Guinea: Health Facility and Community Visits to Dubreka and Kindia

“Ebola était un mal necessaire.” -Health official

After two weeks in Guinea, I can already see that I've learned a lot. Beyond the dozens of academic articles I’ve been reading about adolescent sexual and reproductive health, I also spent some time in communities this week. I came into this summer with some of my own research questions, but through my interactions, these have been refined. This past week led me to really question: 

1. What does it mean to be Ebola-affected?
2. How are things different now than before the Ebola outbreak?
3. What gaps still exist, especially regarding the well-being of young women?

What does it mean to be Ebola-affected?

• The stats about the Ebola epidemic are clear – it is a disease that rapidly and unexpectedly attacked and affected thousands of lives in Guinea, West Africa, and beyond. But what does it really mean for a country, or community, to be affected by such a devastating disease. I would argue that, as a biosocial framework can help us to understand, Ebola cannot simply be viewed as a biological condition. Instead, it must also be understood for its political, economic, social, and cultural consequences. 
• This past week, I accompanied the Health Communication Capacity Collaborative (HC3) and Jphiego’s Maternal and Child Survival Program on a two-day trip to visit some health facilities and communities to see the work they have been doing in Ebola response. During this trip, I toured a few health facilities, visited a nurse and midwife school, and met key stakeholders including a Prefectural Health Director, Regional Health Director, medical professionals (doctors, nurses, and midwives), community health workers, a mayor, and, most importantly, members of the local communities. 
• I learned that Dubreka, community that took us 1.5 hours by road to get to, had 142 confirmed cases of the Ebola virus that resulted in 52 survivors and 90 deaths. In Kindia, one of the largest cities in Guinea, a facility we visited experienced a decline from 60 patients per day in 2013 to <5 patients per day during the 2014-15 outbreak. Though these numbers may not seem huge on a global scale - and although these are certainly not the hardest hit communities here in Guinea - our conversations revealed to me that the Ebola outbreak really instilled a fear and distrust in community-health facility relationships. These sentiments must be addressed to effectively address the daily threats of malaria and infectious disease that remain common in these communities.

From left to right: Conkary, Dubreka, and Kindia

How are things different now than before the Ebola outbreak?

• Perhaps the most asked question during our site visits was: “What is different now?” At the health facility in Kindia, the medical director suggested that an average of 16 people are now seeking services daily, and we observed at least two dozen women waiting with their children to get vaccinated. The Prefectural Health Director also explained that the Ebola outbreak has also created an urgency surrounding the enforcement of the rules and regulations for infection and disease control, which were often disregarded before. One example he shared was that during the outbreak, a patient came from Sierra Leone and the chief doctor carried him, gave him IV without gloves, and sadly, eventually died. He also described that it wasn’t uncommon for those seeking emergency care to come to the facility by foot. 
• Now, following the Ebola outbreak, investments have been made in better disease control and prevention and in the training of staff. Facilities are clean and sanitized regularly, every room has a large bucket of water and soap for handwashing, and everyone’s temperature is taken upon entering the health facility, again for safety precautions. Ambulances and motos are available and equipped to handle emergency cases. And with initiatives like HC3, more community engagement is emerging to orient the community to some of these changes. 

Every person entering the facility is required to wash their hands
and get their temperature checked.

What gaps still exist, especially regarding the well-being of young women?

• What these visits revealed to me is that although some positive strides have been made in response to the outbreak, there are still a disheartening number of gaps that remain. The health systems and practices were not strong or consistent prior to the Ebola epidemic, and investments in some of these basic necessities still need to be made. Although each room had a large bin of water and soup, running water was not regularly available, to me, highlighting a key sanitation concern. In one of the non-renovated maternal and child health rooms that we toured, the water damage on the ceiling was evident from the constant rains, leaving questions in my mind about problems we couldn't easily see. And although the projects I observed are funded through USAID, who are all the stakeholders investing in building Guinea, and in what way are these activities sustainable?
• I was also struck by how generalized some of the approaches to increasing demand in health services seemed. Yes, there was some targeting of women, of men, of health care workers, of Imams (Islamic religious leaders), but no where did I see any explicit focus on youth. I wondered if culturally Guineans only recognize "young children" and "adults," and thus the category of "youth" resonates less in the context. But on the other hand, when I saw mothers at the facility who still looked half my age, I couldn’t help but think that a focus on young women, as I hope my research will reveal, remains important to improving health here.

One of many young mothers, which as I
observed, was not uncommon in the places
we visited. 

It is unfortunate, as the Prefectural District Director said, that "Ebola was a necessary evil" to see some improvements in the healthcare system. I am encouraged to see some of the ongoing responses and look forward to speaking with more stakeholders about the problems they see young women face.