エボラ出血熱の生存者
Yo sobreviví al Ébola
Mamadou es de los pocos que han vencido al rebrote mientras veía morir a varios familiares
La epidemia del virus está lejos de estar bajo control. “Llevará meses”, aseguran los expertos
Claves del virus
FOTOGALERÍA El Ébola avanza imparable
GRÁFICO Brotes de Ébola en las últimas décadas
José Naranjo 17 ABR 2014 - 19:04 CET
Un médico se coloca el traje de protección para entrar en la sala de aislamiento de Médicos Sin Fronteras en la región de Guekedou. / AFP
A medical protective suit standing to enter the isolation ward of MSF in the region Guekedou. / AFP
Un vêtement de protection médicale permanente à entrer dans la salle d'isolement de MSF dans la région Guekedou. / AFP
Miembros de Médicos sin Fronteras atienden a los enfermos en una sala de aislamiento instalada en la región de Guedekou, al sur de Guinea, a finales de marzo. / AF
MSF members serving patients in an isolation room installed in Guedekou region, south of Guinea, in late March. / AF
Membres de MSF au service des patients dans une salle d'isolement installé dans la région Guedekou, au sud de la Guinée, à la fin de Mars. / AF
Entrada del hospital Donka en Conakry, la capital de Guinea, el pasado 27 de marzo, donde se atiende a los enfermos del Ébola. / Cellou Binani (AFP
Check the Donka hospital in Conakry, capital of Guinea, on 27 March, where the sick attends Ebola. / Cellou Binani (AFP
Vérifiez l'hôpital Donka à Conakry, capitale de la Guinée, le 27 Mars, où le malade assiste Ebola. / Cellou Binani (AFP
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I survived the Ebola
Mamadou is among the few that have overcome the regrowth while watching several family members die
The virus epidemic is far from being under control. "It will take months," experts say
Keys virus
PHOTOGALLERY Ebola speed ahead
GRAPHIC Ebola outbreaks in recent decades
José Naranjo 17 ABR 2014 - 19:04 CET
Mamadou spent his first night in the hospital of Donka sleeping on the floor in front of the door of the infectious diseases unit . It was last March 26. He had been several days with excruciating headaches, constant vomiting that prevented him from eating and extreme weakness. " I told them I was coming Dabola and the doctor came running in a hurry. I felt abandoned. Was playing on the door, but nobody wanted to open up. The next day someone came with gloves and mask and took me in a wheelchair to the area isolation. But I do not understand anything . when I arrived and saw that there were also my wife , a cousin and two of my uncles , I realized it must be something serious. "
Mamadou did not know it , but he and his family had become the first Ebola patients registered in Conakry , an African city of two million people right now trying to face the latest outbreak of the dreaded disease, that have been infected and 224 people and until Thursday had claimed 135 fatalities ( 122 in Guinea and 13 in Liberia) . Every day there are new cases.
Mamadou was barely standing. " My brother convinced me to take a collective taxi and go to the capital"
It all started on March 14 . Until that day, Mamadou Cissé (fictitious name) , officer of 36 years old, married with no children , led a normal life. With ups and downs and bottlenecks , as almost everyone in the capital of Guinea, since some years ago moved there from Dinguiraye near Dabola , inside the country. But that Friday , his older brother , a merchant who was living in the town , came to his house for help . He was very ill . " He was breathing hard , his chest and complained that his head hurt . Furthermore, vomited and had diarrhea. " Mamadou and his wife welcomed him , nursed him , helped him wash .
Source: WHO . / COUNTRY
" No I took him to the doctor because it was the weekend , but Monday was much worse and decided to submit it ." The venue was a private clinic kipe Dadia , a popular district of Conakry. Twenty-four hours later, on Tuesday 18 March, the sick brother died with a severe case of hemorrhagic fevers. Nobody could imagine then that the " perpetrator " , the silent murderer beginning to leave a deadly trail in Guinea, was nothing less than Ebola , a virus that was identified in 1976 and, until now, had only been shown in forests of the center of the continent . Never before in West Africa.
