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“People’s science”: How West African communities fought the Ebola epidemic and won

Thu, 26 Jan 2017 14:45:48 +0000

Three years on from the start of the West African Ebola epidemic, lessons are still being learned. And the most surprising are not coming from the scientists, but from the affected communities themselves; about how, with hardly any help, they tackled the virus and won. One of the curious aspects of the epidemic, which shook Guinea, Liberia, and Sierra Leone, was the way in which the number of cases started dropping before the main international response was in place. In one area after another, the infection arrived, spread rapidly, and then – apparently spontaneously – began to decline. Ebola first crossed over from Guinea into Liberia's Lofa County in March 2014. A rapidly erected treatment centre at Foya, on the border, was soon full to overflowing. In September, it was treating more than 70 patients at a time. But by late October, the centre was empty. People’s science Paul Richards, a veteran British anthropologist, now teaching at Njala University in Sierra Leone, has been worrying away at this phenomenon. He is convinced the main driver of the reduction was what he calls “People's Science”; the fact that people in the affected areas used their experience and common sense to figure out what was happening, and began to change their behaviour accordingly. He told a recent meeting at London's Chatham House: “One of the pieces of evidence which makes me think that local response was significant is that the decline first occurred where the epidemic began, so that the longer the experience you had of the disease, the more likely you are to see tumbling numbers. So, someone was learning… People ask me, 'How long does it take to learn?'  And we don't know, but on the basis of this case study, it's about six weeks.” A lot of national and international effort was put into public health education, and the messages broadcast on radio were very widely heard. But initially they were not very helpful, with a lot of emphasis on the origin of the disease, and warnings not to handle dead animals or eat bushmeat.  In fact, it now seems likely that only the very first case came from a wild animal; all subsequent cases were caused by human-to-human transmission.   The villagers interviewed by Richards and his team were sceptical about the government’s warnings: “If eating bushmeat is dangerous, why did no one get ill before”, was a typical question raised. He found the conclusions they drew from their own observation and experience were much nearer the mark.  “We know our own people,” they told him. “So, we know that it’s socially obligatory to wash the bodies of dead people and to attend their funerals. We monitor very closely who's not doing that, who's not paying attention to their social duties.   “So, it very quickly dawned on us that the people who were attending funerals were the ones that were dying, the good people, the ones that do their social duty,” Richards recounted. “So, from that we knew that it was something to do with funerals and we started modifying our behaviour.” Kieran Kesner/IRIN A healthcare worker stands next to a woman overcome by Ebola Getting organised The areas where Richards was working in Sierra Leone had been badly affected by the civil war. But that period had taught them how to organise, and how to depend on their own resources. The Kamajor civil defence groups, which had protected villages from the notoriously brutal RUF rebels, were revived as taskforces to track cases, enforce quarantine, and bury bodies safely. Across the border in Liberia, the same thing was happening. Nyewolihun, a small village in the forest, not far from the original source of the outbreak, put itself into quarantine.  Matthew Ndorleh, the headmaster of the local school, told IRIN: “We didn't allow anyone to go and sleep in any other place, and we didn't allow anyone to come in. We set up a taskforce of young men to man checkpoints at all the entrances to the village, and everyone obeyed it.”  It was hard, [...]



Five rare humanitarian success stories of 2016 (plus caveats)

