In Guinea, the epidemic isn’t just killing people. It’s threatening to tear the country apart.
- By Peter Tinti<p> Peter Tinti is a freelance journalist based in Mali. Follow him on Twitter at @petertinti. </p>
GUÉCKÉDOU, Guinea — Thérèse Moundekeno was a pharmacy student in Conakry, Guinea’s coastal capital city, when she received a phone call in April advising her to do everything possible to come home to Guéckédou, a city deep in the country’s southeastern Forestière region. It was the latest in a string of bad news for Moundekeno, whose sister and brother-in-law had died of a mysterious illness weeks earlier. Now her mother had fallen sick. By the time Moundekeno could leave school and make the daylong trip back to Guéckédou by public transport, her mother was dead.
When she arrived at the hospital, a doctor with the organization Doctors Without Borders (Médecins Sans Frontières, or MSF) refused Moundekeno’s request to see her mother’s body. "He told me the same virus that killed your mother can kill you," she recalls.
For her mother’s funeral, Moundekeno says she had little choice but to eschew local traditions and her religious beliefs, which would require her to clean and dress her mother’s body before burying it. It was an agonizing decision, made all the more painful when she saw her mother’s cadaver loaded into the hospital vehicle in a graceless body bag rather than vibrant traditional fabrics.
"When the vehicle arrived at the cemetery, everyone dispersed," Moundekeno says, holding back tears. "Everyone."
"Who is going to help me bury my mother?" she asked the few remaining onlookers. No one answered. The driver, an older man who wouldn’t normally be tasked with that type of labor, took pity on her and grabbed a shovel. Two nurses from the hospital also pitched in. "The way she was buried bothers me so much," Moundekeno says, "but I could do nothing!"
"My mother was one of the first confirmed cases of Ebola," she adds. "Before that, the disease that was killing everyone was not known."
In just about any other time and just about any other place, Moundekeno’s story would be an exceptional one, but here in the Forestière region of Guinea, where the Ebola outbreak began in March and has since spread to five countries, infecting more than 7,000 and killing more than 3,000, the outliers are those who have not lost a friend or loved one.
The unprecedented epidemic has the Centers for Disease Control and Prevention (CDC) in Atlanta concerned that hundreds of thousands could die from the disease before the outbreak is brought under control. With borders closed, quarantines imposed, and West African economies left in shambles, there is also a growing fear that what began as a public health crisis is quickly morphing into a full-blown catastrophe for Guinea, Sierra Leone, and Liberia, countries already struggling with poverty, the ravages of past civil wars, and other enormous development challenges. In the case of Guinea specifically, recent attacks targeting health workers have sent shock waves through the country, reinforcing fears that the longer the Ebola crisis continues, the greater the possibility that it could tear apart a social fabric delicately woven along ethno-political lines.
To the untrained eye, Guéckédou might seem like a remote, inaccessible city in Guinea’s interior. The decrepit roads that lead to the Forestière region mean it can take hours for a car to travel just 100 kilometers on certain stretches. Mud-brick houses with corrugated sheet-metal roofs dot an undulating green expanse, offering idyllic vistas that often serve as the backdrops of Western imaginations — and stereotypes — about West Africa.
But the muddy streets and shoddy buildings should not obscure the fact that towns like Guéckédou are cosmopolitan, where people from all over the region plug into the global economy. Traders from a mosaic of ethnic groups and nationalities shuttle back and forth across borders, engaging in commerce and finance and linking consumers with goods from all over the globe.
The transnational nature of the Forestière region, which shares long, porous borders with Liberia and Sierra Leone, underscores just how different this Ebola outbreak is from its antecedents in central Africa. During those crises, the bulk of the outbreaks were in relatively remote areas, enabling local health officials and the international community to get out in front of an epidemic before it could sufficiently spread beyond those unfortunate communities. This crisis, however, requires a coordinated effort across three countries, each with its own sets of challenges and sociopolitical peculiarities.
During Guinea’s first three decades of independence, gained in 1958, President Sekou Touré set out to dismantle what he considered "backward" traditional leadership structures, such as secret societies, in the Forestière region as part of a haphazard attempt to consolidate state control over the area. Regardless of his intent, Touré’s policies proved divisive, privileging certain ethnic groups over others. The introduction of multiparty politics in 1993 ushered in Guinea’s first real foray into semicompetitive electoral politics, but with few traditional organizing principles in the Forestière left intact, it also paved the way for political rivalries to form along ethnic lines and over questions of ancestral claims to the region.