That same day, hospital staff moved the body to the morgue. There, a paternal uncle of Mamadou took over the body. "It's a ritual , wash the corpse, prepare . For us is very important and is always someone older family who is in charge ." On Wednesday March 19 , Mamadou started with the body to Dinguiraye , where he was buried 24 hours later . " My wife was in Conakry , but many people attended the ceremony ," he says . That afternoon began to suffer the first symptoms. "I had a severe headache, but I waited to see if it was wrong. Did not think it was related to my brother. The next day (Friday) should have gone to the mosque , but could not, I felt worse and worse , and began to vomit a lot. I went to the health center and was told that it was malaria; gave me pills and some vomiting for cutting , but during the weekend did not get better . "
MSF members serving patients in an isolation room installed in Guedekou region , south of Guinea, in late March . / AFP
This Saturday, March 22 , the authorities of Guinea made a surprising announcement . Since January , a number of deaths from haemorrhagic fevers had shaken the South, a mysterious epidemic that began to acquire concern dyes. Given the extent of the cases and the virulence of evil, the Ministry of Health had decided to send blood samples of seven deaths at Pasteur Institute of Lyon . All of them tested positive for Ebola virus and , what was worse , it was the deadly Zaire strain , with a fatality rate of between 60% and 90% . The affected districts were Guekedou , Macenta , Nzerekore and Kissidougou , forest regions called Guinea.
" We do not know what has been the source ," says Philippe Barboza , an epidemiologist at the World Health Organization ( WHO), which has worked on the outbreak in recent weeks in Conakry. "In January and was suspicious deaths , but we do not know if all can be attributed to Ebola because it is buried without getting tested. In this part of the world 's other haemorrhagic fevers , such as Lassa , so we can not know. What we do have clear is that all outbreaks of this epidemic , Guekedou , Macenta , Conakry , are linked together, is the same epidemic. And that began in the forest region . "
Scientists suspect that the natural host of the virus are several species of bats fruit eaters . " These bats move across West Africa, moving , it is normal that the virus circulates . Possibly the outbreak comes from any human contact with sick animals in the forest , "says Barboza, who notes that the virulence of Ebola comes from its ability to jump from one species to another , such as avian flu, but then the spread between humans is not so simple, only occurs through contact with fluids of people already ill. "What is unusual is that this outbreak is affecting several countries, cross-border transmission ( confirmed in Guinea and Liberia cases suspected in Mali and Sierra Leone ) , but consider that we are talking about the same ecological zone" , adds.
On Wednesday 26 March, Mamadou was in Dabola and beginning to suffer the second phase of the disease. His health had deteriorated so much that he could barely stand . They had appeared diarrhea. " I was afraid to eat because everything she ate she vomited . Still, my brother convinced me to try to go to Conakry , so we took a jeepney in the morning and arrived at nine in the evening. I stopped by the hospital. " Although no one had informed Mamadou , by then his wife , his cousin and two uncles were already admitted .
Check the Donka hospital in Conakry , capital of Guinea, on 27 March, where the sick attends Ebola . / Cellou Binani ( AFP )
The next day I had blood drawn five . " One of my uncles was a dentist. I wanted to go , I was not happy , but he convinced us to wait for the results, we should have something very contagious and we thought of the children in the house , we could beat them the disease. " Each presented different symptoms , but all had fever, severe headache and , to a greater or lesser extent , vomiting and diarrhea. The next day came the fatal news. Was Ebola . " They told us not directly, but heard talk among themselves ; I knew what the disease was because I had read something years ago , so I said nothing to my wife and my cousin did not want to scare them even more . "
Analyses Family Mamadou no longer had to travel to France. Donka Hospital had a hemorrhagic fevers specialized laboratory received , from the early days , the support of the Pasteur Institute , which sent experts from Dakar and Paris. "It is true that this is the Zaire strain ," said Dr. Jean Claude Manuguera of Pasteur in the French capital , " but this is a local variant whose lethality , so we are seeing around 60% . That is, in the lowest range of the Zaire strain : six killed ten hit " .
The Government, in constant coordination with WHO , just took a few hours to announce that Ebola had appeared in the city. Outside the hospital , psychosis began to spread . During the preceding week, all had taken refuge in the thought that this was a bad thing " forest " of southerners from Conakry to be seen with contempt because " eat monkey meat and are ignorant and uneducated " . But that all changed on March 28 . The virus officially entered a chaotic as few and where, no doubt , would be more difficult to track overpopulated city.
