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Fighting Ebola

The key to stopping the virus: Behavior change.

By Alexander Gelfand • Graphics by KarBel Multimedia

Confronted with a fast-moving Ebola epidemic, Guinea, Liberia and Sierra Leone declared national emergencies and called for international assistance. These were important moves, but a Bloomberg School alum and a DrPH student contend the key to containing Ebola will be a straightforward yet deeply challenging task: changing people’s behaviors.

Initially, misinformation and rumors ruled, says Tolbert Nyenswah, MPH ’12, Liberia’s assistant minister of health. Many denied the existence of an outbreak, believing instead that Western powers had fabricated the crisis to harvest body parts, or that local officials had invented it to attract international aid.

At the same time, cultural practices such as bathing the dead prior to burial drove up infection rates. Villagers opposed health workers who sought to dispose of infected corpses according to safety protocols. And many health workers also fell ill, in part because they simply were not trained to deal with the virus, which had previously been confined to smaller outbreaks in Central Africa. Some failed to protect themselves properly or to isolate themselves once infected.

As a result, health agencies have had to mount vigorous public information and social mobilization efforts. In addition to appealing to the West for health workers trained in Ebola case management, Nyenswah appeared in Liberian media to personally tamp down false rumors of cures and vaccines. He also coordinated a massive campaign urging people to avoid contact with the bodily fluids of victims, eschew travel and seek immediate treatment if ill, and notify public health authorities of suspected cases. But results will take time. “Denial has been overcome,” he says, “but behavioral change has not taken place yet.”

In Guinea, meanwhile, the Red Cross adopted a culturally sensitive approach to body management. In addition to clearly explaining why bodies must be isolated and disinfected, volunteers now also offer family members the opportunity to don protective gear and observe the process themselves, says Tim Roberton, a DrPH candidate who traveled to Guinea in July to analyze emergency response efforts by the Red Cross.

“Typically, case management gets the most attention,” says Roberton. “But what’s going to stop this outbreak is changing people’s behavior in the community.”