Ebola: The Story | Journeyman Pictures

Transcript

Ebola: The Story – Full Transcript

00:00:30,234

SALLY SARA: Like many nations in this unstable part of Africa, it’s strife that’s lifted Sierra Leone out of obscurity and into the world’s view. Brutal civil war, thousands of children pressed into service as soldiers, mutilation as a weapon of intimidation.

00:00:55,594

SALLY SARA: Now that war’s over, another has begun but this time the nation has to combat a very different, very deadly scourge - Ebola.

00:01:06,594

PATRICK MASSAQUOI: “You know, considering the fact that I am going into an affected area that is currently infected by Ebola, it takes a man, you know, for you to go back”.

00:01:23,234

SALLY SARA: Our cameraman, Adam Bailes, is travelling with Red Cross worker, Patrick Massaquoi who’s returning to the Ebola battle zone despite the risk and the worries of his family.

00:01:36,514

PATRICK MASSAQUOI: “You know when you are back from this affected area, friends stigmatise you, even when I went there for the first time, when I came back and my wife said, I mean since you are coming from that place you have to stay far off, you know, for 21 days. I have to really convince her, I have to show her pictures on the videos, that... even though we are involved in that, we are highly protected, you know?”

00:02:10,274

SALLY SARA: They’re heading south-east towards the borders of Guinea and Liberia.

00:02:18,594

PATRICK MASSAQUOI: -Very good morning sir

POLICEMAN: -How are you?

PATRICK MASSAQUOI: I'm fine

00:02:22,954

SALLY SARA: Through the roadblocks and a long pot-holed stretch of road, it’s a 12-hour drive to the town of Kailahun and an Ebola coordination facility on the front line of this African emergency.

00:02:38,354

SALLY SARA: Once Foreign Correspondent’s crew is through, this and other checkpoints will be closed to media as a national crackdown intensifies.

00:02:48,874

DR RICHARD BROOME: [Adviser, International Red Cross] “The environments in which people are living is absolutely a critical part of the effectiveness of the spread of this outbreak.

00:02:57,474

DR RICHARD BROOME: People are living in very basic housing with poor access to water, no ability to isolate themselves. There’s very poor access to healthcare as well. But then there are all these cultural issues as well, such as a healthy mistrust of government, especially in some of these countries that have had very severe civil wars for many years.

There’s a lot of beliefs in black magic and I suppose traditional beliefs, so people often explain things through witchcraft and curses - and all those things come together I suppose with a disease like Ebola to result in these explosive outbreaks.

00:03:54,994

SALLY SARA: Dodo is a town of about 3000 midway between Freetown and Kailahun.

00:04:03,914

SALLY SARA: A large crowd’s gathered. A Red Cross Dead Body Management Team has just arrived and they’re suiting up in the middle of the main street.

00:04:13,114

RED CROSS WORKER: “They want to see... they want to see what we are doing”.

00:04:18,234

SALLY SARA: They’ve been alerted a middle aged man has died in his bed overnight.

00:04:23,674

MAN FROM VILLAGE: “He’s fifty five years old, married with one wife and a child, a boy child. He has been a farmer and he also collects palm nuts from the palm tree”.

00:04:45,514

SALLY SARA: The Sierra Leonean government has decreed that any inexplicable death must be dealt with by designated authorities. Traditional community funerals are not allowed.

00:04:57,234

RED CROSS WORKER: “We are now going to the house and get the... well... just the body management team, Body Management Team enter house and spray and they will proceed with the burial”.

00:05:09,514

SALLY SARA: So, while the circumstances of this man’s death are unclear, his body is being handled as if he had died of Ebola. A sample will either confirm or eliminate Ebola as a cause, but the body will be sealed in plastic, doused with chlorine and taken away for burial. It’s disturbing and confusing for the town’s people. Dodo hasn’t experienced an Ebola death or any infections during this outbreak and they don’t want their town stigmatised.

00:05:50,714

MAN FROM VILLAGE: “Since no, have not got any person die of Ebola.”

REPORTER: No cases?

MAN FROM VILLAGE: No cases of Ebola.

00:05:59,314

SALLY SARA: The new emergency procedures are also causing a little consternation for local leaders here.

00:06:05,394

VILLAGE LEADER: “I am asking if he died of Ebola. That is my concern”.

RED CROSS WORKER: “We are not saying that the cause of the death of this old man now is as a result of Ebola - but what normally this is... is probable case.... probable case... it might be, it might not be”.

VILLAGE LEADER: “Okay”.

RED CROSS WORKER: “That is why government have said we should be doing the burial”.

VILLAGE LEADER: “Well I know that is the procedure that we should not do the burial on our own, but because of the convoy, the way it looks… so fearful that this is a new thing... for the community people - so the majority may have that in mind and be doubtful - is this man not affected by Ebola also?

