Category Archives: Ebola and Poro

Mali reports second Ebola death

A police officer stands guard outside the quarantined Pasteur Clinic in Bamako November 12, 2014. REUTERS/Joe Penney

A police officer stands guard outside the quarantined Pasteur Clinic in Bamako November 12, 2014. REUTERS/Joe Penney

Today Mali reported its second confirmed case and subsequent death from Ebola.

An imam from the Guinea border town of Kouremale died on 27 October from an Ebola-like disease two days after appearing at the Pasteur Clinic in Bamako, the Malian capital of 2 million people. Unfortunately, Ebola was not suspected, and the man was never tested.

His body was ceremonially washed in a Bamako mosque, and then returned to Guinea. It is feared that if indeed he was infectious, many mourners and other contacts could have become infected (in both Mali and Guinea).

A nurse who cared for him at the hospital became ill, tested positive for Ebola virus two weeks later on 11 November, and died later that evening. More than 90 possible contacts have since been placed in quarantine, and the clinic has been locked down.

The first case reported in Mali was a two-year-old girl who became infected at a funeral in Sierra Leone but subsequently died in Mali after traveling there with her Grandmother. No other cases in Mali have been traced back to the girl, and her known contacts have completed their 21-day quarantine period.

Likewise, the imam translocated from across the border in Guinea. Therefore, the nurse was probably the third Malian case, but the first person known to have contracted the disease within Mali.

We have discussed the roles that the traditional rituals of the Poro and Sande societies play in the spread of the virus, but this case illustrates that the neighboring Islamic rituals, particularly funerary customs, are also possible disease vectors.

Wikipedia, Ebola, and African Languages | Mali | UMass Ebola Panel 28 October

27 October 2014

• Wikipedia, Ebola, and African Languages: Wikipedia Is Emerging as Trusted Internet Source for Information on Ebola

Beyond Niamey reports that an article in the New York Times, “Wikipedia Is Emerging as Trusted Internet Source for Information on Ebola” (26 Oct. 2014), mentions translations of a main article on ebola “into other languages” – from English being understood. Those translations are coordinated through the Medical Translation Project / Translation Task Force (MTP/TTF) of the WikiProject Medicine, the

• Mali to keep Guinea border open despite Ebola death: president

• Ebola Epidemic to Be Discussed by Panel at UMass Amherst 28 October 2014

University of Massachusetts in Amherst announced that four panelists will discuss “The Ebola Epidemic: How We Got Here, Current Preparedness, and Future Outlook” on Tuesday, 28 October at 6 p.m. in the Campus Center Auditorium at the University of Massachusetts Amherst.

The speakers are:

  • Martha Anker of the UMass Amherst School of Public Health and Health Sciences, a global surveillance and response expert in infectious disease
  • George Corey, executive director and medical director, University Health Services
  • Donna Gallagher, founding coordinator, UMass Medical School Office of Global Health
  • Alpha Kabinet Kaba of the Pioneer Valley Performing Arts Charter Public School, a native of Guinea whose family has been affected by the Ebola outbreak

Wilmore Webley, associate professor of microbiology and an expert in infectious disease and immunology, will be moderator.

Ebola in Mali: The Guinea-Mali Connection

Potential for Ebola Spread Along Route from Guinea to SW Mali

Some important details were revealed by WHO today regarding Mali’s first recorded case of Ebola, and the situation does not look good.

The two-year-old girl who died on 23 October had recently arrived from Guinea accompanied by her grandmother. Her first contact with the country’s health services occurred on 20 October, when she was examined by a health care worker at Quartier Plateau in Kayes, a city of about 12,000 people near the border with Senegal.

The health-care worker referred the grandmother and child to the Fousseyni Daou Hospital, in the same city, where she was admitted to the pediatric ward on the following day. Symptoms on admission included a fever of 39°C (102.2°F), cough, bleeding from the nose, and bloody diarrhea.

She tested positive for typhoid fever, but not malaria, and was given acetaminophen for fever, but did not improve. It wasn’t until three days after she initially presented that Ebola was confirmed. She died that day.

Long, infectious travel route a concern

Of major concern is the extensive travel history of the child and her grandmother. The grandmother traveled from her home in Mali to attend a funeral in the town of Kissidougou, in southern Guinea. This is home to the Mel-speaking Kissi, and very close to the Mande-speaking Koranko, both ethnic groups with Poro (variously called Poro, Tɔɔma vandiamua, or Komo by the former, and Gbangbani among the Koranko).

