July 28, 2014

Caitlin Rose, a nurse from Washington, DC, recently returned from Macenta, Guinea, where MSF was working with Guinea’s Ministry of Health to contain an outbreak of Ebola. Her duties included contact tracing—working to follow the path of the highly contagious disease as it moved through the community.

The project was supposed to be an exploration, so it was a small team, just three or four other people who arrived a few days before me. But they found cases right away, so they set up an isolation ward and more staff was sent in. I took over contact tracing and was working with a mixed team of Guinean and MSF staff to locate people whom the sick, dying, or dead had been in contact with.

Ebola is highly contagious outside isolation, so when dealing with patients or suspected cases we always wear gloves and N95 respirator masks, and we always have a bottle of 0.5 percent chlorine solution with us to spray down our gloves between taking a temperature or touching a suspected patient. You have to keep a two-to-three meter distance between yourself and others to keep the risk of droplet contamination as low as possible. If you find someone who is sick, you alert the ambulance team and the water and sanitation and logistics people right away.

Contact tracing is fairly low-risk because most of the people aren’t sick. It’s very important, however, because it’s one of primary methods of breaking the cycle of transmission. We actually didn’t find a lot of infected people but we did monitor a lot of potential cases—taking temperatures every day, going through symptoms, checking and double checking to make sure they hadn’t made contact with anyone else.

The outbreak in Macenta wasn’t difficult to trace. A doctor in town had gotten infected and transferred the disease to a lab. From there, lab staff caught it and then passed it to a relative. It was a fairly logical progression. We knew who was at greatest risk: the immediate family members of people we had in isolation, and the baby of a mother who died from the disease.

There were other challenges, though. This is the first time there’s been an outbreak of Ebola in Guinea, or in most of West Africa, and it’s a very frightening disease. This particular strain, Ebola Zaire, is extremely lethal and usually kills eight to nine out of ten people. People get very sick very quickly, and foreign aid workers arrive in outlandish protective gear. It’s very hard to reconcile traditional cultural and religious beliefs with the strict medical protocols of Ebola. That’s hard to understand and hard to explain, and rumors spread that MSF had brought the disease, because we showed up and started isolating patients who walked to the ambulance, walked into the hospital, but later died.

There were violent protests and we were evacuated, but after several days of negotiation with local authorities, MSF returned. Some patients have since been discharged from isolation, but the outbreak has not yet been declared over.

When we arrived, because we’d never worked in Macenta before, some local health staff thought MSF dealt solely with Ebola. This isn’t the case, of course, but I think a situation like this does sum up what we actually do: take risks to go places that others aren’t, and to provide care to people who are really need it.

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