Ebola Threatens a Way of Life a Report from Sierra Leone Examines the Cultural Struggle to Eradicate the Virus

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A burial team inters a person who had died in an Ebola holding centre in Makeni, Sierra Leone.

DISPATCHES Ebola threatens a way of life A report from Sierra Leone examines the cultural struggle to eradicate the virus.

BY ERIKA CHECK HAYDEN, it another 1.5 km to the village of Mayata. She from Sierra Leone’s fourth-largest city to the BOMBALI DISTRICT, SIERRA LEONE and at least five others there have died. Guinean border (see ‘On the road’), they will But just a few hundred metres from Yeli have to convince people to abandon some ince September, the Ebola virus has Sanda, the village of Yoni has not seen a single long-held beliefs and customs. stalked the villages and towns along the case of Ebola. As soon as the village chief “If we don’t get cooperation from traditional Kamakwie–Makeni Road, a rutted, red- learned that Ebola had struck, he forbade his institutions, we could spend a long time chas- Sdirt track that serves as the main artery for a citizens from visiting Yeli Sanda or attending ing this, village to village, all the way to the bor- string of villages in the western part of Sierra burials of its residents. His swift action has der,” says Adam Goguen, the registrar at the Leone’s Bombali District. kept the 100 people of Yoni healthy while other University of Makeni and a resident of Yoni. Yeli Sanda, a village just a few kilometres communities have been devastated. His village looks like any other in the district: outside the district’s capital city of Makeni, Public-health officials and local leaders a clutch of houses fronting dusty yards, backed was the first place to be hit. Over the follow- who have volunteered in the Ebola fight say by small farming plots cleared out of the ing months, more than 40 people in the settle- that Yoni’s experience scrubby forest. But the exceptional behaviour ment of about 700 became infected; 22 died. NATURE.COM is instructive: to banish of its residents — their willingness to cut social In November, the virus infected a woman in Video diary from the virus from the Kam- ties and abandon cherished traditions — has so Tambiama, about 11 km up the road. A friend Sierra Leone: akwie–Makeni Road, far kept it safe. As difficult as it is, public-health who visited her acquired the virus and carried go.nature.com/phwqhd which runs for 150 km officials say, changing behaviour is the key to

a person at great risk of contracting the disease — normally, anybody who did this would face weeks of quarantine. But nothing about the GUINEA Kamakwie Gbangbani burial, from the participants to the Conakry location, was shared with public-health officials. “We’ve spent years trying to change behav- iours, for instance in the HIV epidemic,” says Peter Salama, global emergency coordinator for Ebola with the United Nations charity Unicef. In SIERRA the case of Ebola, “we’ve got weeks or months”. ON THE ROAD LEONE Since September, local o cials STAND-OFF IN MAYATA have fought Ebola in villages Aected villages Some customs, like the burial of the Gbangbani along the Kamakwie–Makeni man, are specific to their cultures. Others, such Road in Sierra Leone. Makeni as attending a neighbour’s funeral, are more universal. But they can be just as deadly. The woman who introduced Ebola to Mayata did nothing more unusual than visit an ill friend in Freetown a neighbouring town. With her and five other 5 km people in Mayata now dead, surviving relatives and neighbours are inclined to run. That has pulled them into conflicts with public-health stopping the Ebola outbreak that has ravaged nurse of witchcraft when she correctly pre- workers attempting to enforce a quarantine. West Africa for a year. “No more social life. No dicted that people who attended Ebola victims’ In early December, Father Francis Sehdu more business. No more travelling,” says Sorie funerals would contract the disease themselves. Sesay, a dean of theology at the University of Bundu Conteh, a disease-surveillance officer. But the rift between the two villages has started Makeni, found village elders in a stand-off with “We need people not to see us as a threat,” he to heal now that Yeli Sanda’s outbreak has a Mayata woman who was the only survivor adds. But that is difficult when officials are ask- subsided. In November, Yeli Sanda’s chief was out of four adults in her household. She had ing people to restrict their lives so drastically for suspended for flouting disease-control rules. fled for several days to an unknown location reasons that can be hard to understand. and had just returned to the village. But she In Yeli Sanda, communication problems SECRET BURIAL refused to go into quarantine back at the house, began with the very words that local officials One of the most effective ways to stop a disease where four orphaned children remained. first used to talk about Ebola: there is no word such as Ebola is contact tracing — tracking As Sesay and the elders pleaded with the for ‘virus’ in the tongues spoken in the villages down and quarantining everyone who may woman, she stared straight ahead, her arms along the Kamakwie–Makeni Road. Before have had close contact with a person who folded across her chest. She feared being the outbreak reached the area, Ebola educa- shows symptoms. But sent to a distant district for treatment. Sesay tors there described the pathogen as a kind of when a prominent “If we don’t get explained that she would not be sent away — tumbu, or maggot. When Ebola came to Yeli community member cooperation only watched for symptoms. And if she was Sanda, a man searched through the blood of in Yeli Sanda became from traditional diagnosed with Ebola, she could be treated at a someone who had died from it, looking for the infected, traditions institutions, local centre that had just opened. maggots. In doing so, he potentially exposed made contact trac- we could spend The woman relented at last, and agreed to be more people to the virus. ing impossible. The a long time quarantined in her home. Sesay climbed back Yoni chief Pa Alpha Tarawalie understood man was a member chasing this.” into his vehicle and pulled out onto the Kamak- the situation better than most. He says that he of Gbangbani, one of wie–Makeni Road. He stared out of the window decided to cut his people off from Yeli Sanda on several ‘secret’ societies in Sierra Leone that can at the forest that stretches for kilometres in every the basis of what he had heard on BBC radio have an important role in village life. The groups direction, wondering where in the country’s vast broadcasts, and seen while delivering supplies are far from secret in terms of membership — interior the woman had fled to. to quarantined communities on the outskirts of in many villages almost every adult belongs to “What about inside, where vehicles and Makeni. With accurate information and a wit- one. But their proceedings and rituals, including burial teams don’t go?” he asked. “People go to ness’s appreciation of the disease’s devastating their burial rites, are kept out of public view. these villages, away from the road, and spread effects, he says, he was able to convince his peo- When the man died, his fellow members took it there.” ■ ple to sever ties with their closest neighbours. his body to a remote village and kept to tradition The measure angered people in Yeli Sanda, by burying it under cover of darkness. Handling The Pulitzer Center on Crisis Reporting who felt shunned, and even accused the Yoni the body of someone who has died of Ebola puts provided support for this coverage.