Dr. Mateusz Plucinski

Dr. Mateusz M. Plucinski

Q: This is Sam Robson here today with Dr. Mateusz Plucinski. Today is February 14th, 2018, and we're back at the audio recording studio at CDC's [United States Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. This is our third interview as part of our CDC Ebola Response Oral History Project. I encourage anyone who's listening to this, if you haven't, to listen to the previous two interviews that we've done with Mateusz about his part in the Ebola response and his work on malaria in Guinea after that happened, and really taking a very interesting look at how the epidemic affected malaria eradication efforts, or malaria control efforts. Thank you again for being here with me.

PLUCINSKI: My pleasure.

Q: I think today we are just going to start off from the beginning. What happened with Guinea-Bissau? You were a team lead there. Start us off. How did all of that begin?

PLUCINSKI: I urgently started getting involved in the Guinea-Bissau response 00:01:00over the summer in 2015. In terms of background, by then, Guinea had been registering cases throughout the country. Originally, the epidemic had, of course, been localized to Conakry and then the Forested Region in the Southeast. But over the next few waves of the epidemic, the epidemic became more generalized and spread throughout the country. Over that summer, 2015, there started being a fair amount of cases in two prefectures in the north of Guinea, Boffa and Boke. Both of those prefectures border Guinea-Bissau. So Guinea-Bissau 00:02:00is a former Portuguese colony nestled between Senegal and French Guinea. I guess half of its border is with Senegal, half of it is with Guinea, and the southern border with Guinea is marked by pretty heavy bush or forest. It's a very porous border. There was this fear that, just like Senegal had received imported Ebola cases from Guinea, and Mali, that there would be a similar kind of transmission into Guinea-Bissau. To preempt that, CDC began deploying people to Guinea-Bissau 00:03:00as part of the larger Ebola response. My involvement actually started here in Atlanta where there was a--some sort of seminar or meeting, and I actually met two folks from Guinea-Bissau: a physician, Dr. To, and a woman who worked for the Ministry of Health, Mireille [Rosa]. They were actually the first people from Guinea-Bissau I ever met. I met them here, I was introduced to them. A few months later, I was asked--or maybe I finally accepted--the chance to go to 00:04:00Guinea-Bissau. There had been a lot of offers and I had been postponing it for multiple reasons. A lot of it had to do with the fact that my branch was hesitant to let me deploy again for Ebola. But eventually, I think they relented.

Q: Just a couple of questions if you don't mind. Do you remember the time period in which the cases were starting in--I'm going to mispronounce these--Boke and Boffa?

PLUCINSKI: Yes. I think, again, this is three years after the fact, but my understanding was it was June and July of 2015.

Q: And then your meeting with Dr. To and Mireille would've been about the same time period?

PLUCINSKI: Around the same time. And they were here I think for some kind of US-government-sponsored travel. Young leaders kind of thing. I want to say 00:05:00that's what it was.

Q: Were they both young people?

PLUCINSKI: Yes, both relatively young. That's why they were here. They might've been touring the EOC [Emergency Operations Center] as well. They were not like high placed or anything like that in the government. They ended up being the two people that I would eventually work with in Guinea-Bissau when I got there.

Q: Do you remember anything more specific about that meeting? Were you just talking about personal things, like how's Atlanta, or your different parts in the Ebola response?

PLUCINSKI: It was a very brief meeting, actually in this building, in Building 19. I think they were here for some kind of luncheon or banquet. I got invited, and I ended up just chatting with them very briefly. I think the extent of it was, I really want to go to Guinea-Bissau, I've never been there, and they were 00:06:00like yeah, you should come at some point. At that point, I really didn't think that I was going to go and get a chance to go to Guinea-Bissau. But it was quite fortuitous because it turned out when I got there, I already knew people, at least two of them.

Q: And you mentioned that your branch was a little hesitant. Was that just given all of the previous deployments that you had been involved in?

PLUCINSKI: I think it was my deployments as well as deployments from the branch itself. By then, so this is mid-2015, an epidemic had--CDC had been involved going back to March 2014, so a lot of the branches had felt that they were being depleted, their staff was being depleted due to deployments. The branch, the Malaria Branch, which has a lot of Francophone epidemiologists and some 00:07:00Lusophone epidemiologists, felt that they were unfairly being--as well as other people with a lot of global health experience, felt that they were being tapped quite heavily by the agency. So there was a point at which they really tried to make a concerted effort to stop deployments, just because the actual malaria projects, for example, were being often put on hold or perturbed in some way just because there was so much staff overseas in affected countries. I don't think it was necessarily something specific to me, I think it was just the branch became hesitant to deploy anyone. I actually don't know the inner workings of how much each branch was contributing and what the quotas were, but 00:08:00my understanding is that there was a lot of discussion around that at higher levels.

