Mamadou spent his first night in the hospital of Donka sleeping on the floor in front of the door of the infectious diseases unit. It was last March 26. He had been several days with excruciating headaches, constant vomiting that prevented him from eating and extreme weakness. “I told them I was coming Dabola and the doctor came running in a hurry. I felt abandoned. Was playing on the door, but nobody wanted to open up. The next day someone came with gloves and mask and took me in a wheelchair to the area isolation. But
I do not understand anything. when I arrived and saw that there were also my wife, a cousin and two of my uncles, I realized it must be something serious. “
Mamadou did not know it, but he and his family had become the first Ebola patients registered in Conakry, an African city of two million people right now trying to face the más recent outbreak of the dreaded disease , which have been infected and 224 people and until Thursday had claimed 135 fatalities (122 in Guinea and 13 in Liberia). Every day there are new cases.
Mamadou had barely stand. ” My brother convinced me to take a collective taxi and go to the capital “
It all started on March 14. Until that day, Mamadou Cissé (fictitious name), officer of 36 years old, married with no children, led a normal life. With ups and downs and bottlenecks, as almost everyone in the capital of Guinea, since some years ago moved there from Dinguiraye near Dabola, inside the country. But that Friday, his older brother, a merchant who was living in the town, came to his house for help. He was very ill. “He was breathing hard, his chest and complained that his head hurt. Furthermore, vomited and had diarrhea. ” Mamadou and his wife welcomed him, nursed him, helped him wash.
“No I took him to the doctor because it was the weekend, but Monday was much worse and decided to submit it.” The venue was a private clinic kipe Dadia, a popular district of Conakry. Twenty-four hours later, on Tuesday 18 March, the sick brother died with a severe case of hemorrhagic fevers. Nobody could imagine then that the “perpetrator”, the silent murderer beginning to leave a deadly trail in Guinea, era nothing less than the Ebola , a virus that was identified in 1976 and, until now, had only been shown in the center of the continent’s forests. Never before in West Africa. On the same day, hospital staff moved the body to the morgue. There, a paternal uncle of Mamadou took over the body. “It’s a ritual, wash the corpse, prepare. For us is very important and is always someone older family who is in charge.” On Wednesday March 19, Mamadou started with the body to Dinguiraye, where he was buried 24 hours later. “My wife was in Conakry, but many people attended the ceremony,” he says. That afternoon began to suffer the first symptoms. “I had a severe headache, but I waited to see if it was wrong. Did not think it was related to my brother. The next day (Friday) should have gone to the mosque, but could not, I felt worse and worse, and began to vomit a lot. I went to the health center and was told that it was malaria; gave me pills and some vomiting for cutting, but during the weekend did not get better. “This Saturday, March 22, authorities made a surprising announcement Guinea. Since January, a number of deaths from haemorrhagic fevers had shaken the South, a mysterious epidemic that began to acquire concern dyes. In the extensión cases and virulence of evil, the Ministry of Health had decided to send blood samples of seven deaths at Pasteur Institute of Lyon. All of them tested positive for Ebola virus and, what was worse, it was the deadly Zaire strain, with a fatality rate of between 60% and 90%. The affected districts were Guekedou, Macenta, Nzerekore and Kissidougou, forest regions called Guinea.
