Ebola Proves Persistent in Guinea, Where Crisis Started

Ebola Proves Persistent in Guinea, Where Crisis Started

 

While epidemic seems contained, new cases continue to emerge

By Betsy McKay in the Wall Street Journal

More than a year after Ebola began spreading in West Africa, public-health authorities are struggling most to stop it in the country where it began.

The epidemic, so explosive last summer and fall, has been contained to a coastal area around and between the capital cities of Guinea and Sierra Leone. But the number of new cases is still staggering for an Ebola outbreak—82 in the week ended March 29, according to the World Health Organization. Most are in Guinea, where the first cases of the deadly disease were diagnosed in March 2014.

Guinea closed the border with Sierra Leone this week to try to stamp out the remaining epidemic. The number of cases in Sierra Leone is declining.

Health workers confront many of the same obstacles in Guinea now that they did last year, though this time on the other end of the country. Fearful, suspicious locals drive Ebola workers away. Some care for their sick loved ones at home, or bury highly infectious corpses with their own hands, despite warnings that the deadly virus spreads through bodily fluids.

“There’s a lot of resistance,” said Raphaël Delhalle, field coordinator in Conakry for Doctors Without Borders, on a recent afternoon, just after the humanitarian aid group had admitted more than 10 patients for treatment. “The population is still thinking Ebola doesn’t exist, or that we are giving them Ebola.”

Recently, he said, a woman in a Conakry neighborhood pulled a knife on a medical team, including a Doctors Without Borders staff member, forcing them to leave.

Officials say they are confident they will rid West Africa of the epidemic. But to do that, they will have to overcome persisting resistance in communities and track down every last case. Guinea is especially important: It is the largest of the three most heavily affected countries, a gateway to much of West Africa, bordering six countries.

Liberia appeared to have extinguished the epidemic in early March, when the person with its last known case was released from a clinic. But those hopes were shattered later in the month when a woman was diagnosed with and then died of the disease, setting off a scramble to find and monitor all those who had contact with her.

Guinea has had far fewer Ebola cases than either Sierra Leone or Liberia, where the virus took off in capital cities. Guinea also has a more developed public-health system—one that helped prevent the virus from exploding in the capital, said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, who traveled to Guinea in March. But, he added, “paradoxically, because of that, there is less awareness and less behavior change.”

Guinea also has some bigger challenges, including a larger, more culturally diverse population, less-developed road and radio networks and fewer nongovernmental organizations providing social support, Dr. Frieden said. Liberia and Sierra Leone also had help battling Ebola from the U.S. and British militaries, respectively, health officials note.

Guinea has received less foreign aid than its two Ebola-affected neighbors. Of $5.1 billion made available by foreign governments, private funders and others as of the end of January, $543 million was specified for use in Guinea, compared with $1.28 billion for Liberia and $1.15 billion for Sierra Leone, according to the United Nations Office of the Special Envoy on Ebola. Another $835 million was for the region generally and an additional $1.2 billion was either for other activities such as research and development, or it hadn’t been earmarked or allocated.

“There is a very strong case to be made for the international community to consider very seriously offering more resources to Guinea,” David Nabarro, the U.N. special envoy on Ebola, said in an interview, citing a need for infrastructure improvements and more health experts to help with the epidemic.

Now, Guinean and international officials are redoubling their efforts to stamp out the disease. The CDC has sent fewer staff to Guinea than either Liberia or Sierra Leone over the past several months “simply because we don’t have a lot of French speakers,” Dr. Frieden said. But it now has 52 staffers in the country, up from 24 at the end of December, while 46 are currently in Liberia and 89 in Sierra Leone. Dr. Frieden said he has talked with French-speaking nations about supplying more epidemiologists.

The WHO recently engaged social anthropologists and communications experts to draft a report on the causes of community resistance, and has been addressing them one by one, said Jean-Marie Dangou, the agency’s representative in Guinea. “Communities perceived our interventions as top down, they wanted to be part of the response,” he said. “They wanted us to explain more extensively what the disease is, what are preventive measures, and decide on their own what to do.”

Unicef has funded 21 radio stations—along with fuel to keep them running— that reach as much as 80% of the country with information about preventing and treating Ebola, said Guy Yogo, the agency’s deputy representative in Guinea. They include a station that serves Forecariah, a town in western Guinea that has had multiple Ebola cases recently and had no station for months, he said. The stations have helped to counter rumors “and to provide a voice to people to interact and share experiences,” he said. “It has been really, really helpful.”

Unicef has also organized door-to-door campaigns in communities, led by a community messenger, and organized forums at which local Ebola survivors speak. Such efforts to teach people how to prevent Ebola and get treated helped the forest region where it started rid itself of the disease, he said.

“We want to replicate what we did in Conakry and surrounding districts,” he said. Already, “things are really improved.”