EBOLA OUTBREAK IN MALI ECLIPSES EARLY SUCCESS

Outbreak in Mali Eclipses Early Success

By DONALD G. McNEIL Jr.NOV. 12, 2014


A police officer on guard outside the Pasteur Clinic in Bamako, Mali, where a patient with the country's second confirmed case of Ebola died. Credit Joe Penney/Reuters

The West African nation of Mali, which just beat its first outbreak of Ebola, has confirmed a second one that is larger and more threatening, global health authorities said on Wednesday.

The victim who apparently began the new outbreak was an imam who fell ill in Guinea and traveled to Mali for better treatment at a major private clinic in Bamako, the capital.

The new cases will add to the mounting total of Ebola victims. In its last update on Nov. 5, the World Health Organization said there had been more than 13,000 confirmed or suspected cases in West Africa since the epidemic began. Some 5,000 have died.

The imam died at the Pasteur Clinic in Bamako on Oct. 27. Because of his status, his body was washed at a large mosque and returned to Guinea for burial after a funeral at another mosque.

The Pasteur Clinic failed to diagnose Ebola as the underlying cause of the kidney failure for which it was treating the imam. Kidney failure is a possible complication of late-stage Ebola.
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The outbreak was detected only after a nurse at the clinic fell ill and died, and the chief W.H.O. representative in Mali heard from his counterparts in Guinea that members of the imam’s family were dying.


Mali

Bamako

Guinea

Sierra

Leone

Liberia

Atlantic Ocean

Bamako

100 miles

MALI

Kourémalé

GUINEA

“It was a real failure by the clinic,” the W.H.O. representative, Dr. Ibrahima Soce Fall, said in a telephone interview.

Now the clinic is closed and under quarantine — as are the mosque in Bamako, one or two other Malian clinics where the imam was treated, and the family compound where the nurse lived.

Among the patients quarantined at the clinic are 10 United Nations peacekeepers stationed in Mali who were wounded in fighting in the north.

On Wednesday evening, Malian health authorities confirmed that one of the clinic’s doctors also had Ebola.

Cars lined up to enter Guinea from Mali at the border in Kourémalé in early October. Closing the border has been considered impractical and a violation of Malian hospitality. Credit Joe Penney/Reuters

The clinic is now surrounded by police officers, with armored vehicles from the United Nations peacekeeping mission nearby.

“Most nurses and doctors had gone home when the clinic was quarantined, and I fear the patients will be left without proper care,” said Dramane Maiga, the clinic’s director.

Health experts are trying to trace everyone with whom the imam, the nurse and others with suspected cases of Ebola came into contact.

The task will be complex because the imam fell ill nearly a month ago, on Oct. 17, in Kourémalé, a town that straddles the Guinea-Mali border. The consequences for Mali were not recognized until Nov. 10, when doctors ordered an Ebola test on the dying Bamako nurse.

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So far, 28 workers at the Pasteur Clinic, which is not related to France’s Pasteur Institute or its African offshoots, have been quarantined, as have 50 people who had contact with the nurse.

A friend who visited the imam at the clinic has died of unknown causes and is a suspected case, although no blood samples are available to test, the W.H.O. said.

“We’re still working on the contact tracing,” Dr. Fall said. It is not yet clear how many people may have been exposed.

The mosque connection is worrisome, Dr. Fall added, because it is unclear how many people touched the imam’s body. No one has fallen ill there so far.

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The imam traveled in a private car, not on public transportation, and at least four members of his family who were in the car are now ill or dead in Guinea.

His first wife has died, as has his daughter. The daughter died Monday, and Ebola was suspected, but the family declined offers of a safe burial. His brother, second wife and son are ill and in Ebola treatment centers.

Teams including advisers from the W.H.O. and other health agencies are working at the clinic, the mosque and the border.

The Malian authorities have not closed the border, which is 500 miles long and crossed by many gravel roads. Also, in a holdover from the divisions of French colonialism, it separates many extended families who are used to traveling back and forth.

In addition, Mali has a tradition of welcoming both strangers and those with clan connections — a principle known as diatiguiya (pronounced JAH-tih-GEE).

The new outbreak is frustrating for the health authorities because they were feeling triumphant about their containment of the country’s first case: a 2-year-old Guinean girl, Fanta Condé, who died in the town of Kayes in northwestern Mali on Oct. 24.

Katarina Höije and Cheick Diouara contributed reporting from Bamako, Mali.