Anyway, I had had this invitation to go to Guinea-Bissau for a while, and finally I got permission from my branch to go. I was scheduled to go in August/September 2015, and the idea was that I would replace Dr. Juliette Morgan, who was the team lead before me in Guinea-Bissau. I actually knew Juliette from a long time ago. She was an epidemiologist working for the Malaria Branch as a resident advisor in Mozambique for six or seven years. Actually, my second TDY [temporary duty assignment] ever for CDC had been to Mozambique on 00:09:00Juliette's invitation. She obviously speaks Portuguese, having worked in Mozambique for a while. She's a native Spanish speaker as well. They had sent her to Guinea-Bissau to be a team lead there for several weeks prior to my deployment. I actually remember speaking to her over the phone prior to getting there. Unfortunately, we didn't overlap. The idea I think would've been for us to overlap in Guinea-Bissau, but there were issues with travel, and specifically the government of Guinea-Bissau was dissolved around the time that I was supposed to go. Meaning, basically, I think all of the cabinet was dismissed. 00:10:00And actually for the whole time I was there, there was no minister of health. So it was a bit of a tricky situation in general, and that actually resulted in the postponement of my trip by about a week, which meant that I didn't overlap with Juliette. I think Juliette was actually pulled out when this all kind of went down. Actually, nothing got resolved, I think folks just realized that it was relatively stable, that it was going to be like that for a while. So, they ended up sending me about one week later than expected.

It was a bit strange because, I think in general, CDC's involvement was a bit unique because--I don't know about the current situation, but back then in 2015, there were no diplomatic relations, official diplomatic relations between 00:11:00Guinea-Bissau and the US. It was one of the few countries, for example, without a US Embassy. I am certainly not an expert in international relations, but my understanding is that that was due to some longstanding problems in the relationship. Guinea-Bissau was for a while something of a narco-state, and one of the hubs for illegal drugs from South America to Europe. There had been some political issues as well. When I flew into Guinea-Bissau, it was actually through Dakar. I could've flown directly to Guinea-Bissau through, for example, Morocco, but the idea was for me to spend a few days in Dakar and get all of the 00:12:00necessary briefings in Senegal since there was no official USG [United States government] presence in Guinea-Bissau.

Q: And they do have that embassy in Dakar.

PLUCINSKI: Yes. The US?

Q: Yes.

PLUCINSKI: Oh yeah. The US has a fairly big embassy in Dakar. Like one of the new embassy complexes. My flight was delayed by a day, but I ended up spending maybe a day and a half in Dakar. In Dakar, I met with Mike [Michael H.] Kinzer, who had been one of the CDC team leads for the Ebola response in Guinea. I think he had been team lead when I was there for my previous deployment, and I had met him there and then he ended up being appointed CDC director for Senegal, country 00:13:00director for Senegal. Not just for Ebola but full-stop CDC country director in charge of the entire CDC portfolio. I met with him very briefly. Technically, Guinea-Bissau was under his umbrella, if you will, since there was no official presence in Guinea-Bissau. To some extent, that was true for CDC but also the US government in general, so everything in Guinea-Bissau fell under the US Embassy in Dakar. There had been an embassy in Guinea-Bissau, and it was closed. One of the first things that I did when I arrived in Guinea-Bissau was actually got taken to see the embassy, which was bullet-ridden and in a bad state. But it was 00:14:00defended by the Senegalese Army, who had some agreement with the US Embassy in order to provide protection for the empty US Embassy, very interesting. There was some presence in Guinea-Bissau with, not an embassy, but a bureau liaison office, BLO, something of that sort. I'm not quite sure of the exact nomenclature. So there was someone, a representative in-country, if you will, but not an ambassador, not a consul. They had, for example, a US government vehicle there, and it was driven by a driver called Cubana, who was the person 00:15:00who picked me up at the airport when I arrived.

