On 22 March, what was to become the largest recorded outbreak of Ebola was officially declared in Guinea.
It is believed that the outbreak originated in the Guinée Forestière region in December 2013. Previous outbreaks of Ebola had mostly erupted in remote villages in central and eastern Africa, where they could be more easily contained. This time, however, Ebola broke out at the junction of Guinea, Liberia and Sierra Leone, where people regularly move across the porous borders. The deficiencies of the public health system in Guinea and the fact that early symptoms of Ebola are similar to malaria – a salient health threat in the country – led to misdiagnosis of infections early in the epidemic and allowed for the spread of the disease.
Médecins Sans Frontières (MSF) was collaborating with the Guinean health ministry on a malaria-focused project in the hospital in Guéckédou and 20 community locations in Guinée Forestière when Ebola was suspected. On 18 March a reinforcement team with viral haemorrhagic fever specialists arrived in Guéckédou and started an exploratory intervention, supporting the health ministry in collecting samples for analysis. Once the Ebola epidemic was declared, the malaria programme was put on hold as staff were reassigned to help the MSF emergency team build the first Ebola management centre (EMC) in Guéckédou. The malaria programme closed in August.
The EMC in Guéckédou opened on 23 March and served as the main centre for Ebola cases in the region, caring for patients, carrying out health promotion and outreach activities, and training medical and sanitation staff. A psychosocial team also worked at the EMC to support patients, and spent time with families and communities, helping address their fears and cope with the loss of family and community members. By the end of the year, 1,076 Ebola cases had been confirmed, and 430 patients had recovered and been discharged from the facility.
To reinforce the activities of the EMC, MSF opened a transit centre in Macenta, Nzérékoré region, facilitating detection, triage and referral of patients coming from the southeast of Guinea. Psychological support was also provided. Between March and November, 520 patients were transferred to Guéckédou EMC. At the end of the year, the transit centre was converted into an EMC and handed over to the French Red Cross.
On 25 March, MSF opened an EMC within Donka hospital in Conakry, Guinea’s capital city. The team conducted health promotion, educational and outreach activities, including identification of possible patients with Ebola, provided psychosocial support and trained medical and sanitation staff. By the end of the year, 1,463 patients had been admitted; 594 of these were confirmed to have Ebola and 290 recovered.
Telimele district, 270 kilometres north of Conakry, was relatively far from the country’s Ebola epicentre in the southeastern forest region, but Ebola cases were reported in May. MSF teams were quick to respond, transforming one of the local health centre’s wings into an isolation area and building an EMC nearby which opened within days. By the end of July, Telimele was declared Ebola free.
Researching Ebola treatment
In the absence of specific human treatments for Ebola, MSF partnered with the French National Institute of Health and Medical Research (INSERM) to trial an experimental treatment in the midst of an outbreak. The drug tested in Guéckédou for efficacy against Ebola was favipiravir, an antiviral used in Japan to combat resistant flu in adults. Soon other sites, not managed by MSF, were also included in the favipiravir trial. More trials for treatments, vaccines and diagnostic tools were planned to start in the region early in 2015.
In order to bring the Ebola outbreak under control, critical components of the response – such as surveillance, contact tracing, community mobilisation and infection control protocols – needed to be strengthened, and MSF continually asked for more support in 2014. Many Guineans remain reticent to accept messages about Ebola, as the general level of knowledge about it is low. Health workers, patients, contacts and survivors are often stigmatised and this prevents people from seeking medical help – such as those suffering from malaria, which has not receded as a health issue during the Ebola crisis.
Measles vaccinations in Conakry
In February 2014, MSF vaccinated more than 370,000 children aged between six months and 10 years against measles in the Conakry neighbourhoods of Matam, Ratoma and Matoto. At the end of the intervention the vaccination coverage was just over 87 per cent. Staff treated 2,948 cases of measles, 241 of which were severe.