Thu, 29 Dec 2016 08:25:35 +0000

It’s hard to see the silver lining around a year as awful as 2016, but a few good news stories did emerge. Here are some recent successes from the humanitarian world, with our caveats: Paris Agreement enters into force Given that 2016 broke a number of unenviable global warming records, it seemed advisable that the Paris Agreement to combat climate change, adopted by 195 countries in the French capital in December 2015, should come into force and be implemented in good time. The first, easier part was achieved surprisingly quickly – enough parliaments had ratified it even before delegates gathered in November in Marrakesh for Paris’s follow-up meeting, COP22. But as for implementation, the devil is in the detail, and much will depend on whether countries live up to the nationally determined contributions that underpin the Paris accord. Plans are now in place for countries to sign off on a new rulebook that envisages them taking responsibility for their own progress from 2020. Joe Dyke/IRIN Parched earth following a drought in northern Afghanistan. The region has been hit by increasingly unpredictable weather, with most experts agreeing it is an effect of climate change. Caveats: There is the small matter of a climate change denier, namely Donald J. Trump, being elected president of the country that has been the driving force behind the Paris agreement. And, even if President Trump can’t (and/or doesn’t choose to) torpedo one of the last remaining planks of his predecessor’s legacy, the accord could still be too little too late. Analysis shows that even if national targets are fully implemented, the world will be 2.7 degrees warmer by the end of the century – a temperature rise that would have disastrous consequences. IS loses ground In a year of bad and worse news, the fact that so-called Islamic State is being forced off the land it controls is a chink of light for those civilians who have known the horror of its rule. The group has been kicked out of key holdings in Iraq – Ramadi and Fallujah – and lost al-Shaddadi in Syria’s Hassakah province, and Manbij near the Turkish border. Libyan forces backed by US airstrikes recently finished off the group in Sirte. It now holds no territory in the country, although members are still active. And the Iraqi army and its allies are now making slow progress towards Mosul, its last stronghold in Iraq – victory there would leave Raqqa in Syria as its major territorial holding, although it is resurgent in and around Palmyra. Caveats: We’re loath to call any military campaign ‘good’ – the Iraqi military’s assault against IS in Fallujah involved a punishing siege, and there have been many reported cases of retribution (often by allied militias) against civilians after liberation. And then there are the civilian casualties of course – those IS has been said to use as human shields or execute for attempting to flee, and those killed in coalition airstrikes, not to mention the innocent victims of the more relentless bombing campaigns ordered by the Russian and Syrian governments. There’s also growing concern that as IS-controlled territory shrinks, the group will increasingly turn its attention to sowing chaos in the sort of attacks regularly seen in Baghdad, and recently at a Christmas market in Berlin. That said, it’s hard to forget the jubilation of those liberated from IS rule – women smoking cigarettes, men cutting the beards they had forced upon them, and church bells ringing. Peace in Colombia? In November, Colombia’s Congress approved a peace deal with the FARC rebel group, bringing an end to more than half a century of fighting and – proponents hope – allowing the country to begin a process of healing. The deal will see FARC disarmed and demobilised, and its assets used for victim compensation. The group will form a political party, and have a guaranteed 10 seats in Congress. If the agreement, seen as tougher on FARC than the origina[...]



