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Up tick in cases cause concern

By Elizabeth Glaser Moderator Emeritus | 27 May, 2015

In the past month Sierra Leone and Guinea were on track to zero cases, with just 2 new cases diagnosed in Sierra Leone and 7 cases in Guinea during the week of May 10th 2015 . However, there were increases in new cases with 27 cases in Guinea and 8 in Sierra Leone during the week of May 17th, followed by 9 cases in Guinea and 3 in Sierra Leone this week .

Most new cases were associated with unsafe burials in the community.
WHO sent a team to Guinea to investigate an outbreak near the border with Guinea -Bissau, which to date had had no reported cases of Ebola.

Guinea has been through a number of cycles of surges and then declines in cases since the original outbreak in December 2013.

What systemic or community factors might contribute to this on going (but diminishing) cycle?

What factors contributed to Liberia achieving and maintaining zero cases despite sharing a border with Sierra Leone and Guinea?

Might Ebola become endemic in Guinea?



Pierre Bush, PhD Replied at 12:30 AM, 1 Jun 2015

I think the Liberian success in the fight against Ebola Virus is mostly due to the massive US Army intervention. The deployment of a large number of our troops who built health clinic post, and laboratories coupled with massive education campaigns were very instrumental in curbing cases of Ebola in Liberia. The intervention in Sierra leone and Guinea were of lesser magnitude. The work in these two countries should be on going.

Robert Cannon Replied at 2:50 AM, 1 Jun 2015

Absolute rubbish! The strength and cohesion of individual communities and their ability to define and implement new cultural norms for the treatment of the sick and care and respect of the dead in response to the carnage of EVD eventually stopped the epidemic. Traditions fed the flames, the communities subsequently quenched them by adapting and finding new and safer ways of caring for their own. External interventions had only a meager supporting role.

EDITH MUTURI Replied at 3:50 AM, 1 Jun 2015

Ebola has persisted in Sierra Leone and Guinea courtesy of culture and more specifically unsafe burials. The truth is that only the natives got the power to change the narrative and foreigners can do very little. We must see political, religious and community leaders showing deliberate effort to change the narrative.when HIV infections were out of control in Botswana and everyone was in denial the then President Festus Mogae took a HIV test publicly and Botswana found it's road to recovery. Can we see political leaders in Sierra Leone making such efforts? We can send as much foreign aid and expertise as we wish but recovery lies in the hands of the citizens of Guinea and Sierra Leone.

Elizabeth Glaser Moderator Emeritus Replied at 12:15 PM, 1 Jun 2015

There are few enough cases being reported in both countries, therefore I had assumed that there would be more careful and intense education and outreach in affected communities (1) to care for the ill in an ETU (2)to reduce the chance of transmission (3) increase survival chances, and if the person died, then (4) to ensure safe burial. That has not occurred.did the government not know that there were cases in those communities until deaths occurred? If so how well are they tracking chains of transmission?

Pierre, while the US Armed forces helped set up labs and did terrific training of health care personnel, the ETUs they helped build were completed far too late to make any difference in the epidemic.

In my opinion, it was the organization and will of the Liberian people that made all the difference. The county health teams tracked cases, communicated between counties and NGOs, educated groups on transmission, assured access to chlorinated handwashing stations, set up or advised on temperature checkpoints etc. It was a time when political will and community response amplified the overall response and spurred it towards success..

Fred Hartman Replied at 12:55 PM, 1 Jun 2015

Hello everybody, I have followed this discussion with great interest,
having spent the better part of October in Liberia organizing our own
organization's response to the Ebola outbreak. I remember attending the
weekly update meeting in mid-October when we were all pleasantly shocked to
learn that only 50% of the ETU beds available were filled. Of course, the
continuing downward trend continued. The US Army at that meeting indicated
that they would continue to build the ETUs, since they were committed to
that course of action.

