After ebola, what next for West Africa’s health systems

IRIN: As rates of Ebola infection fall in Guinea, Liberia and Sierra Leone, planning has begun on how to rebuild public health systems and learn lessons from the outbreak. Nobody is declaring victory yet. But in Sierra Leone, the worst-affected country, there were 117 new confirmed cases reported in the week to 18 January, the latest statistics available, compared with 184 the previous week and 248 the week before that. Guinea halved its cases in the week to 18 January – down to 20 – and Liberia held steady at eight.

The epidemic is not over until there are zero cases over two incubation periods – the equivalent of 42 days. “It’s like being only a little bit pregnant – there’s no such thing as a little Ebola. We have to get to zero, there can be no reservoirs of Ebola,”  Margaret Harris, spokesperson of the World Health Organization (WHO), told IRIN.

But after 21,724 cases and 8,641 deaths in nine countries since the epidemic began in Guinea last year, there is some light. And health workers are already starting to look at what’s next. “Right now important meetings are going on in each country to work out what needs to be done to rebuild - in some significant respects to build health systems almost anew - and to build back better,” said Harris.

A European Union donor conference isdue at the beginning of March in Brussels. “What we want to see as a country is a resilient health system that can withstand shocks,” Liberia’s Assistant Health Minister Tolbert Nyenswah told IRIN. “Our plan [to be presented in Brussels] will be finalized by the end of February. It will be well costed with tangible goals.”

Ebola tested the public health systems in the three West African countries to near destruction – most places in the world would have also struggled. But where the three failed was at the basic “nitty-gritty” level of “standard surveillance, testing and monitoring, the containment of cases, the bread and butter of public health”, said Adia Benton, a social anthropologist at Brown University in Rhode Island....

Ebola training in Guinea, shot by CDC Global CDC Global, Wikimedia Commons via Flickr, under the Creative Commons Attribution 2.0 Generic License

Questions over Mali's ebola response

IRIN: The failure of a top Malian hospital to detect probable cases of Ebola has raised questions about whether the country's health system is sufficiently prepared to tackle the disease.

"We have several confirmed cases," Samba Sow, head of the Mali's National Centre for Disease Control (CNAM), told IRIN. "Our goal is to prevent the virus from spreading." But the government only released an Ebola emergency plan on 30 October, a week after the first Ebola case.

In Kayes, where a two-year-old girl tested positive for Ebola on 23 October, the hospital was caught off-guard. Only two of its 160 workers had received training on how to detect and treat Ebola patients and how to protect themselves while doing so, said hospital director Toumani Konaré. "The staff had the right protective gear, but they didn't know how to use it," he told IRIN.

Before the current outbreak in Mali, the World Health Organization (WHO) had categorized the country as at-risk, due to its long border and strong economic ties with Guinea, where the epidemic began. It was targeted as a country to receive technical assistance, including training on infection prevention, epidemiological surveillance and contact tracing.

Sow said preparations started in April. However, those preparations were focused mostly on the 805km border that Mali shares with Guinea. The government started to send a few health workers to check travellers for fever and other signs of the virus among the chaos of trucks, buses, bush taxis and motorbikes at border checkpoints.

The Ministry of Health says the Kouremalé border checkpoint, where an imam who died of Ebola in Mali on 27 October had entered from Guinea, checks more than 1,000 people and 150 vehicles per day....

Ebola outbreak: 'Thousands of orphans shunned'

BBC News: At least 3,700 children in Guinea, Liberia and Sierra Leone who have lost one or both parents to Ebola this year face being shunned, the UN children's organisation has said. Carers were urgently needed for these orphans, Unicef said.

A basic human reaction like comforting a sick child has been turned "into a potential death sentence", it added. The World Health Organization (WHO) says more than 3,000 people have died of Ebola in West Africa. It is the world's most deadly outbreak of the virus.

The figure on the number of Ebola orphans follows a two-week assessment mission by Unicef to the three countries worst-affected by the outbreak. An earlier version of this story said that 4,900 children had lost parents but the correct figure is 3,700. It found that children as young as three or four years old were being orphaned by the disease.

Children were discovered alone in the hospitals where their parents had died, or back in their communities where, if they were lucky, they were being fed by neighbours - but all other contact with them was being avoided....