MAN: Thank you very much. Very happy.

VILLAGE LEADER: So no problem”.

RED CROSS WORKER: “So you feel more informed?”

VILLAGE LEADER: “Yeah, yeah. I’m better informed.”

00:06:53,154

DR RICHARD BROOME: “One of the real problems with Ebola is that the most infectious risk is a dead body of someone who’s died from Ebola. Now that’s a real challenge again in places like Sierra Leone because often people would be dying in communities and they would be having traditional funeral and I guess there are few better ways of spreading Ebola than a lot of the traditional funeral practices that go on in these remote parts of West Africa”.

00:07:17,674

RADIO STATION: We want to welcome, the International Federation of the Red Cross. As and Epidemologist, what is Ebola?

BROOME: Ebola is a virus

00:07:26,434

SALLY SARA: Australian Doctor Richard Broome recently spent a month in Sierra Leone helping to streamline the Red Cross response to the Ebola outbreak. He’s seen first-hand the emergency collide with customary practices.

00:07:46,114

DR RICHARD BROOME: “For the Muslim funeral, for example, it’s traditional to wash the body prior to burial and again so that would put a number of people at risk and then for some of the more tribal or remote areas there would be very traditional burial practices, such as wakes, where lots of people might come into contact with the dead body”.

00:08:06,834

SALLY SARA: It’s the wet season. Roads turn to quagmire and can become more difficult and dangerous. But locals find a way to get from one place to another and out where national borders are porous, mobility is making the transmission of Ebola all the more difficult to contain.

00:08:29,754

SALLY SARA: Kailahun is a market town of around thirty thousand people at the centre of a region of almost half a million. The commerce here makes it a magnet for people from neighbouring Guinea and Liberia. In this outbreak, the central focus of the fight against Ebola is here… Foreign Correspondent has been granted special access to this crisis coordination centre where patients are being tested and quarantined. It’s run by MSF with help from the International Red Cross and the World Health Organisation.

00:09:15,634

MALCOLM HUGO: “The squares on the board represent the… gives us the information on admissions, discharges, deaths”.

00:09:22,114

SALLY SARA: It’s where we find Australian psychologist Malcolm Hugo.

00:09:26,634

MALCOLM HUGO: [Psychologist, Medecins Sans Frontieres] “Okay in the last week and a half

to two weeks there’s been a significant increase in the number of cases coming here and also a significant increase in the number of confirmed cases. People are scared. I guess the kind of suddenness, the suddenness of the epidemic and the catastrophic impact it’s had on small communities where whole families have virtually been wiped out and for surviving members, whether it be a psychological or psychosocial response available to them. And, I mean, culture’s obviously important, but sometimes these people tend to be neglected by their communities because of the stigma attached to it”.

00:10:10,274

SALLY SARA: Malcolm’s retired from his Adelaide practice and for the past decade has undertaken at least one international crisis assignment a year.

00:10:21,714

MALCOLM HUGO: “I’ve worked with one Ebola outbreak in Uganda in 2007. I’ve done two missions in the West Bank. I’ve worked in MDRTB, a drug resistant tuberculosis program in Khadija, which is part of Georgia. I spent six months in Baghdad last year. I was in the Philippines following the typhoon over Christmas. I was in Haiti after the earthquake. I was in Aceh after the tsunami in 2004”.

00:10:56,314

MALCOM HUGO:“You’ve come to pick up some bodies?”

MAN: “Yes, yeah”.

MALCOLM HUGO: “How many will you be picking up?”

MAN: “Nine”.

MALCOLM HUGO: “Nine.

Body removal A busy day… okay”.

00:11:19,394

SALLY SARA: Far from here there’s an intense effort to develop a vaccine. The death rate for this strain is slightly lower than those of previous outbreaks, but most people admitted to this facility can expect to die. That makes Malcolm Hugo’s work here vitally important.

00:11:42,394

MALCOLM HUGO: “I really think grieving and the faith, the way people respond to the death of loved ones, it’s pretty universal. Obviously people are really upset and particularly when they can’t do the things that they traditionally do when somebody dies”.

00:12:19,514

NURSE: “We are taking their temperature... whether they have a fever - at least if it starts at 37.5 or more, that will give us a clue about them.

00:12:35,754

SALLY SARA: In this outbreak there’s been confusion in communities about symptoms. They’ve been told a high temperature is one sign, but earlier health alerts also cited bleeding as another. As it transpires, bleeding is not an indicator with this strain - but many people acting on the earlier advice, assumed they were okay and didn’t present for testing”.

