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Côte d'Ivoire

In Côte d’Ivoire, Ebola knocking on the door

Outreach workers in Côte d'Ivoire are sharing vital information about the Ebola virus, such as symptoms, how it is spread and preventive measures.  Download this video


By Eva Gilliam

With few resources but much resolve, two social workers in Côte d’Ivoire travel far and wide to educate communities on keeping free of the virus, even as an epidemic rages just across the border.

MAN, Côte d’Ivoire, 8 October 2014 – In a concrete courtyard surrounded by multi-family homes in a crowded neighbourhood in Man, Côte d’Ivoire, Koné Disso greets the family he has come to see. With both hands in the air, he puts on a smile and says, “I greet you like this now! Remember, Ebola!”

© UNICEF Video
Koné Disso (right) speaks in a radio interview in Man, Côte d’Ivoire, about preventing transmission of the Ebola virus.

Everyone laughs, but there is still an awkward moment as social workers Koné and his Ebola prevention education partner Sialou Kouamé sit down on a bench and begin to share les nouvelles, or “the news” – the opening conversation that is part of any social visit in Côte d’Ivoire, the chat before getting down to business.

Today’s business is not so new. For months, Ebola awareness campaigns have been airing on radio and television. Pop songs have been written about the disease, its signs and symptoms, and how to avoid transmission. Ring tones can be heard in markets advising against shaking hands, eating bush meat or touching the sick or dead.

Forty-nine year-old Miriam Doumbia sits across from Koné, her niece translating from Koné’s French to her local Malinké dialect. She carries a baby in her lap, and her family is crowded around her, listening.

“Since I was born, I've never even heard of this disease,” Mama Doumbia says. “But now we hear about it all the time. What is this disease that keeps us from touching our sick?”

Changing behaviour

For Mama Doumbia, it’s hard to accept the idea of being unable to help someone who is sick or touch their body once deceased. In a culture where families live together in tight quarters, share meals from the same plate and serve as mothers and fathers to all the children in the village, the changes required to avoid any potential spread of Ebola are enormous.

“For every illness there are measures to take to prevent it,” Koné says. “But with Ebola, it's much more difficult because it touches their culture.”

Avoiding shaking hands is possibly the easiest of the changes, but even that much requires a tactful approach from outreach workers.

“We are a friendly, warm culture,” explains Sialou. “It can be very rude not to shake the hand of the village chief, or of an elderly person, in particular. But we are also a culture that uses a lot of irony and humour. So we try and make light of these new changes, smiling and laughing, to put people at ease, because that is just the beginning of the message that we need to give them.”

© UNICEF Video
Koné and fellow social worker Sialou Kouamé talk with a man about Ebola. “For every illness there are measures to take to prevent it,” Koné says. “But with Ebola, it's much more difficult because it touches their culture.”

Koné and Sialou climb on their Honda 200 motorcycle and head out of town. They have no masks and no gloves. All they carry is a worn poster with the list of signs and symptoms of Ebola that have illustrations along the side – a casket with a corpse, a person shivering with high fever, a doctor well protected.

When they reach the village of Deupleu, they locate the chief and ask if he can invite anyone who is still around in the late morning heat to come for a meeting. Twenty minutes later, mostly women and children gather around the chief’s house, and the two social workers begin the conversation. Have they heard about Ebola on the radio? What have they heard?

“More than just changing how we greet each other or show our affection, the behaviour changes required to prevent any contraction or spread of Ebola go much further,” says Koné. “Because for many, especially in rural areas, it impacts on their ability to survive.”

“We know it’s real”

One of the primary messages on Ebola prevention is not about the chance of the outbreak spreading from neighbouring Liberia or Guinea, but rather how to avoid new infection from handling or eating bush meat.

Côte d’Ivoire is covered in dense, lush forests, home to all sorts of animals that are hunted and eaten to supplement the local diet.

While periodic cases of Ebola from animal to human transmission occur in some countries, the mere possibility of it happening here has meant that bush meat is quickly becoming off limits.

Forty-five year old Yvonne Seu and her husband are farmers and have seven children. Before the Ebola prevention campaign, she never bought meat in the market.

