stop doing things without explaining why," Dangou told the Thomson Reuters Foundation.

In a shift in policy, community leaders, including healers, are given information and asked to act on it as they see fit. As a result, many have appropriated the "Stop Ebola" messages.

Traditional healers are also supplementing disease surveillance and helping response teams that search for cases.

"Most traditional healers are now aware of the risk of treating Ebola patients. More and more patients are coming to health facilities after a referral from their healer," said Dangou.

A PRICE

Given their important role in efforts to stamp out Ebola, the services of traditional healers should come at a price, said Joseph Souro Mamadouno, 58, a Catholic guérisseur from Macenta.

"Ebola is here today, but it could be cholera tomorrow. We can spread health messages, but the government should cover costs of transport, food and the time we take off work," said Mamadouno, who also works at the local agriculture school.

According to the healers' association, some 2,000 herbal practitioners in Macenta, a district with a population of around 300,000 close to the Liberian border, are out of pocket as a result of the Ebola response.

Ebola shares symptoms with less serious diseases traditional healers say they can treat: fatigue, fever, headache, vomiting and diarrhoea. But now these cases are referred to hospitals.

Koly Beavogui, 80, an animist traditional healer from Macenta said she and other female guérisseurs have been reduced to begging for food from neighbours and foraging in the forest.

The scrawny woman, with a wrinkled face and toothless smile, used to treat five to six people a day, but now hardly sees anyone.

"When the sick come to see me, I only ask them to give me whatever they can afford, because we don't buy illness, so we shouldn't have to pay for treatments," said Beavogui, sitting outside her freshly-swept, mudbrick house.

But others are fearful of turning Ebola into an industry.

"I'm not in favour of incentives, because it looks like we are in an Ebola business. These people should become agents of change, in their own community, without any kind of payment," the WHO's Dangou said.

(Reporting by Misha Hussain; Editing by Ros Russell)

This article is the first in a Thomson Reuters Foundation series on preventing disasters, ahead of a conference to adopt a new global action plan to reduce the risks of disasters in Sendai, Japan, in mid-March.

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