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--:-- Noel King: Today Explained, Ramas Firm, we've talked a lot on the show about places that have struggled to deal with this pandemic. The United States or, you know, the United States and even the United States. But one place that has done a relatively great job over the last year or so, Africa. and one country within the continent of Africa that's had an especially good response, Senegal.
--:-- Sean Rameswaram: Vox's Jen Kirby flew there a couple of months ago. And when she told me that, I was like, Jen, you flew to Senegal a few months ago in the pre-vaccine pandemic? I was scandalized. I was like, Jen, how could you? Well, I felt pretty safe doing it. I took a lot of precautions. You had to get tested before you got on a plane.
--:-- Noel King: But I wanted to look at a country that started off the pandemic without a lot of resources. They didn't have a lot of doctors. They didn't have a lot of hospital beds. So how would a country like that prepare to take on a pandemic that has, quite frankly, bested countries far richer and more powerful than Senegal?
--:-- Sean Rameswaram: And in terms of the numbers, how'd they do? Pretty good on paper. Sénégal has recorded about 40,000 cases and a little over 1,100 deaths in a country of 16 million people. It is likely that that is an undercount and that there are a lot more cases that have not been recorded by the system.
--:-- Noel King: But even with that, it compares favorably to a place like the United States, which if we did that, we'd have a fraction of the number of cases and deaths that we have now. What do we need to know about Senegal? Well, it's in West Africa, so it's in the neighborhood of a lot of other countries that you may know, like Guinea and Sierra Leone, and it has a porous border with Gambia.
--:-- Sean Rameswaram: It's a former French colony, so French is spoken there and a lot of other languages as well. And when it comes to, for example, its doctors, there's only about seven doctors per 100,000 people compared to, say, the U.S., where there's about 260 doctors per 100,000 people.
--:-- Noel King: So now I really want to know how they managed to do a lot better than the United States with so few doctors. How did they pull off something that sounds like a medical miracle? Well, why don't we first talk to a guy named Abdule Bousso? Okay, who's he? You're the director of emergency operations. Is that the correct title? Yes, he's a health emergency operations center. And it's kind of like a cross between FEMA and the CDC.
--:-- Sean Rameswaram: And he's been doing this job for a while. Now it's seven years. It's since 2014. So 2014 is kind of a big year for West Africa because that is the year of the Ebola epidemic in the region. It's been called one of the most challenging outbreaks of the deadly Ebola virus the World Health Organization has ever faced.
--:-- Noel King: This is the deadliest outbreak of Ebola on record. Ebola is a pretty rough disease with a really high lethality rate. The virus spreads through contact with bodily fluids and is fatal in up to 90% of cases. Thousands of people got infected, about 28,000, so much lower than COVID, but about half of those people died.
--:-- Sean Rameswaram: And, you know, countries like Sierra Leone, Guinea, Liberia, Senegal's neighbors were hit really hard. And so officials were really worried, you know, would Ebola come to Senegal? And the disease did. There was one case of Ebola. The victim is a young Ghanaian, a student at university in Conakry.
--:-- Noel King: We will track down everyone who is infected and eradicate the problem. We are all working in just one case and I don't know how in the other country they manage. But they caught it relatively quickly. they were able to isolate the patient and all of his contacts, and that's it. They survived the epidemic with just one Ebola case.
--:-- Sean Rameswaram: And after that, we thought on setting up one structure dedicated to emergency. After the Ebola pandemic, they realized they didn't want to have to respond quickly in emergency every time. They wanted to create permanent infrastructure so they'd be able to be ready for the next emergency when it came. And so they began to build the health emergency Operations Center.
--:-- Noel King: And it permits us now to be more comfortable, I can say, to face this COVID outbreak. Okay, so Senegal has this sort of agency and system set up for health emergencies like let say COVID So what does it look like when COVID arrives When the first case arrived in Senegal which was right at the beginning of March they basically put into action their Ebola playbook
--:-- Abdule Bousso: You need to detect test rapidly isolate and to treat patients Test rapidly, isolate, and treat patients. It's probably helpful to take those three things one by one because they seem really obvious when we think about COVID now, but maybe weren't so at the beginning.
--:-- Sean Rameswaram: The idea is first to test, of course. And luckily, Senegal has one of the premier labs in Africa. It's based in Dakar. It's called the Institut de Pasteur. At the start of the COVID-19 outbreak, it was only one of two labs in Africa that could test for COVID-19.
--:-- Noel King: So for years, we've been working with coronavirus. So we have some experience. So that's Amadou Sal. He's the head of the Institut Pasteur. I think it's probably helpful to think of him a bit like Senegal's Dr. Fauci. Nice. We do epidemic all the time. And I mean, In Africa, you have 120 epidemics every year.
