Why Ebola Has Spread So Far and Fast in West Africa

By Edward K. Chapnick

The questions of why and how Ebola has spread so far and so fast in West Africa during 2014 are the subjects of much debate and analysis. Among some of the answers are the following:

  • Poor infrastructure: This part of the world doesn’t have a well-developed infrastructure. Things such as running water, sanitation, and healthcare systems are severely lacking. For example, the number of physicians in the affected countries was one to four per 100,000 people before the onset of the Ebola outbreak, which made it impossible for doctors to get control of the outbreak, even from the beginning.

  • Inexperience: Although some countries (like Nigeria) have had experience with responding to large epidemics, many other countries (like Liberia) haven’t had experience.

  • Delayed response: The global healthcare leaders and policy makers didn’t agree quickly enough with Doctors Without Borders that the epidemic would or could be as big as it is, and therefore, response was delayed.

  • Urban areas affected: In addition to remote, low-density villages, the outbreak has hit high-density urban areas. This is different from many of the outbreaks in the past. Urban areas contain more people that live closer together, are more mobile, and interact with each other at a higher frequency than remote villages do, enabling the virus to spread even faster.

  • Cultural divide: Local residents and westerners typically have significantly different cultural values. Many locals’ beliefs (especially concerning sickness and death) cause them to not abide by directives given by health officials. Many locals believe that the cause of this sickness and death isn’t a virus that can be treated or prevented, but rather black magic.

    Many locals who were ill or who had sick family members rather would seek the help of a local healer or witch doctor than a western physician. Treatment by these healers proves to be fatal in most cases, because Ebola patients require intensive medical care to have a reasonable chance at survival.

    Western physicians frighten many locals who view the physicians as taking away their loved ones where their loved ones often end up dying. (If they do attempt to receive medical help, Ebola patients often wait too long to seek it, severely limiting their chances for survival.)

    Additionally, the care provided in many of the local understaffed, poorly equipped, and overcrowded hospitals isn’t adequate to treat these seriously ill people. Locals then make the faulty (but understandable) deduction that the doctors are killing their people.

    Furthermore, the western approach of isolating Ebola patients to treat them harshly conflicts with many West African beliefs surrounding illness and death, which involves extensive contact with the sick and dying.

    Additionally, people in these areas are naturally skeptical of government and authorities, given their past with intense civil war and corruption, and won’t even let western health officials be in their homes or villages.

  • Hopelessness: With such a high fatality rate, some people don’t think there’s any point in going to a hospital, because they think death is inevitable.

  • Fear of hospital germs: The loved ones of sick people don’t want to take them to the hospital for fear that they will contract Ebola from the hospital.