Highlights of Ebola virus
- What is . It is a virus Filoviridae of variable morphology and can reach great lengths . It takes its name from the Ebola River in Zaire , where the first outbreak was identified . The virus is transmitted from wild animals to humans , and also between those resulting from direct contact with blood , secretions, organs or other bodily fluids. The fruit bats of Pteropodidae family are considered as the natural host for Ebola .
- Symptoms . Ebola is characterized by fever , intense weakness, headache , muscle and throat . These symptoms are followed by vomiting , diarrhea, rash, and impaired renal and hepatic function , even in some cases internal and external bleeding .
- The first case . The August 26, 1976 in Yambuku , a city north of Zaire (now the Congo) . Its spread , infecting 318 people , of which 280 died.
- Victims . Since its discovery, 2,611 cases were detected ( until 16 April) of which 69 % were fatal. There is no vaccine against Ebola .
More difficult, a daunting task . "We have to follow the chain of transmission. Each infected person do a list of people with whom he had contact . We're talking about a thousand people in total at present to which we will see every day. Thousand people once a day , imagine "said Barboza . "In the Forest Guinea , the outbreak is still active, but it will be easier to control. Here in Conakry , we will take months. It is the first time we have a major epidemic of Ebola in a city. " For all this work for epidemiological surveillance , WHO relies on local health structures and the Red Cross. "The most graphic simile is the sack of rice falling . At first it is relatively easy to collect 90 % of the grains , but then you have to go to granite countertops. And many end up under furniture or between the tiles . "
These grains of rice may be in fact anywhere . In the villages , the drive chain is more predictable, undecideable , you can easily follow . But in Conakry , the chance of infection multiply. This is the Gordian knot of the problem. Newspapers open editions each day with figures , personal stories and news halfway between reality and rumor. That if a person entered a bank bissap juice in the mouth, purple , and spit it out like blood , causing a stampede that helped him steal the box. If a girl in the neighborhood of Hamdallaye proposes sex as being infected . Ebola is not . But fear itself is very visible these days in the city .
In the market of Madina , one of the most populous of Conakry , meat sales have fallen. Awa Diallo , who has spent 20 years grilling skewers next to the bridge that crosses the highway , said " people are afraid , all kinds of rumors circulating ." In all public buildings and even travel agencies, restaurants and entertainment venues, will now require desinfectarte hands . Bleach has become a coveted product. At the international airport in the city has increased security : thermal cameras to know the temperature of passengers, medical checks before boarding. The idea is that the virus does not jump off Guinea.
Michel van Herp , an epidemiologist at Doctors Without Borders ( MSF) , carries and seven outbreaks of Ebola behind . Ensures that this is " a detective investigation in which we have not yet made the hunter (referring to the person who probably caught the infected bat or monkey animal, which was then ingested and transmitted the virus to humans) . His family would have been the first to suffer the disease and then health workers and Macenta Guekedou that attended . One of the major problems of this epidemic is its amplitude. Unlike Congo or Uganda, here people move a lot , are always going from one place to another. And that expand the virus. For example , the director of the hospital in this town died when he came way Conakry and was buried in Kissidougou " . It is estimated that at least 30 % of the confirmed cases are health workers, the most exposed to the virus when caring for patients .
It is the first time we have a major epidemic of Ebola in a city , "says epidemiologist Barboza
These doctors and nurses, but also traditional healers and family caregivers , the first to try to calm the pain and symptoms of patients in a country where , particularly in rural areas, access to public health structure does not it is always easy. The Guinean Dr. N'Famara Bangoura , who these days faces the Ebola isolation center Donka , knows of what he speaks. " A doctor can not refuse a patient , we have to address them, trying to alleviate the symptoms. The problem here is that this disease is not known , it is something new , health workers did not know how to cope , what protection adopt " he says.
Following the government's announcement on March 28 , in the makeshift isolation facility Donka hospital things went from bad to worse. The old man who had washed the body of Mamadou brother had just joined too. And six were family members . "I was the one most solid of all , they were very concerned , especially the elderly," recalls Mamadou . " My uncle was newly arrived very agitated , the catheter is removed and stained with blood. He put him in a separate room ; walked with great difficulty, just had no strength , and he died on Saturday night . When I got up the next morning found his body lying in the yard and a great blood trail. He was the first to die. " In the following days also killed two other guys Mamadou , the virus raged with the weakest.