00:13:03,714

MALCOLM HUGO: “It’s difficult to give bad news to patients and I think some of the nurses understandably avoid doing this by just saying to patients, oh you’re going to be moved to a different section, rather than telling them why they’re being moved to a different section, that they need to be isolated from the negative cases. Also they’re concerned about the reactions that they’re going to get. Understandably patients are going to be distressed when they hear this news or in some cases they get a bit angry, so I guess it’s just human nature to try and avoid that conflict”.

00:13:49,954

SALLY SARA: It’s here in a relatively open space cordoned off by a plastic fence - a make shift buffer zone - that infected patients wait for Ebola’s crippling onset. They’re given some pain relief and told to keep up their water intake. They can only hope to survive its three-week attack phase.

00:14:13,514

DR RICHARD BROOME: “It seems that in Sierra Leone at the moment the mortality rate is somewhere in the order of 60% and it’s a virus that spreads through contact with people’s body fluids. Essentially, the virus is one that just overwhelms your body’s immune system and ability to cope and as a result your organs begin to fail, your blood vessels become leaky. So it’s really just overwhelming… an overwhelming of your body by the virus”.

00:14:51,074

SALLY SARA: For many still reeling from civil war, fear of Ebola is eclipsed by a fear of authority, suspicion and superstition have been keeping people away.

00:15:04,994

MALCOLM HUGO: “Particularly when I first came here, lots of rumours about the activities here. There were rumours that body parts were being taken or MSF were injecting people and . I’ve certainly met people that have come here, patients that have come here that were in fear of ah… we were going to take all the blood out of them – a whole range of things”.

00:15:34,514

SALLY SARA: Despite the almost agricultural appearance of these facilities, safety protocols are strictly observed and policed. Everything that’s spent time near or within the isolation zone is scrubbed and sterilised, and yet among the more than 1400 deaths so far in this outbreak, many have been among the volunteers and medical staff dealing with it. Across West Africa, about 170 have been infected. More than 80 have died.

00:16:29,314

SALLY SARA: The busy, colourful city of Kenema is Sierra Leone’s third largest and about three hour’s drive from Kailahun, depending on the rain. It’s home to a large government hospital – the scene of the nation’s single biggest loss of medical staff to Ebola. 20 health workers died after contracting the virus. On the outskirts of the city, Amanda McClelland is overseeing g the rapid construction of another Ebola coordination centre to take some of the pressure off Kailahun.

00:17:08,994

AMANDA MCCLELLAND: So what’s happened is the resident ministers is gone to the road construction company that’s building the highway and essentially forcing them to bring their machines and stuff down. The pressure and the speed that we need to move in the Ebola is

something that we haven’t felt before. Every day we waste, the epidemic continues to spread and is not under control so it’s an unusual situation and extremely concerning”.

00:17:33,394

SALLY SARA: Amanda’s a Queenslander who’s leading the Red Cross response to Ebola in Sierra Leone. She’s a nurse and tropical diseases expert and like any other medical professional, she’s worried about Sierra Leone’s capacity to cope with and contain Ebola.

00:17:51,394

AMANDA MCCLELLAND: “We’ve seen health workers make mistakes.A lady was full term pregnant, presented, was… seemed to be miscarrying. They took her to the maternity ward… they were taking care of a full term miscarriage, and half way through they realised actually she was an Ebola patient and she was positive. Now that one mistake, we’ve got ten to fifteen health workers that are possibly contaminated from that one case”.

00:18:15,234

SALLY SARA: The race is on to get this new Ebola clinic up and running but it will take several months.

It’s a devastating death rate but 4 in 10 are surviving. Back at the Kailahun crisis centre, these teenagers have endured the normally lethal 21-day cycle of the virus and have just been cleared to leave the isolation ward.

00:18:47,474

MALCOLM HUGO: “She had Ebola. Her husband died here”.

00:18:53,194

SALLY SARA: They’ve survived but they’ll head back to their homes and into another ordeal.

00:19:02,074

MALCOLM HUGO: “There’s still a lot of misunderstanding about Ebola in the community even though we have health educators, people still believe that because patients have been here, that they.... when they go home they may be contagious. There has been cases where people when they’ve gone home been marginalised within the community and there’s been quite a stigma involved so we just go home to make sure, yeah”.

00:19:32,034

SALLY SARA: Twenty percent of the patients in Kailahun are under the age of 15. They’re brought here because they’re infected or the family members caring for them are infected. They can be difficult to handle.

00:19:46,794

MALCOLM HUGO: “The baby was positive and has been an inpatient for over three weeks. It was about two weeks ago the baby actually crawled under the fencing here and walked out into the middle of our compound and I’ve never seen people scatter so quickly and she was just standing there with her hands on her hips, yeah, a little two year old feeling quite powerful with the impact she had on all the people here. But somebody quickly suited up and picked her up and returned her to the compound”.

