Ebola: Lessons from Guinea
Interview with Ms Jacqueline Sultan, Minister of Agriculture, led by Julia Wanjiru, Lomé, 4 March 2015
What lessons do you draw from the Ebola epidemic in Guinea?
This crisis has been a huge lesson, learned through a great deal of pain obviously. This is an unexpected event that we had no knowledge of, a completely new disease for us. We thought it was something that could happen only in Central Africa, and suddenly it was discovered in West Africa, with all of the hysteria and misconceptions that come with it.
Ebola has made us aware of the weakness of our health system and our lack of readiness to respond. Beyond the shortcomings of our health services, we were also confronted with the lack of understanding in our entire population. We had to integrate this dimension into the sensitisation system. Obviously we were extremely cautious before deciding on the approach to take to combat and control the epidemic. Until then, in Central Africa, Ebola had developed in very confined, remote rural areas. This is the first time we have seen the epidemic leave its area of origin, travel a thousand kilometres and take root in a capital city.
Guinea struggled and debated for months over more or less random approaches to control the disease. There were no laboratories, community services, etcetera, that were ready to act. This trial and error approach lost us at least six months which allowed the epidemic to spread over a large part of our territory and beyond the borders.
It does not really matter where the epidemic originated. The fact is that it exploded in our country and in neighbouring countries - Sierra Leone and Liberia - but prompted different reactions from partners and brotherly countries. In Guinea, we felt a little alone; at times there was a feeling that some research organisations came to see but were not there to respond and give us answers. In Liberia, on the contrary, there was an extremely strong, fast and powerful response from the United States with the arrival of the Marines and a comprehensive approach. Britain, meanwhile, attended to Sierra Leone. There were three different responses in three countries that were suffering the same epidemic.
What was the role of the media?
The media, both local and international, have contributed to sensationalising the epidemic. Perhaps they had no other news at that time. Whatever the reason, we have been the object of great stigma in the eyes of international opinion, yet without benefit of an effective reaction in relation to what Guinea, a country in danger, a country in distress, might expect. We had extremely alarming news clips, stigmatising countries, giving sometimes contradictory information from various partners who did not necessarily have practical knowledge of this disease. The media frenzy is also explained by the fact that this was a first for the world, to see that Ebola could not be circumscribed and could cross barriers, jump continents and become a global health problem.
How would you explain public distrust toward the treatment centres?
We understand this reaction because it reflects a lack of information and conflicting discourses. Initially, Ebola was presented as a lethal disease with a quasi 100% death rate, which provoked great distrust in our health services. People thought that they would die in the hospital once they had Ebola. In Guinea, we have a survival rate of 57%. It was something new that even major laboratories and international health agencies had not expected at all. This shows that Ebola in West Africa is a whole other epidemic, different from that of Central Africa, and therefore requires a different approach. This is the lesson that we are learning in West Africa and in Guinea: This epidemic is different. "No 100% death rate, you can recover if you seek medical attention early on", was a primary message!
Who are the victims?
Rural areas paid the highest price. I also want to underscore that we had a lot more deaths of women, because it is women who cared for the sick and for children. When there is an epidemic, women are always on the frontline.
How would you assess the reaction from partners?
I think that there is an important lesson to draw. The partners came, each with their methodology, each with their approach, and there was no co-ordination. There was an extraordinary loss of time. Each reflected in his corner without a common vision of the whole, without the capacity to benefit from the help of partners. Treatment centres arrived eight months after the decision was taken to establish them. The very lengthy procedures made it so that help arrived a little late to address certain emergencies.
In addition, while local healthcare was absolutely urgent, the relocation of patients was favoured initially. Besides, being transported from one place to another was also a vector for spreading the disease.
Finally, each partner raised funds individually with its own agendas instead of developing a common agenda. We know that similar initiatives - for example health monitoring systems - were conducted in parallel, without co-ordination and at very different costs. I think this also is one of the important lessons. Millions of dollars were mobilised, but we do not have a clear vision of how this money was spent. This is what created a veritable business, and we regretted the lack of co-ordination of our partners' actions.
In this instance, we would have liked to have AGIR better co-ordinate a common response, an alliance whose main purpose would be to react to such crises by providing a unifying framework for action. That is why we are calling on all stakeholders to ensure that the operational capacity to respond to such crises is quickly established. I believe that there are lessons to be learned in terms of approach, and AGIR is an inspiration.