--:-- Sean Rameswaram: So as soon as we heard about what was happening in China, it was late December. And then we started getting ready for that. And by mid-January, we had the tests. And so once the Institute at Bastor could figure out testing, they tried to figure out a way that they could make it so that they could test in all the regions, not just in Dakar.
--:-- Noel King: We managed to have in each of the region of Senegal, three labs that was in a position to deliver a test within 24 hours. Wait, 24 hours? I mean, I was getting COVID tested in December of 2020, and it was taking like days to get results.
--:-- Abdule Bousso: They had 24-hour testing almost immediately? Yes. As officials told me, the idea of testing rapidly was really important, and they wanted to make sure that testing came back no later than 48 hours.
--:-- Sean Rameswaram: To be fair, they didn't have a ton of testing capacity, but the capacity they did have was rapid and was able to get results really quickly. What about the other two that we mentioned, isolation and treating? How did Senegal handle those two?
--:-- Noel King: Yeah, so if you tested positive for COVID... Any positive cases, even if they have symptoms or no symptoms... You would have to go into isolation in a treatment center, which could be a hospital or another place that was set up to treat COVID patients.
--:-- Abdule Bousso: And also we took all the contact person and isolate them also sometime in hotels. The government rents the hotel during this period. We use it as a quarantine center.
--:-- Sean Rameswaram: Basically, just to sort of recap, if you tested positive, Senegal made you go into quarantine and they paid for your room and board. and they made sure that you were basically out of your household and out of the community.
--:-- Noel King: And the goal for Senegal was, listen, we don't have a lot of doctors. We don't have a lot of hospital beds. So if we can try to slow community transmission as much as possible, maybe we can prevent this pandemic from overwhelming our health system.
--:-- Sean Rameswaram: And did that work? It worked and it didn't work. As all things COVID, it was complicated. So the Ebola playbook that they were using was pretty intense. If you tested positive for the coronavirus, an ambulance might come to your house with doctors in like full hazmat suits, like the full on PPE.
--:-- Noel King: And this would really freak people out. And it kind of created the stigma because no one wanted to be the house that had, you know, this kind of scary situation or your neighbors looking.
--:-- Sean Rameswaram: And so it created this stigma around COVID where people were less likely to want to come forward and get tested because they were afraid of kind of getting called out. So their strategy was just to kind of freak people out.
--:-- Noel King: Well, that wasn't their strategy, but that's the kind of unintended consequence of the strategy, I think. And of course, beyond that, there were other challenges. The policy was really expensive. It's really costly to put people up into hotels.
--:-- Abdule Bousseau: And Bousseau told me that 60% of the people that went into quarantine were asymptomatic or had mild symptoms. So they were using all these facilities for people who just really weren't sick and probably could have isolated at home.
--:-- Sean Rameswaram: And the other thing was the families that did have to go into quarantine, you know, they needed support. And the government struggled to provide them basic food and necessities.
--:-- Noel King: And so in the end, the policy that was meant to slow transmission ended up creating all of these unintended consequences that made it really difficult to make it sustainable, even if it probably did help to slow some of the community transmission.
--:-- Sean Rameswaram: But we are talking about a success story here. How did they manage to persevere in spite of all that? Well, so they decided to kind of mix things up a little bit. So once they realized that this wasn't Ebola and people could kind of quarantine at home, they turned their focus to high-risk cases.
--:-- Noel King: So basically, the people who are most likely to get really sick, they would make sure that they had access to treatment centers. And anyone else who seemed to be pretty healthy, they got to stay at home, although they would have medical teams check up on them by phone or sometimes even door-to-door to make sure that their situation didn't change.
--:-- Sean Rameswaram: But, you know, especially this fall, their cases were really, really low, and people sort of let their guard down. And sure enough, the cases started to pick back up right around the winter of this year.
--:-- Noel King: And I'm sure that's a familiar story to almost everyone listening to this, where people were taking restrictions seriously at first, but then less so as time went on.
--:-- Sean Rameswaram: Was Senegal able to be successful in their handling of COVID in the long run over the course of the pandemic? Yeah. So the second wave was definitely worse than the first by far. but the healthcare system never was fully overwhelmed.
--:-- Noel King: And one of the reasons why it was able to withstand both the first and an even more intense second wave was because of this whole other side of the Senegalese COVID response, which I didn't even really realize until I landed there and learned about it myself.
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--:-- Sean Rameswaram: Jen, you mentioned just now that there was this whole other side to the Senegal story. We have now entered the second side of this episode. This feels like a great time to talk about it.
--:-- Noel King: Yes. So to tell you more about it, I want you to meet somebody first. She wishes you would one day be able to speak English. You speak English very well. I wish I could speak French. Great. I never meet people anymore. Her name is Madame Traire. Je suis Bayenne Nougat de la Cicaprudis. My French is terrible, Jen.