00:20:23,754

SALLY SARA: That child is Lansanna. She’s now being cared for by one of the health workers at the MSF clinic, Mush Tiah and Mush’s husband, Abu Bakar Sesay at their home in Kailahun.

00:20:42,754

MUSH TAH: “So when I go to the containment centre where I can see babies that have lost their mother, lost their family, I can volunteer to take them because I can feel their hurting where a baby is left at this age… when they have lost their mother”.

00:20:57,194

SALLY SARA: Lansanna came to the emergency centre with her parents.Her mother died, her father fights on. Ebola has claimed 17 members of her family.

00:21:11,01

MUSH TAH: “Some babies have got no mothers, some families have all died, so it’s very disheartening. Even now at this time, children do not go to school. So I mean, it’s very disheartening that this Ebola has come to us here”.

00:21:32,474

AMANDA MCCLELLAND: “Some communities that we’ve worked with, they’ve lost 30 or 40% of their population. Some of these places are quite small and how do those communities then undertake agriculture in the future? What happens when the adult population has you know been killed by Ebola and only the children are left? Then we’re seeing what we call almost Ebola orphans where

whole families have died and only the young children are left. So the impacts of this epidemic will be long term in these countries”.

00:22:07,794

DR RICHARD BROOME: “I think the psychology is an enormous part of an Ebola outbreak and not just for the people who are sick themselves, but also for the communities where they’ve come from.

Making sure that they understand the nature of the illness in that person and that once they’ve recovered, that they’re not going to, you know, be able to transmit the disease. The people who’ve recovered, one of the really important things is getting.... they can almost become ambassadors for the disease. They are the people who can give people most hope and use them as symbols of you know,success in this Ebola outbreak to try and change the overall psychology I think and people’s view of Ebola”.

00:23:08,634

MALCOLM HUGO: “Yesterday we had 10 deaths which is a bit of a record for us. I’d estimate at around the 35-40 mark within the last week so it’s been a difficult week for most people. I think the big concern is what’s going to happen to the people here. It’s the first time in Sierra Leone that they’ve had this sort of experience, so it’s a very new and frightening experience for people”.

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00:24:10.21

MAN (Translation): We are spending today here so people can come and get preventive measures.

In order to wash their hands with chlorine. You see?

REPORTER: Why?

SOLDIER (Translation): I’m even asking kids to come and do so because the sickness doesn’t choose. Either big, small, no, the sickness will come anywhere, for any person whatsoever. So that’s why I have ordered them to come and do it.

00:24:31,874

ASHLEY HAMER: Halfway through our drive to Kailahun, we stopped at Kenema, which is another big Sierra Leonean town, and the site of the Kenema government hospital, which was one of the first hospitals to start taking Ebola patients, because it was formerly a centre for Lassa fever, which is also a very deadly disease. MSF and the Red Cross tell me that hospital is a death trap. I went there to see what it was like, and it was chaotic to say the least. I wandered in and nobody checked me at all. Patients are potentially wandering in and out. There's a dirty screening tent on the right hand side as soon as you come in, where nurses in degrees of personal protective, but inadequate personal protective, equipment are interviewing potential Ebola patients, sick patients, about their symptoms.

00:25:32,22

NURSE: We are doing screening - taking patient histories, past and present histories. If they have Ebola we send them to the Ebola ward. Because in some cases, some have symptoms of Ebola – headache, vomiting, diarrhoea - and if you have this we send you to the Ebola ward.

00:25:54,274

ASHLEY HAMER: You have no idea whether the people that you are come into contact with there have Ebola. When I arrived, I overheard a doctor in the background tell me, "Don't touch the walls". The place is potentially completely contaminated, and yet, at the same time, there's a maternity ward, they are trying to treat malaria, they are trying to treat typhoid, as well as having this Ebola isolation unit there.

00:26:25,594

REPORTER: How many patients are in the hospital now?

NURSE: Here? Now? Plenty! I can’t recall it now.

00:26:32,874

REPORTER: Do they have Ebola?

NURSE: Yes! Some are getting Ebola, some are not. We have some that we admitted today.

00:26:42,914

REPORTER: I understand that some nurses have died here?

NURSE: Yes.

00:26:47,994

REPORTER: Can you tell me how many?

NURSE: Well, we are now close to 20.

00:26:54,514

ASHLEY HAMER: You simply cannot have people wandering in and out with potential Ebola symptoms at the same time as patients who might not have Ebola at all and I got the impression that the nurse just didn't really know what she was doing.

00:27:13,554

ANJALI RAO: It's a dramatic death toll amongst the nursing staff. If they are struggling, it's hard to imagine the situation for the villagers. How do they get information about this disease?

