Gert van der Hoek
In Memoriam - Editor, Senior Moderator
GUINEA
Long overlooked by international efforts, response in Guinea painfully slow
Guinea was the first country affected by Ebola in West Africa, but initially the country benefited from
little international support. As the epidemic expanded to neighbouring countries, the largest
international commitments to help respond went largely to Liberia and Sierra Leone;since September,
however, local and international commitments have been trickling in.
The situation in Guinea is alarming. Since August, case numbers in Guinea have been on the rise, and
in November the caseload was about 25 per cent higher than it was in October. The outbreak has also
been spreading geographically: new areas are reporting infections and 17 of Guinea?s 33 prefectures
have reported cases in the past three weeks.
The national task force for the coordination of the Ebola response is improving; but at the same time,
at the prefecture level there are still gaps that must be filled with urgency. Deployment and
reinforcement of the different activities required to control the outbreak ? and support from
international partners to the Ministry of Health (MOH) to implement them ? is urgently required in
most of the areas affected.
At present, there are only four case management facilities receiving Ebola patients. In mid-November,
the French Red Cross(FRC) took over the MSF-built case management centre (CMC) in Macenta, and
the French government now fully finances the structure and the attached laboratory ? a positive
development. But the FRC and MSF are two of only a handful of international organisations running
case management facilities in the country. Two other CMCs are being built by the World Food
Programme (WFP); but for the moment, only one international organisation has been identified to run
one of the supplementary facilities.
Like in Sierra Leone and Liberia, the absence of implementing partners willing and able to manage
CMCs and a lack of trained staff have been a bottleneck and the source of large delays. MSF has taken
a key role in training staff from other organisations: so far around 120 national and international nonMSF staff have been trained in MSF?stwo CMCs. However, training these individuals to safely staff
the new CMCs takes time, on the order of weeks; meanwhile case numbers continue to mount.
There is insufficient capacity for isolating and providing supportive medical care to patients in Guinea.
As of the middle of November, MSF?s Gu?ck?dou CMC was full to capacity, with the majority of
patients coming from far away areas.
Other activities such as alert, surveillance and patient referral to case management facilities are slowly
starting to receive the support required in terms of expertise, human resources, training, supervision
and logistics; however, they are still fragile and insufficient. Ambulance services require urgent
improvement, for instance: in Macenta and other areas, confirmed and suspected patients are
transported in the same vehicle for long periods, potentially causing individuals who are not already
sick to become infected.
Awareness-raising, a key activity to help communities to adapt behaviour and reduce transmission,
remains very weak for an intervention that began eight months ago. These activities are unevenly
supported throughout the country and there is still a great deal of resistance towards the Ebola
response. Around Conakry, for example, there are still areas where MSF teams are not welcome.
Again, training for both local and international staff in safely leading these activities remains a major
constraint.
MSF
Long overlooked by international efforts, response in Guinea painfully slow
Guinea was the first country affected by Ebola in West Africa, but initially the country benefited from
little international support. As the epidemic expanded to neighbouring countries, the largest
international commitments to help respond went largely to Liberia and Sierra Leone;since September,
however, local and international commitments have been trickling in.
The situation in Guinea is alarming. Since August, case numbers in Guinea have been on the rise, and
in November the caseload was about 25 per cent higher than it was in October. The outbreak has also
been spreading geographically: new areas are reporting infections and 17 of Guinea?s 33 prefectures
have reported cases in the past three weeks.
The national task force for the coordination of the Ebola response is improving; but at the same time,
at the prefecture level there are still gaps that must be filled with urgency. Deployment and
reinforcement of the different activities required to control the outbreak ? and support from
international partners to the Ministry of Health (MOH) to implement them ? is urgently required in
most of the areas affected.
At present, there are only four case management facilities receiving Ebola patients. In mid-November,
the French Red Cross(FRC) took over the MSF-built case management centre (CMC) in Macenta, and
the French government now fully finances the structure and the attached laboratory ? a positive
development. But the FRC and MSF are two of only a handful of international organisations running
case management facilities in the country. Two other CMCs are being built by the World Food
Programme (WFP); but for the moment, only one international organisation has been identified to run
one of the supplementary facilities.
Like in Sierra Leone and Liberia, the absence of implementing partners willing and able to manage
CMCs and a lack of trained staff have been a bottleneck and the source of large delays. MSF has taken
a key role in training staff from other organisations: so far around 120 national and international nonMSF staff have been trained in MSF?stwo CMCs. However, training these individuals to safely staff
the new CMCs takes time, on the order of weeks; meanwhile case numbers continue to mount.
There is insufficient capacity for isolating and providing supportive medical care to patients in Guinea.
As of the middle of November, MSF?s Gu?ck?dou CMC was full to capacity, with the majority of
patients coming from far away areas.
Other activities such as alert, surveillance and patient referral to case management facilities are slowly
starting to receive the support required in terms of expertise, human resources, training, supervision
and logistics; however, they are still fragile and insufficient. Ambulance services require urgent
improvement, for instance: in Macenta and other areas, confirmed and suspected patients are
transported in the same vehicle for long periods, potentially causing individuals who are not already
sick to become infected.
Awareness-raising, a key activity to help communities to adapt behaviour and reduce transmission,
remains very weak for an intervention that began eight months ago. These activities are unevenly
supported throughout the country and there is still a great deal of resistance towards the Ebola
response. Around Conakry, for example, there are still areas where MSF teams are not welcome.
Again, training for both local and international staff in safely leading these activities remains a major
constraint.
MSF