KENEMA Sierra Leone When Mohamed Swarray contracted the deadly Ebola disease in June, he was confined to a tented isolation ward at Kenema in eastern Sierra Leone. But he didn't stay there long.
Suspicious of the doctors in their masks and body-length protective suits, he slipped out and fled to the capital Freetown 300 km (185 miles) away. There, he was nursed in a private home for a week before being traced by officials and hurriedly returned, weak and frightened, to the Kenema unit.
With West Africa facing the deadliest Ebola outbreak ever, with 400 dead so far, this kind of fear and mistrust is driving dozens of victims to evade treatment, frustrating foreign and local doctors trying to contain the epidemic.
The outbreak in Guinea, Sierra Leone and Liberia has left some of the world's poorest states, with porous borders and weak health systems undermined by war and misrule, grappling with one of the most lethal and contagious diseases on the planet.
Dr. Amara Jambai, Sierra Leone's director of disease prevention and control, said at least 57 suspected and confirmed Ebola cases were "missing", the victims having fled or gone into hiding.
"When you lose cases that way, you will not know where the next case will appear," he told Reuters.
Ebola causes fever, vomiting, bleeding and diarrhoea, and can kill up to 90 percent of those it infects. Highly contagious, it is transmitted through contact with the blood or other fluids of infected people or animals.
"My biggest problem, as it stands, is getting people to accept the disease," said Sheik Umar Khan, the doctor tasked with leading the fight against Ebola in Kenema's hospital.
"These escapes, emanating from fear and misunderstanding, make our work even more difficult," he added.
Medical charity Medecins Sans Frontieres (MSF) says Ebola is "out of control", located in at least 60 places across Guinea, Liberia and Sierra Leone. [ID:nL6N0P44YA]
Guinea has rejected this warning, saying it has its epidemic under control. But governments' reluctance to fully admit and report the scale of outbreaks can also hamper containment.
The World Health Organization has called on other West African States to prepare to tackle the disease and is co-hosting a meeting of West African health ministers in Ghana this week to try to strengthen the region's response. [ID:nL6N0P82C6]
Swarray was tracked down in Freetown after messages about his escape were broadcast on local radio. The nurse friend treating him believed he had typhoid and is now being monitored for Ebola. His mother, who traveled with him, is still missing.
The outbreak has spread since it first started killing victims in Guinea's remote southeast in February. It reached the capital Conakry and moved into neighboring Liberia.
For months, Sierra Leone said its own suspected cases tested negative. Then, late last month, it confirmed Ebola in its remote northeast. Since then, there have been 191 laboratory confirmed cases, including 63 deaths, with many more suspected.
<For a map of the region affected by Ebola, please click - here>
Kenema, now on the frontline of Sierra Leone's fight against Ebola, is located in the diamond-rich east. Attacked by rebels during the 1991-2002 civil war, it has since become a bustling regional hub, the West African nation's third largest city.
Sierra Leone's first Ebola case was a so-called 'sowei', a traditional women's leader and healer who treated the sick crossing over from Guinea, according to Dr Mohamed Vandi, the chief medical officer for Kenema district.
By tradition, only women were allowed to touch or wash her dead body, so the majority of the next cases were also women.
Sierra Leone officials have since banned traditional funerals and the bodies of Ebola victims must now be buried by health workers clad in green protective suits and face masks.
Schools in the Kenema area are closed and travel restricted.
At the Moala checkpoint on the road to Liberia, masked health workers take the temperature of all travelers to monitor for anyone who might be carrying a fever.
But many still put faith in traditional methods.
At the same Moala checkpoint, police and soldiers tied herbal rope bracelets around travellers' wrists, telling them a local traditional healer had been told in a dream that doing so could ward off Ebola.
Posters on walls warn of Ebola symptoms, urging sufferers to go to hospital. But Sierra Leone's health system is weak - the country has the highest rate of maternal and infant deaths in the world, according to U.N. figures.
The Kenema isolation unit consists of two tents erected just meters away from the main hospital, where two doctors and two ambulances are based to cover a district of 800,000 people.
Donors and international health organizations have rushed specialized equipment to the zone but staff complain about shortages, even of basic items like gloves.
A local population with little knowledge of the disease can be easily spooked by rumors.
Vandi said stories were circulating that doctors were removing limbs of Ebola victims before burying them. Police have been deployed and last week fired tear gas at the hospital to prevent relatives from trying to retrieve bodies.
Terrified by such reports, Isata Momoh, who came down with symptoms of the disease, initially fled the ambulance sent to take her to the hospital. "When I thought I had the sickness I ran away into the bushes and hid," she told Reuters.
Momoh only emerged from hiding when the diarrhoea and vomiting became too bad to bear. She was treated and recovered.
Khan rejected MSF's statement that the disease was out of control in the region. He said more cases were coming to light because of improved official surveillance. "People are coming to terms with the fact Ebola is a reality," he said.
Vandi, the Kenema medical officer, said if the diamond town could beat the disease, the rest of Sierra Leone could do so.
Local people were wary of government reassurances, recalling similar statements during the civil war years when rebel raids, rather than disease, had traumatized the town.
"One day the government would say the rebels had advanced to within touching distance. The next it would say they had been repelled, and you'd see them entering the town," said Karmoh Kajue, an unemployed man nursing a beer at the Kenema Plaza bar.