Polio hopes and Zika fears in the vaccine race

Wed, 06 Apr 2016 15:57:00 +0000

It’s busy times for the vaccine industry – a new vaccine against dengue fever has been deployed in the Philippines, research for a vaccine against Zika virus is gaining steam (although questions remain over the threat it poses), the Ebola outbreak refuses to go away, and a yellow fever outbreak in Angola has exposed an alarming lack of stockpiles. Against this backdrop, the biggest-ever effort in human immunisation might finally be reaching the beginning of the end. Wild polio, once crippling hundreds of thousands a year, is found now in only two countries – Afghanistan and Pakistan. There have been just nine reported cases so far in 2016. If polio were in full retreat in 2017, it would mark 40 years since the last natural case of smallpox – the first disease to be completely wiped out in human history, in 1977. The multi-agency polio eradication programme led by the WHO since 1988 shows that the road to eradicating any disease is long and expensive, even one with relatively simple characteristics (unlike a number of other diseases on the global agenda, polio can only survive in humans; there’s no reservoir in animals or insects). The Polio Eradication Initiative has a budget of more than $1 billion per year. allowfullscreen="allowfullscreen" allowtransparency="true" frameborder="0" height="400" mozallowfullscreen="mozallowfullscreen" msallowfullscreen="msallowfullscreen" oallowfullscreen="oallowfullscreen" src="//datawrapper.dwcdn.net/FXwkI/1/" webkitallowfullscreen="webkitallowfullscreen" width="80%"> The research and development stages of any drug or vaccine take years, but that’s only one ingredient. Public education and mobilisation, funding, and, inevitably, tackling anti-vaccine suspicion and rumours, have all played their part in the twists and turns of the polio campaign. The same will surely be true of any future eradication programme. The next steps of the anti-polio drive require a synchronised switch in the type of vaccine, due between now and 1 May in 155 countries, and then, in the years to follow, a gradual transition to injectable vaccines to replace the oral drops so many countries are familiar with. Unintended consequences Until this year, the most common oral vaccine protected against all three types of polio. Since type two is now eradicated in the wild, the new version of the vaccine only protects against types one and three. Some surprising data is a factor behind this move. While the number of naturally-acquired cases of polio last year were 74, the total number was 106. How? In a tiny minority of cases – the WHO suggests it’s a 2.7 million to one chance – the oral polio vaccine backfires and causes paralysis: the signature symptom of polio. Given the right circumstances, both in the patient’s stomach and an unhygienic environment, the polio virus can further survive in faeces and be transmitted to others. This, circulating vaccine-derived polio virus (cVDPV) is most commonly a variant of type two, so it makes sense to remove the pathogen from the vaccine now if it’s not present in the wild. In 2015, 32 cVDPV cases were reported from Madagascar, Laos, Guinea, Myanmar, Nigeria and Ukraine. allowfullscreen="allowfullscreen" allowtransparency="true" frameborder="0" height="400" mozallowfullscreen="mozallowfullscreen" msallowfullscreen="msallowfullscreen" oallowfullscreen="oallowfullscreen" src="//datawrapper.dwcdn.net/OZpRs/1/" webkitallowfullscreen="webkitallowfullscreen" width="100%"> Therefore, the old oral polio vaccine was in fact the cause of about a third of cases of polio-related paralysis last year. Governments accept the rare incidents of vaccine-derived polio as an acceptable price to pay along the road to worldwide eradication. Using only the new bivalent (two-pronged) vaccine should reduce this unintended consequence significantly, while concentrating firepower on the remaining two types. Developed countries now tend to use the injectable polio vaccine, which carries no risk of vaccine-derived polio. The[...]



