How did the world survive Ebola?

By Kamalini Lokuge PhD ’05

In March 2014, an unknown outbreak began killing people in remote villages in Guinea. It was similar to past Ebola outbreaks I’d been involved in, so I was unsurprised when Médecins Sans Frontièrs (MSF) asked if I could come to Guinea.

I left Australia a few days later, seconded by ANU to support the MSF response in Conakry, the capital of Guinea. In Australia there was significant media attention on the outbreak, particularly the lack of specialised hospital facilities to care for those sick with Ebola. Less attention was paid to another critical element, engagement with affected communities to ensure that they understood the disease and how to control it.

Ebola, unlike the flu, is not very infectious. People are infected following close, unprotected contact with someone who is very sick, or with the body of someone who has died of Ebola. People who have been exposed to Ebola can therefore be monitored and if symptoms occur can be admitted to a treatment centre and cared for safely, activities we call surveillance and contact tracing. How successful these activities are depends on how you engage with patients, their families and communities.

Each day in Conakry I would take surveillance staff from the World Health Organisation and Ministry of Health and visit patient households. The first family we visited had just lost a young man to Ebola. They had had many foreigners in white LandCruisers visit, so had been marked as a house that had Ebola and were furious. We arrived in my undercover blue pickup and spent two hours with them, talking about the disease, who we were, why we were there, and how the family could protect themselves. That afternoon, the head of the family brought two sick young men who had been hidden by the family to the treatment centre. Both turned out to have Ebola. The surveillance staff were enthusiastic and hardworking young men and women and I think that was my greatest achievement, to support people to work safely and effectively.

What really worried me in Conakry was the lack of known connections between patients diagnosed with Ebola. With these gaps, you are at risk of losing track of the disease.  The only way to fill them is through effective contact tracing, which was not happening in Conakry. Two factors had led to this:  a reluctance to admit that the situation was out of control, and agencies not agreeing who should pay the small travel costs for volunteers. MSF with its untied, unconditional funding arranged to pay the contact tracing volunteers, meaning that within a few days of my arrival we were able to fill many of the gaps in transmission. But that was not the case in Guekedu, where the outbreak started in Guinea. Very few contacts were under follow up, and from there the outbreak spread to Sierra Leone and Liberia.