At a nightclub in the Nigerian capital Saturday, nearly 500 miles from the nearest Ebola patient, two partygoers bumped elbows in what has become an alternative greeting to the handshakes that typically last well into a conversation.
The men then pointed at each other, acknowledging the funny new greeting – a response to the Ebola outbreak, which has infected 12 people and killed four in the past five weeks in Nigeria.
Nigeria has earned praise for moving swiftly to contain Ebola. But as the outbreak drags on, with two more diagnoses over last weekend, the public is increasingly tense as false information and simple realities complicate government response.
Ebola has killed more than 1,200 people this year, according to the World Heath Organization, in an outbreak it calls an international emergency. All but four of the deaths have been in Guinea, Sierra Leone, and Liberia. But health workers fear that a large outbreak in Lagos – arguably Africa’s most populated city – would pose a new level of threat.
Containment efforts have thus far been able to forestall that possibility, keeping the death toll very low. The government has launched a massive education campaign, and has tracked down hundreds of people who may have come into contact with the disease, according to Health Minister Onyebuchi Chukwu.
“Little has been said about the successful containment in terms of ensuring that it did not spread so rapidly as it has done in other countries,” he says as his staff passes out flyers with cartoon illustrations aimed at educating people about how to behave.
Indeed, the health threat has noticeably changed some longstanding practices. Just a few weeks ago, at crowded bus stations, for example, passengers would elbow their way on to minivans in what is jokingly called an “African queue” and pile in practically on top of each other. Now, travelers line up neatly and enter one by one, demanding that the normally overcrowded buses limit the number of passengers.
“Everybody is scared because they say you can get it through body contact,” says Alexander Akinwale, a passenger traveling around town trying to sell advertising for his magazine.
Even in upscale, rarely crowded neighborhoods, locals are wary. On a breezy, tree-lined street Monday night, the yoga instructor at an Abuja spa was taking students' temperatures and limiting her class to 12 people – though that wasn't even necessary, as many people were staying home of their own accord.
With the relatively small number of cases, many Nigerians are optimistic that a large outbreak may be averted altogether, preventing new pressures on Nigeria’s already flailing hospital system.
On a small scale, Nigeria has the facilities to isolate and treat Ebola patients, according to Dr. Aliyu Bappa, a pathologist and former Nigerian Medical Association chairman. But if it were to spread rapidly, the hospitals, which often lack regular running water, electricity, oxygen, and protective equipment, are far from ready. “Some places claim isolation rooms, and if you go there all you will see are empty rooms,” he says.
Public hospitals don’t even have doctors at the moment, says Dr. Bappa, as a national doctors’ strike that predated the Ebola outbreak enters its eighth week. Doctors say they will not return to work unless hospitals are upgraded. The union discussed calling off the strike because of Ebola, but ultimately is pressing on because, without more resources, they can’t do much to help, he says.
“We may get into a situation where even the hospital staff may run away,” Bappa says.
Preparations are under way to upgrade hospitals in response to the outbreak and to build isolation units in all of Nigeria’s 36 states, according to Minister Chukwu. But in many areas, residents say they don’t want contagious patients treated in their neighborhoods, and are hampering efforts both to upgrade hospitals or build isolation units, he says. If the public does not get on board, he fears protests or even violence.
Over the weekend in Liberia, men armed with clubs raided an Ebola ward, declaring “there is no Ebola” and looting the clinic, according to reports, potentially spreading the virus. Conflicting reports said as many as 30 patients either escaped, were carried away by their families, or otherwise disappeared. Some of the missing patients have been re-hospitalized, reports said.
The Liberian raid is largely blamed on fear of the disease and belief that it is a hoax. However, Nigerian youth leaders say it is not ignorance to assume that if an Ebola clinic opens in the neighborhood, it means either there are already Ebola patients in the area or there will be.
“I would keep away from that facility,” says Ayo Omolale, a political science student at the University of Abuja.
Rumors of false cures have also already killed as many people as Ebola itself as the government scrambles to dispel myths.
Almost every day, health officials speak publicly against whatever is the most recent “cure” fad. Still, before the latest suggestion could be squashed last week, four people died from drinking large amounts of salt water to stave off Ebola in cities hundreds of miles from the outbreak.
Even avoiding handshakes, which officials suggest but say is not entirely necessary, is raising tensions.
“Everybody is running away from each other right now,” Omolale says.