Remco Van de Pas is currently for a research assignment in Guinea, one of three countries in West Africa affected by Ebola. Together with the national research center for training and promotion of rural health (CNFRSR) of Maférinyah, Conakry, the Institute of Tropical Medicine will explore policies and possibilities to strengthen the public health system in Guinea during the ongoing Ebola outbreak and afterwards. During his visit, Remco will keep a journal. Below you find the first episode (9/1/2015).
Given my professional background, I didn’t come unprepared; yet, this trip to Guinea has been a sobering and humbling experience. In Belgium or other countries in the North, while working on global health issues and related international frameworks & governance dilemmas, I sometimes tend to forget the daily life and health realities for people in places like this. Guinea has an average life expectancy of 54 years, and has one of the highest infant and maternal mortality rates in the world. This visit makes me realize again how unequal our world is. It’s just insane.
We are developing an innovative research program here in Guinea to assess health workforce requirements to respond to the Ebola outbreak, and to find out how newly enrolled community health workers, midwives, nurses etc. can be integrated in the regular workforce after the outbreak. As of now, 78 health workers have died in Guinea because of Ebola, which puts a real strain on their colleagues. We would also like to assess how different national and international agencies will function and hopefully sustain the effort once the epidemic is over. An important aspect of the Ebola (or any other infectious disease) outbreak response is that one already needs to consider how to prevent a next epidemic.
I am working together with Dr. Eugene Lama, a friendly experienced practitioner and researcher. He is originally from the forest region in Guinea and has an extensive network of colleagues and contacts. We planned to visit N’Zerekore, which is situated in the forest region. The idea was to travel by car. This would enable us also to visit the place(s) where the first outbreak occurred in December 2013. It would also help me to understand better the context and considerable social and environmental variety in the country. The road journey was about 800km in total, with a road only partly paved. It took us about two days.
The start in Conakry was already telling. We needed to exchange foreign cash money on the market. After considerable negotiations, we received a pile of local currency bills that afterwards quickly went into the hands of the owner of a car company, whose car and driver we hired for the trip. I wonder how a fiscal system to fund health services could ever work, when the majority of the financial transactions occurs in the informal sector.
I started to make some sense of things once we passed the first places in the forest region, Kissidougou and Gueckedou. Both are close to the border with Sierra Leone and Liberia, and main hubs for trade and commerce between the countries. Because of the economic downturn, there is little traffic on the road. Fuel is scarce, and so we had to wait several hours at a gas station to refill. I had some time to walk around looking for some bottled water. Then I saw and recognized the other side of globalization. Many adolescent girls and boys, nearly all with an empty look in their eyes, were sitting in the shade, with obviously little prospects. There were many small shops selling either liquor (whiskey or pastis, thanks to the French Colonial heritage), over-the-counter medicines, mobile telephone vouchers or lottery cards. It took me a considerable amount of time to find water. Fresh vegetables were nowhere to be seen.
Gueckedou, the place where the Ebola outbreak started, is a dreadful place. This area was in the 90s inhabited by Sierra Leonean rebels and refugees. Much of the original forest has been destroyed. Kilometers long plots of monoculture palm plantations have replaced the forest since. Palm oil is a key export product. The health centre and schools are empty and dilapidated. While wandering around there, two remarkable resemblances popped up in my mind with the first Ebola outbreak in Yambuku, former Zaire (now DRC), in 1976 – as described by Peter Piot in his book ‘ No time to lose’. The Yambuku outbreak also took place relatively close to a large palm oil plantation. And also in Yambuku, poor health services became a main site for transmission. The main difference is that during this 2014 outbreak, the virus has made it to major urban areas, and as a consequence is so difficult to halt.
The situation here is not merely a public health urgency, it’s also “development” that has gone ugly. The Ebola outbreak had its roots in and further aggravated a grave socio-economic situation, with limited possibilities for education, employment, or even traditional farming for a rapidly growing young population.
We then received very bad news. The mother of Eugene, 90 years old, had just passed away in N’zerekore. Her death was not related to the Ebola virus. We rushed back to meet his mourning family.
Instead of our research work, the next two days will be spent with a funeral ceremony and traditional rituals. I give my condolences to the family and just adjust our plans. A mother is a pillar of each African family, hence many people come to pay their respect…