Ebola – a test too far for one little girl

June 2015

In Guinea, the Ebola outbreak continues and resources are needed to end the epidemic. When testing and treatment options are too far away, people are less willing to cooperate. Mariam's* case illustrates this problem. As a WHO team discussed her symptoms, she listened and showed no signs of distress. When she was told she must go to Conakry – over 3 hours away – she began to sob and her family refused to send her.

Child’s parents talking to Ebola team, Guinea
WHO/P. Haughton

Dr M’Bemba Camara has been working for the past 4 months in the Forecariah prefecture where communities have been hit hard by Ebola. More than 250 people have died from the disease in this prefecture alone. A member of WHO’s surveillance team in Guinea, Dr M’Bemba sets out each morning with a social mobilizer or communicator for Alassoya, a Forecariah sub-prefecture. Dr M’Bemba is now well accepted in this area.

A father initiates discussion with Ebola team

Each day, Ebola monitoring teams and community members bring him information about sick family members, friends or contacts. This morning, shortly after he arrives, a member of the Ebola monitoring team comes to tell him that there is a young girl down the road who has been sick for a few days. He heads straight there to visit the child, Mariam, and investigate these reports.

Mariam’s father is a respected elder in the community and when it comes to Ebola, he is more than ready to cooperate with the investigation teams. He explains that he took his daughter to the hospital several days ago when she was feeling unwell, but was told that everything was fine. However, as Mariam’s symptoms persisted for several days, he wanted to be safe, so he called the Ebola team.

Dr M’Bemba begins his evaluation by using a contactless thermometer to take Mariam’s temperature and goes through a list of questions to detect symptoms and signs. According to WHO processes, if 3 or more such symptoms and signs are present and the patient is a contact of someone confirmed to have Ebola virus disease, they are considered to be a suspected case of Ebola. Mariam has 7 of the signs and symptoms on the list.

Ebola treatment centres are full

Mariam’s father agrees that she needs to be taken to a treatment centre to be tested and the Red Cross are called to bring an ambulance. But there is a problem. There are limited beds in each of the prefecture’s treatment centres and today the centre in Forecariah is full. The team enquire about the treatment centre in Coyah, just over an hour away, but after an intensive 4-day surveillance campaign identified 39 suspected cases, this centre is full too. Their only option is to send Mariam on 3 to 4 hour drive to the capital, Conakry. This is where Mariam’s father draws the line.

Mariam and her parents talking to Ebola team, Guinea
WHO/P. Haughton

Cooperation quickly turns to reticence

There is no one who can accompany Mariam as the rest of the children in the family are also young, including a newborn baby. She will be gone for several days while they await test results to determine if she has Ebola. But the dangers of not evacuating someone with a suspected case of Ebola are too high: leaving Mariam at home with her family is not an option.

The head of the sous-prefecture comes to talk to the father, but he is not convinced. The WHO Ebola team then drive both of them into Forecariah centre to see the head of the prefecture. Here, in consultation with WHO and the local authorities, Mariam’s father accepts that sending his daughter to the treatment centre in Conakry is the best option.

Mariam is a very strong 8-year old, but when her father explains that she has to leave her family to be treated in Conakry, she begins to sob uncontrollably. Unable to watch her daughter in such distress, Mariam’s mother picks up her newborn baby and supplies for the infant and gets ready to climb into the ambulance. But at the last minute, Mariam’s father stops her, puts on the required protective clothing and accompanies his daughter to Conakry.

Reticence quickly returns to cooperation

"Reticence is a crucial problem for us. First, you have to talk to families to try to make them understand the importance of evacuating a sick family member. If, after all your explanations, they still don’t understand, you have to escalate the information to the local authorities," Dr M’Bemba explains.

In moments like these, the difficulties caused by lack of resources are clear. The Ebola response has not yet finished and vital funds are still needed to end the epidemic. These situations are stressful – not only for the families involved, but also for Ebola teams who are charged with supporting the families and helping them to understand the risks involved. Additional resources can make a world of difference when it comes to reducing community resistance and violence.

Thankfully, after 3 days in Donka Hospital in Conakry, Mariam’s test results came back negative.

With increased vigilance in each of the affected prefectures in Guinea, WHO is working to ensure any new cases are caught early, avoiding further spread and working to end the Ebola epidemic.

* Not her real name.