DANDANO, Guinea — “Bring out your sick!” the chief shouted angrily at the crowd, shaking his fist and warning of illness and death for the whole village if it did not obey.
“Don’t hide them,” he yelled. “If you don’t expose them, you will suffer!”
Slowly, haggard and dazed, a procession trudged to the muddy village center — a student, a minibus driver, a 5-year-old girl and farmers — with bloodshot eyes betraying the symptoms of Ebola. They walked with two village elders flanking them at a wary distance. The crowd edged away fearfully.
Then something just as unusual happened: A Red Cross team went to work freely, tossing water bags to the sick, sheathing them in plastic robes, rubber gloves and face masks. They were taken away down a rough dirt road by a waiting ambulance.
“There are many, and they are still hidden,” said a Red Cross nurse, climbing in.
This remote, mountainous part of Guinea is where the world’s worst Ebola outbreak began nearly a year ago, in villages hidden by dense forest, high reeds — and a long history of resistance to the distant central government.
Throughout the epidemic, villages like this one have been steadfastly cut off from the outside world. Residents have killed local officials proselytizing about Ebola, blocked barely passable roads with trees and vehemently refused help from outsiders, viewing them — in their moon suits of protective gear — as propagators of the virus.
But now, in Guinea’s inaccessible Forest Region, where staunch resistance has stymied efforts to fight the outbreak since its inception, villagers are finally opening up, surrendering their sick and dead.
“We said ‘no’ because when there is a situation where you don’t know the details, you resist; we were afraid,” said Lavillé Sakovogui, one of the village elders here.
But villagers kept dying. The region has been battered by the virus.
“We are in a crisis here,” said the village chief, Siba Koevogui. “You’ve got to send help.”
“It is out of control”
The consequences of resistance have been disastrous. Though the refusal to acknowledge and help fight the disease appears to be dissipating, health officials and local authorities say, the resistance has done its work, allowing the disease to spread unchecked.
After so much time, the work of tracking down Ebola victims and everyone who had contact with them — the traditional method for halting outbreaks — has become all the more difficult.
“Since these villages have been closed for such a long time, it is out of control,” said Sara Tomczyk, an epidemiologist for the U.S. Centers for Disease Control and Prevention in the district capital, Macenta, three hours away on a bad road.
At first, the region’s resistance was passive, borne of fear.
“The people could just go hide in the bush” to avoid health workers, said Pascal Piguet, a Doctors Without Borders official in the adjoining district, Guéckédou, where the outbreak was first identified in March. “They thought we were the vectors.”
But the outbreak, instead of petering out in the spring, as many international health officials believed it had, continued coming in waves, intensifying the residents’ distrust of the government and international health workers. Soon, their resistance turned into something more violent.
Vehicles belonging to Doctors Without Borders were pelted with stones. In September, eight officials and local journalists, part of a delegation sent to warn of Ebola’s dangers, were killed by a mob in the village of Womey, the dismembered bodies dumped in a septic tank.
In another village, Koyama, the highest-ranking district official was held hostage for hours under a hail of stones.
It became impossible for the Red Cross and other international teams to enter villages to retrieve sick people or bodies.
Bad relations
A long, tense history of antagonism with the government fueled the clashes. The state tried to stamp out traditional religious practices in Guinea’s Forest Region in the 1960s and 1970s, seeding a hatred that still festers.
“State officials went from village to village, burning masks used in initiations and village sacrifices,” Mike McGovern, a University of Michigan political anthropologist, wrote in the book “Unmasking the State: Making Guinea Modern.”
Now, with the Ebola epidemic refusing to go away, the tide of resistance appears to be turning. Transmission of the disease is still “persistent” and “intense” in Guinea, the World Health Organization said in its latest report, and there have been more than 1,000 deaths.
The district in which the village of Dandano is situated, Macenta, is the worst-hit in the country.
It is too soon to say whether the new change in attitude, fostered over weeks of negotiations, will make a difference.
“When they open, they open slowly,” said Michele Telaro, the Doctors Without Borders leader in Macenta.
But it is clear to officials that there is little hope of fighting the disease until the distrust is overcome.
“The greatest danger is this reticence,” said Dr. Daniel Yota, the WHO leader in Macenta. “In three weeks, we could contain it, if every village opened up.”
Amara Cissé, an elder in another village in the Macenta district that has opened in recent days, stood in front of solemn-faced residents recently and said: “We were wrong. But we didn’t understand the cause of this sickness.
“We refused them [health officials], because of what was being said; people said that if you send 20 away, 19 would die,” Cissé said, referring to the low survival rates of people with Ebola.
In Dandano, it took a quick succession of deaths through October to overcome the resistance. Barely a month ago, people in the village were burying unprotected bodies themselves, barehanded.
Now, open, darkened doorways in the village spoke to emptied houses: The occupants had fled into the bush in fear of the disease.
“I’m afraid, and everyone I know is afraid,” said Sagno Marah, a 38-year-old gold miner, as the chief harangued his flock in the center of the village.
In less than three weeks, at least 15 people in Dandano, population 2,000, had died.
With a constellation of remote villages off the radar of surveillance, health officials are convinced that the disease is simmering in places they have not yet reached. One rainy night this month, a motorcycle taxi deposited a middle-aged woman on the steps of the hospital in Macenta. The driver fled.
The woman bent over on the steps, breathing heavily and uttering sharp cries. When she got up unsteadily, the hospital workers on the porch scattered. Doctors Without Borders workers carried her off in a stretcher.
She had just enough strength to say she had come from a village on the Liberian border, hours away on dirt roads. Later in the evening, she died.