00:27:23,154

ASHLEY HAMER: There are teams, local teams, of volunteers who are going out into the rural communities and telling people about symptoms, telling people how to prevent the disease, and telling people what to do if they believe themselves or a relative may have contracted Ebola.

00:27:44:03

VOLUNTEER: We have these charts which we use to display to the people and tell them what to do and what not to do. You see? Now like this one we get the other infection through somebody who has been infected. Like if I’m infected, if I touch the person or if somebody touches me, then the disease will be infecting him too.

00:28:06,674

ASHLEY HAMER: The problem is that this is a vast area with a very large and dispersed population and there are simply not enough people on the ground who are trained to be able to cover the population and genuinely educate people, help people to understand in their own local context, what this disease is and how to prevent it.

00:28:31,954

ANJALI RAO: Now, I understand that funerals are a risk for everyone concerned. Why is that?

00:28:37,434

ASHLEY HAMER: Ebola is transmitted by physical contact with an infected person and a deceased person somebody who has tied from Ebola - is at their most contagious immediately after death. I went out with the Red Cross dead body management team, who are deployed to local communities whenever a death in the community is reported. The government has ordered that all deaths in the communities need to be reported, at which point the dead body management team are deployed to safely deal with that dead body.They have to bury it in the correct, disinfected, safe way and they must swab the body, because it is impossible to tell whether somebody has died of Ebola just by looking at them.

00:29:34:23

DEAD BODY WORKER (Translation): We will still pay the same last respects to the loved one who has died. Okay? The only difference will be that you won’t be able to wash them like you wash them normally, okay?

00:29:11,354

ASHLEY HAMER: The dead body management team made a very big show of dressing up openly in their personal protective outfits so everybody could see what was going on. As you can see they dressed me in some protective gear to be able to stand outside the house and film the process of them going inside and protecting the body.

They then went inside, dealt with the body, and brought the body out. It was a very distressing thing to see. The relatives were - the emotion was raw amongst the relatives, who were right there watching the dead body management team extract the corpse of their relative and bring it out into the front compound.

00:30:43,434

REPORTER: Is it always a big gathering like this? Does the whole village always come out to see?

00:30:50:05

DEAD BODY WORKER: Always.. Always people come out to really see exactly what we are doing and how we are doing it, because the perception used to be different. They were claiming that when this exercise was being done, we were taking some parts from the corpse to do rituals. So this is why now we open the window wide, and they can stand afar, and see what is happening inside.

00:31:21,794

REPORTER: When you turn up in a village, you go to a village to do a burial, and people are angry with you, or they are afraid, how does that make you feel?

DEAD BODY WORKER: Well, I feel uncomfortable because while I’m doing the right thing, people are trying to be ungrateful for my efforts so I feel uncomfortable. Yes even as I’m speaking to you we’re I’m staying in my communities people are afraid of me when they hear that I’m working with the dead body management. So they are afraid of me. So we cannot eat - we cannot share eating together.

00:31:57,634

ANJALI RAO: Well, this was obviously a dangerous assignment. There are very few journalists reporting from there. Did you feel at any point that you may be exposed to the disease?

00:32:07,394

ASHLEY HAMER: I never felt that I was at risk of physical harm, certainly not. There was no risk of public disorder. But, there's no doubt that the paranoia that comes over you, when you realise you are in the middle of a serious disease outbreak – you cannot see it coming. It makes you distrust people. It makes you so aware of everything that you are touching - every footstep that you take, every person who is near you. That gave me a bit of a sense of what the local people are feeling to be told that they are living in the midst of this highly deadly virus, and not knowing where it's coming from and how it can be contracted.

MAN: this sickness is a killer disease, it’s going to kill all of your families. We are totally afraid, this is the main point.

00:33:06,714

ANJALI RAO: Did you get any sense of order at all? Is anyone taking control of the situation, or at least trying to?

00:33:13,514

ASHLEY HAMER: Médecins Sans Frontières or Doctors Without Borders are the experts in the field out there. They have established in June the biggest ever Ebola treatment centre. It's an 80-patient treatment facility outside Kailahun town centre. It feels extremely ordered and the planning that has gone into the construction of the place, which was only established in June, has been absolutely meticulous.

00:33:46,954

ANJALI RAO: It must be an eerie feeling to be only 2m away from somebody infected with this horrible disease. What did you feel when you were talking to the patients?

00:33:55,834

ASHLEY HAMER: It is an unnerving feeling to stare into the eyes of somebody who you know is sick with Ebola. You are divided by a plastic fence. They are in the high risk zone and you are in the low risk zone. But because Ebola is transmitted by very close contact with an infected person, physical contact and the sharing of bodily fluids, it is safe to be able to talk to somebody like that. And I met patients who were feeling OK - they were feeling strong. They had been there a couple of weeks, and they were, I hope, on the mend.