The region near Kissidougou in Guinea where the first Mali Ebola patient attended her mother’s funeral. This is home to the Kissi, and very close to the Koranko. (From Carey 2007).

The funeral may have been for the child’s mother, who was reportedly symptomatic with Ebola before her death, but this has yet to be confirmed. On 19 October, the grandmother left Kissidougou to return to Mali, taking the child with her on public transportation. The girl’s nasal bleeding began while they were still in Guinea, meaning that the child was symptomatic, and therefore infectious, during their travels through Guinea and Mali. Travel was by public bus through the towns of Keweni, Kankan, Sigouri, and Kouremale to Bamako. They stayed in Bamako for two hours before travelling on to Kayes.

Considering that the first patient out of the more than 10,000 cases to date was one 2-year-old boy in Guédéckou, Guinea, the tremendous opportunity for viral spread all along this travel route in ominous.

Kayes is near the borders of Guinea-Bissau and Senegal, and only 420 kilometres (260 mi) northwest of the capital Bamako.

Carey, Neil. 2007. Masks of the Koranko Poro: Form, Function and Comparison to the Toma. Amherst: Ethnos.

_________. 2013. Comparative Native Terminology of Poro Groups. Secrecy: Journal of  the Poro Studies Association, 1(1), 1-21.

_________. (2014). Art of the Kissi.  Retrieved October 8, 2014, from HTTPS://www.porostudiesassociation.org/art-liberian-kissi/

WHO. (2014). Mali Confirms its First Case of Ebola: Ebola SitRep 24 October 2014.  Retrieved October 25, 2014, from HTTPS://www.who.int/mediacentre/news/ebola/24-october-2014/en/

First Mali Patient Dies, Ivory Coast Searching For Ebola Suspect

Ebola in West Africa Update | 24 October 2014

2-Year-Old Girl Dies of Ebola in Mali —  Côte d’Ivoire looking for Guinean Ebola Medic

Yesterday Mali became the 6th nation in West Africa to confirm Ebola. Today the 2-year-old girl died of the disease, having just arrived from Guinea. (HTTPS://www.porostudiesassociation.org/ebola-spreads-mali/).

Medical staff wearing protective masks wait for passengers arriving from Guinea at Abidjan's airport on October 20, 2014 (AFP Photo/Issouf Sanogo)

Medical staff wearing protective masks wait for passengers arriving from Guinea at Abidjan’s airport on October 20, 2014 (AFP Photo/Issouf Sanogo)

A two-year-old girl, who was Mali’s first reported case of Ebola, died on Friday, shortly after the World Health Organization warned that many people had potentially been exposed to the virus because she was taken across the country while ill.

The girl had travelled with her grandmother hundreds of miles by bus from Guinea via Mali’s capital Bamako to the western town of Kayes, where she was diagnosed on 23 October. Health workers are now trying to trace hundreds of potential contacts in a bid to prevent Ebola taking hold in Mali.

WHO said that an investigation into the girl’s case revealed that she had already started showing symptoms — and was therefore contagious — before being taken to Kayes.

“The child’s symptomatic state during the bus journey is especially concerning, as it presented multiple opportunities for exposures – including high-risk exposures – involving many people,” it added.

The girl was seen by health workers on Oct. 20 in Kayes but was referred to another hospital the next day where she tested positive for typhoid but was also bleeding from her nose. It was not until Oct. 23 that she tested positive for Ebola, WHO said.

Kayes is near the borders of Guinea-Bissau and Senegal, and only

Kayes is near the borders of Guinea-Bissau and Senegal, and only 420 kilometres (260 mi) northwest of the capital Bamako.

WHO said that 43 contacts had been identified and isolated but a second Malian health official, who asked not to be identified, told Reuters that authorities estimated that at least 300 people had been in contact with the infected child.

Hours before Mali confirmed the case on Thursday, WHO Assistant Director-General Keiji Fukuda said the agency had “reasonable confidence” that there was not widespread transmission of the Ebola virus into neighbouring countries.

In the capital Bamako, residents voiced alarm at the girl having spent time in the city’s Bagadadji district before travelling on Sunday to Kayes, some 600 km to the northwest near the Senegalese border.

Mali was the sixth West African nation to record a case of Ebola. Senegal and Nigeria have successfully contained outbreaks and has been declared free of the disease. Spain and the United States have had a several cases, the newest an ER doctor who had just returned from treating Ebola patients in Guinea, but was not quarantined. He became ill and tested positive for Ebola today after breaking his self-imposed quarantine for some bowling and fun in New York City.

