A Médecins Sans Frontières specialist on how the unprecedented spread of the ebola virus in west Africa makes the work of medics tougher than ever

I received a message at home in Brussels about this strange disease which had broken out in Guédeckou, in southern Guinea. They thought that perhaps it was Lassa fever, but when I received a description of the patients' symptoms, it was clear to me that we were talking about ebola. A couple of days later I was in Guinea.

The World Health Organization (WHO) has described the West Africa Ebola outbreak as one of the "most challenging" incidents the world has ever seen. So far, Guinea has counted close to 160 suspected cases of Ebola; more than 100 people have died from the disease. In neighboring Liberia, there have been 10 fatalities so far, with 21 other infections linked to the disease.

Around 65 percent of those infected don't survive the virus, said WHO spokesman Tarik Jasarevic. There is no vaccine or cure. It's crucial to quickly detect an infection - also to stop the disease from spreading any further, Jasarevic added.

I've worked in every major outbreak of ebola since 2000. What makes this one different is its geographical spread, which is unprecedented. There are cases in at least six towns in Guinea, as well as across the border in Liberia. The problem is that everybody moves around – infected people move from one village to another while they're still well enough to walk; even the dead bodies are moved from place to place. So, as an epidemiologist tracking the disease, it's like doing detective work.

The other problem is that ebola has never been confirmed before in Guinea, so you can be blamed for being the messenger – you're the guy bringing the bad news that the village has been touched by ebola. To them it means death, so people often refuse to believe the reality.



We were tracing a patient who we finally found staying with family members in a very small village. He was an educated man – a professor. He'd become infected while caring for a colleague, who had caught the disease by caring for his sick uncle – when somebody is sick in Guinea, they are always cared for by people of the same sex.

The professor realised it was probably better for him to come with us to the MSF centre, but his nephew and an elderly female relative suddenly appeared and took the sick patient off into the forest. They had no confidence in the health system, and believed that people were killed in our centres, so they decided to keep their relative in the forest and cure him with leaves and herbs.

I followed them into the forest. They were very aggressive – the nephew took a big stick and was hitting the ground – but behind the aggression you could hear the pain in his voice. Eventually, we got a sample from the sick man, to make a proper diagnosis. The next day he asked us to come and collect him.



Patients are cared for in the MSF centre. For health staff, it is normal to feel some kind of fear when you enter the isolation area for the first time, even if you are well protected. But you follow a kind of ritual – for dressing and undressing, and for all the activities you perform inside – little by little, you gain confidence.

You never enter the isolation area alone – you always enter in pairs. And you only go in for short periods, because it is very hot in Guinea and even hotter inside the yellow protective suits. It is tiring, especially if you are doing physical work. We always write our names on the front of our aprons so that the patients know who is in front of them.

Inside the centre, we try and make the patients as comfortable as possible. Sometimes we bring the parent of a sick person in to visit them. They have to wear a protective suit with a mask and goggles and gloves. The relatives are supervised, so there is no possibility of any contact with a patient's bodily fluids.

Patients who are deeply affected by the disease do not have a lot of energy to communicate. The mood can be very sombre with those in a terminal stage, who have only a few hours left before they die.



When a patient dies, we put them in a special body bag so that the burial can be done according to family traditions. If the patient comes from a village, we take the body back and advise relatives about what they can do – and what they should not be afraid to do – during the funeral. Once the body bag has been sprayed, it can be handled with gloves, so the mourners can wear their normal clothes to the funeral. We do not steal the body from the family; we try to treat it with dignity, and respect their traditions as much as possible.

The mortality rate for ebola is high, but there are survivors. Just before I left Guinea, our first two patients left the MSF centre cured of the disease: Théréèse, 35, and Rose, 18. Both are from the same extended family, which had already seen seven or 10 deaths from the disease.

Their relatives were overjoyed. There was a huge celebration in the village when they returned. They come from a family of local healers, so the news that they were cured will spread to other villages, and I hope this will create further trust.

People can survive; as the patients left, our teams were cheering. To know that they survived helps you forget all the bad things.

The Ebola virus is spread through the exchange of blood or other bodily fluids. Initial symptoms resemble those of the flu or malaria: Between two and 21 days after becoming infected, patients start to feel weak and experience headaches, muscle aches and chills. They develop high fever paired with diarrhea and nausea. The infected die of severe internal bleeding, in particular of the gastrointestinal tract, spleen and lungs.

So far, Ebola outbreaks have only been recorded in Central Africa, such as in Sudan, Congo or Uganda. The disease was named after a river in the Democratic Republic of Congo where it was discovered in 1976. According to the WHO, there have been 15 epidemics in Africa killing more than 1,300.

Not only humans can contract the virus - wild animals such as gorillas or chimpanzees can fall ill to Ebola as well. Experts have pointed to a certain type of bat as a suspected carrier of the virus.