A look back at Ebola

Mon, 28 Dec 2015 00:00:00 +0000

The past year has been a roller coaster ride for West Africa, with Ebola coming and going and coming and going, and then coming once again. But now, after nearly two years battling the deadly virus, the region finally seems to be Ebola-free. None of the three countries most affected – Guinea, Liberia and Sierra Leone – has had an active case since mid-November. Experts warn that there will likely be a re-emergence of Ebola at some point, but governments, health workers, communities and aid agencies all say they are now better prepared to stop any new flare-ups. The region may enter 2016 Ebola-free, but the impact of the outbreak is still being felt by many. More than 28,600 people were infected and 11,315 died. Hundreds of thousands more lost jobs or loved ones or had their lives in some way turned upside down. Economic losses totalled an estimated $1.6 billion in 2015 alone, according to the World Bank. Kids finally returned to school this year after months of disrupted classes, but the long-term impact on children and education won’t be known for years to come. And, despite waning stigma, not all survivors or Ebola workers have been accepted back into their communities. IRIN has covered the ups and downs of the outbreak from the start, as far back as March 2014. Here’s a look back at a selection of our Ebola stories from the past year: The good Before the Ebola outbreak, many Guineans used to rely solely on local medicine men or “féticheurs” to treat their various ailments and illnesses. But as local communities watched both their people and traditional healers die from Ebola – their powers apparently not strong enough to combat the virus – more and more of the sick began taking the advice of health workers and seeking out care from licensed doctors and nurses.  See: Ebola's silver lining: Guineans learn to have faith in hospitals  For a long time after the outbreak began, families were forbidden from holding traditional funerals, due to fears the events would help spread the virus. They thought they’d never be able to give their loved ones a proper goodbye. But as more and more communities were declared Ebola-free this year, and public gatherings resumed, many finally got that chance. See:  A year on, Guineans finally lay Ebola souls to rest A great number of Ebola survivors, particularly early on in the outbreak, lost their jobs, were excluded from community events, and were often even shunned by their own families. But thanks to large-scale education campaigns, many are now being welcomed back home.  See: Liberia Ebola survivors find unexpected hope The bad West Africa is known for its friendly, personal interactions – even among strangers. But Ebola, which is transmitted through bodily contact, changed all that. Too afraid to get too close to anyone, many people gave up their most common practice: the handshake. See: Guinea Ebola diary: In the land of lost handshakes Guinea’s Gueckedou region, where the outbreak began, was declared Ebola-free in January 2015. But this photo feature and reportage from IRIN West Africa Editor Jennifer Lazuta show how, months later, the extent of the damage was only just starting to be realised. See: Photo feature: Ebola and me: Tales from GuineaSee: The pain of the new normal: Guinea after Ebola Things in Sierra Leone and Liberia were looking up mid-year: unemployment was down for the first time since the outbreak began and schools had reopened after nine months of closure. But many families said they still didn’t have enough to eat and malnutrition rates among children under the age of five remained high. Just 10 percent of students initially returned to class, according to Save the Children. Many were too afraid; others had already turned to selling goods on the street, in order to support their families.  See: Ebola in Sierra Leone: A long way to goSee: Schools reopen but Ebola keeps pupils on the streets See: Ebola effect ripples on in Liberian schools [...]



Ebola: Where are we now?

Wed, 26 Aug 2015 23:00:00 +0000

For the first time in more than a year, no one in either Sierra Leone or Liberia is being treated for Ebola, raising hopes that after more than 11,000 deaths and 28,000 infections throughout West Africa, the epidemic could finally be winding down. But 18 months after the World Health Organization (WHO) formally announced the beginning of the Ebola outbreak in March 2014, the last thing the region needs is another false dawn. Three months ago, Liberia was declared free of the virus only for new cases to emerge. See: Bush meat trade roaring again despite Ebola ban Although there are just three known cases left in the region and just 629 potential contacts still under observation, the epidemic isn’t yet over. Here is where things stand: Guinea Cases: 3,792 Deaths: 2,527 Guinea is where the outbreak started in December 2013 with the death of a two-year-old boy. Now, 20 months on, much of the country is Ebola-free, including the southeastern forest region where the index case originated. But there remain a few pockets of resistance, particularly in and around the capital Conakry, where the only three current cases in the entire region were recorded during the week ending 23 August. Approximately 600 people are still under observation in Guinea and WHO warns that “there remains a significant risk of further transmission,” particularly because one of the positive cases – a taxi driver who was not previously on any contact lists – could have spread the virus to his passengers. Guinea is also the site of the first health worker infection in more than one month.  Liberia Cases: 10,672 Deaths: 4,808 Last month, Liberia began a 42-day countdown to being Ebola-free, but not for the first time. The outbreak was previously declared over in the country on 9 May. But on 30 June, the Ministry of Health announced that a teenaged boy had tested positive in a small town on the outskirts of Monrovia. Over the next two weeks, five more cases were confirmed. The source of the second outbreak is still unknown, but Ebola response teams were able to quickly contain the flare-up. The last patient was discharged on 23 July and all potential contacts have since passed the 21-day incubation period. Liberia could once again be declared Ebola-free on 3 September. Sierra Leone Cases: 13,541 Deaths: 3,952 Sierra Leone has now gone two consecutive weeks without any new cases being reported. The last patients were sent home as survivors on 24 August. Just 29 contacts are still under a 21-day surveillance period, which is set to end on Saturday. If no new cases surface, Sierra Leone will be declared free of Ebola on 5 October. jl/ag   101925 201410131425370692.jpg News Health Ebola: Where are we now? Jennifer Lazuta IRIN DAKAR/BISSAU Guinea Liberia Sierra Leone West Africa Français [...]