There is much concern about the preparedness of Mali, one of the world’s poorest countries, to contain an outbreak. Home to a large U.N. peacekeeping mission, the mostly Muslim country is still battling northern Islamist militants after a brief war last year.

IVORY COAST CONTACT

Both Mali and Ivory Coast have put in place border controls in an attempt to stop Ebola entering from Guinea or in the case of Liberia too. However, a visit to Mali’s border with Guinea by Reuters this month showed vehicles avoiding a health checkpoint set up by Malian authorities by simply driving through the bush.

Learning that one of his patients had Ebola, a Guinean health care worker slipped surveillance and fled to the Ivory Coast today, where a manhunt for him is underway.

Raymonde Goudou Coffie, Ivory Coast’s health minister, said they did not know if the man had Ebola but had to be traced as he had been in contact with someone who had the disease.

If this man is carrying the virus, he might become the first Ivorian Ebola case.

 

West African Ebola Education Material in Wrong Language

NYHQ2014-1017

Are We Educating W. Africans in Pig Latin?

When some of us were children (pre-texting era) we would use “Pig Latin” as a coded language when we didn’t want someone within earshot to understand our secrets. Our elders simply talked in the languages from the “old country”.

Since local and international aid groups and health care workers are making important efforts to educate W. African communities about Ebola avoidance, reporting, and decontamination, one would assume they’re doing so in languages that the people can understand, right?

Not so, points out Don Osborn on the linguistics site Beyond Niamey, who has been making this irony clear to us for quite awhile. West African Ebola education material is often in the wrong language.

Several recent posts on his blog have highlighted the need to provide information about Ebola in diverse African languages. He mentions two important efforts to share material for communication on the disease, which include almost no information (yet) in African languages: the Ebola Communication Network (ECN), funded by USAID and run by the Center for Communications Programs at the Johns Hopkins Bloomberg School of Public Health; and “Ebola and C4D,” a page on UNICEF‘s Communication for Development (C4D) website.

The need for translators and materials in appropriate languages and dialects (such as Krio, and various Mande, Limba, Kruan languages) is essential, as e.g. only 13% of Sierra Leone women use English.

He notes that on the “Ebola and C4D” page, apparently launched in August, all linked materials are in English, French, or Portuguese, with one item in Khmer and one poster from Uganda in “Bantu” (which is a language family – may be Runyoro or Luganda – seeking to identify).”

Osborn makes a valid plea for “any proactive effort to develop the collection of materials in African languages in affected areas that might otherwise be overlooked.”

Nothing We’re Doing or Might Do Will Halt Ebola in W. Africa

0,,17911388_403,00No Short-Term Curb Expected in Ebola Epidemic

Improved infection control practices, increased contact tracing, and even hoped-for pharmaceutical interventions like vaccines or antiviral drugs will apparently not halt the short-term spread of Ebola in West Africa, according to a new study.

A new research paper (Rivers et. al. 2014) using existing data from Liberia and Sierra Leone to model the forecast of the epidemic, concluded that “Near-term, practical interventions to address the ongoing Ebola epidemic may have a beneficial impact on public health, but they will not result in the immediate halting, or even obvious slowing of the epidemic.”

“…the epidemic has progressed beyond the point wherein it will be readily and swiftly addressed by conventional public health strategies. The halting of this outbreak will require patient, ongoing efforts in the affected areas and the swift control of any further outbreaks in neighboring countries.”

This is consistent with earlier predictions by those who stated that the window during which the epidemic might have been contained was back in May and June 2014 and was missed, such as Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg. Early in September, he agreed with others who believe that there is no way to halt the disease now in Liberia and to a somewhat lesser degree in Sierra Leone. His prognosis was grave, predicting that the only way Ebola will stop in Liberia is when it has infected all of the people and killed almost half the population—about 5 million people. He felt that more and continued efforts, particularly international in scope, were still needed, and he did not suggest that we should abandon Liberia and Sierra Leone as lost causes. (Osterath 2014) .

Ebola Update: All Poro Groups Now Involved in Liberia, Sierra Leone and Guinea

Ebola virus (shown spewing from an infected cell) does not recognize ethnic or political borders.

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October 11, 2014

Ebola Update

Neil Carey

All Poro ethnic groups in Liberia, Sierra Leone, and Guinea have now had cases of Ebola.

• In Liberia, the rural district of Gbarpolu, has reported its first two confirmed cases. This is home to some Gola, Kpelle, Belle, Gbandi and Mende people (Map 3).