--:-- Sean Rameswaram: She works at a health center in a neighborhood in Dakar. And I really wanted to talk to her because she's a buy-and-go. A buy-and-go? Yes, that's exactly right. A buy-and-go. Voilà. A buy-and means sister to someone's father, so basically like an auntie.
--:-- Noel King: and they're kind of like community godmothers. That sounds nice. What do they do? Our role is to go see the mothers who are at an age of pre-credits in the health of the mother and the child.
--:-- Sean Rameswaram: I heard l'enfant. That means child. Yeah, yeah, that's their job. They have this formal role in the health care system where they're basically doing maternal and child health.
--:-- Noel King: So, you know, if you're a mom and you just had a baby, they might come to your house and make sure that, you know, you're doing okay. Sort of like a postnatal checkup.
--:-- Sean Rameswaram: Or when you have young kids, they'll be like, hey, did you get your kids vaccinated? And so that our goal is to sort of be this link between the health care system and the community.
--:-- Noel King: Is that kind of like a doula? In some ways, yeah. Except for this is, you know, in pretty much every neighborhood, you might have a buy and go. And this wasn't like a pandemic innovation. The buy and go is like something that's been around for a while?
--:-- Sean Rameswaram: Right. Yeah. Yeah, this has been a part of the Senegalese health system because, as we've talked before, Senegal's health care system doesn't have a ton of resources.
--:-- Noel King: So you may live in a neighborhood or a village that only has one very small clinic that might only have a nurse. And the job of a buy-and-go and other health care volunteers is to make sure as many people in the community and their neighborhoods are connected with the health care system.
--:-- Sean Rameswaram: And then during COVID, buy-and-goes, like Madame Trori, played a much larger role in the pandemic fight. So what was our role? It was to raise awareness, to go from house to house, to go to schools, to go to tailor's workshops, to mechanical workshops, etc., where there are agglomerations, even where there are children playing soccer in the soccer fields.
--:-- Noel King: We've been everywhere to raise awareness. I was organizing talks. When I see, for example, children, students, I organize talks. I discuss with them. I ask them questions. I talk to them a little about the disease, what to do, what to avoid.
--:-- Sean Rameswaram: They also fought misinformation and some of the stigma that we talked about in the first part of the episode. So, you know, they would encourage people to get tested and say, listen, it's not a shameful disease, but the best thing you need to do is get medical care.
--:-- Noel King: The reality is it was a dialogue and it was really important because these are trusted figures. So people tend to believe or understand or want to listen to what they have to say.
--:-- Sean Rameswaram: Man, if only we had trusted figures. If only. So these buy and go figures, these doula types, they really make a difference in Senegal. It seems so.
--:-- Noel King: I mean, Senegal had a lot of the same problems that other places had with misinformation and, you know, people bristling against restrictions. They said it was, oh, it's just a city disease or it's a fake disease and all those kinds of things.
--:-- Sean Rameswaram: But at the same time because they were, you know, figures who had a lot of respect in their community. People knew them from, you know, other things that weren't COVID-19. They were able to get people to understand that this was about their community.
--:-- Noel King: And so as Amadou Saul told me, there was a sense of social consensus that compares favorably to a place like the United States. Kind of like a bottom-up strategy, I guess, as we recently covered on this show.
--:-- Sean Rameswaram: Like, it sounds like it's kind of this strategy that the United States might be trying to shift to. to get local doctors more involved in getting out the vaccine because they are the trusted figures in their communities.
--:-- Noel King: Did Senegal have any more sort of bottom-up structures in place? Yeah, exactly. And the doctor analogy is really perfect, and that's why a lot of health experts I talked to before said, you know, one of the reasons why Senegal did so well is because they, like, had the language to do this before.
--:-- Sean Rameswaram: But it wasn't just buy and goes and other people in the medical field There were plenty of youth groups and women clubs and other volunteers who all got on board with the COVID response in their communities Some of them did health outreach like Badam Chaur Some of them helped provide resources like food to families who were struggling during the pandemic
--:-- Noel King: Or they you know just came up with projects that they felt their community needed Take an organization called Deklik for example Deklik. Yeah, Deklik. It's a youth organization that works in Zeganshaw, which is in Senegal's southern region.
--:-- Sean Rameswaram: I met with two community organizers, Demba and Miriam, and Miriam was very excited to talk to me. I actually just ran straight from my bed to here, like just had time for a shower.
--:-- Noel King: And the reason she was excited to talk to me is because they were really proud of the work that they had done during the pandemic. Generally, they work on community improvement projects and they work with youth and that's a pretty big range from 18 to 35.
