Questions over Mali's Ebola response

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.

On 11 November the authorities put Clinique Pasteur, one of capital city Bamako's most frequented hospitals, under quarantine after two members of its staff were diagnosed with Ebola, one of whom later died.

An elderly man from Guinea, an imam, died in the hospital on 27 October, from what experts now believe was Ebola. The imam was treated for renal failure, which could have been a result of a kidney disease, but is also a late-stage symptom of Ebola. No samples were taken.

"It was a failure by the clinic to not detect or report the case until a second staff member fell ill," Ibrahima Socé-Fall, the representative for the World Health Organization (WHO) in Mali, told reporters. Mali's president, Ibrahim Boubacar Keïta, ordered an investigation.

On 17 November local authorities announced that they were trying to trace more than 500 people who may have been exposed to the virus.


But some Malians are concerned: "I wonder how the Guinean patient could cross our borders and be admitted so easily to a clinic as renowned as Clinique Pasteur," said Moussa Camara of Mali's National Youth Council. "The fact that the patient was coming from Kourémalé in Guinea, a centre of the Ebola outbreak, should have alerted authorities."

Ibrahima Socé-Fall, the World Health Organization (WHO) representative in Mali, said the country has the capacity to tackle the disease. "You can't say Mali wasn't prepared, people were trained," Fall told IRIN, although he did not specify how many.

On the plus side...

The Malian authorities are working with international partners, among them WHO, the US Centers for Disease Control, UNICEF, NGO Alima, and Croix Rouge Mali to trace, isolate and monitor over 400 contacts of those who have died.

Several WHO epidemiologists will soon join CNAM's rapid response team of doctors, nurses, social workers and laboratory technicians.

Oumar Ouologuem, a communications officer with the Ministry of Health, said the government is planning an isolation and treatment centre in Siby, 50km southwest of the capital. "When we started making plans for a centre in town, the neighbours objected," said Ouologuem. "That's why we decided to find a location outside the capital."

The authorities say the site will open if they have more cases, but could not give a precise date.

Médecins Sans Frontières (MSF) has set up two treatment centres, one in Bamako and one in Kayes. For the moment, its treatment centre in Bamako is the only one there. Natalia Torrent, the Ebola response coordinator in Mali for MSF-Spain, told IRIN they have six beds for suspected cases and six for confirmed cases, adding: "We are working on enlarging the site and giving technical advice on how to set up the CNAM treatment centre."

In one area, at least, Mali's health system seems to be already up to speed. Mali's national laboratory, SEREFO, one of one of the hills overlooking Bamako, boasts a level-3 biosafety laboratory, equipped by the US National Institutes of Health (NIH) to handle the diagnosis of tuberculosis, HIV and Ebola.

SEREFO director Ousmane Koita said their lab can get Ebola test results within a few hours. Even so, if the number of suspected cases continues to rise, it will have a hard time keeping up.

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