The
Ebola outbreak may be waning in West Africa, but just one case in a
country with a brittle health structure could cause a surge in
infections. Ebola Deeply went behind the scenes in Guinea-Bissau, which
shares a border with Guinea, to learn about the level of preparedness
there.
Frequent
travelers to West Africa know that Guinea-Bissau – a tiny
Portuguese-speaking country with a broken coastline spilling out toward
remote, rugged islands – is one of the region's best-kept secrets. There
is charm in its cobbled streets, decaying architecture and tropical
beaches. But it also has fewer resources, slower development and a more
brittle health system than most of its neighbors, having been weakened
by a history of civil war, coups and counter-coups.
So
far, despite recently reopening its border with Guinea, Guinea-Bissau
has managed to remain hidden from Ebola, too. Since December 2013, the
virus has slipped across Guinea's borders, penetrating four of them:
Liberia, Sierra Leone, Mali and Senegal, with just one case recorded in
the latter. Authorities in Guinea-Bissau know they are not immune to an
outbreak.
But how prepared are they for a case?
Not
very, said the World Health Organization (WHO) in a November report
that highlighted Guinea-Bissau's biggest weaknesses in Ebola
preparedness. One of the greatest hurdles: the time it would take to
properly test a blood sample.
"Guinea-Bissau's
National Public Health Laboratory does not have the required biosafety
or biosecurity level or the human or structural resources to diagnose
Ebola,” reads the report. 'The country has not yet established a formal
agreement with the Institut Pasteur in Dakar for laboratory diagnosis of
Ebola, and has not identified carriers that could transport samples by
air; it is still exploring the possibility of transporting samples by
road (over 800km).”
According to Placido Cardoso,
president of the National Institute of Health and the man in charge of
Guinea Bissau's Ebola response, a verbal agreement with Dakar's Institut
Pasteur could allow samples to be transported by air.
“We
are trying to work with them in a general agreement, not just for Ebola
but for other diseases as well,” Cardoso told Ebola Deeply.
Working
on that basis, if a suspected case of Ebola occurred outside of the
capital Bissau, it could take at least five days to properly diagnose a
sample.
“It can take one day to collect and come
to Bissau ... and then there is the sending of forms to federal
authorities. I don't believe that it can take less than five days,"
Cardoso said.
At the peak of the outbreak in
Sierra Leone, delays in Ebola diagnosis often resulted in dead bodies
being left in houses for more than 24 hours – waiting for confirmation
whether the body could be buried in the traditional manner, or whether
the deceased was an Ebola victim and therefore needed to undergo a safe
burial from an Ebola burial team.
Access to
burial teams is another issue of concern for Guinea-Bissau. In
mid-January, the country's first burial teams were trained by WHO and by
experts from China. But even among authorities, not everyone is sure
they exist, and few people know how to contact them.
“They
have been properly trained, in an effort to stop the illness in case it
arrived in this country,” said Stephen Manjuba, Guinea-Bissau's
director general of communicable and non-communicable diseases unit at
the health ministry.
A treatment and isolation
center has been established by MSF (Doctors Without Borders) in Bissau,
but it has the capacity for only 20 patients. A second isolation center
in the town of Gabu, near the border with Guinea, can hold 12 patients.
Manjuba said that more than 80 percent of the recommended measures to prevent Ebola have been adopted in the country.
Do people feel reassured?
"We
are afraid of Ebola ... if it gets here it will be disastrous because
of our way of life," said Tiago Sede, who lives in the capital, Bissau.
"We live in close proximity and the hygienic conditions are not the best
here," he said.
Outbreaks of other diseases have
spread quickly in the past in Guinea-Bissau. In 2012, a cholera
outbreak infected 1,500 people in this country of 1.7 million. And in
2013, more than 700 people contracted cholera in a fresh outbreak.
Social
mobilization programs and awareness-raising activities have also been
limited in Guinea-Bissau, and the language division between the country
and its neighbors (Guinea-Bissau's official language is Portuguese, but
it is surrounded by English- and French-speaking countries) means that
audio and print materials are harder to come by.
Marta
Dabo is a nurse at a government-run clinic in Gabu. She told Ebola
Deeply that she has received only limited training about the symptoms of
Ebola, and has not been provided with protective gear. Lack of
information can be as deadly as a lack of resources.
"I
know that Ebola looks like a very bad sickness, worse than malaria,"
Dabo said. "But I wouldn't know when to decide not to touch the patient,
or when I should worry about a risk to myself. Besides, we only have a
very small supply of gloves at the clinic, and no substantial overalls."
Speaking
to Ebola Deeply last week, Dr. Tom Frieden, director of the Centers for
Disease Control and Prevention (CDC), said, "There are no shortcuts to
preparedness. You need surveillance networks, you need rapid-response
teams, isolation capacity, burial capacity and communications capacity.
"In
the ring countries (such as Guinea-Bissau), we've come a long way, but
we have much further to go than we've come," Frieden added.
