A first visit to this West African republic for the Goodwill Ambassador, coinciding with the formation of a new cabinet.
REPUBLIC OF GUINEA (JUNE 18-22)
In June I made my first visit to the Republic of Guinea. A country of 9.7 million located in West Africa, Guinea reached the WHO's goal of eliminating leprosy as a public health problem in 2006. For succeeding in this endeavor, working with limited resources, it is regarded as a model case in Africa. However, as I would learn during my stay, it still has much to do.
As is usual on these missions, my visit had several purposes: to meet with political leaders to secure their ongoing commitment to leprosy control, to encourage health officials and people working in the field in their work, to spend some time with people affected by leprosy, and to promote efforts to end social discrimination, especially through media coverage of my visit.
However, on this occasion, because of the fluid political situation, it was unclear up until the last minute who I would be meeting, or even if I would reach Guinea at all. A month earlier, President Lansana Conte sacked the prime minister he had appointed only a year earlier, replacing him with Ahmed Tidiane Souare. Adding to the air of uncertainty, the new prime minister was to take several weeks to name his new cabinet. Then, just two days before I was due to arrive, the police went on strike over pay and conditions, emulating the military who had staged a similar (and successful) protest weeks earlier. The police were joined by customs officials, which led to the closure of the airport. Eventually, the strike was put down by the military on June 17, but at a cost of 8 deaths and 64 injuries.
In the end, I arrived on June 18 as scheduled in the capital, Conakry, and was greeted at the airport by Health Minister Sangare Hadja Maimouna Bah. As it turned out, this was her last week on the job, as she was to be replaced when Prime Minister Souare finally named the new ministerial line-up a couple of days later.
When we met again the following morning, I thanked her for the ministry's commitment to fighting leprosy, and she promised me that this would continue, while noting that pockets of high endemicity persist and that greater efforts are needed to prevent cases of disability.
Later in the day I was briefed by Dr. Fatou Sakho, the coordinator of Guinea's national leprosy program, which was established in 1985. In 1990, Guinea had a registered prevalence of 11.9 per 10,000 population; in 2007, the rate had dropped to 0.74. Of the 803 new cases reported last year, 70% were cases of multibacilliary leprosy, 12% showed grade 2 disability and 9% were child cases.
Dr. Sakho said that of Guinea's 34 prefectures, 28 have achieved elimination. Four of the remaining six currently have a prevalence rate of between 1 and 2, and the two others (which border Sierra Leone and Liberia, respectively) of over 2. It is in these six prefectures especially that more work must be done to reinforce surveillance activities and to alleviate the social, physical and economic consequences of the disease.
On the morning of June 20, I paid a short visit to a health center in Madina, a suburb of Conakry. This is an outpatient facility that sees some 80 patients a day, including those with TB and leprosy. I arrived when the center opened at 9 a.m., and there were already many people present, including some 10 people affected by leprosy who had come especially to meet with me. I am told that Guinea has a well-developed system of primary health care, which has played its part in the country achieving the elimination goal.
|Meeting with the president of Guinea's National Assembly, Elhadj Aboubacar Sompare|
From the health center I went straight to an appointment with Prime Minister Souare, who had just announced his new cabinet the night before. In my brief remarks, I asked him to pass on the three messages that leprosy is curable, treatment is free, and that social discrimination has no place. For his part, the prime minister gave me his commitment to fighting leprosy and discrimination. Next, I called on the president of the National Assembly, Elhadj Aboubacar Sompare, to deliver a similar request, and he impressed me greatly with his knowledge of the disease.
Supporting Guinea in its fight against leprosy are several NGOs, and I had an opportunity to meet with them that afternoon. Of the international NGOs, the Mission Philafricaine has had the longest presence in Guinea, dating back to 1982. It operates in Forest Guinea, where it opened a center in Macenta and began treating people with MDT. Currently it provides support by training people affected by leprosy to become self-reliant and offers reconstructive surgery. The Raoul Follereau Association has been in Guinea since 1985, where it works in Upper and Lower Guinea, supporting the health ministry by supplying drugs, training staff, providing vehicles and fuel and also conducting awareness campaigns in rural communities. A third international NGO, the Order of Malta, operates in Middle Guinea, but its representative had just been appointed to the new cabinet, and could not be present at our meeting.
There are also two local NGOs. One is the Raoul Follereau Guinea Association (AGUIRAF), which covers the whole country, going into the interior, investigating patients' needs, providing assistance to help people affected by leprosy become self-reliant, and promoting social integration. Another is an association representing people affected by leprosy, founded in 2005. To date, however, its activities have been constrained by lack of funds.
On June 21, I left Conakry at 8 a.m. to visit a health facility in Kindia, an upland city 135 kilometers east of the capital. With a population of some 135,000, Kindia is a major producer of fruit and vegetables, which are shipped by truck to Conakry each morning. The health post at Damakanya is one of 20 in Kindia prefecture, and specializes in patients with HIV/AIDS, leprosy and TB. Originally set up to treat cases of sleeping sickness caused by the Tsetse fly, the health post sees an average of 20 patients a day. At the back is a garden cultivated by persons affected by leprosy, who grow mangoes, oranges, grapefruits, coconuts and more for sale in Conakry.
|The Goodwill Ambassador is given a rousing welcome during a visit to a health post in Damakanya, Kindia.
To welcome me, about 20 persons affected by leprosy had come in from the surrounding area. There was a colorful welcoming ceremony with music, song and dance, as well as a short skit performed by people affected by leprosy that went as follows. A man visits a health center, where he is diagnosed with leprosy, registered as a patient and prescribed MDT. On his return home, his wife flees in horror to her parents when she discovers what's wrong with him. But after being given the facts about leprosy by her mother, who is properly informed about the disease, the sobbing wife calms down and goes back to her husband. It was quite a performance, and all played their parts with gusto.
Based on what I saw and heard in Guinea, I hope that the health ministry will be able to execute an effective plan of action to tackle the prefectures where leprosy remains a problem, focusing on early detection and prompt treatment, and on conquering the stigma that prevents people coming forward for diagnosis and which makes their social rehabilitation harder. I especially urge the health ministry and its partner NGOs to work together closely and in a coordinated way at every level, so that their efforts achieved the desired outcome. I intend to follow Guinea's progress with interest.