Inside Cameroon’s battle to stay Ebola-free

At the border town of KyoEssi, where three Central African countries meet, the torn and peeling remains of posters warning the public about the risks of Ebola still line the walls of schools, hospitals and other surfaces with public exposure, two years after they were put up.

                In 2015, as the worst outbreak of the Ebolavirus Disease (EVD) in history spread across four West African countries, including Nigeria just next door, public health officials flooded this teeming tripoint with thousands of poster messages as part of a campaign black out the epidemic.

                UN agencies like the United Nations Children Fund (UNICEF) and the World Health Organization (WHO) supported the Ebola prevention and readiness effort, providing billions of francs in technical and material support. The United States Agency for International Development (USAID) funded the intervention.

                Today, all but a few posters have either been torn off or become too old and faded to keep on the walls. But the few that have survived age and cycles of sun and rain testify to the initial urgency of action expressed in 2015, when the minister of public health Andre Mama Fouda came to the city to launch the anti-Ebola campaign.

                In addition to printed messages, some of which contained images of people showing Ebola symptoms and others with preventive actions like proper hand washing with water and soap, officials set up Ebola response squads and protocols in hospitals, stocked protective gear, trained health workers and sent women and youth leaders into the communities with megaphones.

                The program covered up to seven of the country’s ten regions, which authorities considered “potential hotbeds” of the Ebolavirus, because of the existence of natural factors that increase the likelihood of an outbreak and loose border open to free circulation of people and animals.

                In the time being, the response appears to have paid off. Cameroon has remained Ebola-free in spite of the high epidemiological risks in the country, a year since the end of the West African outbreak that killed more than 11,000 people.

                Across the South region, where some of the work was concentrated, almost everyone you talk to knows a thing or two about Ebola: how it is contracted and how to prevent it. Health workers have learned to systematically sterilise their tools and work areas, says DrSeverinMetoug, a member of the regional Ebola task force. Hunters, at least, know that it is risky to pick up dead animals from the forest and bring home.

                But officials worry that without any real test to the robustness of the region’s readiness, it is hard to tell how well the health system and the public would handle an Ebola outbreak.

                Risky practices like interacting with and consuming wildlife products are still rampant in spite of the wealth of knowledge, it emerged from interviews. Many communities still clean and embalm their dead traditionally, which can become a major factor of human to human transmission in the event of an outbreak. Proper handwashing is far from a commonplace activity.

                The campaign also appears to have been limited to urban centres. Community leaders drafted to animate public discussions and door-to-to door meetings lack the resources and means of transportation to go further than their neighbourhoods and towns, says Nathaniel Abang Moussa, the delegate of youth affairs in KyoEssi.

“Rural communities are more at risk,” Moussa says. “They are the ones who bring bushmeat to the cities before returning to their villages. We need to find a way to reach them.”

                With no outbreak so far, the campaign is becoming harder and harder to sustain. Ebola has remained a distant and abstract problem in the public conscience and, with time, scepticism has taken root.

                For many, Ebola is a pretext to stop people from eating bushmeat, says MarcelleZimbi, a communication adviser and member of the anti-Ebola team at the regional public health office in Ebolowa. Dealers have chased away anti-Ebola campaigners from the bushmeat market many times, she said.

                Such scepticism and the apparent dissipation of the initial urgency of two years ago appear to be the biggest threat to the anti-Ebola effort appears to be a major threat to keeping the country Ebola-free.  “The message needs to keep going out for a long time,” says Metouk.