Hiccups, say doctors in this remote corner of Guinea, are the final tell-tale sign of infection by the Ebola virus that has killed more than 100 people since an outbreak began this year. Then come profuse bleeding, circulatory shock and death.
But for Rose Komano, the hiccups never came. On Saturday, the 18-year-old mother of three became the first victim to have beaten the disease in the region of Gueckedou, epicenter of the Ebola outbreak in this impoverished West African nation.
In total, 98 people are thought to have died from the disease in Guinea and 10 more in neighboring Liberia, according to aid workers and government officials.
A market town of 220,000 people near the Liberia and Sierra Leone borders, Gueckedou's makeshift clinic is on the front line of Guinea's battle to contain its first outbreak of the haemorrhagic fever, normally found in Central Africa.
Medecins sans FrontiEeres [MSF] - also known as Doctors Without Borders - a medical charity working to contain the virus, has set up two tin-roofed tents in the courtyard of the local health center. One is for suspected Ebola cases and the other is for confirmed cases.
Now, to the delight of the overworked medical staff, they are building a third tent - for survivors.
“When I first saw the medical staff around me in yellow and black, I was scared. I thought I was going to die,” said Komano, who buried her mother and grandmother days earlier after they died from the disease.
“I didn't believe I would recover my health again. I was scared that I would orphan my children - like my mother did me - but now I can hold them in my arms again,” she said.
Eight people have now recovered from the Ebola virus, according to medical tests. The virulent Zaire strain of the disease in Guinea has a fatality rate of up to 90 percent.
Lucky genes and intensive medical care helped Komano become one of the handful to escape death. Other patients were cleared to go home from the Donko hospital in Conakry last week in what the World Health Organization (WHO) dubbed “Lazarus” cases - after the Biblical figure restored to life by Jesus.
Komano's 12-year-old niece and her sister also are recovering as the levels of virus in their blood fall.
But for this family, living in a remote part of Guinea where traditional beliefs are held in high regard, the real battle may have only just begun.
Chocolate, Nescafe and raw onions
In past outbreaks, the sick were abandoned by their families or just dropped off at the isolation wards. If you survived, nobody would talk to you or touch you, said Ella Watson-Stryker, in charge of health promotion for MSF in Gueckedou.
“Ebola disease transmission is not understood at a biological level in remote villages across Africa where people believe in witchcraft and traditional medicine,” she said.
“It's sad because people really do want some sort of magic potion or cure but unfortunately all we can tell them to do is wash their hands,” Watson-Stryker said.
SMS messages circulating in the country claimed that a Guinean medical researcher in Senegal has found the cure for Ebola - hot chocolate, Nescafe, milk, sugar and raw onions taken once a day for three days. In nearby Macenta, an angry mob attacked an MSF clinic, accusing the organization of bringing the deadly virus to their town, forcing it to shut down.
The MSF team has been helping to educate people on how the disease spreads and how it can be prevented. The team is starting to reintegrate patients who have survived the virus.
“We try to make sure that everyone understands once someone is no longer sick, they really cannot continue to spread the disease,” said Watson-Stryker, noting fewer people were asking their staff about witchcraft than at the start of the outbreak.
For Komano, the initial signs are good. When she returns to her village, her family and friends cheer loudly and come out to hug her, a considerable leap of faith in a country where many people are now too afraid to shake hands.
“I feel much better and I'm ready to go home. There's laundry to be done and I need to clean the house,” she said.