"There are many people in West and Central Africa who are dependant on protein from bush meat," Sebastien Calvignac-Spencer said, a scientist working for the renowned Robert Koch Institute in Berlin.

The virus could spread to primates and humans who handle infected meat. As a reaction to the outbreak, Ivory Coast outlawed sales and consumption of bush meat.

Sunday 13 April 2014

http://www.dw.de/ebola-virus-continues-to-rage-in-west-africa/a-17554825

http://www.independent.co.uk/life-style/health-and-families/health-news/exclusive-a-mdecins-sans-frontires-specialist-on-how-the-unprecedented-spread-of-the-ebola-virus-in-west-africa-makes-the-work-of-medics-tougher-than-ever-9256670.html

12 killed in road accident in Myanmar

The bus carrying about 44 passengers bound for Yangon from Taunggyi, the capital of Shan State, collided with a family car at 2:10 am local time at a location of about 267 kilometers from Yangon. Both vehicles were almost destroyed, Xinhua reported.

The passengers with serious injury were admitted to a nearby hospital.

Sunday 13 April 2014

http://english.farsnews.com/newstext.aspx?nn=13930123001200

All 36 bodies recovered in Washington landslide have been identified

The Snohomish County Medical Examiner’s Office said Friday it has identified all 36 bodies recovered from the Oso landslide.

The 36th victim, identified Friday, was 14-year-old Denver Harris.

Seven people remain missing.

A flood warning remained in effect until Thursday April 17 for the north fork of the Stillaguamish River. Flooding continued to be an issue in the area due to slide debris that was partially blocking the river and pooling of water behind a dam of debris.

On Saturday it will be three weeks since the huge landslide traveled nearly a mile, crossing the North Fork of the Stillaguamish River to bury a residential area.

The Federal Emergency Management Agency said more than 370 individuals or families have registered for assistance.

About 30 houses were destroyed in the slide and the debris blocked a long stretch of state highway 530 near Arlington. The mudslide struck on a Saturday morning March 22, a time when most people are at home. Of the 49 total structures in the neighborhood, authorities believe at least 25 were full-time residences.

Local seismic measurement stations clearly show that the event happened with no warning and so quickly that victims in its path had little chance to run for safety. Even if it had been slower, there would have been nowhere to run — the slide area was almost a mile across.

"We have whole houses here and then we have houses that look like they've been through a blender and dropped on the ground," said Snohomish County Fire District 1 Battalion Chief Steve Mason.

Much of Highway 530 was ripped off the ground.

“The power of the slide came down with so much energy and just wiped out the highway bed and there is nothing left,” said Steve Harris, division supervisor for the Department of Emergency Management.

The search for victims by heavy equipment, dogs and bare hands was going "all the way to the dirt" as crews continued to look for anything to provide answers for family and friends.

On April 3, President Barack Obama declared the site a major disaster area. The declaration made programs available to help affected individuals and businesses.

After touring the site of the mudslide, Department of Homeland Security Secretary Jeh Johnson said federal help will continue until "this is done."

Volunteers and over 70 members of the National Guard joined professional rescuers over the weeks to help recover the bodies of the dead and retrieve mementos for the living.

Recently, the search area was deemed contaminated due to sewage and chemicals and too dangerous for volunteers.

The Oso landslide is probably the second deadliest natural disaster in Washington’s history, after the 1910 Stevens Pass avalanche that killed 100 people.

A 1999 report filed with the U.S. Army Corps of Engineers state that the hillside had "the potential for a large catastrophic failure," according to an article in the Seattle Times.

When asked days after the slide whether he knew about the report, Snohomish County Emergency Management Director John Pennington said he hadn't gotten a chance to look at the article.

"I want to know why this slide went," he said. "I'm not just an emergency director, I'm also a dad and I want to know why this happened. There have been warnings and advance notifications of the high risk of a landslide. We've done everything we can to mitigate that risk."

Initial death tolls were projected to be almost 200 people. But over a week into the search effort the number of missing and dead was greatly reduced.

Early into the recovery effort, Cory Kuntz and several volunteers worked with chainsaws to cut through the roof of his uncle's house. The home was swept about 150 yards from its previous location. Kuntz said his aunt, Linda McPherson, was killed. He and the others pulled files, his aunt's wallet and a box filled with pictures from the home.

"When you look at it, you just kind of go in shock, and you kind of go numb," he said.

Sunday 13 April 2014

http://www.wcnc.com/news/national/All-36-bodies-recovered-in-landslide-have-been-identified-255019001.html

Search teams that rely on drones could run afoul of FAA

Texas EquuSearch relies mostly on horseback and all-terrain vehicles to search rough terrain. But it also employs 4-pound aerial drones to survey the ground with digital cameras.

