Going viral?

As Maritza Alvarez-Romero, 62, heads back to Guinea-Bissau, a small West African country nestled between Guinea and Senegal, she’s nervous. Like most in West Africa, she has watched as the deadly Ebola virus has spread. The hemorrhagic fever, passed through contact with bodily fluids, has killed more than 2,000 people since it appeared in Guinea last March. It has since spread to Liberia, Sierra Leone, Nigeria, and most recently, Senegal.

In August, Guinea-Bissau closed its borders with Guinea, and shortly after announced a nationwide “hygiene drive” that involves disinfecting public places every last Saturday of the month. Outside a market in the nation’s dilapidated capital, Bissau, President José Mário Vaz held a dustpan as he championed this effort. Soldiers fanned out into the city with rakes, brooms, and wheelbarrows.

Alvarez-Romero calls the cleanup effort “a good start.” But she says the country has a long way to go. Born in Costa Rica, Alvarez-Romero became an American citizen in upstate New York, where she taught high-school English for 30 years. Six years ago she moved to Bissau to serve as resident translator, liaison, and school principal at Casa Emanuel, a Christian orphanage on the outskirts of the capital.

Work often takes Alvarez-Romero into downtown Bissau. She describes trash strewn and heaped on red dirt streets. Chickens, goats, and pigs roam near open markets filled with shoeless children. While Ebola-stricken countries such as Liberia push for hand-washing, the practice is unheard of in Bissau, where only one in five people has access to tap water. Men and women urinate openly in the streets, and it is normal to contract rashes from dust and pig feces, Alvarez-Romero said.

These conditions have long been breeding grounds for malaria, cholera, and typhoid. Those with money often travel to Senegal or Morocco for medical care, as public hospitals offer little help. Poorly paid doctors and nurses sometimes steal donated drugs since they can be sold for profit to pharmacies. Patients pay for their own medications, and many times, “If a person has to choose between a malaria pill and a bowl of rice, they’ll choose the rice,” Alvarez-Romero said.

About 20 minutes from downtown, Casa Emanuel sits on four acres enclosed by a large iron gate and 1-foot-thick, white-washed concrete walls built originally to protect the 150 orphans from family members trying to kill them, believing they carry a curse. Founded in 1995 by Costa Rican dentist Isabel Johanning, Casa’s cleanliness, running water, and electricity—along with a hospital and K-12 school—attract many outsiders seeking education or medical attention.

Still, Casa’s challenges underscore the complexity of containing Ebola. Four on-staff doctors and nine nurses mostly treat pregnant women and newborn babies, but they try to help anyone who shows up in need. Visiting doctors, nurses, and students sometimes bolster the orphanage’s staff and supplies, but limitations are the norm. Alvarez-Romero and Casa’s medical staff worry about Ebola’s malaria-like symptoms and the 21-day incubation period that make detection difficult: “We know we’re not prepared to help someone with Ebola.”

Cultural traditions have long compounded viral containment at Casa. When cholera threatened the area in 2008, villagers were leery of Western medicine. Often they followed a witch doctor’s traditional cures and potions over the physician’s care. As in other West African countries, many families also follow strict burial procedures: Family members manually wash their dead before hosting a wake in their home, believing that those who fail to attend will be haunted.

The threat of Ebola has Casa taking precautions. If it hits, they may close the school and hospital in order to protect the orphans. “We’re human, so yes, we’re nervous,” Alvarez-Romero said. She finds strength each morning when the children line up before their classes and sing a simple tune: “Let’s give thanks to the Lord … for all He has given us.”