I should say, when I arrived, I was the only one there. Juliette had left, and some of the lab [laboratory] team she had been overseeing left as well. So I was a team of one. But by then, there was a network of partners in place, a lot of whom were getting money from the US government and the Ebola response. It was not completely virgin territory, there had been folks there, a fair amount of deployers, there was a lab there. I was plopped into this pre-existing structure. But again, when I arrived, I was the only one there. After that day 00:16:00and a half into Dakar, I took a short twenty minute, thirty minute flight maybe to Bissau--it's extraordinarily close. The problem, and I'll talk about this later, is the transport in and out of Bissau is quite difficult and quite infrequent and problematic. But I flew in on ASKY, which is an airline I want to say based out of Togo that has some affiliation with Ethiopian [Airlines]. I got picked up by Cubana, who was really my first exposure to Creole. Guinea-Bissau is a former Portuguese colony up until 1975, or mid-seventies, it was a 00:17:00Portuguese colony. It's unique. It's very different from Angola and Mozambique in the sense that they say that Guinea-Bissau was never truly colonized, in the sense that the interior of the country was always very rebellious. The Portuguese always really focused on the coast, which it did in Angola and Mozambique to some extent, but in Guinea-Bissau, specifically, they really made no efforts whatsoever to either control or develop the interior of the country, even though it's quite small. Of the Portuguese colonies, Guinea-Bissau--in the Portuguese, Lusophone world, Guinea refers to Guinea-Bissau, so I might make 00:18:00that slip up. But for the Portuguese, Guinea was the worst place to go or to be sent of all the colonies. Maputo was great, Luanda was great if you could go there, but Bissau was the place that you didn't want to go. Let's say the conditions were not nearly as good as the other countries and development was not as good. Of course, it had existed for a long time, for centuries, being an integral part of the Portuguese slave trading empire, and very linked to the Cape Verde Islands, which are also basically a stopping off point for the slaves that were hunted in the interior of the continent. But because basically, the 00:19:00Portuguese have never really had a really strong presence in Guinea-Bissau, the language--whereas in Angola or Mozambique folks really do speak clean Portuguese, it's quite widespread. In Guinea-Bissau, very few people speak Portuguese. A much larger proportion speaks Creole, which is a midway intelligible Portuguese, in the sense that when I got there, I could probably understand a quarter of what was being said. It's definitely got a fair amount of Portuguese words, but also a big vocabulary from the indigenous languages. It 00:20:00is mutually intelligible with the Creole from Cape Verde. I don't know if you've heard of Cesaria Evora, she's a famous singer from Cape Verde, they called her the "Barefoot Diva." She passed away in the last few years, but she was very famous. I think even in the US you can hear her songs on the radio sometimes. She sings in that language, which I don't really understand. When I got there, that was pretty much the first shock, was that Cubana, our driver, only spoke Creole, basically. We certainly figured out a way to communicate. But that was 00:21:00definitely the first shock for me. I was taken to the Hotel Coimbra, which is where most of the international partners stayed. This is an old hotel in the center of town, very close to the main hospital--this is the national referral hospital--to the docks, the main fortress, if you will, which is the headquarters for the army, most of the restaurants and so on. Bissau is tiny, a very small city, very provincial in many ways. Very, how would I say this, underdeveloped.

We were all pretty much staying in Hotel Coimbra, and I'd say the majority of the guests in the hotel were folks associated with Ebola response. Like the other countries, there were multiple partners there in-country supporting the Ebola response. In contrast to the other countries, the main contingent in Guinea-Bissau was not WHO [World Health Organization], it was not CDC, it was the Portuguese government. The Portuguese government had deployed a mission, basically, maybe of a dozen people to Guinea-Bissau and had been doing it for several months. That mission was at the time led by a Portuguese physician, a 00:23:00doctor aptly named Dr. Rui Portugal, who was a maybe fifty-year-old, mustachioed, Portuguese guy. Very friendly and very talkative. He's one of the first people that I met, and he was in charge of this group. But other than him, everyone there was very young, probably in their twenties. Some very junior staff that had either been offered or volunteered to go to Guinea-Bissau on these several-week missions. And there was a lab team that had set up basically a PCR lab in the main hospital. Actually in the morgue of the main hospital, the 00:24:00former morgue. There was a group of emergency response physicians and nurses, and then communications people. Very similar to what CDC had been deploying to the other places. But this was a group that was sent there by the Portuguese government. In addition, there was one WHO consultant, Joaquim, Dr. Joaquim [da Silva], he was from Mozambique and he had been there for a while, several months. There was IMC, which was International Medical Corps, that had received 00:25:00money from maybe the CDC Foundation or CDC itself to do preparedness trainings. There was a group from IOM [International Organization for Migration], which is kind of a quasi-UN [United Nations] agency related to migrations. They were actually one of the main people that I worked with. At the time it was led by a Frenchman, Jean-Francois [Aguilera], who had come in from Senegal. Then there was UNICEF, which was led by a Brazilian woman who was there temporarily leading 00:26:00that mission. Those were the main partners that we worked with, and a lot of them were either based at Coimbra, staying there, or would show up there. And I'm sorry, IMC was led by an Italian, Dr. Alessandro [Bavcar].