“We do not know what has been the source,” says Philippe Barboza, an epidemiologist at the World Health Organization (WHO) , who has worked on the outbreak in Conakry in recent weeks. “In January and was suspicious deaths, but we do not know if all can be attributed to Ebola because it is buried without getting tested. In this part of the world’s other haemorrhagic fevers, such as Lassa, so we can not know. What we do have clear is that all outbreaks of this epidemic, Guekedou, Macenta, Conakry, are linked together, is the same epidemic. And that began in the forest region. “ Scientists suspect that the natural host of the virus are several species of fruit bats eaters. “These bats move across West Africa, moving, it is normal that the virus circulates. Possibly the outbreak comes from any human contact with sick animals in the forest, “says Barboza, who notes that the virulence of Ebola comes from its ability to jump from one species to another, such as avian flu, but then the spread between humans is not so simple, only occurs through contact with fluids of people already ill. “What is unusual is that this outbreak is affecting several countries, cross-border transmission (confirmed cases in Guinea y Liberia , suspicions in Mali and Sierra Leone), but consider that we are talking about the same ecological zone, “he adds. On Wednesday 26 March, Mamadou was in and started Dabola undergo the second stage of the disease. His health had deteriorated so much that he could barely stand. They had appeared diarrhea. “I was afraid to eat because everything she ate she vomited. Still, my brother convinced me to try to go to Conakry, so we took a jeepney in the morning and arrived at nine in the evening. I stopped by the hospital. ” Although no one had informed Mamadou, by then his wife, his cousin and two uncles were already admitted. The next day they took blood at five. “One of my uncles was a dentist. I wanted to go, I was not happy, but he convinced us to wait for the results, we should have something very contagious and we thought of the children in the house, we could beat them the disease. ” Each presented different symptoms, but all had fever, severe headache and, to a greater or lesser extent, vomiting and diarrhea. The next day came the fatal news. Was Ebola. “They told us not directly, but heard talk among themselves; I knew what the disease was because I had read something years ago, so I said nothing to my wife and my cousin did not want to scare them even more. “Analysis of Family and Mamadou did not have to travel to France. Donka Hospital had a hemorrhagic fevers specialized laboratory received, from the early days, the support of the Pasteur Institute, which sent experts from Dakar and Paris. “It is true that this is the Zaire strain,” said Dr. Jean Claude Manuguera of Pasteur in the French capital, “but this is a local variant whose lethality, so we are seeing around 60%. That is, in the lowest range of the Zaire strain. Six dead in ten affected “
The Government, in constant coordination with WHO, it just took a few hours to announce that Ebola had appeared in city. Outside the hospital, psychosis began to spread. During the preceding week, all had taken refuge in the thought that this was a bad thing “forest” of southerners from Conakry to be seen with contempt because “eat monkey meat and are ignorant and uneducated “. But that all changed on March 28. The virus officially entered a chaotic as few and where, no doubt, would be more difficult to track overpopulated city.
More than difficult, a daunting task. “We have to follow the chain of transmission. Each infected person do a list of people with whom he had contact. We’re talking about a thousand people in total at present to which we will see every day. Thousand people once a day, imagine “said Barboza. “In the Forest Guinea, the outbreak is still active, but it will be easier to control. Here in Conakry, we will take months. It is the first time we have a major epidemic of Ebola in a city. ” For all this work for epidemiological surveillance, WHO relies on local health structures and the Red Cross. “The most graphic simile is the sack of rice falling. At first it is relatively easy to collect 90% of the grains, but then you have to go to granite countertops. And many end up under furniture or between the tiles. “
These grains of rice may be, in fact, anywhere. In the villages, the drive chain is more predictable, undecideable, you can easily follow. But in Conakry, the chance of infection multiply. This is the Gordian knot of the problem. Newspapers open editions each day with figures, personal stories and news halfway between reality and rumor. That if a person entered a bank with juice bissap in the mouth, purple, and spit it out like blood, causing a stampede that helped him steal the box. If a girl in the neighborhood of Hamdallaye proposes sex as being infected. Ebola is not. But fear itself is very visible these days in the city. The Madina market, one of the most populous of Conakry, meat sales have fallen. Awa Diallo, who has spent 20 years grilling skewers next to the bridge that crosses the highway, said “people are afraid, all kinds of rumors circulating.” In all public buildings and even travel agencies, restaurants and entertainment venues, will now require desinfectarte hands. Bleach has become a coveted product. At the international airport in the city has increased security: thermal cameras to know the temperature of passengers, medical checks before boarding. The idea is that the virus does not jump off Guinea. Michel van Herp, an epidemiologist at Doctors Without Borders (MSF), carries and seven outbreaks of Ebola behind. Ensures that this is “a detective investigation in which we have not yet made the hunter (referring to the person who probably caught the infected bat or monkey animal, which was then ingested and transmitted the virus to humans). His family would have been the first to suffer the disease and then health workers and Macenta Guekedou that attended. One of the major problems of this epidemic is its amplitude. Unlike Congo or Uganda, here people move a lot, are always going from one place to another. And that expand the virus. For example, the director of the hospital in this town died when he came way Conakry and was buried in Kissidougou “. It is estimated that at least 30% of the confirmed cases are health workers, the most exposed to the virus when caring for patients.This is doctors and nurses, but also traditional healers and family caregivers, the first to try to calm the pain and symptoms of patients in a country where, particularly in rural areas, access to public health structure is not always easy . The Guinean Dr. N’Famara Bangoura, who these days faces the Ebola isolation center Donka, knows of what he speaks. “A doctor can not refuse a patient, we have to address them, trying to alleviate the symptoms. The problem here is that this disease is not known, it is something new, health workers did not know how to cope, what protection adopt “he says.
