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Guinea knows how to fight Ebola. But can it handle four outbreaks at once?

The city center in Conakry, the capital of Guinea. (John Wessels/AFP via Getty Images)

CONAKRY, Guinea — When he heard about Ebola resurging in Guinea, cardiologist Fode Kaba hoped his country could dodge catastrophe this time.

The hemorrhagic fever killed more than 11,000 people across this West African nation and two neighbors from 2013 to 2016 in the deadliest outbreak on record. Health-care workers knew what to do when new cases arose this week: Trace contacts, isolate the potentially exposed and warn everyone to take special precautions.

But medical centers are already stretched thin as Guinea confronts the coronavirus pandemic on top of yellow fever and measles outbreaks. People are tired of locking down and losing work in an era of seemingly endless restrictions. And the flare-up emerged where the last epidemic started: a region near the borders with Liberia, Sierra Leone and Ivory Coast.

“We lost a lot of doctors on the front lines — even my best friend,” said Kaba, who treats patients in the capital, Conakry. “The government needs to do more in rural areas where there are poor health centers, poor roads and poor electricity. The panic is there.”

How Ebola sped out of control

Health officials projected optimism on Feb. 14, when the West African nation declared a new epidemic. Sakoba Keita, head of the National Health Security Agency, estimated Guinea could contain the menace in six weeks.

Messages of support poured in from all over.

“The world cannot afford to turn the other way,” Jen Psaki, the White House press secretary, said in a statement. “We must do everything in our power to respond quickly, effectively, and with commensurate resources to stop these outbreaks before they become large-scale epidemics.”

West Africa has more Ebola-fighting experts than anywhere else on Earth, and Guinea is expected to receive 11,000 Ebola vaccines this weekend from the World Health Organization. Busy markets have shuttered. Weddings and funerals are on pause.

“We are not panicking,” said Amie Kaba, a physician in Conakry. “We learned lessons from the last outbreak.”

Yet the early details about how Ebola returned have spooked some doctors.

The death toll rose to six on Wednesday. Guinea has counted 10 suspected cases and at least 216 people who interacted with them, but experts say more contacts are likely to emerge.

The nightmare began again with a sick nurse in the town of Gouécké. She reported a fever, headache, abdominal pain and trouble keeping food down on Jan. 18.

A doctor diagnosed her with typhoid, according to a WHO report. Five days later, she got a second opinion and another diagnosis: malaria. She sought a traditional healer before dying Jan. 28.

The nurse was “buried unsafely,” the report found, and five of her family members, along with the traditional healer, caught Ebola. Five of that group died.

Authorities are still trying to record every person the nurse encountered on her 10-day quest for help. Someone who attended her burial, for instance, developed symptoms and took a bus to the hospital.

“There are certainly a lot more contacts,” said Amer Sattar, a general physician in Conakry who worked on the last Ebola response. “Those people are now impossible to find.”

One big obstacle, he said, is a lingering perception that reporting symptoms to the government means certain death. Some fear if they enter an isolation center, they will never come out. Quashing stigma was central to getting the last outbreak under control.

Doctors and nurses, meanwhile, shoulder crushing work schedules. By Thursday, Guinea had confirmed 15,088 coronavirus cases and 85 deaths. (Infections have flattened since record highs in May, but health officials urge vigilance.)

“There is a systemic shortage of health-care workers,” Sattar said, “because of the lack of training centers and because the pay is horrendous.”

Leaders in Guinea vowed to mend those problems after the last Ebola outbreak. The government pledged to recruit 6,000 more health-care workers and boost salaries by 40 percent. Spending on health care climbed from 4 percent of the national budget to 8 percent.

Many of the recruits were sent from the capital to rural areas. Yet they struggled to stick around, according to a 2019 study in the peer-reviewed journal Human Resources for Health. The researchers found absenteeism rates of up to 41 percent at the small-town medical centers they toured.

“Participants reported that the staff, purposefully recruited from the capital, was parachuted in underserved areas for just a few months to benefit their civil servant salary,” the authors wrote.

A health-care worker described the city recruits as “prepared for anything except staying in rural areas.”

One of those rural areas is the epicenter, Gouécké, which is 533 miles from Guinea’s capital.

Ivory Coast sits to the east, Liberia is just south and Sierra Leone borders on the west. All three have ramped up epidemiological surveillance at the frontier, aiming to avoid the kind of cross-border contamination that set off the explosion of infections in 2014. (The index case, a toddler thought to be infected by a bat, exhibited symptoms in December 2013.)

Teams from the United Nations and WHO are bolstering the response in the epicenter, while ringing the alarm about another Ebola outbreak in Congo. (The Central African nation has confirmed four cases and two deaths.)

The pandemic has already “pushed health workers and health facilities to the edge,” said Matshidiso Moeti, WHO’s regional director for Africa.

More than 28,000 people contracted Ebola before West Africa’s epidemic ended.

One was Fode Abass Camara, 51, who lives near the town where the nurse died. The virus killed 13 of his family members.

“The news that Ebola is back is scaring me at night,” said Camara, a fruit seller. “I haven’t been able to sleep for the past few days.”

Loss haunts him. He flips through the local news and sees politicians weaving through maskless crowds.

“Tell me how I can protect myself from Ebola and corona when our leaders aren’t wearing masks?” he said. “May God save Guinea.”

Paquette reported from Dakar, Senegal.

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