• As of 7 October, all ethnic groups in Liberia have become involved, although SE Grand Bassa County (Bassa) and Maryland County (Grebo) have not had any active cases reported in the 3 weeks prior (according to WHO). The case in Grand Gedeh (Kran) that was reported on 19 September was not included on the map below.

• NE Sierra Leone and much of northern Guinea have also not reported any new cases during the 3-week incubation period prior to 19 September.

 There is still no significant headway being made in the fight against Ebola. A total of 8399 confirmed, probable, and suspected cases of Ebola virus disease have been reported in seven affected countries (Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain, and the United States of America) up to the end of 8 October. There have been 4033 deaths (WHO UPDATE).

• Medical infrastructure strain and social unrest continues, particularly in Liberia and Sierra Leone. These factors inhibit containment efforts.

• When American healthcare workers (HCW) Dr. Kent Brantley and Nancy Writebol became ill, there were difficulties in securing medivac from Liberia. This highlighted the dual problems of inadequate training of HCW and inadequate infrastructure to support aid workers. These problems continue, and have many negative side-effects on recruitment capacity, medical infrastructure resilience, and translocation risk. Local containment efforts will continue to be inhibited until these problems are addressed.

 For some unknown reason, Côte d”Ivoire has yet to report a case. Many people wonder if this is not due to a failure to report. Although there have been no new cases of Ebola reported in Grand Gedeh County (Kran territory) since an infected man from Ganta (Mano land) became ill in Zwedru, active and new cases have occurred along the Ivorian border with N’Zerekoré, Guinea, and Nimba, River Gee and Grand Kru Counties, Liberia.The risk of movement of infected individuals to Cote d’Ivoire is increasing.

• These problems contribute to the growing global scale of the problem. It is almost certain that there will be new global infections involving HCW treating aid workers (such as those reported in Spain) and in the United States, for as long as foreign HCW working in West Africa are unable to obtain local treatment, and West African borders remain porous (which they will).

• The potential remains for re-emergence in countries making progress towards containment. This ‘twin peaks’ nature of distribution has historically been observed around Ebola outbreaks, and has already occurred in Guinea and as we’ve noted in Foya, Liberia.

• There seems to be a general mistrust of the data, and there remains concerns about information suppression and incomplete public health data.

Figure 1 shows the location of cases throughout the countries with widespread and intense transmission. In Liberia, the rural district of Gbarpolu, has reported its first two confirmed cases (WHO).

Advice for African Art Dealers, Collectors, Travelers:

Although we’ve briefly discussed the issue of decontamination of objects and the wisdom of avoiding possible exposure to newly arrived travelers from West Africa, the following advice meant for physicians is useful:

• When asking a travel history, TRUST BUT VERIFY and err on the side of caution.

• Significant lack of data and active information suppression in West Africa is inhibiting accurate assessments.  This is a poor indicator.  Epidemic curves now falsely show a “peaking out” of cases.  This is not the reality.  Things remain very much completely out of control.

• Several African nations have resumed flights to Liberia.  This is an exceedingly poor decision according to infectious disease experts.

• As noted above, there are new cases popping up along the NW border of Côte d’Ivoire.  We are waiting for a declaration of Ebola involvement in this country, coming by water from across the Cavally River or from newly re-established flight connections.

• There are reports of West Africans who have successfully fled by airplane to Colombia, and reported intercepts at the southern border of the US.  Some of this information requires verification, but if true, it is obviously a point of concern for the involved states, and this is no longer just an East Coast problem.

Ebola Update

October 6, 2014

125 Belle-Gbandi-Loma 5in

Belle (Kuwaa) face mask. Kpawolozu, Liberia. 12¾ inches (23 cm). Used when a Poro Zo died, it was shared with the neighboring Loma and Gbandi.

Despite the continuing fears of the public and against general medical opinion, U.S. officials continue to downplay the possibility of an Ebola outbreak occurring here.

The multiple medical errors in Dallas that resulted in a symptomatic, contagious Ebola patient being sent home from the emergency room are the norm, not an exception. To expect otherwise is unrealistic. Omissions, errors, failures in communication, judgmental lapses…that’s reality in any primary medical setting.

60% of nurses polled say we are unprepared. An overwhelming percentage of physicians polled by Sermo last week said we are unprepared to detect and contain Ebola.

I envision the following scenario: A Liberian (Loma, Kissi, etc.) who is incubating Ebola virus in his body goes to Robbins Field in Monrovia for a trip to the US (or France, or the U.K.). If remembering to do his job, an airport worker asks if our traveler had been caring for an Ebola victim. He says no. An inaccurate temperature reading is taken by a handheld thermometer waved in front of his forehead, and is declared “normal”. No surprise, as he took ibuprofen. He flies on cramped airplanes, and after two layovers arrives in Newark or JFK or Heathrow or Orly. He takes public transportation to “Little Liberia” on Staten Island, or to Philladelphia, or Paris, or London, where he then lives in crowded quarters with extended family or friends.