WHO: Ebola spread outpaces control effort

Voice of America News: The head of the World Health Organization has told the presidents of West African nations stricken by Ebola that the outbreak is moving faster than efforts to control it. Dr. Margaret Chan, WHO's director general, says if the outbreak continues to worsen, the consequences could be "catastrophic" in terms of lost lives and socio-economic disruption.

Chan is in Conakry, where she met Friday with the presidents of Guinea, Sierra Leone, Liberia and Ivory Coast. WHO and the West African leaders are finalizing a $100 million plan to fight the spread of Ebola, which has claimed nearly 730 lives.  Chan said more than 60 health workers are among the victims, and that some international relief workers have been infected.

The WHO chief said her hope is the plan emerging from the Conakry meeting will mark "a turning point" in the international response to the outbreak. Several hundred medical personnel are about to be deployed to West Africa, Chan said, and an emergency committee will meet on Wednesday to assess the international implications of the outbreak.

Referring to the scale of the ongoing Ebola outbreak as unprecedented, WHO spokesman Gregory Hartl told VOA the outbreak is probably worse than the figures indicate. “There could well be cases in the community that we have missed because this has been one of the biggest challenges in terms of also tracing contacts," Hartl said. "People run away.  They do not want to be treated in the health centers.  They are afraid or they do not believe that the health centers can do them any good, so they try to be treated by their families and they get sick and die there.”

Hartl says key elements of the emergency plan are to stop transmission of the Ebola virus and to prevent the spread of the disease to neighboring at-risk countries by strengthening and scaling up all control and response measures....

An electronmicrograph of the Ebola virus, image by Cynthia Goldsmith at the CDC, public domain

Fighting Ebola and its myths

IRIN: A months-long battle to bring West Africa’s Ebola outbreak under control has stretched medical teams to the limit, while mistrust in some communities has impaired prevention work and raised questions about the delivery of health warnings.

The outbreak, which was first declared in March in southeast Guinea, should have been winding down now, with cases reducing as controls take effect, said Armand Sprecher, a public health specialist with Médecins Sans Frontières (MSF) in Guinea.

Sprecher, who has worked on haemorrhagic fever outbreaks like Ebola and Marburg in places such as the Democratic Republic of Congo’s Western Kasai area, explains that outbreaks normally run their course and eventually die down because they are contained within a limited geographic area.

That looked to be the case in May with optimistic signs that the outbreak had already peaked, or was even over. But those hopes have since faded, with new cases being identified in Guinea, Liberia and Sierra Leone. At least 340 people have died of the disease so far in the three countries, according to the World Health Organization (WHO).

In Guinea, the worst-hit among the three West African countries, traditional burial rituals are still being observed despite the health hazards and many people are reluctant to be traced for medical surveillance (as a precaution for having come into contact with those infected)....

Color-enhanced electronmicrograph of Ebola virus particles, Thomas W. Geisbert, Boston University School of Medicine - PLoS Pathogens, November 2008, Wikimedia Commons, under the Creative Commons 2.5 license

Ebola outbreak death toll in West Africa rises to 135

Voice of America News: The World Health Organization says the death toll from the Ebola outbreak in West Africa has risen to at least 135. In a Thursday statement the WHO says Guinea's health ministry had reported a total of 122 deaths, while 13 deaths had been reported by Liberian health officials.

The WHO says officials are investigating more than 200 suspected or confirmed cases of the virus in Guinea, Liberia and Sierra Leone. Six suspected cases in Mali tested negative and no new suspected cases have been reported.

This is the first major outbreak of Ebola in West Africa. Authorities say it began in a forested southeastern region of Guinea in February.

The Ebola virus is spread by contact with bodily fluids. It causes symptoms that include vomiting, unstoppable bleeding and organ failure....

A CDC image of the Ebola virus

Curbing west Africa’s ebola outbreak

IRIN: As health authorities and aid groups work to contain the spread of Ebola in Guinea which has killed 59 people and infected scores of others since January, suspected cases have emerged in neighbouring Liberia, prompting calls for a regional response.

Haemorrhagic fever symptoms first appeared in Guinea’s southern forested region. Eighty-six people have so far been infected. Authorities are urging restriction of movement and observance of hygiene to prevent further infections.

The cases have mainly been reported in the four southern districts of Guéckédou, Macenta, Nzérékoré and Kissidougou near the border with Sierra Leone and Liberia. Médecins Sans Frontières (MSF) has dispatched some 33 tons of medicines and equipment to Guinea to help curtail the epidemic which is infecting 1-3 people a day.