Those drones were not used when the group surveyed an area of about four square miles near James Stephens’ residence Saturday, said Ray Ortiz, chief of detectives for the Vernon sheriff’s office. Nor was Stephens was found.

If the Texas group had used the drones, it could have run afoul of the federal government.

Using the drones in their search for Stephens would have violated a Federal Aviation Administration order not to fly the unmanned aircraft.

Texas EquuSearch has used drones since 2005 to locate 11 bodies, including those of a Houston man floating in Buffalo Bayou and a 2-year-old boy in Liberty County, said Tim Miller, its founder. In all, the group — which provides its services to families free of charge — has been involved in more than 1,350 searches in 42 states and eight foreign countries. Its help in the search for Stephens came at the request of his family.

“The bottom line is they won’t let us fly, and that drone has been so very valuable on so many searches,” Miller said. “When someone disappears, time is of the essence and it saves us a lot of time. And it’s very inexpensive.”

Brendan Schulman, a New York attorney representing Texas EquuSearch, said the FAA ordered the volunteer group to halt its use of drones Feb. 21. Schulman has asked the FAA to reverse the ban and let the Houston area group operate legally by April 16. If not, it plans a federal court challenge.

EquuSearch has avoided using drones since the FAA asked it to stop, Schulman said, but an emergency would force a difficult decision. “We hope the FAA will do the right thing in the next few days so we aren’t continuing to wait on a determination of legality.”

In Washington, an FAA spokesman would not speculate on what action might follow if EquuSearch flies its drones. “We hope they abide by our request to stop unauthorized operations.”

The agency noted that it has given emergency approval to use drones for relief work in natural disasters and search-and-rescue operations, but said a group such as Texas EquuSearch must be sponsored by a governmental agency that already has FAA permission to fly a drone. “We are not aware that any government entity with an existing certificate of authority has applied for an emergency naming Texas EquuSearch as its contractor,” the FAA said, adding that the process could take as little as a few hours.

Schulman and Miller said the FAA process of operating under another agency’s certificate is difficult and time-consuming. “I don’t care if it’s a couple of hours,” said Miller. “If we have a missing child or even an adult out there, a couple of hours is a matter of life or death.”

EquuSearch is being supported by U.S. Rep. Ted Poe, R-Texas, who has sponsored federal legislation that would govern the use of drones by law enforcement and others to protect privacy rights. “The big issue is the FAA should not be in the business of deciding who can get a drone and who can use a drone. They are making the decisions based on their own opinions.”

The FAA’s long delay in developing rules for drone operation has frustrated many users, who note the technology is evolving much faster than the government can set out rules for their use.

“Texas EquuSearch represents one of the many beneficial uses” of drones in search-and-rescue operations, said Melanie Hinton, communications director with the Association of Unmanned Vehicle Systems International. “This latest development further underscores the need for the FAA to immediately begin its long-delayed rule making to establish a regulatory framework for (drone) technology.”

The drones proved invaluable in EquuSearch’s effort to locate the body of Devon Davis, a 2-year-old who went missing from his home in rural Liberty County in April 2012.

“We had hundreds of searchers out there for about five days, including the FBI, the Texas Rangers, Houston Police Department and all the volunteer fire departments in Liberty County,” Liberty sheriff’s Capt. Ken DeFoor said. “We were about 30 minutes away from closing down the search on the fifth day when we launched a drone.” Fifteen minutes later, DeFoor said, the drone spotted a red dot in the weed-choked waters. Searchers recovered the body of the boy, who was wearing a red shirt when he wandered from home.

“I cannot understand the controversy going on about the use of drone aircraft for searching for lost children, dementia victims and the victims of foul play when the FAA has no problem with people flying drones for sport,” DeFoor said. “To me, it’s illogical and it makes no sense.”

Sunday 13 April 2014

http://www.shreveporttimes.com/article/20140413/NEWS01/304130035/Search-teams-rely-drones-could-run-afoul-FAA?nclick_check=1

At least six dead and more missing in Tajik mudslide

Six children have been killed and at least seven people are missing and presumed dead as a result of a mudslide in south Tajikistan, an emergency ministry spokesman told Reuters on Sunday.

Landslides and spring floods are common in Tajikistan, the poorest country in Central Asia, as over 90 percent of its territory is mountainous.

The mudslide struck on Saturday night in a village around 230 km (150 miles) south of the Tajik capital Dushanbe, near the border with Afghanistan.

"The slide came in the middle of night which is why there are so many victims. We have recovered six bodies so far. They were all children," spokesman Orif Nozimov said.

Locals are working with emergency services to excavate a house buried in mud, Nozimov said, adding that the death toll could be higher than the 13 estimated so far.

Sunday 13 April 2014

http://in.reuters.com/article/2014/04/13/tajikistan-mudslide-idINDEEA3C05P20140413