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From Guinea: The Doors Shut by Ebola are Starting to Open

Amanda Puckett, technical advisor, IntraHealth International

The culture in Guinea is vibrant and thrives on close-knit communities and personal relationships. When the largest-ever outbreak of Ebola started here in March 2014, it threatened not only the health of Guinea’s population but also the ties that bind its people together.

Since then, there have been over 3,000 confirmed cases and over 2,000 deaths.

At the turn of the year, the number of new cases started to drastically decrease, but since I arrived in Conakry in early February, the pendulum has swung and cases are sharply on the rise again.

I came to Guinea to explore whether mHeroIntraHealth International and UNICEF’s mobile platform to for reaching the country’s far-flung health workers with two-way communication and critical information—could help the government combat the epidemic and help strengthen the health system after Ebola has ended.

Ebola closed doors and ignited fear.

But sitting down to enjoy a beautiful Conakry sunset with Diallo, a fellow public health worker and new Guinean friend, gave me the opportunity to get outside my day-to-day submergence in statistics and surveillance data and learn about how Ebola has affected everyday life. I asked Diallo what life was like here when Ebola arrived.

He told me that life didn’t stop when Ebola happened. But Ebola closed doors and ignited fear.   

He talked of the people he knew who had contracted the virus. Some survived. Many did not, including one of the health workers who were brutally killed by frightened villagers in September as their team tried to raise awareness of Ebola in rural Guinea.

Diallo also spoke with gratitude of the response efforts on the ground to eradicate the virus. Hotels are buzzing with international aid workers who are laboring at all hours of the day and on weekends to end the epidemic. From what I have seen here, there are many people working collaboratively and openly to find the best solutions to assist in Guinea’s recovery efforts.

Activities target all aspects of the health system and range from intensive surveillance of contact tracing to epidemiological and biological research to community sensitization, procurement of equipment and supplies, and construction of Ebola treatment units.

The Guinean government and other stakeholders have been overwhelmed by the aid response. At the request of the President Alpha Condé, all of these Ebola-related activities are coordinated through the Ebola Coordination Unit, or, as it is called here, the Cellule.

The head of the Cellule, Dr. Sakoba Keita, reports directly to President Condé, indicating how seriously the government is taking Ebola and the efforts of their national and international partners. Before any team is deployed to a prefecture for surveillance or sensitization efforts, the Cellule must know. 

Only when the woman and baby died did health center staff learn she had been in contact with Ebola.

Despite all the coordination and progress, some people are still reticent to seek help if they suspect they have Ebola.

My friend told me about a pregnant woman outside of Conakry who went to a health facility with bleeding. The health center staff decided she was far enough along in her pregnancy to deliver the baby via Cesarean section. When both the woman and the baby unexpectedly died, the staff learned from her family that she had been in contact with someone who died from Ebola.

The woman did not disclose this when she went to the facility. The physician who performed the surgery contracted the virus.

Stigma is a real concern here. For Ebola patients who survive, returning to their communities is not easy. Despite receiving a certificate that proclaims they are “Ebola Free,” many are not welcomed back. Their former neighbors fear they could still spread the virus.

Some research suggests the virus can live in some bodily fluids such as semen for up to three months after a patient has been “cured,” and this has some communities spooked. 

Too, there continues to be unrest and rioting. According to the World Health Organization, at least one-third of Ebola-affected prefectures in Guinea reported at least one security incident in the week ending on February 8. 

Since I arrived, several cars have been burned to retaliate against a health team that tried to take a possibly-infected patient to a treatment center.  

In Guinea, la réticence is a huge challenge as much of the public is suspicious of those who are trying to help. Aid workers continue to face ongoing threats, from verbal abuse to physical attacks.

A friend who works for the International Federation of Red Cross and Red Crescent Societies, the organization responsible for all safe and dignified burials, told me that rocks are thrown at the their teams’ cars regularly when they go to retrieve bodies. The importance of engaging community and religious leaders in Ebola communication and sensitization efforts cannot be emphasized enough.

More Ebola treatment units are opening, and no new health worker infections have been reported.

Despite the challenges, things are slowly improving. More Ebola treatment units are opening, and for the week ending February 8, no new health worker infections were reported.

Over the past two weeks, I have been talking with staff at the Ministry of Health, the Cellule, and many other partner organizations about mHero—a powerful two-way communication platform that the ministry and health workers can use to instantly communicate information both during the Ebola recovery effort and beyond.

However, other partners here are also implementing mHealth activities, and the government is adamant that everyone collaborate and work together. Fortunately, mHero is designed to integrate easily with other technologies, and we have been successful in engaging other partners.

We’ve also received a letter of support for mHero signed by the Minister of Health. This is a powerful affirmation that the ministry is supportive and shares a vision for using health information systems and mobile technologies to strengthen Guinea’s health systems and improve its health services.

After the sunset, Diallo told me he is grateful for all of the NGO support here in Guinea. 

“It has been wonderful,” he said. “The doors are finally starting to open again.”  

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