Post-Ebola Syndrome: It's not over for Ebola survivors

Sun, 09 Aug 2015 23:00:00 +0000

West Africa’s Ebola outbreak might be winding down, but the struggles facing survivors in Guinea, Liberia and Sierra Leone are far from over. Beyond psycho-social problems related to stigma and post-traumatic stress disorder, more than half of survivors say they are suffering from debilitating joint pain, headaches, and fatigue. At least 25 percent have experienced some degree of change in vision, with many now close to being blind, according the World Health Organization (WHO). “I was cured from Ebola last October, but since then I have been suffering from severe pain in my joints,” 45-year-old Kebeh Jomah, who lives in Monrovia, told IRIN. “Sometimes it is so serious that I don’t walk around… I hardly visit people anymore. All day I am sitting home crying from joint pain.” Chris Tuan, 18, said his vision has been getting increasingly worse since he was discharged from an Ebola Treatment Unit (ETU) in Liberia in November. “I hardly see from a far distance anymore,” he said. “I am gradually losing my eyesight. I am worried. Sometimes I can’t walk alone. Someone has to help me to move around…This is no joke.” Medical mystery Doctors and other Ebola specialists say they are still unsure exactly why recovered Ebola patients, months later, are still suffering from these lingering side-effects, which many refer to as “post-Ebola syndrome." It is also unclear why the symptoms manifest themselves in so many ways in different people and to varying degrees. “We have very preliminary data – and I will again stress it is very preliminary – that suggests that patients who may have had more severe, acute disease may have more severe chronic disease after the initial recovery,” said Doctor Daniel Bausch, a clinical infection control specialist for WHO. But while studies from previous outbreaks have shown that the virus can survive in certain parts of the body, where the immune system does not reach, such as the eyes and testes, even for months after recovery, Bausch said nobody knows why patients are experiencing other physical problems, such as headaches and joint pains, in places where the immune system can reach. “That’s really one of the big knowledge gaps in which we need more research,” Bausch said. During past outbreaks, the number of people infected was always much smaller and so was the number of survivors, making it difficult to perform studies on a largescale. Now, there are more than 13,000 survivors across the three most-affected countries, giving experts a chance to have a more comprehensive look at the various long-lasting effects of Ebola. Even that, however, may be difficult, as the testing requires special biosafety facilities and can sometimes be invasive for the survivor. “It would be difficult… to really do studies that would measure, for example, cleaning the virus out of the eye, because that requires a relatively complicated procedure of tapping [and] putting a needle in someone’s eye – that’s [something] not too many of you would probably like to volunteer for,” Bausch explained. A need for care Beyond the need to better understand the long-lasting effects of Ebola, the more immediate need for these survivors is care. “When you say joint pain, it sounds like a minor thing, [but] it can be quite a major thing for many people,” Bausch said, explaining that many people in these three countries rely on farming and other manual labour for their survival, but are now unable to go back to work and provide for their families. For eye problems, in particular, if the inflammation, which causes vision problems, is left untreated, the person can go completely blind, according to WHO. There are no known treatments for any of these ailments, however, and trained eye specialists are rare. In Sierra Leone, for example, there are just two ophthalmologists for the entire country. Doctors say they are currently treating people’s sy[...]



Ebola vaccine: reason to be hopeful?