When our traveler gets nausea, vomiting, belly pain and diarrhea he goes to the nearest urgent care, walk-in clinic, drugstore or emergency room. Eventually he is briefly seen by a nurse or P.A. or medical student, maybe even by a physician. Being just one more in a long line of patients seen that day with identical symptoms he is reassured, maybe given a Rx for unnecessary antibiotics, told to keep hydrated, and to take some Tylenol or Motrin for fever and Imodium for diarrhea.

He goes back to his dwelling where he continues to spread virus. Eventually he makes it back to the hospital via ambulance.

The number of people he has already infected is staggering. The public health system and the hospital may be able to trace many of his contacts, but certainly not all. Public apologies are made downplaying the incident and pointing out how the reason for this mistake has been remedied.

And he is just one person. Remember those 395 Ebola cases in West Africa that were all traced back to just one traditional healer in Sokoma, Sierra Leone? Sure it’s a different culture, but the virus doesn’t know that.

The condition of Mr. Duncan, the Dallas patient, has been downgraded from serious to critical. Here is his timeline, as reported by the NY Times (data from USAID):

Screenshot 2014-10-06 17.44.47

Today Reuters reported that there is a “high risk” of Ebola spreading to the U.K. and France by the end of October. WIth no changes made in current containment efforts, there’s a 75% chance the virus will hit France by Oct 24, and a 50% of it reaching Britain by then. If flight restrictions are implemented, the numbers fall to 25 and 15%.

A Spanish woman is the first person to contract Ebola outside of Africa. She was one of the many health professionals in Spain who cared for a priest and a missionary who became ill in Africa and were flown home for treatment. She became sick on September 30, but wasn’t hospitalized until October 1.

In an ironic twist, people in Sierra Leone are raging over the delay in picking up and disposing of corpses, whereas just last month villagers were attacking workers for attempting to collect and bury bodies. This speaks well for community education efforts, though not for public health responses.

In the meanwhile, the exponential growth of the disease continues in West Africa. The hardest hit areas continue to be the homes of the Loma, Gbandi, Belle, Mende, Kissi, Kpelle, Mano and Dan.

Screenshot 2014-10-06 17.53.32

Ebola spreads to Grand Gedeh County

The Ebola epidemic continues to increase exponentially in Lofa County in northeastern Liberia, southeast Sierra Leone, and the Guédékou area of Guinea (where Patient Zero died in December 2013. This heavily hit region is home to the Kissi, Northern Kono, Loma (Toma), Kpelle (Guerzé), Gbandi, and Belle (Kuwaa). It has spread outward, infecting the Kru, Sherbro, Malinke and Temne, Krio and other groups.

Unless something drastically changes in current containment efforts, the CDC predicts 1.4 million cases by January.

One German epidemiologist stated that Ebola will only stop in Liberia when everyone has been infected and almost half the population—about 5 million people— have died.

So far, Côte d’Ivoire has been spared, due in part by their early closure of all border crossings with Liberia. I expect that it won’t be long before someone swims or otherwise makes it into onto Ivorian soil, as we saw during the conflicts in the 1990s, spreading the virus.

As was unfortunately expected, Grand Gedeh County, home of the Liberian Kran and Sapo, just reported its first case of Ebola.

Chris Nyenapee, reporting for AllAfrica, stated that a 35-year-old man in Zwedru, Grand Gedeh County, tested positive, making it the first case in the county since the outbreak of the disease in the country in March. He was showing signs and symptoms of the disease when the Grand Gedeh County Health Team (CHT) picked him up from the Zwedru Central Market last Friday. One must assume that he had made several direct contacts since he became infectious, and the job now is to trace them and isolate them for the usual 21-day quarantine period. Zwedru

The patient apparently migrated from Ganta, Nimba County (Mano country, the site of George Harley’s pioneering work on the Poro and his clinic in the first half of the 20th century) to Grand Gedeh County following the death of nine of his family members from the disease early this month.

The man was transported to Gbarnga, Bong County for treatment when they observed that he was showing signs and symptoms of the virus, adding that he later tested positive for the disease.

Should Ebola make a foothold in Zwedru, crossing the nearby Cavalla River into Côte d’Ivoire is not unlikely, and would infect the Guéré (Ivorian Kran).