Ibrahim Sacko turns up the volume on his public address system and steers his motorbike into the early morning traffic along the streets of Kayes. Stopping at a red light at one of the city’s busier thoroughfares he picks up the microphone and starts to share a simple but important message with the waiting commuters.
Since the Malian government recently confirmed the country’s first case of Ebola, Sacko has toured the city day and night urging people to halt the spread of the disease by washing their hands.
Whether stuck at traffic lights or not, they tend to listen because Sacko occupies a special place in Malian society: he is a griot – praise-singer, oral historian and mediator.
Since Ebola came to his country, Sacko has noticed a rapid change in people’s behaviour. “We Malians are used to greeting each other with French cheek kisses and hearty handshakes,” he says. “This stopped as soon as people heard about the Ebola case.”
However, the authorities’ reaction to the health crisis has been less speedy. Despite a swift initial response, the ability to build the capacity needed to detect suspected cases and treat patients has been slow – and hampered by bureaucracy.
A second person has died of Ebola in Mali in an unrelated case. Officials say a nurse died on Tuesday after treating a man who had arrived from Guinea at a clinic in the capital Bamako. The clinic is now in quarantine.
The new case came a day after the World Health Organisation said it had released from isolation 25 of more than 100 people thought to have come into contact with country’s first victim.
In Kayes – where Mali’s patient zero died on 24 October – humanitarian organisations have taken over operations, setting up a treatment centre and training medical staff and volunteers.
The victim, a two-year-old girl who had recently returned from Guinea, was treated at the city’s Fousseyni Daou hospital. When she and her grandmother were admitted on 21 October, only two of the hospital’s 160 staff knew how to identify and handle suspected Ebola cases.
“We never had Ebola in Mali before,” says Dr Abdouramane Koungoulba, the paediatrician who first examined the child. “Even if we knew how to recognise the symptoms and how to treat the person, we lacked experience.” But now, he adds, “we know what to expect”.
Two weeks into their isolation, none of the 79 relatives and health workers who may have had contact with the girl is showing symptoms of the disease. To stave off boredom, Unicef has provided the family with a TV and toys for the children.
“We’re all doing really well,” says Mamadou Traore, the retired health worker who urged the family to take the girl to the hospital. He is now isolated at the hospital, waiting for the 21-day quarantine period to end. “We’re just counting the days before we get to go home,” he says.
Mali’s first encounter with Ebola began when the grandmother, a 43-year-old woman from Kayes, decided to bring her granddaughters, aged two and five, back from Guinea.
Her daughter, a Malian, had married a Guinean health worker and moved there a little over a year ago. When he fell ill and died – according to some he had Ebola-like symptoms – the grandmother travelled hundreds of kilometres to the small town of Beyla, southern Guinea, to fetch her grandchildren.
The two-year-old was already showing symptoms when they crossed the border into Mali; by the time they reached Kayes, she had a high fever and a nosebleed. “The grandmother took the girl to see a marabout, a local healer, but he didn’t recognise the symptoms,” says Dr Samba Sow, an expert on infectious diseases who is leading the country’s Ebola response.
The child tested positive for typhoid at the hospital but it wasn’t until a relative told staff she had come from Guinea that the authorities in the capital, Bamako, were alerted. It took 24 hours for the rapid intervention team to reach Kayes – apparently because there was no team on standby.
“Finally, I offered to send two of my own staff members,” says Sow, who travelled to Kayes the next day. “It was important for me to be on the ground and monitor the response.”
The grandmother told doctors that she and the child had taken at least two long-distance taxis to get to Bamako, and that the girl had come into contact with several family members and relatives in Kayes.
“We know the bus stopped in a village about 20km east of Kayes and one person got off,” says Sow. “It’s important to find this village and notify the authorities should any of the villagers fall ill or die an unexpected death.”
As many as 108 people may have had contact with the child: 29 people in Bamako have been isolated and are being monitored in their homes, while the authorities are still looking for nearly 50 people who may have been infected.
The national laboratory in Bamako has tested seven people suspected of having the virus – including the girl’s grandmother and sister – and all tests have been negative.
If no new cases are reported in 42 days, Mali will be declared Ebola-free. But, as Toumani Konare, director general at Kayes hospital, is careful to point out: “We’re not quite there yet.”
Outside the hospital, though, life is gradually returning to normal. A proffered hand is no longer met with a terrified look.
Other habits – such as sharing tea and eating from the same plate – survived the panic. Some customs, says Konare, as he raises a cup to his lips, are sacred: “If Malians stopped drinking tea, you would know something was really wrong.”