Thu, 30 Jul 2015 23:00:00 +0000

News that an Ebola vaccine trialled in Guinea has proved 100 percent effective has elicited both excitement and caution from a range of actors closely involved in the outbreak, which also struck Liberia and Sierra Leone and has claimed more than 11,000 lives since March 2014. Some 1,200 frontline workers and 4,000 others who came in contact with the virus were vaccinated between 23 March and 26 July in Guinea, as part of a trial run by the World Health Organization (WHO), Médecins Sans Frontières (MSF) and the governments of Canada, Norway and Guinea. Research published today in The Lancet found that the vaccine, known as rSVS-EBOV, protected 100 percent of participants who were treated immediately after exposure.  Experts warn that more data and research is needed to determine how much of a game-changer the vaccine is. It is unclear how soon the vaccine protects those inoculated against Ebola, how long the protection lasts, what side-effects the vaccine may have, especially on high-risk groups such as pregnant women and children.  IRIN asked some key Ebola-response players about their reaction to the news. Dr. Unni Krishnan, Plan International’s Head of Disaster Preparedness and Response “The early results offer a ray of hope. However, this development shouldn’t take the attention away from building strong public health systems, which is a key antidote for all health emergencies.”  Martha Paulson, Ebola widow and mother-of-three from Monrovia, Liberia “This is the best news I have heard since 2014. I am really afraid of that disease. I lost my husband to Ebola…. I wish he was still alive before the discovery of the Ebola vaccine. But thank God…. We just want to tell the researchers that we are grateful. Liberia is [waiting] for it.”  Dr. Bertrand Draguez, Medical Director for MSF “These results are promising and we should definitely make this vaccine available to at-risk groups as soon as possible. But it is also of crucial importance to keep working on all the pillars of an Ebola response including contact tracing, health promotion and isolation of infected patients.”  Margaret Harris, WHO spokesperson “It’s very good news, but… at this stage, it’s a vaccine only used for high-risk groups…. It’s very important to understand it’s a tool for prevention, but it’s not something that can cure Ebola and it’s important to understand that all the other things used to prevent Ebola must continue.”  Guinea’s national regulatory authority and ethics review committee says it plans to continue the trial based on these preliminary results, but it is still unclear what should happen next. “To say exactly when and where [the vaccine will be used next] would be jumping the gun, because you need to look at who would benefit, who would provide it, cost and so on,” Harris said. “Those are not decisions that can be made overnight. All the pieces of the puzzle are now being brought together, but to put a timeline on it would be misleading.” Many people simple expressed excitement at the breakthrough: Joy Coleman, Liberian nurse “I just heard the news and I am here shouting in my office. We are so happy as a nation to hear this good news. A lot of people died in this country. I even lost six of my colleagues who were nurses…. Although it’s coming late, it’s better late than never…. We hope they can immediately send it to Liberia so all our citizens can be vaccinated against Ebola virus disease.”  jl/pc/ag 101812 A billboard reading: Against Ebola - Let's protect ourselves. Hand-wash with soap News Health Ebola vaccine: reason to be hopeful? IRIN DAKAR Guinea Liberia Sierra Leone West Africa [...]



Can WHO learn the lessons from Ebola?