After the government’s announcement on March 28, in the makeshift isolation center Donka hospital things went from bad to worse. The old man who had washed the body of Mamadou brother had just joined too. And six were family members. “I was the one most solid of all, they were very concerned, especially the elderly,” recalls Mamadou. “My uncle was newly arrived very agitated, the catheter is removed and stained with blood. He put him in a separate room; walked with great difficulty, just had no strength, and he died on Saturday night. When I got up the next morning found his body lying in the yard and a great blood trail. He was the first to die. ” In the following days also killed two other guys Mamadou, the virus raged with the weakest. then, MSF had already taken charge of the isolation zone Donka. One of the most important aspects to consider are safety measures. And that has moved to Conakry a team of 40 hygienists. “We use about 300 liters of chlorinated water per patient / day. Several times in the same day disinfect protective equipment, beds, mattresses and bedding, “says Rob D’Hont, responsible for this task. The strange thing is that Ebola is relatively easy to kill. “It’s a very strong virus. We use a chlorine concentration of between 0.05% and 0.5%, while for the anger we have to use up to 2%, “he says. Once disinfected, protective equipment is dried outdoors. Mere exposure to sunlight can also with himAlthough initially impressed, Mamadou eventually get used to all these people wearing astronaut suit. “Every day was something new, latrines, water tank, shops, disinfection measures … With them I started to feel more confident and I also had the first signs of improvement. The family brought us food, but I could not smell it, I was tired of throwing up. Then they started giving me Plumpy Nut (a nutritional supplement) and began to eat slowly. And I remember when I drank my first sip of water, I felt through my throat and into the stomach. And not vomited! That gave me hope. “
Patients admitted to the isolation center are allowed to have mobile phone and, if not with infusion wander the public areas, but prevents the suspected cases mix with confirmed to prevent new infections. The latest development is opening an area for family visits, which you can see but not touch: there is a margin of separation of two meters. However, the demand for visits is not high. Fear causes havoc. The Argentina Dr. Fernanda Mendez has already had to face to face with Ebola four times, two in Uganda and one in Congo. Exit the isolation area completely drenched in sweat. “The suit that we not let the air”, says between gasps. MSF staff can only be within one hour; at noon, when the heat, 45 minutes. And always go in pairs if anyone feels faint. “I just saw four confirmed Ebola patients. We watched her vitals, treat your symptoms. Two of them have deteriorated, one has begun to take bloody diarrhea and the other has light bleeding, edema in the legs is clouded “signs. Some who are now admitted are the medical staff of the clinic where Mamadou kipe Dadia took his brother. Doctors, nurses, technicians ray … “The worst thing is not being able to touch them, the eyes can only see us through the glasses,” Mendez added. Others, however, improved. About forty have overcome the disease. “The sooner they are taken care of, most likely to survive,” said Dr. Barboza, “the problem is that the early symptoms are confused with malaria, widespread here. Although there is no treatment for the virus, they moisturizes, nourishes them, they calm the pain. And your immune system does the rest. ” On Thursday April 3, a week after admission, Mamadou was discharged. He had defeated Ebola. “The same day they told me and another guy we had to leave Conakry. He was jumping for joy, but I could not be happy. My three uncles had died there and were still inside my wife and my cousin, “she recalls. But in the following days both also received the coveted news that the virus was gone from his body, that he had been completely removed. However, despite that they can not spread the disease (except the first three months through semen, so heal men who receive a lot of condoms), one of the problems they have to face is the social stigma. “Just outside the center told me that the insulation market held weekly in Dinguiraye had been suspended because of our family. I felt ashamed. Then, since we returned home, the neighbors have not come even once to greet us. They closed all day house windows overlooking the communal courtyard and will not collect tap water that we share there. They are afraid, we reject, we point the finger. But we’re alive and we know that with time and with the right information will no longer do so. So now I thank God every minute. “ A few days ago, the Government of Guinea reported that the” epidemic is under control. ” Specialists disagree emphatically. Every day new cases continue to occur. Sometimes five, sometimes ten. Other suspects who were just confirmed. Y nuevos foci may appear. It is unpredictable. An early warning system is active throughout the country. At the slightest doubt, the patient will be for referring to relevant evidence. Until you spend at least 40 days without any new cases, ie two periods of incubation (from 2 to 21 days), it can not be taken for control. The good news is paradoxical that kills so fast that this limits their ability to expand. It is also opinionated, but not invincible. “The first is to accept that Ebola is here,” concludes Van Herp. And that will take time to defeat him.
I survived the Ebola
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