Bridging the Mind and Heart: Lessons from Guinea on the International Health RegulationsPosted on by
In the field, especially during outbreaks, people are the bridge between policy and action. But in global public health, we often use policy-heavy language that lacks personal connection. We talk about “building capacity.” We talk about “implementing the International Health Regulations.” But what does it all really mean? Sometimes we overlook the association between public health policies and the people who work every day, sometimes in nearly impossible circumstances, to make them a reality.
One of the core requirements under the International Health Regulations (IHR) is that countries have the human resources – the people – they need to respond to public health threats when they occur. I can think of no better example to illustrate the importance of this than what I saw happen in Guinea last fall, at the height of the Ebola outbreak.
The personal side of global health policy
During the Ebola epidemic in West Africa, countless healthcare workers have put themselves in harm’s way to help control the disease and provide care and comfort for those sick with Ebola. One of these public health heroes, Ebola survivor and Guinean emergency room nurse Marie Claire Tchecola, was recognized by the U.S. Department of State in March as a 2015 International Women of Courage awardee, along with nine other women from around the world. The award honors women who have shown exceptional courage and leadership in advocating for human rights, women’s equality, and social progress—often at personal risk.
I had the privilege of working with Marie Claire during my November deployment to Guinea. As a health communication specialist working in global health at CDC, the work I do in Atlanta supports our agency’s global health security goal of helping the nearly 70% of the world’s countries that are unprepared to effectively detect, assess, report and respond to potential public health threats. Although our programs have a clear and compelling link to the IHR, it’s often difficult to communicate that goal with heart. Marie Claire’s story is one among many from the Ebola epidemic that shows us how we can take the ideas behind a framework like the IHR and put them into practice.
“When Ebola came to Guinea, we knew nothing about it. We were told there was no medicine for it. When you were diagnosed, you were isolated. When you died, you were put into a plastic bag. So yes, people were scared. People didn’t want to come to the hospital. We were just waiting to die. As a survivor, it’s difficult for us to tell our story. It’s difficult to get the message out that you can survive this disease.”
Marie Claire Tchecola, Ebola Survivor
A passion for people
Marie Claire grew up in a small Guinean village. She is the first woman in her family to receive an education. She told me she could have been a doctor but chose nursing, “because you can affect more people.” Because only the doctors at Donka Hospital—Conakry, Guinea’s largest hospital—were supplied with gloves, Marie Claire was exposed to the Ebola virus while treating a patient in July 2014. Once she identified her own symptoms, she quickly checked herself into an Ebola treatment unit to avoid spreading the disease to other patients and to protect her colleagues.
In addition to fighting the disease itself, Marie Claire also fought the stigma she experienced during and after her illness. She and her two daughters—one who is deaf from a childhood seizure—were evicted by her landlord and thrown out on the street. She has since returned to Donka Hospital to continue her work as an emergency room nurse, which includes triaging and testing patients who may have Ebola.
Working from the inside out
When responding to an emergency, the people who can make the largest impact are those who live in the community. And these people want and need to be trained to meet their own emergencies. To accelerate this kind of training, we used a small US Embassy grant with International Foundation for Electoral Systems (IFES), an NGO specializing in fair elections, to develop a series of Ebola “conversations” (question and answer sessions) within communities throughout Guinea. The goal of the meetings was to build community trust of healthcare workers and contact tracers in all of Conakry’s Communes.
IFES had held massive voter education just before the Ebola outbreak and offered CDC its ready-made network of influencers and trainers to conduct joint trainings alongside local educators. The uniqueness of this partnership lay in its ability to spread information through people who were already trusted by the community. CDC and its partners created a dynamic, flexible social mobilization campaign, which began within Conakry’s five Communes and later was duplicated throughout Guinea.
Marie Claire, along with the U.S. ambassador and other local leaders – including Dr. Mamadou Diallo, a respected imam and physician – worked with CDC to share critical Ebola messages with audiences. These conversations also gave us a sense of the issues Guineans needed addressed and allowed us to test our messages.
Practice makes perfect
During her first meeting, in Matam, in a room filled with dignitaries and residents, a reserved and shy Marie Claire barely spoke above a whisper. However, Marie Claire had a compelling story to tell and, as a healthcare worker and survivor, she was the perfect person to help reach communities with critical messages about Ebola. We just had to help her learn how to say them with greater impact.
We began working with Marie Claire on how to better reach her audience. Sometimes, training one great trainer can have a ripple effect that reaches far and wide. It was clear Marie Claire had these capabilities. Soon, Marie Claire’s fear of stigma was replaced with confidence and clear messages as her public speaking skills took off.
The next six town hall meetings reached over 1,000 people in crowded rooms and were broadcast throughout Guinea. They showed a different side of Marie Claire (photo). In Matoto, the U.S. Ambassador opened the meeting by speaking in one of Guinea’s local languages. A member of the Guinean Parliament and members of the area’s contact tracing team joined him. Questions lasted for several hours and ended with Marie Claire boldly encouraging people to not hide those who are ill and to be honest when coming to a healthcare clinic. The audience literally sat on the edges of their seats listening to Marie Claire’s testimony (photo).
We want to be trained
In March, when Marie Claire came to the United States to receive the International Women of Courage Award, she visited CDC and I had the opportunity to see her again. While at CDC, she met with a small group of infection control experts who looked to Marie Claire’s unique experience to help them find ways to improve training and outreach. One asked her, “What can we do better in a public health setting?”
Marie Claire appeared eager to give her answer. Through her experience with the meetings and her work in the emergency room, she possessed a unique understanding of the value education can bring. “Training,” she said. “Without it, we’re going out to battle without weapons; we are powerless.”
Policy saves lives
When we talk about the important goals of the IHR, such as building capacity in countries or growing the public health workforce, it can be hard to show what this really means for a country. What we are really talking about is not just saving the lives of people like Marie Claire, but also empowering future disease detectives, healthcare workers and educators to save the lives of their fellow countrymen.
The IHR tell us very clearly that a trained and prepared workforce is key to strengthening public health. Identifying and working with people who can help improve conditions in countries like Guinea is one of the main missions of the IHR and global health security.
This is exactly what Marie Claire asked for. Let’s continue our battle to give it to her and her colleagues. Investing in people is an important part of policy and a crucial step toward avoiding the next outbreak.
 Katz R, Dowell S. Time for an International Health Regulations Review Conference. Lancet Global Health 2015. Published Online May 8, 2015. July 2015. Vol 3(7), e352-353
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