00:34:37,834

REPORTER: You are dancing! That's good!

00:34:40,594

MAN: Let's go dancing!

00:34:41,354

REPORTER: You are getting stronger!

00:34:42,514

MAN: Yeah!

00:34:44,354

ASHLEY HAMER: I met a young mother called Hawa Idrissa who was extremely feisty.

00:34:51,114

HAWA IDRISSA: I will not feel happy, because I want to go home to my daughter. I want to see her now.

00:35:01,154

REPORTER: How old is your daughter?

00:35:02,634

HAWA IDRISSA: One year.

00:35:05,114

REPORTER: But she's OK? No Ebola?

HAWA IDRISSA: No Ebola. No more Ebola! Only I have Ebola.

00:35:19,034

ASHLEY HAMER: I left my number with her, and the day before I left, she called me herself to tell me that she had been discharged and she had gone back to her village. It was fantastic to hear that news.

00:35:29,434

MALCOLM HUGO, MSF PSYCHOLOGIST: Step by step, very slowly, getting back to talking with friends...

00:35:33,394

ASHLEY HAMER: There is an Australian psychologist working out there called Malcolm Hugo, from Adelaide, and he is the main MSF psychologist, counselling people who are operating or sick in the treatment facility.

00:35:49,954

MALCOLM HUGO: As you can imagine, they are in a pretty terrifying situation. They're in a life-threatening situation, and they are surrounded by death and a lot of suffering. So there's obviously some psychological effects.

00:36:07,234

ASHLEY HAMER: He introduced me to a young lad of 18, who was one of the survivors - a chap called Lahai, who was extremely relieved to be going home finally.

00:36:20,234

REPORTER: And how many family members? You have mum, you have dad?

LAHAI: My father and my mother they are there.

00:36:27,074

REPORTER: They are waiting for you?

LAHAI: Now!

00:36:31,874

REPORTER: What will you say to them when you see them?

LAHAI: I’ll teach them about Ebola. How to prevent it themselves.

00:36:40,834

REPORTER: You are lucky, you are strong.

LAHAI: Yeah, yeah, I'm very strong.

00:36:45,834

ASHLEY HAMER: I witnessed a discharge counselling session between Malcolm and Lahai, and then I accompanied Lahai back to his village to meet his mother. Lahai was extremely proud of the certificate of negative status that he had been given, which is issued by MSF for every survivor, because it is very important for local communities - in order to be able to accept the infected person back into the community, they need proof that that person is no longer contagious.

00:37:24,914

MAN: No more Ebola.

00:37:26,114

ASHLEY HAMER: And we had to do this to prove to them that it was OK, and that the person could be brought back into the community sail.

00:37:38,114
NARRATOR: Guinea. The first country to contract Ebola, the epidemic that has ravaged West Africa for the past nine months. It is the most severe outbreak of this disease since the virus was discovered forty years ago in the Congo.

00:37:56,674
NARRATOR: We travel to Gueckédou, to learn how this disease has managed to spread so rapidly throughout this entire region. The prefecture, in Guinea’s densely forested region, lies on the border between Liberia and Sierra Leone, and is at the centre of the epidemic.

00:38:17,154
NARRATOR: The boomtown of Guéckédou has a population of over 220,000. The Kissi ethnic group represent the majority here, speaking the Kissi and Malinké dialects, as well as French. Arriving here, it is clear the town is gripped by fear.

00:38:38:14

FIRST MAN: At the moment, the authorities here are telling us that the problem with Ebola is everywhere, and so we need to stay at home. Even at the market, there are cases, you know, it’s nothing like ever before.

00:38:56:01

SECOND MAN: Our prefecture of Guéckédou is being targeted as an Ebola region. What is really bothering us is that everything we do has been put on hold. Public services have been put on hold, all the offices are shut, just because of Ebola. So, that brings a bad reputation to the area.

00:39:12,074
NARRATOR: A bad reputation that Guéckédou could do well without. But a few months after the appearance of the first cases in neighbouring villages, Médecins sans Frontières decided to open their first treatment centre here six months ago.

00:39:31,354

In June, the NGO had considered shutting the centre, as the epidemic appeared to be under control. But a new outbreak of cases in July changed things dramatically.

This makeshift hospital is no longer big enough, and has had to hastily recruit temporary staff to face up to the growing number of cases in the eastern region of the country.

00:40:08:22

WORKER: Here’s the tent, the new tent, we can put at least eight patients in here. Eight patients. Each patient has two buckets, one for vomit and one to go to the toilet in. We change the sheets often, but if the patient excretes or vomits in the sheets we can’t clean them, we burn them straight away.