Sun, 12 Jul 2015 23:00:00 +0000

An independent panel described the response of the World Health Organization (WHO) to the Ebola outbreak in West Africa as “delayed” and “inadequate,” so what systemic changes need to be made to ensure future crises are handled better? Barbara Stocking, who chaired the panel, called it a “defining moment,” not just for WHO but also for member states, who have just pledged an additional $3.4 billion to boost recovery efforts in Guinea, Liberia and Sierra Leone over the next two years. WHO has declared the rebuilding of health systems in Guinea, Liberia and Sierra Leone a “critical priority” and announced plans to help make them more resilient, but the recommendations last week of Starking and her colleagues went much further. WHO must: devise a system that would allow the alarm bell to be rung sooner; create a new body combining emergency response and humanitarian need; and generally cooperate and coordinate more efficiently with its health and humanitarian partners, the panel said. Matshidiso Rebecca Moeti, WHO regional director for Africa, told IRIN that the world health body welcomes the recommendations and has already begun moving forward on some, including the development of a global health emergency workforce and a contingency fund. “The report stated quite strongly that WHO did not have the resources, even now, to adequately respond to an epidemic, to emergencies,” Moeti said. “It’s clear that the capacity of WHO over the years has been taken away as resources become less and less available...The organization needs to do better. We know that… and I think we learned our lesson… I’m quite confident that WHO can do the job effectively in the future.” But the road to change won’t be easy. There are a number of deeply entrenched systems within WHO that will have to be overhauled and other new components that will have to be implemented.  IRIN spoke with five health experts about what needs to come next. Rebecca Sutton, campaign manager for Oxfam UK’s Ebola Response and Recovery programme “We are pleased to see that WHO will continue to be the lead agency responding… but a significant overhaul is needed in terms of culture… WHO needs to be much less bureaucratic and much more able to respond quickly and in a coordinated and fast and effective way, because that was not the case with Ebola.” “Community engagement has been crucial to dealing with Ebola so far and it’s crucial going forward with recovery and dealing with a broader range of diseases… [Interagency cooperation] is also very important and I think the key here is to have better coordination at the district level, which needs a lot more capacity building. It’s at that levels that agencies need to come together.” Ilona Kickbusch, director of the global health programme at the Graduate Institute of International and Development Studies in Geneva and panel member of the WHO assessment report “The WHO is as strong as three key dimensions: how strong it is in its technical excellence, how strong the support of its member states is – in terms of both political and financial support – and, thirdly, the strength and determination of the director general.” “We need a strong WHO… We need an organisation that can respond to the health challenges of 21st century and is truly accountable for that. And that means leadership by the director general and member states.” “Internally, the WHO secretariat needs to make clear and tough decisions on how International Health Regulations and humanitarian sections of the secretariat are now brought together… it should have a board that does independent oversight… it also need to address staffing, organisational culture… and the issue of financing.” Philip Ireland, emergency medical physician at the John F. Kennedy Medical Centre in Monrovia, Liberia, and Ebola survivor[...]



Turn on the taps to defeat the next Ebola

Sun, 14 Jun 2015 23:00:00 +0000

It is a cruel irony that many of the top doctors and nurses in Guinea, Liberia and Sierra Leone will not be around to help rebuild their health systems in the wake of Ebola, having succumbed themselves to the virus. For those that are, the biggest challenges are likely to be electricity, sanitation, and, most of all, water. “How is it possible to build, or rebuild, as you may call it, a health institution or hospital without [access to] water, which serves as a major catalyst to run the facility?” asked Moses Tamba, a spokesperson for Liberia’s Ministry of Public Works. “It is not possible. You need water.” With the head of one international aid organisation warning in recent days that if the Ebola epidemic was to flare up again, health authorities in West Africa would be no better off to deal with it than they were a year ago, it is time to focus urgently on what can be done. Even before the outbreak began in December 2013, the three countries that were to become worst affected had some of the weakest health systems in the world. Frequent power cuts and water shortages afflicted even the most-developed clinics and hospitals in Guinea, Liberia and Sierra Leone on a near-daily basis. During the Ebola outbreak, which has killed more than 11,150 people in the region and is still rife in Guinea and Sierra Leone, a lack of access to water both in private households and public health clinics meant that the virus, which is passed on through contact with infected individuals or soiled materials, continued to spread. Many people were unaware or unable to properly disinfect their homes and belongings. “You need water to boil to wash bedding, clothes, cooking utensils, equipment and so forth,” Tamba said. “You need water to drink, both for hospital staff and the patents. Electricity is also essential to operate our health facilities. This is serious and every health facility needs these [basic necessities].” Lessons learned Worldwide, more than 2.5 billion people still don’t have access to proper sanitation facilities, including toilets, according to a 12 June joint report by the World Bank and World Health Organization. In Guinea, a quarter of the population has no access to potable water, according to the international development organisation WaterAid. In Sierra Leone and Liberia, 40 percent and 25 percent of people, respectively, don’t have sustainable access to safe drinking water.  “If you really look at these figures, they can help to explain some issues around hygiene attitude and the context that has caused Ebola to spread,” head of WaterAid’s West Africa region Mariame Dem told IRIN.  “If you have health centres where you can’t ensure proper hygiene practices, supported by the availability of toilets… and if you can’t ensure 24-hour access to safe water… it will really have a bad impact on [people’s] health and hygiene.” Moving forward All three countries, backed by their international partners, have pledged to improve their public health systems despite the fact that the Ebola outbreak has strained their already limited resources. In Guinea, the government has allocated more than $200 million to modernise and equip Conakry’s Donka hospital with better access to water and sanitation facilities.  Across the country, 3,000 hand pumps will be installed outside hospitals and health clinics so that “patients can stay clean,” Health Minister Remy Lamah told IRIN. The Guinean government has also just completed a new dam that will supply hospitals and clinics in and around Conakry with “constant power.”  The government says it is also in the process of installing generators in many of these facilities in case of power failures. But, for many, it’s a question of too little too late. “If the government had previously taken the initiative to improve the [...]



