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Battling Ebola: Information is the most powerful tool

Although the West African nations stricken by the Ebola outbreak are not tech-savvy, text messaging, phone calls, and even radio are helping educate the most at-risk people.

A sign in West Africa is meant to help people understand what they should do if they think they might have Ebola. Centers for Disease Control and Prevention

While doctors scramble to find an antidote against Ebola, the medical community is starting to use the Internet and simple tech tools as a first line of defense to slow the further spread of the deadly virus.

The Ebola outbreak started in Guinea in March and so far has killed more than 900 people in Liberia, Sierra Leone, Guinea, and Nigeria, according to the Centers for Disease Control and Prevention. Another 800 people may be suffering from the disease, which has a mortality rate of about 90 percent.

It's now a race against time for health workers and government agencies in West Africa who are alarmed at the lack of education about the disease's symptoms and how it's transmitted.

"The average citizen did not believe [what the government was telling them]," said Gabriel Williams, Washington, D.C.-based coordinator for the Liberian Embassy's special Ebola response committee. "They were in denial. This was a strange disease that nobody knew and didn't take seriously."

The CDC is using its website to pump out factual information about Ebola's symptoms and how the disease spreads. The health agency hopes the Ebola updates will spur West Africans living in the US to send text messages, put up Facebook posts, and make phone calls to loved ones back home to education them about the deadly disease.

Few use the Internet

Health agencies trying to reach people in the affected areas also recognize that many Western Africans are more likely to own cell phones than computers. Just 7.4 percent of the Liberian population had Internet access in 2013, according to BuddeComm, an online telecommunications research site that studied tech use in the region. The numbers are even lower in Sierra Leone and Guinea, at 1.6 percent and 1.3 percent, respectively.

It's a different story with cell phones. Some 69 percent of Liberians have cell phones, as do 67 percent of those in Sierra Leone and 38 percent in Guinea.

That's why Liberian expatriates in the US prefer to call and text friends and family back home. "Text messaging," said Philip Suah, a Liberian who lives in Houston, is "a very large portion of it."

The other part is just plain old phone calls, which is why Suah organized a conference call last week with hundreds of representatives of US-based Liberian community organizations.

Liberian mobile phone companies also have sent text messages crafted with the country's Ministry of Health and Social Welfare and Ministry of Information and Tourism. Williams said those messages were educational, focusing on rules and regulations about hygiene, the disposal of dead bodies, and the risks of congregating in large groups.

Ebola spreads through direct contact with an affected person's blood or other bodily fluids including sweat, urine, and saliva. It can also be contracted by eating infected animals including bats, monkeys, and antelopes, bushmeat that's commonly consumed in West Africa.

Lingering suspicion

Nearly 400 people representing dozens of Liberian community groups in the US participated in Suah's conference call to learn how to combat Ebola's spread. There are about 56,000 Liberian Americans, according to the US Census Bureau.

"It was kind of unique," Suah said. He called it "a consolidated effort against Ebola, so that everyone is joining in to fight the common enemy. Usually, there's a lot of division."

As the day for the call approached, Suah, who works in Chevron's Health Safety and Environment division in Texas, worked with Craig Manning, a health communications specialist in the CDC's Viral Special Pathogens branch. Suah also set up a Gmail account and Facebook page where people could submit their Ebola-related questions.

The Liberty Party, which had asked Suah to coordinate the conference call -- and the CDC as well -- asked everyone on the call to share their newfound knowledge with local organizations and their communities. They also hope many will reach out to friends and family in Liberia.

That would be key, said the 41-year-old Suah, who emigrated to the US from Liberia in 1997. Many Liberians don't trust the health care workers, don't believe the government's warnings, and don't even think Ebola is real, according to Suah. "They think it's a conspiracy," he said.

"If a health worker comes into the community, they don't know [that person], and may not trust their intentions," Suah said. "But if you receive a text message from your mom, or your friend...you have a higher likelihood of believing it."

The day before last week's call, Suah's wife's uncle died from Ebola.

"If I picked up the phone now and called a friend back home and say, 'This is what happened to my wife's uncle,' and tell the story, then all of a sudden it hits home," he said. "I've called a lot of them to connect with them and to say, 'This is real.'"

Information radio

In April, not long after Ebola broke out in Guinea, the CDC's Manning traveled to the region with his supervisor, Pierre Rollin. Although the number of cases at that point was only "slowly ticking upward," Manning recalled his surprise at the Guinean government's lethargic response to the crisis.

Officials at the US embassy as well as local officials helped them reach out to Guinean radio stations with audio of presentations that Rollin had prepared that address practical ways to ward off the disease, such as steering clear of bushmeat like monkey or bat, washing hands frequently, wearing gloves and face masks when around sick people, and not directly touching the bodies of Ebola victims at funerals.

At the time, authorities weren't sharing information about how Ebola is transmitted, let alone its source and symptoms, he said. "That stuff was not being talked about," Manning said. "There was simply this level of anxious concern."

Manning knew, though, he had to get the information to as many radio stations as possible, especially in the most rural areas of the country. He put all the audio files of Rollins' talks on his Mac and then shared the files by copying them to portable USB drives he brought to every radio station he visited. He also copied the files to CDs. "If someone is going up country, we'll put a CD in his pocket and say 'Go,'" Manning said.

Manning also emailed station directors and begged them to play the 30-to-45 second spots. Fortunately, many stations started airing them in heavy rotation. One station manager in the Guinean capital of Conakry told him in April he "would play them until the outbreak is over."

A colleague who is currently in Guinea emailed Manning last week and said the spots are still getting airplay.

Those simple public service announcements probably helped reduce panic over the outbreak early on in Guinea, Manning said.

Unfortunately, the CDC didn't have enough people like Manning to get to Liberia or Sierra Leone soon enough to have the same impact there.

Four questions

Still, it's not too late for information to make a difference. When he gives public talks in the stricken areas, Manning says he tells people, like a woman in Sierra Leone who didn't know if she had the disease, that there are four questions that can determine if someone is at risk for Ebola.

  • Has a person eaten monkey or bat in the last two weeks?
  • Have they been taking care of someone at home who has Ebola without proper protections, like gloves and masks?
  • Have they been in a clinical setting with Ebola patients without proper protection?
  • Have they attended a burial or funeral of an Ebola victim and been directly involved in the mourning, in the crying, and in the touching of the body?

If someone's answers, like those of the woman in Sierra Leone, are no, there's almost no risk. Just telling that story at public talks relaxes people, Manning said. "They just don't know what puts them at risk."

Manning plans on taking part in another conference call this Saturday. "I'll probably be given a little space at the beginning to do my song and dance."

When Gabriel Williams, of the Liberian Embassy in Washington, D.C., speaks about "song and dance," he's not just using a phrase. In Liberia, especially in the most rural areas, health officials are trying just about anything they can to spread education about Ebola -- including literally doing song and dance.

A dance group with singers and drummers brings people of the community together, Williams said. They then demonstrate, with health workers, how to clean your hands, how to put gloves on, and what to do if there's suspicion someone is sick.

Manning said he'd never seen these performances but knows that dramatization is a powerful communications tool in West African communities. "What is working in that situation is whatever leads to the behavior change that helps keep people from getting sick," Manning said. "If it's working, it's working."