In a tiny thatched bamboo hut, I squat by the patient, but was afraid to touch her. I could barely see her in the darkness, laying on a rough wooden platform -- her bed. I feared I could catch her disease.
Her illness had killed up to two-thirds of the local population, including up to 90 percent of the women. Yet the local population had fought Western efforts to stop it.
I had told them that the disease was caused by an infectious agent -- "a tiny living thing, smaller than an insect," I said. But they believed it was caused -- and could be cured -- by sorcery. They accused their enemies of having spread the scourge. Many argued that Western health researchers who had entered the region had in fact introduced the disease. The people continued to engage is traditional rituals when individuals died, spreading the epidemic ever further.
The disease was kuru -- caused by a prion closely related to that which causes "mad cow" disease (or bovine spongiform encephalopathy) -- and it had spread among this group in the highlands of Papua New Guinea through mourning rituals. When patients died, their loved ones consumed the body - the women and their young children had little other meat in their diet. But as a result, many of these mourners subsequently developed the disease. When they died, others consumed them, transmitting the prion ever further.
When Westerners first entered the region in the mid to late 1950s and discovered the disease, they encouraged the New Guineans to end these cannibalistic rituals, but the local population continued, often performing these rituals at night, to be undetected. The incubation period, I found, could last over 40 years. Patients -- like the woman before me -- were still dying of it in 1981, when I first traveled to the area to monitor the number of cases in the epidemic. No treatment exists.
In recent weeks, as the Ebola epidemic explodes ever more quickly, I have found myself thinking back often to this experience.
With the patient in that dark hut, my fear was irrational. After a few minutes, I overcame it, reminding myself of how the disease in fact spread .
What I learned there, though, was how deeply instinctive such fear can feel, and how vast the cultural divides can be that need to be bridged to combat an epidemic. Not just epidemiological monitoring -- which I was doing -- but intensive, multifaceted, on-going education was essential in a very different society and language, where literacy, education and familiarity with science were all low. I saw, too, how difficult such education was -- addressing what the disease is, what causes it, and how it in fact does and doesn't spread.
Ebola is spreading rapidly in part because of traditional burial rituals in which mourners bath and prepare the deceased's body. Unfortunately, these acts are transmitting the virus.
Hence, education and interventions to stop the epidemic will directly challenge long standing practices and beliefs, and thus need to be altered, but will be difficult to change. To think otherwise is naïve.
Last week, the WHO presented a plan for monitoring and trying to contain and stop the Ebola epidemic. The 27-page report mentions the word education a handful of times, but only in passing, and includes the term "risk education" once. No elaboration is provided. Yet the success of any efforts to combat the epidemic must involve extensive education. These efforts will be controversial -- how to persuade local populations to alter deeply-imbued long standing rituals and attitudes -- and must be done carefully and sensitively. But as the world looks in horror at an epidemic spinning wholly out of control, such lessons are crucial.
I will never forget the darkness in which I sat in New Guinea, and my terror. I can only begin to imagine how such horror pervades the regions of Africa heaviest hit by this scourge.
But we must learn from responses to such epidemics in the past if we are to succeed today. Such lessons will be difficult to craft, requiring expertise in culture as well as medicine, but need to be integral parts of our global response.