But, after this meeting, the MOHSW staff that we knew implored us to work
with the USG representatives to develop a strategy that would strengthen
rebuilding, rather than an emergency response. The USG-built ETU with 200
beds in Monrovia, that took 3 months to build, opened in mid-October and
closed in December due to lack of patients. The ETU in Bomi County opened
in November and never saw a patient. We met several times with the USG
representatives in place in Monrovia and presented a proposal for more
community-based support in Montserrado, Bomi, and several other counties
that was rejected. They wanted us to construct, and staff, community care
centers at a time when it was clear to us that more support was needed to
Districts and communities to further their own control efforts. We
declined to participate in the USG-funded structural approach and continued
to develop our own approach, a Framework for Ebola Response and Recovery at
the Local Level, with our own funds. We will shortly roll that out in
previously affected counties, since much needs to be done to both detect
and respond quickly to newly introduce cases, and to rebuild.

Having been there and suffered together with the Liberian people, I agree
completely that, while the USG response was helpful for policy development,
surveillance, and contact tracing, the emphasis on expensive physical
structures distracted from the community development work that eventually
turned the tide of the epidemic. In my humble opinion, it was the
resilience and strength of local communities, including neighborhoods in
Monrovia, that ended the epidemic. Not enough emphasis was placed early on
on the involvement of social scientists and BCC to involve communities. In
the end, they did is themselves with some modest support from donors.

Best regards, Fred Hartman

*A. Frederick Hartman MD MPH*
*Global Technical Lead*
Malaria and Communicable Diseases
Management Sciences for Health

Elizabeth Glaser Moderator Emeritus Replied at 1:35 PM, 1 Jun 2015

Well said, Dr Hartman. Now how can Sierra Leone and Guinea follow suit?

Gaël CLAQUIN Replied at 5:51 AM, 2 Jun 2015

Without will to pursue this debate endlessly nor to point at a
diplomatic middle way, I honestly believe we must recognize the truth is
a combination of these various contributions:

* recognition of the reality of the disease indeed took place,
especially in Monrovia, by all levels of the society, and the
severity of the epidemic at its peak in this very concentrated
capital city of Monrovia (i.e. cadavers in the street, ever-growing
number of infected families, giving an "end of the world" landscape
for all inhabitants) contributed.
The rather bold approach by the head of state Helen Johnson Sirleaf
may have been stronger than in other countries and helped to move
things (is this your impression ?).
So shock therapy on denial, which may not have taken place elsewhere
because the epidemic had a different profile, more widespread and
less intense in a short time.
For example we still heard recently of doctors in the capital city
of Guinée (Conakry) denying Ebola's reality, transport of disguised
cadavers in a seated position in cars for burial purpose (all this
happened anywhere but still occurring 18 months through the
epidemic, it's telling)
* definitely the answer from the international community came too late
and with bureaucratic delays and time needed to mobilize and ship
resources from big organizations like the UN or DoD indeed ETU where
opened when the epidemic was on its way to be controlled, thanks to
appropriate adaptation of behaviour by the population, with the
support of their fellow citizens and NGO on the ground. That said,
having ETU outside in the vicinity of Monrovia made more sense than
piling more in Monrovia (and there is a coordination issue there as
Chinese also opened one, Germans tried also but were overtaken by
the former [their dedicated powerline was even 'stolen' by the
chinese I heard :-D ]. Epidemic dynamic analysis showed that the
offer of treatment in isolation contributed roughly half to the
control of the epidemic and having this offer in counties like Bomi,
Bong, Cape Mount were there was still low-level on-going
transmission certainly helped not to enter in the kind of continuous
small-scale epidemic as still observed in Sierra-Leone and Guinée.
It is not correct to state Bomi county ETU had no patients, there
was a dozen or two (plus remember most patients were denied access
to national health system facilities for fear of Ebola so many non
Ebola were managed also in ETU)
* the issue of rebuilding health system is for me another debate. As
discussed earlier this has been caused by decades of mismanagement
by international organizations in charge (or supposedly) of
"development" and national authorities. So no quick fix there and
difficult to ask people (particularly not geared to it such as DoD)
to switch their mandate on a sudden. Besides USG had partners
trying to address this already on the ground, plus other NGOs that
would have been in a much better position to do the job.

Regards to all

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This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.