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Virus infects West Africa with terror

Canadians told to avoid travel to region

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Abbas Dulleh / The Associated Press  
A worker sprays disinfectant inside a government building to prevent the spread of the deadly Ebola virus in Monrovia, Liberia.

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Abbas Dulleh / The Associated Press A worker sprays disinfectant inside a government building to prevent the spread of the deadly Ebola virus in Monrovia, Liberia.

JOHANNESBURG -- Even the word was chilling: Ebola. The virus stole into the girl's house in her small, eastern Guinea town, invisible as death, and swiftly killed her grandmother and great-aunt. There were dark rumours everywhere that Ebola was witchcraft.

Soon her mother and aunt fell sick too. Health workers with Doctors Without Borders came and talked to the family for a long time. Then they donned yellow, heavy plastic suits, white plastic aprons, masks and bibs and took 12-year-old Rose and her mother and aunt away in an ambulance.

And everybody knew, when they took you away, you never came back.

This is a time of terror in many West African communities as they face the world's worst outbreak of one of the deadliest known diseases, easily spread through bodily fluids and difficult and dangerous to treat. Rose's story, recounted by her nurse, exemplifies the fear -- and sometimes bravery -- that comes with the epidemic.

In the Doctors Without Borders isolation ward, things got worse for Rose's family. Her mother, feeling depressed and hopeless, gave up, waiting for death. Her aunt was also sure she was going to die.

"No, you're not," Rose insisted.

But they were right to be afraid. Only about 40 per cent of those sickened in the outbreak have survived; in past outbreaks, the mortality rate has been as high as 90 per cent.

Since this outbreak began in Guinea in February, nearly 730 people have died there and in neighbouring Liberia and Sierra Leone, the World Health Organization said Thursday. The risks for health workers are high, and several senior doctors have died, including Sierra Leone's top Ebola doctor, Sheik Umar Khan.

For some international health workers, the hardest thing isn't wearing the suffocating plastic suits in the humid West African heat. Nor is it the impossible-to-answer questions from terrified people as they watch loved ones being taken away, perhaps forever.

It is the children in their cribs in the isolation units. Toys are placed in the beds with them and the cribs are placed near windows, so people outside the unit can wave.

"The people inside the treatment center are completely alone. We can't be there with them for hours on end. We have to go in and out," said Monia Sayah, a Doctors Without Borders nurse who recently returned home to the United States after treating patients and counselling families for 11 weeks in Guinea. She worked on an Ebola outbreak in the Democratic Republic of Congo in 2012.

Sayah said she was especially moved by the children. There was Rose, the 12-year-old who refused to give up. There were babies whom she sadly watched die. She saw no child younger than four survive Ebola.

Doctors Without Borders encourages family members of patients, especially relatives of small children, to don protective garments and go into the isolation ward to be with them. But some are too afraid.

With the outbreak raging out of control, Sierra Leone's president, Ernest Bai Koroma, declared a state of emergency late Wednesday, quarantined areas affected by the virus, banned public gatherings and deployed security forces to assist in house-to-house searches to find those with symptoms, after dozens of suspected victims fled in panic.

The U.S. Centers for Disease Control and Prevention Thursday warned Americans to avoid all non-essential travel to Guinea, Liberia and Sierra Leone.

Canadian health officials are also telling residents to avoid travel to the three African countries.

The agency had said Thursday there was no need for a travel warning, based on information from the World Health Organization. But it has upgraded its travel-health notice, saying Canadians can help health officials control the outbreak in the affected countries by staying away.

The health agency says while the risk of contracting the illness remains low, travellers could find it hard to access health care services if they get sick, and could also be exposed to the virus while seeking medical care.

Michael Stulman of Catholic Relief Services, currently in Sierra Leone, said the outbreak was likely to worsen before it improves.

"We definitely haven't seen the worst of it. The treatment centres are at full capacity and as soon as a new treatment centre is set up it's almost immediately full," he said.

"This is a scary virus and it can kill you, and the majority of people with it are dying. As soon as someone from the World Health Organization shows up and says your family member or friend has tested positive and we need to monitor you, people get scared and they hide."

When Rose's mother and aunt were at their lowest points in the Doctors Without Borders isolation ward, the girl was at her most determinedly cheerful. She knew all the staff and patients by name. She chirped and chattered.

When her mother or aunt lost hope, she kept coaxing them. She told them to keep drinking water.

"They were very depressed and thought they were going to die," Sayah said. But they recovered and eventually went home. Rose, still infectious, had to stay on in an isolation facility. So she appointed herself an unofficial medical assistant, hovering around helpfully, telling Sayah if she missed something.

Rose was one of the lucky ones. She recovered and went home. But afterward, she came back every day to the place where she had nearly died.

"She and her aunt came back every day to the facility to see us," Sayah said. "They just needed to come back."


-- Los Angeles Times, with file from The Canadian Press


Some communities in Guinea blame humanitarian agencies and health workers for bringing the disease. Stulman said myths had spread the hospitals were killing centers from which no one emerged alive -- or the disease didn't really even exist, having been concocted by humanitarian agencies to raise money.

But there has been progress recently in public education, he said. "People are now acknowledging Ebola does exist. But this is going to need a lot more work."

Catholic Relief Services is running education campaigns in the region to get the message out that those who seek treatment, which includes rehydration and medication for symptoms, have a better chance of survival.


"The impact on these families, outside the emotion and trauma of their loss, is that the people who are most affected are usually young and strong because they're the ones taking care of the sick all day," Sayah said.

Doctors Without Borders meets with village elders and community members and counsels patients, often for hours, on the need to seek treatment. Family members also ask questions.

"A lot of them will say, 'Are they coming back?' It's a very hard question to answer. It's important to be honest. You just tell the truth and say you will do your best and get them as quickly as possible to the treatment facility," Sayah said.

Republished from the Winnipeg Free Press print edition August 2, 2014 A17

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