There were so many opportunities for the Ebola virus to invade Guinea-Bissau. A farmer unknowingly carrying the disease could come in undetected from neighboring Guinea to tend his crops. An infected trader could arrive by bus from Senegal to the north to sell his wares in the capital. A fishermen from Sierra Leone with symptoms could dock on the islands just off the coast unbeknownst.
Yet the virus never came.
Even as Ebola hop-scotched its way across West Africa, from the hilly streets of Freetown to the forests of Guinea, it miraculously never infiltrated Guinea-Bissau. It is especially remarkable when you consider how Mali, Nigeria, and Senegal all had cases of Ebola as a result of people traveling from the neighboring countries ravished by Ebola, but Guinea-Bissau has never seen a single case.
The country may have dodged a bullet so far, but it is still very much at-risk of the virus. A tiny, impoverished nation of just 1.7 million people, Guinea-Bissau in many ways was the perfect breeding ground for the virus to flourish. It shares a porous land border with Guinea, the likely source of the Ebola epidemic and its islands and coastline are commonly visited, with little official border control, by fishermen from Guinea and Senegal; Guinea-Bissau suffered many years of civil war that stunted the country’s development; and its health system is underfunded and weak, particularly in rural areas where Ebola would likely first appear. It is for these reasons that Guinea-Bissau is one of the World Health Organization’s four highest priority countries for Ebola preparedness efforts.
Starting in April 2015, International Medical Corps began working in Guinea-Bissau to help the national health system prepare to quickly and safely respond to an Ebola outbreak. Drawing on experience gained by treating Ebola patients in five facilities in Liberia and Sierra Leone, International Medical Corps has been training health workers and other professionals in Ebola case management, from identifying the symptoms to infection prevention and control and treatment.
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One of them is Iama Coutinho Sampa, a psychologist working at a health center in Bubaque, one of the remote regions off the coast of Guinea-Bissau that are considered highly vulnerable to Ebola. I met her in November following a simulation on patient triage and protocols around putting on and removing personal protective equipment, a process known as “donning and doffing.” The exercise was part of a five-day training program at the National Public Health Institute in the capital, Bissau.
“It is never wise to underestimate this risk since we have cases in the region,” she said. “We are not immune to this danger since we come into direct contact with those populations, especially from Guinea-Conakry, which has seen Ebola within its borders … Without preparing we will be unable to manage the disease if the need arises.”
Piloted in Liberia, the Multi-Agency Training Collaborative program covers the various facets of Ebola case management, from patient transport to proper use of personal protective equipment, psychosocial support, and safe burial protocol. With funding from the Paul Allen Foundation, International Medical Corps brought the training program to Guinea-Bissau and built a mock Ebola Treatment Unit, giving participants a chance to run through real-life scenarios.
“It is not only theory, but also showing the technicians how to do it and show what points were wrong,” said Dr. Mireille Pereira, the Infection Prevention and Control Coordinator of INASA who works closely with International Medical Corps and other international organizations on preparedness efforts. “And it’s also something really interesting — so the learning continues.”
For Coutinho Sampa, the training was helpful to not only better equip her to work at the health center, but also to give her knowledge that she can impart to others when she returns home. “Since I am on this course learning all of this, I can communicate all that I have learned to the population both at the health center and in my community to make people understand the causes and how to deal with the issue to avoid discrimination and further infection in the future more easily,” she said.
In addition to trainings in the capital, International Medical Corps — with funding from the U.K. Department for International Development through The Start Network — is equipping rapid response teams in five regions in Guinea-Bissau to swiftly investigate suspected Ebola cases and, if needed, carefully isolate and refer them for treatment. More than 136 doctors, nurses, and other specialists have been trained to be part of RRTs, which consist of one epidemiologist, one doctor, three nurses, one psychosocial officer, four hygienists, two lab technicians, four burial team members, and one logistician.
I visited an RRT training while in Guinea-Bissau and found the participants eager to learn. Many told me it was the first one they have done that includes practical simulations in addition to classroom work. “It is very different now because before, we didn’t know how to prevent or defend the Ebola because we had no equipment or knowledge,” said Dr. Leandro Ocargo Có, who is part of the RRT in Bafata, a region in central Guinea-Bissau. “But now, we are ready to defend and fight against Ebola.”
While the RRT trainings focus on Ebola, they also touch on other infectious diseases that are endemic to Guinea-Bissau, such as cholera, meningitis, and measles, in the hope that the teams can also respond to other outbreaks. “This team is very useful because it can be used not only in Ebola,” said Antonio Pedro Sidjanito, regional director of health for Bafata. “It can be used in cholera, meningitis — outbreaks that we have had before.”
While the Ebola outbreak is finally waning, Guinea-Bissau will likely remain vulnerable to Ebola, as small flare-ups, like the one that occurred last month in Liberia, are expected to continue for some time even after countries are declared “Ebola-free.”
For Dr. Mireille Pereira at INASA, the country is on what will be a long process to fully prepare for an outbreak of Ebola or other infectious disease. “In terms of our activities that we must do for this preparation, I can say that we are more prepared now that these activities are on course,” she said. “But are we 100 percent prepared? I don’t know how to answer that. But we need more simulations. Without a doubt. We need more.”