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Reflections on Ebola Work in Guinea, April 2015

Posted By Mari Gasiorowicz , Friday, July 24, 2015
Updated: Thursday, July 23, 2015

Mari Gasiorowicz, MA is an epidemiologist in the AIDS/HIV Program at the Wisconsin Division of Public Health. CSTE continues to seek epidemiologists who wish to be deployed for Ebola response. If you are interested, look at the bottom of the page for information on how to be considered.

I had the fortune to be part of a CSTE team of seven sent to Guinea and Liberia, West Africa for the month of April 2015 to provide epidemiologic and infection control support to help end the Ebola epidemic.

More than a year into Guinea's Ebola epidemic, banners, posters and radio messages help to create a relatively high level of awareness of existence of the disease.

The degree to which precautions were practiced was variable. In the capitol, many office buildings had guards that thermo-flashed visitors to check their temperature. We also washed our hands with 0.5% chlorine bleach solution a dozen times a day. Social distancing—avoiding handshakes and maintaining a distance of several feet—was practiced more in urban than in rural areas.

During my first assignment, in an outlying district in the capital, the day started and ended with a long meeting in a room not large enough for the 25 to 30 people in attendance. We reviewed the alerts that came into the Ebola hotline (115) overnight and the coordinator assigned teams to investigate.

Alerts include all deaths, irrespective of cause, and illness that may be due to Ebola. Each team included a Guinean doctor or trainee and one or two investigators (West African, European, or North American epidemiologists). The doctor asked questions to determine whether it was possible that the death or illness was Ebola-related—duration of illness, symptoms, travel of the patient or visitors to or from other regions of the country. Conversations typically took place in a local language, with the doctor translating into French for foreigners.

The doctor explained to the family that we needed to call Red Cross because all deaths had to be tested for Ebola and secured (wrapped in personal protective equipment (PPE) material). In my experience, close family members with whom we spoke directly were agreeable. But other family members or mourners from the community often objected to the involvement of Red Cross. Washing the body and burying a loved one is very important; ceding these responsibilities to outsiders is met with a great deal of resistance, particularly in Guinea.

The doctor then called Red Cross and we waited up to four hours for the ambulance to arrive and complete their assignment. Red Cross staff explained the steps: suiting up, testing the body, securing the body, and if the family allowed, taking the body to the morgue. If Ebola was not indicated, the family would be able to collect the body and conduct the burial themselves.

I spent the second two weeks in a rural prefecture helping observe and monitor outcomes of a four-day social mobilization campaign to reach 55,000 households. After a brief training, 500 teams of three were deployed to visit households to provide information using a laminated flipchart with graphic images of Ebola symptoms and instructions in case of illness. Teams were also supposed to thermo-flash each household member and ask if anyone was ill.

After meeting with the village leader for permission, we observed these thorough and engaging presentations as teams traveled household to household. Children often followed the team so they heard the presentation several times. We then visited households that had received the presentation and asked what members took away. While the donor community viewed the campaign's purposes as education and case-finding, we found that receiving soap (the six-bar incentive) and learning about Ebola were the main takeaways. All agreed that the campaign was a formidable effort but that its impact could have been greater if conducted earlier in the epidemic.

While we focused on Ebola, people continued to live their regular lives – watching soccer, going to mosque, and preparing and eating perfectly cooked mango stew. Both health professionals and rural residents displayed gratitude for our efforts.

Despite uncertainty, chaos, heat, intermittent electricity and running water, traffic and difficult working conditions, I am very grateful to have had the opportunity to participate in the massive effort to address Ebola in West Africa. Thank you to CSTE for providing the opportunity, to CDC for the financial support to CSTE and support in-country, and to my health department for encouraging my participation.

 


 

CSTE is seeking to identify additional experienced epidemiologists who would be willing to travel to affected Ebola regions in West Africa. In addition to French-speaking epidemiologists, we are seeking qualified epidemiologists who speak Portuguese and those who speak only English. You can apply through the CDC/CSTE Ebola Deployment Application Form. Deployments are 30 days in length with a 3-5 day training in Atlanta, GA immediately prior to travel. CSTE would support travel and onsite expenses (per diem, lodging, travel insurance, etc.). CSTE may also support salary in terms of salary reimbursement to your health agency, reimbursement for vacation days used, or consultant pay.
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