Dr. Barbara Marston of the Centers for Disease Control and Prevention provides an Ebola update at Georgia State University.

The key to turning the tide in the fight against Ebola in West Africa hasn’t been merely deploying more health workers or aid money; it has been community cooperation, a top medical official coordinating the American response said in Atlanta.  

“The way to protect America from Ebola is to control the outbreak in West Africa,” said Barbara Marston, an infectious diseases specialist who oversees the Centers for Disease Control and Prevention‘s outreach in the heavily affected countries of Liberia, Guinea and Sierra Leone. “Every bit of this has to be with community engagement.”

Health workers have found themselves working closely with political and religious leaders to find culturally sensitive ways to change long-held habits that contribute to the spread of the disease, which has killed nearly 8,500 during the most recent outbreak. 

Washing bodies of the deceased, for instance, is a cherished rite, but the process puts caretakers at risk of contracting Ebola. Still, underlying spiritual beliefs are so strong that family members sometimes aren’t deterred. 

“Many members of the population think that an Ebola death would not be as bad as an improper burial,” Dr. Marston said during a Jan. 13 speech at Georgia State University, highlighting the challenges responders face with disposing of infected bodies. “You have to work at overcoming these practices.”

Cremation is a safe alternative, and many communities have alternative funeral procedures in case of house fires. The trick is to apply these procedures to deceased Ebola victims.

“You can imagine that any of those practices are very traumatic for somebody who instead wants a carefully washed, dignified burial,” Dr. Marston cautioned. “We’ve had to work with communities to make the funeral practices acceptable.”

Cultural practices are not the only complications for workers fighting Ebola in West Africa. Survivors returning from isolation to their communities are stigmatized, threatening the social unity that is crucial for beating the epidemic. Dr. Marston said humanitarian teams encourage those who have been treated to stay active with the response effort while their progress is monitored in order to reintegrate into their communities.  

“We want to be careful about it because we don’t have a tremendous amount of scientific data that says they are safe.” Dr. Marston said. “Advocacy helps to overcome stigma.”

Despite progress (cases in Liberia dwindled to 10 this month), it’s not entirely clear how this outbreak will prepare the region for the future. It is difficult to predict where a future outbreak might occur, and reporting new cases often lags due to underdeveloped communication and transportation systems.

Since its discovery in 1976 in Sudan, Ebola virus disease (EVD) appeared in scattered outbreaks throughout central Africa but remained relatively clear from West Africa until it reemerged in December 2013 in what officials believe to be the small village of Guéckédou in Guinea. By the time that case was recognized as the epicenter in March of the following year, the virus had already spread to neighboring countries. 

In Liberia, where U.S. outreach has proved strongest, the CDC has worked alongside local Ministry of Health officials and countries such as France and the United Kingdom to subdue the outbreak. Money and support have flooded in from outside groups, and the U.S. deployed more than 3,000 military personnel in an effort to quell the outbreak. Corporations such as Firestone Tire and Rubber Co., which has a major rubber factory in the country, have also stepped in by providing treatment centers.

Laurence Slutsker, who traveled to Liberia in November last year as part of the CDC’s response team, said that people in some areas are beginning to believe that they are “out of the woods,” for better or for worse.

“It was dramatically different from when I arrived,” Dr. Slutsker told Global Atlanta. “When I arrived, the streets were relatively empty and people were still afraid to congregate in public spaces. By the time I left, the streets were crowded and people were moving around again.”

This renewed confidence, Dr. Slutsker said, may not necessarily be positive if it means that people grow careless.

Ebola is on the ropes, but the knockout punch has yet to be delivered. Liberia aims to be Ebola-free by February.