AS the deadly Ebola virus continues to spread in West Africa, Inagh’s Damien Queally is co-ordinating NGO Plan Ireland’s response to the disease.
In his time with the organisation, he has worked in Uganda, Congo, Darfur, Haiti and Niger. For the past year and a half, Damien has lived in Dakar, capital of Senegal and his main work has been in the area of education and health. He expects to be there for another 18 months.
Damien is now deputy head of programmes for Plan Ireland in West Africa. Plan, he explains, “focuses on children and youth, looking at what are the rights of children and young people” but as the Ebola virus claims its 1,145th victim, his work has shifted sharply in that direction.
“We work with children, their communities, local agencies, government and parents, around seeing how can we help them help their children get access to education, to ensure they are getting vaccinated, to ensure they have good health care, that the girls are not getting married at 12 years of age and we are combating female genital cutting,” Damien explained.
“We are in 14 countries in Western and Central Africa. The countries that are not affected by Ebola, they are continuing with their regular programmes, as well as adding awareness around Ebola and how to protect themselves and to prevent the disease affecting their families or communities,” he added.
“In areas that have been affected by the virus, we have suspended our regular programming because our regular programme often involves bringing people together to discuss their issues and finding solutions to them. We have suspended all of that. All our attention is now focussed on how we can break down the confusion and the rumours around what Ebola is, how can we get people to go to the health centres when they actually have the disease, how can we help the health centres to reduce their risk and treat the people,” he continued.
Damien was in Guinea back in March when this bout of Ebola was first detected (although it now appears the outbreak actually began in December).
Since then, the disease has claimed over a thousand lives with the largest number of cases in Guinea, Sierra Leone and Liberia. Containing the disease is extremely difficult.
According to the WHO, more than 100 healthcare workers have been exposed to Ebola while caring for patients with the virus. The organisation says this is because workers “may not have been wearing personal protection equipment or were not properly applying infection prevention and control measures when caring for the patients.”
“In Liberia, there were some areas where all the health workers just went. They said ‘we are not staying around for this. We don’t get paid enough to risk our lives’ and they all left. So you actually had health centres closed because the health staff had left. Now, we are trying to get the health staff back and provide incentives for them to come back, so we are giving them some extra reward. They might be getting $50 dollars a month, it is not a lot, so if you can give them an extra $50, or something that they can survive on, as well as giving them protective clothing (it is more likely they will stay),” he explained.
“So, while the government says ‘we will provide protective clothing and equipment to all our clinics’, the infrastructure is really weak and really poor and really remote, so the government doesn’t have its own resources to do that. What we are doing in Plan is working with the government, the WHO and MSF and others to make sure health staff have disinfectant material, have chlorine, have gloves, have masks, have sheeting, have disinfectant spray cans, have all these things to protect themselves when dealing with the patients,” he continued.
“Then we are trying to get across to communities that if they don’t send a person showing symptoms to the health centre, then they risk themselves, their community and their family also getting infected by it,” he went on.
Plan is also trying to inform communities about other contamination risks, including traditional funeral and burial practices.
“There is confusion in so many different places and the national health structure doesn’t have the capacity to deal with the speed of spread,” Damien warned.
“The three countries we are looking at, Guinea, Sierra Leone and Liberia, are in the bottom 10 poorest countries in the world. Two of them have come out of a decade-long civil war where you have a generation of people in their 30s that don’t exist,” he continued.
Battling misinformation is proving to be as challenging as providing adequate medical facilities. Damien wants to see better communications and better tracing to contain the deadly virus.
“There is much more technical expertise needed in terms of how to communicate and in terms of tracing. If I have Ebola, who have I been in contact with for the last 21 days, who have they been in contact with for the previous 21 days, it is a matrix, it is huge, but that is what is needed to narrow down the infection areas,” he said.
“It becomes a massive database that is used to trace people. But it needs a lot of human resources, so a lot of local people need to be trained on how they can ask these questions and meet people and do tests and quarantine them locally for the 21 days,” he explained.
Not everyone who has come in contact with someone who has been diagnosed with the disease needs to travel to a central location, according to Damien.
“Take someplace like Inagh say, anyone who has been in contact with someone in Inagh has to go into the hall in the village for three weeks and they are monitored each day to see what the story is. To do that, the people need motorbikes, they need fuel and they need to have clothes and gloves when they are going out doing it, to reduce the risk to themselves. But, at the moment, they don’t even have this fuel so we are trying to give them the fuel so they can at least do that and trace some of the people who potentially have come in contact with the disease.
“Then there is surveillance. You need simple medical equipment to check temperatures and look at symptoms. Then, if people are showing symptoms, the person needs to be further isolated into another unit so as not to risk the other people under surveillance,” he outlined.
As well as a shortage of medical supplies, trained medical professionals and tracing of patients, governments and NGOs are faced with uneducated populations, suggestions of witchcraft, suspicion of foreigners and a lack of communications infrastructure, among other difficulties.
Damien is frustrated that the outbreak wasn’t dealt with quickly enough, arguing that “governments should have done much more, the WHO should have done much more and we wouldn’t be in this situation”.
“People were allowed to move between the infected areas to the capital. They were having meetings, events and everything else and it just spread. It went to the capital, it went to neighbouring countries and a guy got on a plane and brought it to Nigeria,” he said.
Ebola is not a new disease but there is no vaccine and no cure. The haemorrhagic fever first appeared in 1976 in two simultaneous outbreaks, one near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan. The origin of the virus is unknown but according to the World Health Organisation, fruit bats are the likely host. The WHO states that there have now been more than 2,100 suspected cases of the disease in this outbreak, with 1,145 deaths, which means a death rate just short of 55%. The WHO announced last week that staff at the outbreak sites see evidence that “numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak”.
The infection is transmitted by direct contact with blood, body fluids and tissues of infected animals or people. The WHO is advising families and communities against caring for people with Ebola symptoms in their homes and is encouraging them to seek treatment in a hospital or centre.
According to Damien, it is hard for people to send their loved ones to hospitals in some areas because of the low quality of the health system. However, if they decide to care for them at home and are not trained or properly equipped, the risk of further infection increases.
“The people are used to seeing death, they are used to seeing malnutrition and, even they are used to children dying of simple diseases like diarrhoea,” he said.
He believes the haemorrhagic nature of the final symptoms of the disease make it more difficult to contain. “The latter stages of Ebola is not something many people would have seen. It doesn’t spread as easy as cholera and other diseases. It doesn’t become water borne or anything like that, so fewer people have it but when you see it or imagine seeing it, the fear that would instil in anyone…the natural thing is that you would try and help the person but the worst thing you could do is help the person by physical touch, because you are only risking yourself and you are going to go and touch someone else and someone else. But that is the natural reaction.
“Can I try and imagine myself if I was at home and someone had something like that, how would you not be able to comfort them and treat them, especially with a child. How would you not do something? How would you sit there and look at them and have to bring them to a health centre where you know the chances of them coming out is only four out of 10. You are already hearing rumours and lots of different stories about witchcraft and everything else, where you are seeing bodies being cremated or being thrown in the street because people are afraid of it. It is unimaginable for us,” he concluded.
To donate to Plan Ireland, go to www.plan.ie/donate or call 1800 829 829.
A native of Ennis, Colin McGann has been editor of The Clare Champion since August 2020. Former editor of The Clare People, he is a journalism and communications graduate of Dublin Institute of Technology.