“My husband is in the fields all day, and we would set traps for cane rats,” she says. “Twice a week we would get a large enough animal to supplement the rice or other grains – that was our meat. Now, we are too scared to do this, because this Ebola thing – we know it’s real.”

But without the cane rat, Seu’s family has no protein to supplement their diet.

“My husband earns about 500 francs (US$1) a day in the fields. Now I am required to use 200 of that to buy a handful of dried fish in the market,” she says. “The amount of fish we get for 200 francs is hardly even noticeable.”

Closing borders, preparing beds

Ivoirian President Alassane Ouattara recently said in an interview that the country has experienced a 30 per cent expansion in infrastructure over the last three years. This includes rehabilitating health services, which, if Ebola were to enter the country, means a greater capacity to deal with the problem.

© UNICEF Video
Sialou demonstrates Ebola prevention using an illustrated poster, one of the few resources the social workers have for educating people about the disease.

“We have a whole system of prevention,” he said. “From arrival in the country, at our borders, at the airport and in our ports…we’re checking temperatures and making all necessary arrangements to deal with any potential cases.”

In Man, the General Hospital, with the help of UNICEF, has set up a treatment centre that could accommodate four cases in isolation if the disease were to spread. The hospital has set up an Ebola response team and is responding daily to calls about suspected cases.

“Mostly it’s just people who panic when their neighbour gets a fever,” says Dr. Joel Tri Ba, pharmacist and head of the Man Ebola Response Unit of the General Hospital. “But we must take each call seriously, put on our protective gear and go to the site.”

With very limited resources, such as protective clothing, gloves and even petrol for travel, responding to each rumour can be depleting physically and economically.

“It’s scary, and we brave it – but it would be better if we were better equipped,” Dr. Tri Ba says.

Daily Ebola emergency meetings at in Man and other districts look at how government services, NGOs and community groups can help each other achieve the maximum results with minimal resources. UNICEF has donated one tent in Man and another 18 throughout the country, sponsored radio spots for national broadcast, and printed 20,000 Ebola posters on the signs, symptoms and prevention of Ebola.

The government has identified 16 sites to establish Ebola treatment centres across Côte d’Ivoire to respond quickly if cases are confirmed.

Remaining vigilant

The area that Koné and Sialou cover is vast, sometimes requiring a day’s drive from Man. Although they often have no petrol for their motorcycle and little to no funding to help them sleep and eat in the field, they are not disheartened.

“Man is the capital of the region that borders Liberia and Guinea, which, as we speak, are suffering with the Ebola disease,” Koné says. “We're in a high-risk zone, because if we don't get the word out for prevention, we're going to see cases in Côte d’Ivoire – and this region is the most vulnerable.”

While border posts are officially closed, the border itself is extremely porous.

“There are families that live on one side and farm on the other,” says Koné. “Or they herd their cattle back and forth. For this reason, we must remain extremely vigilant. If we can get people to listen, to change their behaviour, we can make it.”

© UNICEF Video
Koné and Sialou speak with Dr. Joel Tri Ba at Man General Hospital, where as a precaution UNICEF has helped set up an Ebola treatment centre.

Back in Man, Koné and Sialou are finishing up a 45-minute conversation with Koné Lassana, a primary school teacher.

“Did you get the SMS?” asks Sialou.

“A few times,” says Lassana, as he reads back the message advising on not shaking hands, helping the sick or touching the dead.

“Even I keep getting them!” Sialou jokes. “You know, it’s hard for us to go to every house, speak to everyone. But now that we have shared with you, we are counting on you to share with others – you can save your friends and neighbours by telling them what you learned today.”

While the two social workers believe strongly in their social responsibility, the threat of Ebola is also personal.

“Every single person,” says Koné, “especially every person living in Côte d'Ivoire, or in a risk zone, must do everything they can to prevent this disease.”

Without the benefit of masks, without gloves, Koné and Kouamé are going door to door every day to warn against a highly contagious disease.

“When I look at my own family, I tell myself this is my motivation – to do everything so that the virus doesn’t come to my country,” Koné says. “It’s worth the risk.”



UNICEF Photography: Fighting the largest Ebola outbreak

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