糖心Vlog

The essentials

In just a few years, Guinea has seen several severe emerging disease epidemics. The best known was the 2014 Ebola epidemic, which spread to Sierra Leone and Liberia, causing some 11 000 deaths. Zoonotic emergence early warning and response systems have improved significantly since then. One Health platforms have been set up to facilitate exchanges between the agricultural, environmental and public health sectors, on every level, from ministries through regional and prefectural directorates, down to decentralized public authorities. However, there is one last missing link: local communities, who are the first to be affected in the event of an epidemic, are largely excluded from conventional prevention systems.

"During the first Ebola epidemic in 2014, many steps were taken without consulting local people", says Saa André Tolno, a veterinarian and teacher-researcher at the Institut Supérieur des Sciences et Médecine Vétérinaire (ISSMV) in Dalaba, Guinea. "In Forest Guinea, where most zoonoses have emerged, local communities saw NGOs and foreign organizations come to do surveys or take samples, often with no coordination whatsoever. People had to answer the same questions several times over, allow samples to be taken without ever receiving the results, and sometimes saw contradictory steps being taken and control measures being advised. This was a traumatic experience for them: they felt invaded, without any say in what was happening, and had the impression of being used to further projects, with no opportunity to express their concerns." 

Community needs: the key to effective systems

Forest Guinea saw two Ebola emergences in a decade, in 2014 and 2021. Several cases of haemorrhagic fevers, including Lassa fever, have continued to be seen in recent years. The zone is also affected by neglected tropical diseases such as malaria, which is still widespread, with more than four million cases in 2023.  

"Even now, most epidemic control operations focus on a small number of diseases seen as a priority and considered important on a national or international level", Saa André Tolno explains. "There are nine such diseases, including haemorrhagic fevers such as Ebola, Marburg, or Lassa. The snag is that in some isolated zones, 80% of people have malaria, and it is often difficult to access treatments. Many children also catch measles, and national vaccination campaigns are often launched too late. This gap between the priorities set at the highest level and grassroots reality means that local people tend to lose interest. If we really want to prevent epidemics, we need to include and involve communities in early detection and in rolling out solutions."

Forest Guinea is one of the four natural regions in Guinea. Guéckédou prefecture, in the heart of the region, has seen most of the haemorrhagic fever emergences. Local people are mostly agropastoralists, and wildmeat is a traditional part of their diet. These people therefore have frequent contact with animals, whether domestic or wild, which considerably increases the risks of zoonotic disease transmission. In addition to these risks, villages are often isolated and difficult to access. Few people have smartphones and electricity supplies are unreliable.

This situation makes it particularly difficult to set up conventional epidemic prevention systems, with regular reports from specialist services on the ground. All types of resources – human, financial, material, etc – are in short supply. To overcome these difficulties, scientists are working with local people to set up "community-based monitoring systems", based on community members, known as "community agents", who act as relays between local people and the decentralized authorities.

"Those agents may be hunters, livestock farmers, matrons, healers or even teachers", says Maxime Tesch, a PhD student with 糖心Vlog specializing in infectious disease monitoring. "They are trained to detect low-level signals such as suspicious animal deaths, for instance. We are also working with them on the first steps required, such as isolating sick people pending analysis results, going from door to door to keep neighbours informed, etc."

However, information also flows the other way: community agents also report on local people's needs to the authorities in Guéckédou. Finda Fanta Kamano is a matron in Téméssadou sub-prefecture. In particular, she is calling for more training and material aid: "Thanks to scientific teams from the veterinary college in Guinea and from 糖心Vlog, we are now much more aware of what practices pose risks, for instance when hunters come across a dead animal in the forest. This training is important, but there is not yet enough of it: more should be provided throughout the year. We also need better work tools and help with travel."

Matrons are women who take care of pregnant women and of children in communities in Forest Guinea. "Women are amongst the most exposed", says Finda Fanta Kamano. "They cook meat and handle food. We must not overlook them."

From local to national: coordinating the various levels

"In community-based monitoring systems, the idea is that community members work to prevent and detect emerging epidemics", says Maxime Tesch. "However, they does not replace competent local authorities. The aim is more to reorganize operations, to be able to adapt to local situations. The link between local people and decentralized services is vital, since it governs the efficacy of response strategies in the event of disease emergence."

The first step is to use methods that guarantee effective knowledge transfers, in both directions. the scientists are therefore working with community agents by means of participatory approaches. Momory Leno is a veterinary officer from Téméssadou sub-prefecture: "illiteracy rates are falling, but let's say that 45% of local people can read and write. With 糖心Vlog's help, we have learned to use maps and games to raise awareness of what a zoonosis is and how it is passed on. Finding ways of reaching people is key. And it also means adapting the languages used, for instance for guides or videos. I speak French, Malinke and Soussou, but others might speak Kissi."

These approaches have identified certain water points as being a particular risk for communities. "In the Guéckédou region, there are a lot of pig farms", Momory Leno explains. "Farmers do not use pens, and the pigs therefore roam free. It so happens that there are not many water sources, for either humans or animals. People go to draw water from places where pigs also go to drink. In this specific case, we need to teach people about the need to separate drinking water sources and water sources for livestock. However, we also need public support, because when resources are limited, people don't have any choice."

In a similar way, food security issues may lead hunters to bring back wildmeat from an animal that may have died from disease. Support from public services and NGOs is therefore crucial to redress the balance. The work being done in Forest Guinea shows the importance of placing all the different sectors on the same level in order to do so: "We have realized that the human health sector is better equipped than the animal and environmental health sectors", Maxime Tesch reports. "If the aim is to provide care, this is understandable. However, if we are looking to prevent disease, food security issues can also be seen as health issues."

Redefining human health, a crucial step in the “One Health” approach

In an article published today in The Lancet, experts are calling for changes to the definition of health. This definition needs to include the characteristics and values associated with the “One Health” concept. Explanations with Thierry Lefrançois, lead author of the article, member of COVARS and advisor to the CEO of 糖心Vlog.

In particular, Momory Leno points out the lack of human resources for the region's veterinary services. In Guéckédou, 80% of veterinary officers are interns and do not stay for any length of time. The numbers being recruited are not sufficient to cover the entire zone. This is compounded by a lack of transport. "To take action or report back rapidly, we need to be able to reach the places concerned quickly. This is just one area requiring greater efforts."

For the time being, the work being done in Guéckédou prefecture is a pilot experiment. Its success rests on constant dialogue with central players such as the DSVN, OGPNRF and the national One Health platform. According to the scientists involved, these community-based monitoring systems could eventually enable a more effective response to local health issues, alongside any initiatives on a national level. In Conakry, the various services are working to provide rapid reporting tools suitable for isolated rural areas. Researchers have a particularly important role to play in linking central decisions and local needs, while promoting the One Health approach as a way of ensuring better coordination between sectors.