“It’s happening along the border, so what we’ve been doing now is to start a collaboration between these neighbouring countries,” said Francis Kasolo, director of the World Health Organization’s (WHO) Disease Prevention and Control Unit in Africa. “Conferences are being held between these three countries to ensure that whenever there is a suspected case it can be identified quickly and appropriate response can be taken.”

In Guinea’s Guéckédou area, district health chief Moussa Kolié said: “We have begun training nurses to help contain as much as possible the spread of new cases.” Funeral gatherings and unnecessary hospital visits were being discouraged, he said...

Ebola virions, from harting the Path of the Deadly Ebola Virus in Central Africa. PLoS Biol 3/11/2005: e403 doi:10.1371/journal.pbio.0030403, Wikimedia Commons, under the Creative Commons Attribution 2.5 Generic license

Lightning detection promises improved storm forecasts

Charlotte Owen in SciDev.net: An alternative to costly radar-based weather services could soon be operational in developing nations, to help them detect severe storms more cheaply and quickly. The technology, which uses lightning detection to forecast when and where storms will strike, has already proven successful in demonstration projects in Brazil, Guinea and India. Next year, Earth Networks — one of the companies at the forefront of the technology — will conduct further trials in Haiti.

As more developing nations increase their numbers of mobile phone masts, which are ideal locations for mounting the lightning sensors on, the proportion of countries using the technology looks set to increase, according to the US company.

Lightning detection costs a fraction of traditional Doppler radars, which can cost tens of millions of dollars for broad regional coverage. “Data from these stations would fill the gaps encountered in the collection and exchange of data on the regional and international level.”

Mamadou Lamine Bah, National Directorate of Meteorology  It also collects data faster and, by monitoring precipitation, can be used to assess the likelihood of floods and drought. According to Finnish company Vaisala, which has more than 100 lightning detection stations located in the United States, when lightning is detected the data can be delivered in less than two minutes.

Vaisala’s Total Lightning system detects the electromagnetic signals given off when lightning strikes the earth’s surface. Information on the location, time, and strength of each strike, and on whether it is positively or negatively charged is then processed and communicated to users of the technology....

Photo by Thomas Bresson, Wikimedia Commons via Flickr, under the Creative Commons Attribution 2.0 Generic license

West Africa hopes new hydropower dams will cut poverty, climate risk

Elias Ntungwe Ngalame at the Thomson Reuters Foundation: West African states in the Niger River Basin are seeking to tackle climate risks and reduce poverty by constructing three hydropower dams in the next five years. In late November, the Council of Ministers of the Niger Basin Authority (NBA), meeting in Cameroon’s capital Yaounde, endorsed an environmental and climate action plan for sustainable management of the scenic basin and its rich natural resources, which have come under threat from climate change.

The projects include a 102 megawatt (MW) hydropower dam at Fomi in Guinea, a 25 MW hydropower plant in Toussa, Mali, and the 565 MW Kandadji dam in Niger. These aim to boost hydro-electricity and irrigation, reduce desertification and flooding, and improve economic activities across the region.

“The West African region is facing urgent problems of food security, rural poverty and climate change that demand answers in the form of investment and infrastructure. We need to give a push to these three multi-purpose hydropower dam projects as a sustainable solution that involves the region’s largest river,” NBA executive secretary Collins Ihekire said in a statement at the Yaounde gathering.

The NBA is the coordinating body for the 4,200 km-long (2,600-mile) Niger River, bringing together the governments of Benin, Burkina Faso, Cameroon, Chad, Côte d’Ivoire, Guinea, Mali, Niger and Nigeria.

The NBA also agreed to rehabilitate three hydropower plants at Kainji, Jebda and Lagdo, as well as multiple run-of-river hydropower stations, optimise water storage, set up irrigation schemes for an additional 1 million hectares (2.5 million hectares) of land, and increase hydropower production to 1,000 gigawatt hours per day.

“Integrating future climate change adaptation and mitigation into our development action plan will enable...sustainable management of our water resources, to better the livelihood of the over 106 million population in the area,” said Emmanuel Nganou Djoumesi, Cameroon’s minister of the economy, planning and regional development, at the closing of the Yaounde meeting....

