This piece is part of a reporting partnership between ONE and Ebola Deeply. Dr. Fatou Mbow is a Senegalese medical doctor and a consultant with Save the Children in Guinea, focusing on community response and covering health and education. She has previously worked as a technical advisor on the Ebola outbreak in Guinea. Ebola Deeply spoke with her about the Ebola response there, and the situation on the ground.
Ebola Deeply: Data from the World Health Organization (WHO) shows that cases of Ebola are still fluctuating in Guinea, with another spike in infections in February, followed by a decreasing trend this week. How is this reflected on the ground?
Dr. Mbow: To some degree, more people are taking measures to curb transmission, but moreover, Guinea finally got the international support that it requested. The national coordination here at government level is strong and attentive, and that’s not something I’ve seen often in 15 years of humanitarian work.
In Liberia, U.S. support has been significant, and there have been many NGOs working on the response. In Sierra Leone, in a lesser way and later, other partners started to come. By contrast, there have been only a few actors on the ground in Guinea, and there was only one NGO working here on the Ebola response to start with. Guinea was not as prominently supported as the other countries, and that’s probably because the figures have been lower and the outbreak here has been seen as less worrying.
Ebola Deeply: Last week the International Committee of the Red Cross (ICRC) released a report that says Ebola responders in Guinea are subject to as many as ten attacks a month. How much resistance is there to the Ebola response at this point?
Dr. Mbow: There is still resistance, as there was in the beginning in Liberia and Sierra Leone. Populations have not always been happy with the response. This remains the key issue here.
Since the epidemic started in Guinea, the numbers have – until recently – been pretty constant. We haven’t had the high spikes that we’ve seen in Liberia and Sierra Leone.
I think it’s interesting that there’s really been an effort in Guinea to make the response happen without violence. So when violence does come from populations unhappy with the response, there is a real interest in finding out why this is, and what kind of response can be provided at all levels to make sure that either the response is better understood or adapted. Guinea has really been very reluctant to use defense forces in its Ebola response; for example, the French military is supporting us, but it is doing so in a technical way.
Ebola Deeply: It’s understandable that authorities want to avoid a repeat of past events; Guinea has an uncomfortable history of quelling protests with force. Do you think a more attentive approach is working?
Dr. Mbow: A social mobilization aspect has always been at the forefront of the response. Force has not been used in Guinea, nor threats of arrest. Instead, the response focuses on listening to people. If you just opt for force, you don’t benefit from people, ordinary people, who have very valuable ideas as to how to make this response better. Their experiences also provide us with very rich material for other crises. Community leaders and religious leaders have been engaged from the outset, but still, they can’t solve everything: If people are not happy, they are not happy. Community leaders have their limits as to how much they can do.
Ebola Deeply: Sierra Leone is a former British colony, and Liberia has strong ties to the U.S. As a former French colony, how involved has France been in the Ebola response?
Dr. Mbow: Guinea doesn’t have a smooth history with France. Guinea was the first country in the region to become independent from France, and at the time there was quite strong anti-French sentiment. So, ever since, France’s relationship with Guinea has generally been along the lines of, “we’re around, but you’ll have to call us up.”
However, the French are doing really interesting things here. They have built a treatment center for health workers, in a way that is very attentive to transmission risks. More than 175 health workers in Guinea have been infected with Ebola, and 100 of them died. One of the biggest problems with the response in all three countries, at least early on, has been the lack of separation between testing areas and treatment areas. If you put a blood testing lab in an Ebola treatment center, it means that you have to go there to get tested. That makes people reluctant to have a test. Also, the fastest kind of blood test generally takes four hours to come back with results, depending on the number of people waiting. That means that you can spend four hours, or more, in a tent with other suspected cases.
So what the French military did, when constructing a treatment and testing center for health workers, was to create unique tents for each person. The French also launched an initiative that trains health workers on infection control measures. Every single doctor or nurse working on the response can attend lengthy training on how to make sure that when they have a consultation, they don’t get infected.
Ebola Deeply: As we look toward rebuilding and repairing, do you think there’s a need for even more international support?
Dr. Mbow: Yes, we need more, but most importantly we need better. The Ebola crisis has exposed government shortcomings in all three countries, but also international community shortcomings in a very prominent way. We need to ask who is credible to provide support for recovery. And we need to make sure that funds do not just make a superficial impact, but go deep down. This applies to every aspect of recovery, down to the individual level. Orphans, for example: We need to make sure that there are systems in place to help them get through, on a long-term basis, not just the death of a parent, but in many cases the death of a whole family.