By then , MSF had already taken charge of the isolation zone Donka . One of the most important aspects to consider are safety measures . And that has moved to Conakry a team of 40 hygienists. "We use about 300 liters of chlorinated water per patient / day. Several times in the same day disinfect protective equipment , beds , mattresses and bedding , "says Rob D' Hont , responsible for this task. The strange thing is that Ebola is relatively easy to kill. "It's a very strong virus. We use a chlorine concentration of between 0.05% and 0.5% , while for the anger we have to use up to 2 % , "he says . Once disinfected , protective equipment is dried outdoors : only exposure to sunlight can also with him.
Epidemiologist Michel van Herp informs the inhabitants of a village in Guinea on Ebola. / MSF
Although initially impressed , Mamadou eventually get used to all these people wearing astronaut suit . "Every day was something new , latrines , water tank , shops, disinfection measures ... With them I started to feel more confident and I also had the first signs of improvement. The family brought us food, but I could not smell it , I was tired of throwing up. Then they started giving me Plumpy Nut ( a nutritional supplement ) and began to eat slowly . And I remember when I drank my first sip of water , I felt through my throat and into the stomach. And not vomited ! That gave me hope. "
Patients admitted to the isolation center are allowed to have mobile phone and , if not with infusion wander the public areas, but are prevented from mixing with suspected cases confirmed to prevent new infections. The latest development is opening an area for family visits , which you can see but not touch : there is a margin of separation of two meters. However , the demand for visits is not high . Fear causes havoc.
The Argentina Dr. Fernanda Mendez has already had to face to face with Ebola four times , two in Uganda and one in Congo. Exit the isolation area completely drenched in sweat. "The suit that we not let the air " , says between gasps. MSF staff can only be within one hour; at noon, when the heat , 45 minutes. And always go in pairs if anyone feels faint . " I just saw four confirmed Ebola patients. We watched her vitals , treat your symptoms. Two of them have deteriorated , one has begun to take bloody diarrhea and the other has light bleeding , edema in the legs is clouded " signs. Some who are now admitted are the medical staff of the clinic where Mamadou kipe Dadia took his brother . Doctors , nurses, technicians ray ... " The worst thing is not being able to touch them, the eyes can only see us through the glasses ," Mendez added .
Donka Hospital Medical protective suits before entering the isolation room . / C. Binani
Others , however , improved. About forty have overcome the disease. " The sooner they are taken care of, most likely to survive," said Dr. Barboza, " the problem is that the early symptoms are confused with malaria , widespread here . Although there is no treatment for the virus , they moisturizes, nourishes them , they calm the pain. And your immune system does the rest . " On Thursday April 3 , a week after admission , Mamadou was discharged . He had defeated Ebola . "The same day they told me and another guy we had to leave Conakry . He was jumping for joy , but I could not be happy . My three uncles had died there and were still inside my wife and my cousin , " she recalls. But in the following days both also received the coveted news that the virus was gone from his body , that he had been completely removed .
However, even though they can no longer contagious (except the first three months through semen , so that men who are cured are a lot of condoms) , one of the problems they have to face is the social stigma. " Just outside the center told me that the insulation market held weekly in Dinguiraye had been suspended because of our family. I felt ashamed . Then , since we returned home, the neighbors have not come even once to greet us. They closed all day house windows overlooking the communal courtyard and will not collect tap water that we share there. They are afraid , we reject , we point the finger . But we're alive and we know that with time and with the right information will no longer do so. So now I thank God every minute. "
A few days ago , the Government of Guinea reported that the "epidemic is under control ." Specialists disagree emphatically . Every day new cases continue to occur . Sometimes five , sometimes ten . Other suspects who were just confirmed. And new outbreaks may occur. It is unpredictable. An early warning system is active throughout the country . At the slightest doubt , the patient will be for referring to relevant evidence . Until you spend at least 40 days without any new cases , ie two periods of incubation ( from 2 to 21 days) , it can not be taken for control. The good news is paradoxical that kills so fast that this limits their ability to expand. It is also opinionated, but not invincible. "The first is to accept that Ebola is here ," concludes Van Herp . And that will take time to defeat him .
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