Doctors alone aren't enough to contain West Africa's deadly Ebola outbreak, which has already infected, and in some instances killed, key medical personnel, including prominent Western and local physicians.
Quebec doctor Marc Forget, who has been on the front lines of the epidemic in Guinea for seven weeks, told CBC News that past Ebola outbreaks were contained quite quickly with the intervention of international groups such as Doctors Without Borders working in conjunction with a country's ministry of health.
This time, he says, "the magnitude of the disease is unprecedented," and a stronger response is required, both in resources and personnel — including water, sanitation and logistics specialists, as well as medical staff.
Dr. Anthony Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases, says one of the big challenges facing the three West African countries fighting the epidemic is that "people are not seeming to even admit, in some cases, that there is a problem, not believing that Ebola is there.
"There have been some very unusual perceptions that it's the health workers that are actually bringing the Ebola in," Fauci said in an interview with TV2Africa.
He also cited the lack of resources for appropriate care and treatment, and noted that another challenge is that the disease is no longer clustered in small, underpopulated regions, but is now showing up in larger centres "where there's a high density of population."
The fast-acting Ebola virus produces a violent hemorrhagic fever that leads to internal and external bleeding, and has already killed over half those infected in the current outbreak, according to the World Health Organization.
As of July 23, the number of Ebola cases in West Africa reached 1,201, with 672 deaths.
The outbreak is devastating large areas of three countries. Guinea has had the most deaths, 319; Sierra Leone has had the most cases, 525; and hundreds are affected in Liberia as well.
Physicians infected
Currently, two Americans, Dr. Kent Brantly and missionary Nancy Writebol, are receiving treatment for Ebola in Monrovia, Liberia's capital. They are both with the American medical charity Samaritan's Purse.
Ugandan doctor Samuel Muhumuza Mutoro died from the virus on July 1 in Liberia.
So did Liberian government official Patrick Sawyer, who died July 25 in Nigeria, becoming that country's first Ebola case. (The hospital where he was treated is now under quarantine.)
On Saturday, Dr. Samuel Brisbane, one of Liberia's most high-profile doctors, died from the disease.
And in Sierra Leone, the top Ebola doctor, Sheik Umar Khan, is receiving treatment.
While these high-profile cases garner media attention, the World Health Organization says "stepping up outbreak containment measures, especially effective contact tracing," is what's now needed.
Quebec doctor returns from the battlefront
Quebec's Forget agrees. He left Africa on July 9, after working in Guinea for seven weeks with Doctors Without Borders, the main aid organization in that battle.
At night, Forget treated patients at the group's clinic in Guéckédou, the epicentre of the epidemic, then during the day he did outreach.
That requires responding to alerts when someone is sick in a village. Everyone who has been in contact with an infected person displaying symptoms is at risk, so Forget and his team needed to check the patient, do contact tracing and then follow up with those people.
For the patient, "If we have any suspicion, we bring him back in a special ambulance so he's isolated, and we explain to his family and the community why he needs to come to the centre," Forget told CBC News during a telephone interview from Montreal.
Outreach also requires that whenever someone tests positive for Ebola, it's essential to decontaminate their home. "We burn, for example, the mattresses, decontaminate the walls and everything with chlorine solution, so people can go back home safely," Forget explains.
Certificate of recovery provides reassurance
The Doctors Without Borders team also takes the few survivors back to their villages and give them a certificate of recovery to fight the stigma toward cured patients.
"If we don't give them any certificate of recovery, then it's sometimes very difficult. They are cured but then they are rejected from the community because people don't understand what's going on."
Forget says that in Guinea, "there's so much misunderstanding and fear about the disease" that community education is critical. "There's a lot of paranoia" about Ebola and even about the outreach programs.
Sometimes people "think it's a foreigner thing that was brought by Médecins Sans Frontières [Doctors Without Borders] and we're spraying the houses and we give them Ebola," he says.
"We faced resistance, we faced hostility. In some villages they completely shut down, they're throwing rocks at us, at ministry of health authorities, Red Cross workers."
Safe burial
Another challenge in trying to contain Ebola is the very strong cultural beliefs in that area of Africa.
As Forget explains, the No. 1 contamination risk is touching the body around the time someone has died from Ebola.
"They do rituals before they bury the body that involves washing the bodies and even, sometimes, sleeping with them, the dead person."
So after someone dies at a treatment centre, the Doctors Without Borders staff bring the family to the centre and do what they call a safe burial.
"We wash the body and we put them in a body bag, but with the zipper open so they can see the face, and we bring the body to the village," in conjunction with the Guinea Red Cross, Forget says.
"People can still do a burial process but in a safe way so they don't touch the body … they can still pray and perform ceremonies but without touching the body.
"When that is understood, things get easier for us," he notes.
Forget says he may return to Africa in October after working in Northern Canada, and hopes others will volunteer.