These people had worked with Juliette, so in the meetings I would introduce myself as Juliette's replacement and everyone understood that. I think either the first or second day that I arrived, we went to the Ministry, which again there was no minister of health but there was a group at the Ministry of Health 00:27:00that continued working. There, I saw Dr. To and Dr. Mireille, who I had met in Atlanta and they were in charge of basically--well not in charge, but they were some of the main actors in the government's fight, if you will. Not fight, but preparedness. And unfortunately, our main contact, the main person running the response, a physician, unfortunately I'm blanking on the name [note: Dr. Placido Cardoso], was basically out the entire time I was there. Actually I think he was being wined and dined in Portugal and Atlanta at the time. And he was the head 00:28:00of their public health institute.

Q: He was from the country?

PLUCINSKI: Oh yeah, yeah, he was from Guinea-Bissau. He was from the Ministry and he was the head of their national public health institute and he was being given a lot of resources from both Portugal and CDC. He was the main contact person. Unfortunately, he was out the--I think I met him maybe the day before I left. And instead he had delegated to Mireille, to a large extent, the activities. And the activities in Guinea-Bissau were mostly--I mean, they were preparedness, so there had not been any cases yet. The activities centered 00:29:00around preparedness and included border control or border screening, the idea if there would be a case, it would come in through the land border likely with Guinea. IOM was working heavily in the districts bordering in the south, bordering Guinea. Also, to some extent, with the fisherman and some of the island communities. So, Guinea-Bissau, if you look on a map, has one river running through it and there's a delta and then there's a bunch of small islands. Those small islands are conducive to fishing, and they're also 00:30:00conducive to drug smuggling. And there was at least an indication that there was a lot of movement between those fisherman from Guinea-Bissau, and similar islands down along the coast of Guinea. Of course, there's no substantial Coast Guard to control that movement. Certainly, the land border was also quite porous as well. IOM was focused on those two aspects around screening and control of the borders. IMC was there, and MSF [Medecins Sans Frontieres] was there as 00:31:00well, although we didn't interact that much with them. But they were there, of course, doing the trainings around setting up an Ebola treatment center if needed, setting the stage for the clinical side if there were to be cases ever treated in the country. And then there was the lab side. So this is perfectly analogous to what was going on in the other countries. The actors were a bit different. But there was a lab that the Portuguese had set up in the morgue, in the main referral hospital. UNICEF [United Nations Children's Fund] was of course doing communication, as is their forte.

What were we doing? CDC was there helping with training. We were in the process 00:32:00of potentially setting up a quick FELTP [Field Epidemiology and Laboratory Training Program] to train epidemiologists through basic epi but also focusing on what to do if there were to be an Ebola case. The main modes of transmission, contact tracing, and preventing a transmission in the health facility setting. That was I would say our main focus. And previous deployers had, I think, 00:33:00focused to a large extent on that training of a cadre of people that could respond and could go out there and do the contact tracing and the case investigations that ultimately were the backbone of the Ebola response. That was what CDC was doing, and we were also involved in the potential rollout of a rapid diagnostic test for Ebola, which at that point had been developed but was still in the process of being piloted. Or I guess we wanted to pilot it. CDC had received a few hundred if not a few thousand tests from the manufacturer and the 00:34:00folks here in Atlanta were interested in deploying it to a place like Guinea-Bissau. One of our projects was to set the stage for that eventual rollout. It certainly didn't happen while I was there, and I don't know if it ever actually happened in Guinea-Bissau or any of the other places. Not to give away the end of the story, but there were never any cases reported from Guinea-Bissau. Sorry for spoiling the ending there. So there was never really a chance to use them. And to be honest, by the time I got there, August/September, a lot of the interest and--not necessarily panic, but attention given to Ebola 00:35:00had subsided since the number of cases in Boffa and Boke prefectures in Guinea had also gone down drastically. So the perceived risk of importation into Guinea-Bissau was smaller to a large extent. That was the context.