00:40:43:19

CAROLINA LOPEZ: Unfortunately the only organisation able to put up treatment centres now is MSF, and we can’t do it all. There need to be other organisations that are here, training people and putting up treatment centres. We never thought that it would be this big, or that its scope would make this epidemic such a huge problem. It requires so many resources, and we don’t have enough.

03:45

WORKER: Move, move!

00:41:17,154
NARRATOR: All these efforts are not enough, and the rain certainly doesn’t help. It’s 7pm, and the day’s work still isn’t finished.

00:41:27,834
NARRATOR: Ambulances are already arriving with seventeen new patients on board. Seventeen in one go is extremely high, and so the centre has to improvise in order to treat them.

These patients have arrived from the neighbouring town of Macenta, a hundred kilometres away, having driven for four hours on bumpy roads to get here.

00:41:57,594
At this stage, they are all suspected of having come into contact with Ebola. The utmost precaution is essential. Only the hospital staff suitably protected can approach the patients and touch them. The virus is spread by direct contact with the bodily fluids of someone who has been infected and has symptoms of the disease, such as fever, diarrhoea, vomiting and headaches.

00:42:27,794
NARRATOR: This tent is just for suspected cases. The new arrivals spend their first night here, waiting for the results of their screening test.

00:42:56,994
NARRATOR: The next morning, the day team is briefed by the night team. They must first count the new arrivals, and separate the suspect patients from those who have already tested positive. Those with positive results must then be placed into an area for confirmed cases.

00:43:19

DR MODET: Firstly, we have to start from the beginning, we return the confirmed patients and move the suspects towards the room of the confirmed cases. Who’s going to go about moving them there?

00:43:34,114
NARRATOR: Dr Floribert Lomboto Lomboto is Congolese, and is a long-term worker with MSF. This morning he is dealing with the suspected cases that arrived last night. Above all, the teams must avoid contamination. It’s a long and gruelling process, done under close supervision. Not even a square inch of skin must be exposed. In line with strict procedure, multiple pairs of gloves, a mask, a body suit and an apron must be worn. This is a task that the medics carry out several times a day, since it is difficult to work in these clothes for more than an hour.

00:44:16,114
NARRATOR: We weren’t allowed into the high-risk areas where the patients stay. However, Dr Lomboto agreed to take in a camera for us and film his work, with the permission of the patients.

00:44:46,954
NARRATOR: His first consultation is with a family who arrived the night before - a young boy, accompanied by his mother and grandmother. It is not uncommon to see several members of the same family arrive together, having been contaminated by each other.

00:45:13

FLORIBERT LOMBOTO (off-camera): The child can’t be there, he can’t be with his mother here. Go over there.

00:45:22,194
NARRATOR: The two women are in a critical state. They were probably not quick enough in getting to the treatment centre. While waiting for the screening test results, the doctor searches for clinical symptoms of Ebola, such as fever, abdominal pains and stiff necks.

00:45:47

FLORIBERT LOMBOTO : The child is in a stable condition. Kilkili, over there, is in a bad state.

00:46:07

FLORIBERT LOMBOTO : There isn’t a drug to treat the virus. Some patients are cured by immune recovery, by an immune reaction, and at the same time by the treatments of symptoms that we give, which stabilise the imbalances brought about by the virus.

The people who die are those who hang about, who come along already having major complications. But the people who come here a bit earlier are mostly cured.

00:46:46,714
NARRATOR: The grandmother of the family died during the consultation. The young mother will not survive either, but her child will be cured after spending a few days in the centre.

00:47:13,314
NARRATOR: Blood samples from new patients are taken to these experts at an EU mobile laboratory. Christopher Logue is an English virologist. He is working here as a volunteer, just like the MSF volunteers.

00:47:29,914
CHRISTOPHER LOGUE: So inside here we have another box, and inside that box, we have tubes, and inside those tubes are our samples.

00:47:40,594
NARRATOR: Christopher and his colleague need to abide by strict precaution measures, since the samples they are handling are extremely dangerous. Most of them probably contain the Ebola virus.

00:47:59,274
NARRATOR: Despite the poor condition of the site, they use the same safety protocols as a high security laboratory.

00:48:12,754
CHRISTOPHER LOGUE: Because of the nature of how highly pathogenic they are, every time that somebody works in the cabinet, we have what’s called a buddy, a buddy system and the buddy works with the operator, to go every step together so that we know that every step is done safely and there is no potential for accidents.

00:48:35,834
CHRISTOPHER LOGUE: As routine we don’t test people until they are showing clinical signs of an Ebola infection, so vomiting, diarrhea, high temperature, because then you have to test everybody and we don’t have the infrastructure here to do that.

00:48:53,834
CHRISTOPHER LOGUE: The conditions they are not like we are used to in our own labs, in England or in Germany, but we have made it as close to that as possible, so it’s, like this morning I said, when you we test samples, you get this negatives, it’s just a really good day, then you know that these people are negatives. When you have a child and it’s positive it’s a bad day. So it’s ups and downs.

