Guineans have lately been so gripped by the performances of their national team in the 2015 African Cup of Nations that preventive health measures against Ebola have been forgotten amidst the collective rejoicing, with many people hugging each other in the streets.
However, there are other areas of concern beyond these impromptu expressions of joy. Although data may suggest a trend towards a certain degree of stabilisation, 2,921 suspected cases of Ebola have been reported in the country as of 29 January, 2,751 of which have been confirmed, since the start of the epidemic in December 2013. This has resulted in 1,911 deaths, 1,591 of them confirmed.
Do these figures reflect reality though?
Guinean residents have raised a few questions about the way the fight against Ebola has been handled by their government. Their concerns are centered around two main themes: the resources dedicated to data collection in the remote regions and how it is validated by the government, and the communication strategy employed by the government where discordant information can be identified.
Regarding data collection, the Guinean health system has certainly been severely hit by the disease that has taken up most of the healthcare resources of the country. Data collection is a daunting challenge without even considering the lack of a robust IT systems to archive and transfer data rapidly.
In addition to the structural challenges, the communication by the government has grown increasingly confusing for Guinean citizens. In previous months, the minister of health reported that Ebola was now under control in some cities such as N'zerekore, when in fact some unexplained deaths were already reported leading to the new spike of Ebola cases reported on February 11.
Members of l’Association des blogueurs de Guinée (Ablogui), the Bloggers Association of Guinea, started a debate on their Facebook page concerning the credibility of official data and the behaviour of some government members. The debate began following the visit of one of its members, Sally Bilaly Sow, to the district of Kokouma, sub-prefecture of Dougountounni, prefecture of Mali. This member wrote the following, regarding which data to trust:
Je crois dans ce cas il faut forcément utiliser les données citoyennes qui sont sur le terrain. Mais il y a un hic que je n'arrive pas à bien cerner. Quand je me déplace avec les responsables sanitaires sur le terrain,ils disent envoyer des rapports de mission. Je ne sais où ceux rapports partent ou est-ce ceux rapports reflètent l'image de la situation sur le terrain ? S'agissant de la sale sortie médiatique d'un ministre de la République pour nier l'existence de la maladie, je crois que à ce niveau, les juridictions doivent prendre leur responsabilité pour le punir avant que la justice ne fasse son travail et qu'il soit remercié du gouvernement, parce qu'il n'en est pas à sa première bévue. De l'autre côté le premier ministre menace de sévir contre les populations qui vont s'adonner à la réticence. Pourquoi ne pas faire de même contre ce véreux et acabit ministre car a priori il est aussi citoyen.
I think that in this matter, data from citizens on the ground must definitely be used. However, there is a problem with this, which I can’t figure out. When I move around with the health workers on the ground, they tell me that they send off mission reports. I don’t know where these reports go to or if these reports give a true picture of the situation on the ground. Regarding the terrible media announcement by a government minister denying the existence of the disease [in some regions], I think that at this level the courts of law must take responsibility for punishing him before he is thanked for his work by the government. After all, this is not his first blunder. On the other hand, the prime minister is threatening to deal severely with civilians who do not obey the gag order on reporting unverified Ebola cases. Why not do the same to this dubious minister who is doing the same as them, since he is, presumably, a citizen as well.
Alimou Sow, a member who works in Guinea for a large international organisation and is familiar with administration processes, responded:
Les rapports de l'OMS sont à prendre avec précaution. Ils prennent en compte plusieurs paramètres donnant parfois des résultats surprenants (augmentation/diminution du nombre de décès sans morts réels sur le terrain pendant une période donnée). C'est à dire que les données peuvent être rétroactives si l'on s'aperçoit que des décès communautaires non comptabilisés étaient dus à Ebola après coup (retard des tests, etc.). Pour la lutte contre la maladie il est clair que l'approche des autorités a été hasardeuse et la communication, dès le début, défaillante. Après plus d'un an, on se demande quel plan de lutte efficace faut il adopter à présent .
World Health Organisation (WHO) reports should be treated with caution. They take into account a number of parameters, sometimes giving surprising results (showing an increase/decrease in the number of deaths without actual deaths on the ground in a given period). It means that the data may be retroactive if it is later found that unaccounted for deaths in the community were due to Ebola (due to test delays, etc.). In the fight against the disease, it is clear that the approach taken by the authorities has been haphazard and there has been a lack of communication from the beginning. After more than a year, we are left wondering which effective plan of action should now be adopted.
Delays have occurred in the transmission of data. The lag might be explained by issue with data transmission from an IT standpoint (a common issue in Guinea). But IT issues are not the only causes of concern when it comes to the lag in Ebola progress reports. Other issues such as data collection and uncertainty of cause of deaths have also come into play. In order to prevent any undue panic by unsubstantiated sources, the government has threatened to jail any bloggers who reports any Ebola-caused deaths that are not validated. Still, it is astonishing that the government through the words of a minister threatens anyone who dares to put up a fight aimed at creating obstacles in the battle against the national scourge, and says nothing when another of its members succeeds in denying its existence.
Sally Bilaly Sow responded:
Nous sommes aux heures des TIC on ne peut pas comprendre cela par le retard. Cela dénote au manque d'expérience qui a prévalu leur choix.
We are living in the ICT era; this cannot be explained by a delay. It is an indication of their lack of experience, which has influenced their decision.