How the Ebola outbreak became the worst on record

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By Africa correspondent Martin Cuddihy

It has been one of the biggest stories of 2014 and it does not look like it is going anywhere.

The Ebola crisis in West Africa has killed thousands of people and it will continue to do so in 2015.

Given the Ebola story has been a constant on the news for the best part of a year, some of the interest has gone. But ignoring the disease is fraught with danger.

On a US talk show recently, White House Ebola response coordinator Ron Klain warned the world against complacency.

“I think we’re nearing a pivot point in this, where the number of new cases overall in West Africa has somewhat stabilized,” he said.

“But this won’t be done until we get all the way to zero. It’s like a forest fire: a few embers burning, and the thing can reignite at any time.”

A stark warning for an indiscriminate killer.

Scientists now believe the first Ebola victim was a two-year-old boy who caught the disease after playing either in or near a tree that housed a colony of bats.

From there he passed the virus onto his family and then to health workers in Guinea.

They then passed it onto their own families and thus the cycle began.

Ebola spread rapidly from country to country

What helped this become the worst ever outbreak of the disease was the fact the haemorrhagic virus was not identified as Ebola until late in March.

This gave it time to get embedded in the population – dense, hygiene poor rural parts of both Guinea and Liberia. From there it spread to Sierra Leone.

Initially the global response was subdued. Ebola was not a new story.

After all, there have been a few major international stories this year: Syria, Ukraine, and various disasters involving planes.

The deputy director of the US Centers for Disease Control in Kenya, Dr Joel Montgomery, has been to West Africa a few times this year.

Dr Montgomery helped to establish new offices in the three hardest hit countries.

When the outbreak was at its worst, in late August and early September, he was there.

“When I arrived it was just a complete and utter disaster. It was very much like a nightmare,” he said.

“Seeing people actually die in the streets from Ebola. It was actually very devastating and very difficult to witness.”

He paints a grim picture and has repeated the warning of Mr Klain about not becoming complacent.

Most experts believe it will be months, at the very least, before transmissions drop to such a point that the worry can dissipate.

Dr Gavin Macgregor-Skinner, an expert in public health and emergency medicine who has also spent time in West Africa this year, says the global response has failed the region.

“We’re not dealing with this as an ongoing public health emergency. And that’s been a huge failure.”

Cultural practices and superstition key to Ebola spread: medic

It is a multifaceted problem. Compounding issues of poor infrastructure and the slow response by the international community are local superstitions, traditions and a lack of access to basic health services.

A lot of communities hold superstitions in regard to the Ebola detection teams.

People do not realise that soap and water are the best defence, and they sometimes seek help from religion and traditional healers before seeing a doctor.

Liberia’s chief medical officer Dr Bernice T. Dahn said cultural practises would have to change to beat the virus.

“For the cultural practices, it’s not a matter of banning it, it’s a matter of behaviour change, behaviour change communication,” Dr Dahn said.

“If you ban it, it could go underground and it could make things worse. So it’s a matter of educating people, people understanding why things should be done right and not be done the wrong way, and they’ll change behaviour.”

Changing these cultural practices will take time and that means the disease keeps re-emerging in areas that have been declared Ebola free.

“We’re seeing the virus circulate between the three countries. So where one area had beaten Ebola they’re now getting new cases in,” said Dr McGregor-Skinner.

“Until we change our intervention, until we change our strategy, until we use all the tools in the toolbox, we are going to keep seeing … this Ebola virus circle amongst the three countries and we’re going to keep seeing cases pop up.”

Until that stops, the Ebola crisis will continue and you might be reading an iteration of this article this time next year.