00:49:32,954
NARRATOR: For the volunteers, moments of respite are short. Only a few hours are spent in the centre here, or back in their accommodation. Even if they are used to emergency missions, nothing could have prepared them for Ebola. Nobody can touch each other, and everybody keeps well apart. The virus is on their minds, all the time.

00:50:06,234
NARRATOR: Michel Komano Komano is an MSF nurse, and his colleague Cécile Millimouno is from the Red Cross. These two medical workers do not spend their days at the patients’ bedsides. They work on the ground to try and contain the epidemic. Day after day, they travel through villages where deaths from Ebola have been reported. They are heading to the village of Kolo Bengou, one of the very first places to be hit by the virus.

00:50:46

MICHEL KOMANO : It was a very hostile village, and it was very hard to get a foothold there. The community did not cooperate with MSF, because rumours run rife throughout these communities. For example, they said that if a patient is taken, they go to the centre and we kill them. So it’s very difficult.

00:51:14

MICHEL KOMANO : The issue is that they don’t know. They knew nothing about this illness or the reasons why they didn’t know about the illness, and so that’s why they’re scared.

MICHEL KOMANO : There have been 25 deaths here, but since then MSF has come back here. We’re thanking God today.

00:51:39

MICHEL KOMANO : In this community, when someone falls ill you need to go and visit them, greet them, pamper them, and reassure them that they’re not alone. We’re really all in this pain together, and that’s what custom dictates that we do. Ebola is a disease through contact, and there are lots of contaminations. If they just fell ill, there would be no assistance, because they weren’t cooperating.

00:52:01,314
NARRATOR: Trust can only be established if patients accept being treated by MSF. Or when some of them return to their village cured, like this young mother.

00:52:19

CECILE MILLIMOUNO: Fortunately for us, she arrived at the centre in good time, and she was able to be cured. So now we have to follow up with everyone else who was with her.

00:52:23,554
NARRATOR: Michel Komano and Cécile’s work involves tracking down all those who have been in contact with a patient or somebody who has died from the virus. That is the case with this family, having lost one of its parents to Ebola.

00:52:41,914

Each member of this family has had check-ups on a daily basis for 21 days – which is the incubation period of the virus. If one of them had displayed the slightest symptom, they would have been transferred to the MSF treatment centre in order to avoid contaminating the village.

00:53:04,354
Today they have finished their observation period. None of them tested positive.

This village has been hit hard by Ebola. Dozens of children have been orphaned, and the loss has taken away from the workforce in the fields, impacting on the economic survival of those who remain. These are just some of the reasons why following up with patients is so vital, and requires such a large taskforce.

00:53:51,954
NARRATOR: In the towns and cities, too, like here in Guéckédou, huge prevention projects are being undertaken. Motor-taxi drivers are the first focus group, since they are one of the most exposed.

Faya Antoine attended MSF’s first prevention meeting.

00:55:01,874
FAYA ANTOINE DOUFANGADOUNO: They told us to avoid touching Ebola victims because this virus is very dangerous.

00:54:23

INTERVIEWER: How do you know if someone is infected before they get on to your taxi?

00:54:30

FAYA ANTOINE: I have chlorine, and before getting onto my bike I have to keep it hygienic – the place where the passenger sits – and I put myself first. I wash my hands thoroughly with chlorine, and you too should wash your hands with the chlorine. I’m afraid, because you know, it’s a very dangerous virus, and we should be afraid of it.

00:55:01,874
NARRATOR: For now preventions like this have been successful in Guéckédou, after months of hard effort. But it has not been enough, either in quantity or speed. The epidemic can be contained one moment, but break out again the next.

00:55:24
MARC PONCIN: We’ve never seen such a broad epidemic, we’re discovering new cases every day. So we’re behind, we’re constantly behind. And every time we feel that it is under control, there will be a new situation which overtakes us. It’s not that we’re running behind the epidemic, it’s that the epidemic is running away ahead of us. It’s sad. Before, epidemics that we’ve seen have been in relatively remote areas where people didn’t move, and so the virus didn’t spread outside of these areas. In the three countries around what we call the ‘Parrot Beak of Guinea,’ that is, the borders with Sierra Leone and Liberia, the same ethnic groups live there. People there don’t respect the borders, they move about, and often have their field on one side of the border while they live on the other. So all three countries are affected by the epidemic in more or less the same way.

00:56:25,114
NARRATOR: Macenta, a nearby town, has recently flared up with the epidemic. The situation here is very unstable. The people are poorly informed, and scared of the sudden peak in cases. This is the hospital where the very first cases of Ebola were treated back in February. The director of the hospital from that time has since died from the virus.