The Niger River from space

Africa's great 'water grab'

Claire Provost in the Guardian (UK): The banks of the Niger river, in southern Mali, have been flooded by a steady stream of foreigners. Coveted by foreign investors eager to snap up large tracts of fertile farmland, the river basin has been at the centre of a race to get hold of African land at rock-bottom prices. Meanwhile, last week, hundreds of smallholder farmers and civil society activists flocked to the same river basin for the first international conference to tackle the global rush for land.

West Africa's largest river, the Niger is thought to sustain over 100 million people as it snakes 4,180km through Guinea, Mali and Niger before emptying into Nigeria's colossal Niger Delta. In Mali, the Office du Niger is home to the vast majority of the country's largescale land deals, seen by campaigners as emblematic of the "land grabs" taking place in developing countries. Recent estimates suggest that foreign investment in Mali's limited arable land jumped by 60% between 2009 and 2010. But the potential knock-on effects of these land deals on local communities' access to water has rarely made it centre-stage.

Ongoing research from the London-based International Institute for Environment and Development seeks to redress this blindspot, honing in on how such land deals might affect water access for fishing, farming and pastoralist communities. In a policy paper out on Thursday, the IIED's Jamie Skinner and Lorenzo Cotula warn that an alarming number of African governments seem to be signing away water rights for decades, with major implications for local communities.

Investors in farmland are, understandably, after land with high growing potential – either land with lots of rainfall or land that can be irrigated. What Skinner and Cotula note is a worrying trend where governments are being rushed into signing away water rights during negotiations where they were initially only considering leasing land...

A canoe on the Niger River at sunset, Guinea, shot by L. Lartigue

West Africa experts tested on their disaster response skills

George Fominyen in AlertNet: Picture the scene: terrified, hungry crowds go on the rampage, attacking cars belonging to humanitarian organisations, storming warehouses to steal food and fuel supplies. As a government what do you do? How, when and where do you deploy security forces to restore some order to your streets? How do you coordinate civilian and military players to provide emergency relief?

Those were some the questions facing disaster management officials from the West African countries of Benin, Ghana, Mali, Guinea, Nigeria and Senegal, who took part in a recent simulation exercise aimed at testing the effectiveness of their decision-making. Run by the World Food Programme (WFP), the simulation exercise was held in Senegal's capital, Dakar, and involved responding to a hypothetical influenza pandemic.

West Africa is more used to dealing with natural disasters such as seasonal flooding, so how did their officials do? "We realised that we still had to improve on a lot of things in the area of coordination," Eugene Hountondji, the head of safety and civil protection training in Benin's interior ministry, told AlertNet. The officials were told to imagine a high death rate and the disruption a severe pandemic would cause a society, compared with the relatively localised problems of flooding....

A 2005 flood in Dakar, shot by MyriamLouviot, Wikimedia Commons, under the Creative Commons Attribution 3.0 Unported license

Record cold snap kills crops, animals in Guinea

AllAfrica.com, via IRIN: Near-freezing temperatures in north-central Guinea in January destroyed crops and livestock on which thousands of people depend for food as well as cash. Elderly locals told IRIN they had never seen cold this intense in Mali, a town in Guinea's Labé region.

"The vegetation looks as if it was burned in a fire," Hannibal Barry of the UN Office for the Coordination of Humanitarian Affairs (OCHA) told IRIN from Mali on 19 February during a joint evaluation by UN agencies, local authorities and NGOs.

Temperatures dropped to 1.4 degrees Celsius from 17 to 26 January, according to a preliminary report by the Food and Agriculture Organization (FAO) and World Food Programme (WFP). The cold wiped out crops - mainly potatoes, tomatoes, peppers, onions and bananas - across five districts in Mali. It is not yet known how many hectares were destroyed, Mamadou Saliou III Diallo, head of agricultural operations at the Mali prefecture, told IRIN after visiting the affected areas.

In one district, the cold destroyed 15 hectares, he said, adding that UN and local officials continued to survey the area. …Many people had borrowed money for crops from a rural credit bank, said Diallo, who lost his potato and tomato harvest. "Now people here are asking themselves how they will be able to pay their debts and at the same time feed their families."

FAO is initially appealing for US$500,000 to help families affected by the cold, Mariatou Coulibaly, FAO emergency coordinator in Guinea, told IRIN from the capital Conakry…

Locator map of Guinea by Vardion, Wikimedia Commons, under the Creative Commons Attribution ShareAlike 2.5, Attribution ShareAlike 2.0 and Attribution ShareAlike 1.0 License