No Ebola, S'il Vous Plait, We're French: The Ivory Coast Mindset

Oct 29, 2014
Originally published on November 7, 2014 2:44 pm

There are all kinds of theories why Ebola hasn't arrived in Ivory Coast, despite the fact that it shares a long and very porous border with two Ebola-afflicted countries, Liberia and Guinea.

Some Ivoirians credit a beefed-up border patrol. The citizens in this country thank God. But Mumadou Traore, who works as a field coordinator for CARE International, has a third theory. He credits the legendarily infuriating Ivorian bureacracy.

French bureaucracy is a "blessing" for us, he says, because people here respect authority. Not like in Liberia and Sierra Leone, he says where people aren't obeying their own health officials.

"C'est mon opinion," he says with a laugh. "It's my opinion."

Traore's opinion doesn't quite hold water. Guinea, after all, is a Francophone country. And that's where the current outbreak began.

But in one way, Traore is onto something. Ebola spreads because of human behavior. I met him in in the central town of Bouafle, just near the country's prime cocoa-growing region. He was giving a training course for rural community leaders, telling them not to shake hands, not to kiss, not to eat bush meat — a popular delicacy — since some animals can harbor the virus and pass it onto humans through their blood.

These are all government directives in place since March. Government can't be everywhere in every village, but Traore believes that the people of the Ivory Coast are following orders.

Adjoua Martine traveled 74 miles to attend this training. She's a farmer of cocoa and rubber trees who lives in a small forest hamlet called Brokoua. Even in her tiny village, in a country that's Ebola-free, the pastors are preaching the government's prevention message. She mimes how she crosses her arms if someone starts to greet her.

You can't stop every person from shaking your hand, she says. But if they try, she tells them: The rules say we mustn't now do this.

Dr. Seydou Coulibaly is the regional health director of Tompki county, which shares the longest border with Liberia and Guinea. He says that in the first weeks of the outbreak, before official prevention directives were issued from the capital, he was telling clinics and hospitals to send him daily Ebola watch reports. He gets a hundred a day. Even before the borders were sealed, he was sending health workers to take people's temperature when they crossed. He's also arranged trainings for schoolteachers and soldiers.

All these efforts will help, he says — maybe not to prevent the virus from coming to the country but at least the first eventual case will be well-managed. That's the main objective.

Coulibaly says his county is far from ready for an outbreak of the magnitude of neighboring countries. There's not enough protective gear for health workers and not enough ambulances to bring patients to isolation centers.

But they are watching for signs of Ebola with remarkable vigilance. The government has set up a hotline number for anyone who suspects they or someone has Ebola. It's a measure of the degree of commitment — or perhaps just fear — that every time I've called I've gotten a busy signal.

If Ivory Coast has turned itself into a nation of spies and informers, Coulibaly says that's a good thing, even if every Ebola alert so far has turned out to be just a rumor.

People will often call to say, "Well, I haven't seen him for a while, so he must have been in Guinea. And heck he's not feeling well, so he certainly has Ebola!" To Coulibaly, this means that the authorities will quickly be informed if and when there is a case.

It's not clear what happens to a Guinean who crosses the border illegally. The local representative of the Guinean community told me that border crossers are immediately sent back. In some cases, Coulibaly says, such individuals are quarantined until Ivory Coast authorities are sure they're not the dreaded, and expected, first case.

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Transcript

MELISSA BLOCK, HOST:

Ivory Coast shares a long and very porous border with Guinea and Liberia, two of the countries at the heart of the Ebola epidemic. Border crossings are officially closed, but it's impossible to truly seal a border that's mostly forest and fields.

We sent NPR's Gregory Warner to Ivory Coast to find out why Ebola hasn't yet come there and how the country is preparing in case it does.

GREGORY WARNER, BYLINE: There are all kinds of theories why Ebola hasn't arrived yet in Ivory Coast. Some credit a beefed-up border patrol. The religious in this Catholic country thank God. But Mumadou Traore has a third oddball theory. He credits the legendarily infuriating Ivorian bureaucracy.

MUMADOU TRAORE: (Speaking French).

WARNER: French bureaucracy is a blessing for us, he says, because people here respect authority. Not like Liberia and Sierra Leone, where he says people aren't obeying their own health officials.

TRAORE: That's my opinion.

WARNER: Traore's theory doesn't quite hold up. Guinea, after all, is a Francophone country. It also has the disease. But in one way, Traore is onto something. The Ebola epidemic, after all, only spreads through human behavior. Traore is a field coordinator for CARE International. I met him in the central town of Bouafle giving a training course for rural community leaders, telling them not to shake hands, not to kiss, not to eat bush meat - a popular delicacy. These are all government directives in place since March but government can't be everywhere in every village.

Adjoua Martine traveled 74 miles to attend this training. She's a farmer of cocoa and rubber trees. She lives in a small forest hamlet called Brokoua and even in her tiny, isolated village in a country that's still Ebola-free, the pastors in her church are preaching the government prevention message. She mimes how she crosses her arms if someone even tries to greet her.

ADJOUA MARTINE: (Speaking French).

WARNER: You can't stop every person from shaking your hand, she says, but afterwards, she tells them the rules say we mustn't now do this. Dr. Seydou Coulibaly is the regional health director for Tompki County. It shares the longest border with Liberia and Guinea. He says that even in the first weeks of the outbreak, before the official prevention measures were issued from the capital, he was telling clinics and hospitals to send him daily Ebola watch reports. He says he gets a hundred a day and even before the borders were sealed he was sending health workers to take people's temperature when they crossed. He's arranged trainings for school teachers and soldiers.

SEYDOU COULIBALY: (Through translator) This will help. Maybe not to prevent the virus from coming to the country, but, at least all these efforts are made so that the first eventual case will be well-managed. That's the main objective, the management of that first case.

WARNER: Coulibaly says they're still not ready for an outbreak like their neighbors have. There's little supply of protective gear in this country and few working ambulances, but vigilant watching is the name of the game. The government has set up a hotline number for anyone who suspects they or someone they know has Ebola. It's a measure of the vigilance or maybe just the sheer panic in this country that every time I've called that hotline, I've gotten this - a busy signal.

(SOUNDBITE OF BUSY SIGNAL MESSAGE LOOP)

UNIDENTIFIED WOMAN: (Speaking French).

WARNER: But if Ivory Coast has turned itself into a nation of worriers and informers, Dr. Coulibaly says that's a good thing, even if every Ebola alert so far has been a rumor.

COULIBALY: (Through translator) People call us to tell us that this person or that person, they're new and they must've come from Guinea and they don't feel well - certainly, it's Ebola. It means that when there is a case of Ebola eventually, we'll know right away.

WARNER: If a Guinean is discovered to have crossed the border illegally, it's unclear what exactly happens to him. The local representative of the Guinean community told me that they're immediately sent back, but Dr. Coulibaly says in some cases they're quarantined until authorities are sure that they're not the dreaded and expected first case.

Gregory Warner, NPR News, Man, Ivory Coast. Transcript provided by NPR, Copyright NPR.