Why isn’t Guinea-Bissau prepared for Ebola?

Mon, 01 Jun 2015 23:00:00 +0000

The government of Guinea-Bissau has known for months about the risk of Ebola entering the country, but it hasn't done enough to prepare. Now there is a cluster of cases just across the border. Residents say it will be good fortune rather than good planning if an outbreak is avoided. “I don’t know why we haven’t gotten Ebola yet,” said Edimar Nhaga, who lives in the capital, Bissau. “It certainly isn’t because of prevention measures taken by the government because they haven’t done enough to avoid the epidemic. I believe it’s been luck so far because, to be frank, we just don’t have the capacity for a proper response. No one should believe that our country could face a hypothetical Ebola outbreak.” As of mid-May, Guinea-Bissau had implemented just 59 percent of the minimum preparedness tasks, including having measures in place for proper epidemiological surveillance, public awareness campaigns, case management, contact tracing, and safe and dignified burials, according to the latest data from the World Health Organization (WHO). The country has not yet identified funding sources or developed a framework in case an Ebola outbreak should occur, WHO reports, and just 20 percent of minimum preparedness activities related to budgeting, including the creation of easily accessible contingency funds for immediate response to a potential case, have been completed. “Guinea-Bissau is definitely a matter of concern,” said Doctor Unni Krishnan who heads Plan International’s Disaster Preparedness and Response program. “If a case arrives, this could either go the way in which Ebola was contained in Nigeria because of quick action and good preparedness measures, or it could go the other way, like how we saw in Guinea and the other (worst-affected) countries.” What Guinea Bissau will struggle to cope with will be the already weak health system and limited number of medical experts and public health specialists. The concern over Guinea-Bissau’s ability to react to an Ebola case is not new, but has been heightened in the past week, following, for the first time in almost seven months, a cluster of cases just across the border in neighboring Guinea’s Boke prefecture, where traders cross daily to sell their wares and farmers come to work their fields. Violent protests in the northern Guinean town of Kamsar have also raised fears that aid workers will be impeded in their efforts to stop the virus crossing the border. The situation, should Ebola actually arrive, is particularly worrying as Guinea-Bissau is among the least developed countries in the world, according to the United Nations Human Development Index. More than 15 years after the end a year-long civil war, which displaced hundreds of thousands of people, the country still suffers from political instability, a fragile economy and poor infrastructure. The public health system is especially weak, with neither enough trained doctors and nurses, nor resources and supplies, to offer quality care during even regular times. There are just seven physicians per every 100,000 people, according to WHO. This is lower than the ratio of doctors that Guinea had before the outbreak began. “What Guinea-Bissau will struggle to cope with (should Ebola arrive) will be the already weak health system and limited number of medical experts and public health specialists,” Krishnan told IRIN. “Looking at the health facilities in Guinea-Bissau, when it comes to disaster preparedness and response, we should be on the higher side of caution, rather than taking it lightly.” Scaling up In light of the recent cases just across the border, organisations such as the International Federation of Red Cross and Red Crescent Societies (IFRC), WHO and Médecins Sans Frontières (MSF) have begun increasing their presence on th[...]