--:-- Sean Rameswaram: And they basically say like, listen, guys, what do you think you need to do to improve your community? And so they may come to them and they'll train them and help them figure out how to do those projects.
--:-- Noel King: And then they might go back to their community and then they train other people. And it's kind of like this chain of, I don't know, community solidarity or community volunteerism.
--:-- Sean Rameswaram: And what exactly did they do during the pandemic? So they did a lot of the same educational work as some of the Bayangos I talked to, and they helped people try to protect themselves.
--:-- Noel King: And Zegenshaw, I should say, is a pretty rural region of Senegal. It's very far outside a place like Dakar. and they don't have a ton of access to PPE and masks.
--:-- Sean Rameswaram: So one of the things that Deklik did was try to teach people how to make those things. Many people here know how to sew. So why don't we use that? And it's not that hard to find material for it.
--:-- Noel King: So people had the material, they had the skill set, but they did not know how to make the stuff. So basically we taught them.
--:-- Sean Rameswaram: The other thing they did was to teach people how to make handwashing kits so they could, you know, sanitize their hands.
--:-- Noel King: And Miriam told me a pretty funny story about that too. We had another program not too long ago where we had to go to a remote island and we found one of those kits, like the hand-washing kits. We did not expect it to be there, but we learned that there was a volunteer who was on site and when she came back to her island, she basically just taught everything that we taught her and she decided to make those things there too.
--:-- Sean Rameswaram: So it was very, it was, I don't know, It was a big surprise that our reach went that far, to be honest.
--:-- Noel King: Wow. So, like, this is one of those, like, teach a man to fish situations. Yeah, pretty much. It is.
--:-- Sean Rameswaram: And, like, the scale is pretty big. You know, Demba told me they had about 300 volunteers for their COVID project. And those volunteers held about 6,000 activity sessions in their home communities.
--:-- Noel King: And those sessions reached over 100,000 people. And that stuff may sound really, really basic. like helping people build hand-washing kits or wearing masks.
--:-- Sean Rameswaram: But you do that over and over and over again, and it works. And so you said you have no cases in the region where you're from there, right? Yeah, exactly. Now we don't have cases.
--:-- Noel King: What's your takeaway, Jen? I mean, you've been covering this pandemic for a year, and you went to Senegal to find out how they pulled this off. But is what happened in Senegal applicable to the rest of the world? Was there something sort of distinct about these buy-and-go's and the fact that they had this system in place?
--:-- Sean Rameswaram: I think it's complicated. I would say that there are definitely some caveats. For example, you know, Senegal is not the only country in Africa that seems to have handled the COVID outbreak well. And we should definitely give credit to the policies and the people that helped make that happen.
--:-- Noel King: But there are some reasons that we just don't understand why places like Africa did better than, say, the United States and Europe. they're a very young population. Senegal has about 60 to 70 percent of its population is under 35.
--:-- Sean Rameswaram: So it's likely that there was a lot more cases that were recorded, but they might be mild and asymptomatic. So they didn't get hit as hard. But even with those kind of caveats, the big takeaway that I learned from Senegal is that sometimes with COVID-19, you don't necessarily need a lot of resources.
--:-- Noel King: It's helpful to have resources and you should definitely be prepared, which Senegal was. But I think, you know, Senegal had learned to fight outbreaks and to do a lot with a little for a long time.
--:-- Sean Rameswaram: And those institutions and the trust that was built really made a difference when you needed to cut through kind of the fear and the confusion around some of the measures related to COVID.
--:-- Noel King: And I think there are some lessons for even countries like the United States to learn from that.
--:-- Sean Rameswaram: Well, Jen, thank you for your reporting. And I'm glad you traveled across the world and came home safe. Yeah, me too. And got to the beach for half a day. Hey! Also, this country where, like, 70% of the population's under 35 sounds like a lot of fun and I want to go visit. I mean, they just lifted all the restrictions when I arrived, but I didn't have, like, any friends or anyone to go out with, and my fixer was like, you must go home, like, at sundown.
--:-- Noel King: I, like, couldn't enjoy it. One day. One day.
--:-- Sean Rameswaram: Jen Kirby, along with our colleagues Dylan Scott, Herman Lopez, Julia Beluz, and Dylan Matthews, plus a whole bunch of other great people, did a whole dang series called Pandemic Playbook about how other countries successfully and less successfully handled this pandemic.
--:-- Noel King: It's worth checking out, and you can find it over at Vox.com. Just search for Pandemic Playbook.
--:-- Sean Rameswaram: And another quick plug, Jen's a part of our foreign team here at Vox, and our foreign team makes a podcast called Worldly. Today they're covering a very important story, the mass grave at that Canadian residential school you've surely heard about.
--:-- Noel King: You can find Worldly wherever you find Today Explained. Thanks. Thank you.
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