Village where the deadly curse of Ebola lives on
West African community still in fear of killer disease amid alarming evidence of how it is spread
The villagers hack a path for us through a dense tangle of leaves and vines towards the decayed carcass of a once great tree. It is on this exact spot in the depths of Guinea’s vast southern forest that the west African Ebola epidemic is believed to have started exactly 10 years ago.
Local legend goes like this: in late December 2013, two young boys were playing at the base of a giant hollowedout tree when they heard a noise from within. They lit a fire and smoked out a roosting colony of bats – many fell into the flames.
Charged by their village with scavenging food, the boys took the bats home where they were cooked and eaten. There was no way of knowing that the creatures were infected with a pathogen that kills 50 per cent of the people it infects.
“We were told this is where the Ebola virus came from,” says Kekoura Lemo, the former chief of Meliandou, pointing to the tree – which was burned by the villagers when its link to the outbreak later emerged.
“When it started, I was very scared as the leader. You see people dying in your village and then the next person and the next. You’re helpless. We had so much death.”
Beside him is 11-year-old Felix Ouamouno. He was just one when the virus spilled out of the forest and tore through Meliandou, killing 25 people. Among those who died were his mother, sister, aunt and grandmother – he survived only because he was separated from the sick. “I wish I could remember them,” he says. “Another family has taken care of me since.”
The village – an impoverished clustering of mud-brick huts without any sanitation or power – was Ground Zero in an Ebola outbreak that would go on to become the worst in history. Between December 2013 and June 2016 nearly 30,000 people were infected and 11,000 killed across West Africa. Liberia, Sierra Leone and Guinea were hardest hit.
Even today, the grim legacy of the epidemic lives on. Sporadic outbreaks have occurred ever since – and experts now believe it is lingering in an unlikely source: the testicles of male survivors.
Two years ago, the virus re-emerged in Guinea – killing 12 people and infecting 23 – and was eventually traced back to someone who had survived the West Africa epidemic and transmitted it via their semen to a partner. The finding, based on genetic sequencing of patient samples, shocked researchers. Prior to then, the longest the virus had been known to persist in a survivor was 500 days.
Prof Miles Carroll, an infectious diseases expert at Oxford University’s Pandemic Sciences Institute, is conducting research into how the Ebola virus replicates in former patients and how long it can survive. “It’s shocking that the virus can persist for so long in the testes,” he says. “This is extremely high risk.”
The race is now on to unpick this
‘When it started I was scared ... you see people dying in your village ... you’re helpless. We had so much death’
scientific puzzle, and ensure the catastrophe which unfolded 10 years ago is not repeated.
The town of Guéckédou, a ragged maze of tin-roofed houses and bustling market streets in south Guinea, carries a dark past. It was here, in the final weeks of 2013, that a sudden wave of sick patients were rushed to hospital, brought from Meliandou and other villages of the surrounding forest, only to expire in bloodied rags. At the time, health officials did not know what was behind the illness. Amid the mounting hysteria that rippled through Guéckédou in those early days, there were reports of the dead being piled high in store rooms and later thrown into mass graves. It took nearly three months to identify Ebola as responsible. By that point, it was too late; the virus had been exported into neighbouring Liberia and Sierra Leone, in what was the beginning of its onward journey through West Africa.
By the time the epicentre of the outbreak shifted away from Guéckédou, in July 2014, hundreds had been infected and died.
Saa Kamano, 46, was one of the lucky ones. He survived his encounter with Ebola after weeks in hospital. “I’m blessed to be here today,” he says.
He is sitting outside the front of Guéckédou’s dedicated infectious disease hospital, rebuilt in the aftermath of the epidemic, but the topic of discussion is not his fight with one of the world’s deadliest diseases or how close he came to death. It concerns what happened next.
After being discharged, Kamano was given a small supply of condoms and told that, even though he was no longer testing positive for Ebola, there was a chance that viral remnants from the infection might still appear in his semen. He was told these RNA fragments would disappear after six months, then after nine months, and then after 12 months.
Kamano’s first marriage broke down in the months after his recovery from Ebola due his then wife’s fear he could be infectious. He still does not know if he has fragments of the virus in his testicles. Given the re-emergence of the disease in 2021, triggered by a survivor much like him, the uncertainty surrounding his own status is a constant worry. “It’s like you’re wounded psychologically,” he says. “It was difficult having this conversation with my new wife at the beginning.” So far, there have been no scares with his wife, indicating that Kamano is free of the virus. But there is no guarantee.
One theory, held by Prof Carroll and others, is that the sexual transmission of Ebola is linked to “extramarital affairs” or new sexual relationships because these partners may not have been exposed in the past to the disease, and therefore lack immunity. Some have suggested that the 2021 Guinea outbreak was the product of an affair, though, perhaps unsurprisingly, there is no evidence to support this theory.
Of those who survived Ebola, only 10 per cent were shedding the virus a year after their infection and, nearly a decade on, a further 5 per cent of this sub-group could possibly be harbouring the virus. “Roughly” half of the survivors are male – not all of whom will be sexually active – which means there is a very small number of men who have the potential to trigger another outbreak.
The fear of what has been has not faded from the village of Meliandou. Here, the horrors of the past remain raw, carried by those who lived through the worst days of the outbreak. Of all those who suffered, Etienne Ouamouno’s story is among the most heartbreaking. His family was the first to be infected. He lost his son, aged two, his three-year-old daughter and then his pregnant wife. Her passing – bloody and catastrophic – came last, and probably served as a super-spreading event.
Today, the villagers of Meliandou do what they can to keep safe from the continuing threat posed by Ebola, which is known to circulate in local bat populations and was present in the region long before the start of the West Africa outbreak. Bats and other high-risk bushmeat are no longer eaten and better hygiene standards are practised, with people reminded every Saturday morning to “keep their homes clean and wash their hands with soap”, says Catherine Lemo, the village’s dedicated health worker.
However, Meliandou remains deeply unprepared for future outbreaks. The village health centre, no bigger than an oversized shed, lacks basic drugs such as antibiotics and paracetamol. It doesn’t have a water tank, sinks or an incinerator to burn bio-waste. Solar panels don’t even provide enough electricity to power the lights at night. And there are no forceps to help deliver babies.
“We want everyone to remember what we went through,” says Mr Lemo. “Otherwise, we risk it happening again.”