In the early 2000s, protracted civil wars in neighboring Liberia and Sierra Leone brought refugees, rebels, and violence over the border and into the Forestière region. The legacy of these conflicts can still be seen in towns like Guéckédou, where countless signs and placards installed by NGOs and foreign governments advertise peace-building projects. Guinea has demonstrated a remarkable ability to take a collective step back every time it seems on the brink of collapse, but the tenuous peace that exists at the macro level cannot hide the extremely violent, internecine flare-ups that are a regular occurrence in many communities throughout the country.
The Ebola crisis has not been spared from these often-toxic domestic politics. Many Guineans, especially during the onset of the epidemic, believe that Ebola is a convenient pretext for sitting President Alpha Condé, who they say will use the crisis as an excuse to delay presidential polls in 2015. Others have insisted that the crisis is part of a broader conspiracy by former colonial master France and powerful mining companies, which locals believe prefer to keep Guinea too weak to stand up to meddlesome foreign powers.
In April, an MSF Ebola center in the Forestière town of Macenta was attacked by an angry mob that had accused aid workers of bringing Ebola to Guinea. Although no one was seriously hurt, the attacks prompted MSF to temporarily shut down the facility. At the time, government and health officials attributed the incident to failures of communication and to ignorance, which could be overcome through raising awareness and a more delicate approach in dealing with affected communities.
Things took an even more insidious turn three weeks ago when, on Sept. 16, a mob armed with machetes and stones ambushed a delegation of people working on Ebola near N’zérékoré, Guinea’s second-largest city and the largest in the Forestière region. Afterward, eight bodies of delegation members were found in a septic tank. In interviews, several survivors corroborated key details, but few were willing to speak on the record due to the highly sensitive nature of the incident. One exception was Christophe Millimono, the director of Radio Rurale in N’zérékoré
Millimono recounted a harrowing story in which community leaders in the subdistrict of Womey received the delegation, which consisted of high-level health officials, government administrators, a preacher, and journalists. Having been welcomed into the area by local leaders, Millimono and his cohort were soon overwhelmed by a violent mob. According to Millimono — who cited strategic road blockages, the simultaneous arrival of the attackers, and the hail of stones that suggested they were collected in advance — the ambush was premeditated.
"It was planned and coordinated," Millimono says. "This was not against Ebola. If it was against Ebola, they would have never received us," he continues, suggesting there may have been other political motives beyond the attack. "I don’t know who is responsible for this."
In the days following, local and national politicians took to the radio and local papers to blame their rivals for the incident. Much like the virus itself, the politics of Ebola have proved alarmingly contagious and threaten to undercut the country’s response to the outbreak.
Countering false narratives about Ebola, including the notion that it does not exist, is a critical ingredient to ending the epidemic, and few voices are better placed to educate others than those who have personal experience with the disease. Despite the fact that the current Ebola epidemic is the largest in recorded history, surpassing all other Ebola epidemics combined, the death rate among those infected in Guinea, as far as public health officials can tell, is considerably lower than those in previous outbreaks in central Africa. Whereas previous death rates often reached a startling 90 percent, Guinea is hovering around 50 percent. The comparatively lower rate, while still grim, means there are more survivors to share their story.
One such survivor is 12-year-old Rosaline Konanio. Bright and soft-spoken, with short-cropped hair and long eyelashes, Rosaline recounted her story as one of the first survivors of the Ebola virus in Guinea.
"I caught the disease from my grandmother, who was infected when she went to a funeral at a village," Rosaline says. "I vomited. I had diarrhea. I had a fever, and my body was in pain." Rosaline was taken to the hospital, where she received what she describes as "marvelous" treatment from local medical staff supported by MSF.
Rosaline’s grandmother and several other women in her family were not so lucky: They all died of Ebola within days of each other. Robert Komano, who lives just a few houses from Rosaline, was married to one of those women for 29 years. She was already sick with the disease by the time MSF reached Guéckédou, and she died only a few days later.
People like Komano, Rosaline, and Moundekeno who have firsthand experience with Ebola are in many ways foot soldiers on the front lines of what has become a hearts-and-minds campaign against an unsentimental and faceless enemy. "I had heard people talk about Ebola before, but in the Congo. It had not arrived in Guinea," Komano says. "Truly, I did not know the danger of this malady because I had never seen it. I only heard about it on the radio." Komano’s message to anyone who will listen is straightforward: "This malady exists, it is serious, and it is very important to take every precaution."
For her part, Moundekeno says, "When I hear people say that this virus does not exist, I have nothing to say."
"I tell them, look at my foyer," she continues, motioning toward her empty stoop. "It is only me who is left."