I was there maybe two weeks, two and half weeks at most, and I have to say that the weeks went by quite uneventfully. A lot of that had to do with the fact that there was no Ministry officially in place with the dismissal of the cabinet. For 00:36:00example, there was a weekly partners meeting that we were expected to go to, that previous teams had always gone to, and I think each time we went there, it ended up being cancelled on the spot, so that was never held. To a large extent, the TDY was an exercise in, how would I say this, basically filling out the time with things to do, given the fact that there was really very little sense of urgency from anyone and really not all that much we could do, given the 00:37:00circumstances. My general recollection is a lot of long lunches, going to meetings at the Ministry and waiting for the meeting to start, and sometimes it just didn't start. It was certainly a very different experience from Guinea, my previous deployments to Guinea where you had that kind of frantic atmosphere. Here, it was quite the opposite. One of the things I was doing was we were moving the CDC offices to a new building, slightly out of the city center and 00:38:00going towards the airport. It was actually in the building that was designed, or it was newly constructed by the Chinese and was meant for the National Public Health Institute. Juliette, I think, had negotiated that we would get one or two offices there, and part of what I did was try to set that up to a large extent. There was no staff, so we ended up allowing IOM to use some of those offices and sit there with us.

Q: Sorry to interrupt, did CDC have local staff temporarily employed?

PLUCINSKI: No. Not as far as I can recall. It was just Cubana, the driver, who was technically devoted for the Ebola response, but mostly he was officially tied to the BLO, the part of the Dakar embassy that was present in Bissau.

So that was the main activity. Visiting partners was another activity. Again, long lunches because everyone was to some extent in the same boat. When I was there, one of my main activities was to accompany a--so there was a visit from 00:40:00two Americans that were affiliated or contracted by Johns Hopkins [University] as part of this communications project. They had won a contract to help develop Ebola communications in the affected countries, and I guess neighboring countries as well. They were in the process of scoping out and planning for Guinea-Bissau. There was a woman from Johns Hopkins, whose name I don't remember [note: Amrita Gill-Bailey], and an independent consultant named Greg Pirio, whom I had actually met before several times since he was one of the few Portuguese 00:41:00speaking consultants doing communications. I believe I had met him in Angola before. I think we were together for three or four days in Guinea-Bissau, and since I had been there longer than them, slightly longer than them, I was serving as their chaperone maybe throughout with all the partners. That took up a fair amount of time. I think a notable trip that we took with them was to go to get outside of Bissau and go to this Catholic parish maybe an hour out of 00:42:00town. There was a priest there, a Catholic priest, who was a very interesting guy. I want to say he was Italian but I think he had been there very long. He spoke Creole and was also extremely active. The reason we spent a lot of time with him or visited him was because he had done a lot of communications activities himself. He had just decided that he was going to do communications. And he had a network of community healthcare workers, or some kind of community volunteers that were brought through the church. He himself had decided to do 00:43:00Ebola communications with this network, and it turns out he had probably one of the most well-developed activities in the country, throughout the country. He was extremely knowledgeable. We went out, me and him, I want to say it was Father Michael but I'm not one hundred percent sure. But that was one of the activities that we did.

Q: Did you and the other partners always see him and his activities as an asset to the response or to the preparedness?

PLUCINSKI: Oh yeah, absolutely. He was one of the few people that was doing anything in Guinea-Bissau. His project was quite impressive, and he was quite 00:44:00well respected by the Ministry and all actors in Guinea-Bissau. Again, communications was certainly not my forte and certainly not one of CDC's priorities in-country, so I never really grasped the full extent of what he was doing or his activities. But I do remember going out and meeting him, and I think he came to one of the dinners that the Johns Hopkins folks organized in Bissau prior to leaving.

The other trip that I did was I went to a place called Buba, which was a district further south towards Guinea. I went there with the IOM folks, actually 00:45:00went in there with their vehicle, so Jean-Francois and his team. We stayed in this place called Buba, and there we met one of the WHO people there who seemed to be the person who was running the show there and was in charge of the entire Ebola preparedness. Training, border control or border screening, surveillance, all that stuff. He was from Guinea-Bissau, a physician, and very knowledgeable and very motivated. IOM at the time was just setting up their operations, they 00:46:00had just received the money and they were there to help plan what they were going to do. We had gone there to make first contact with the folks down there, communicate with and touch base with the folks there, see what kind of activities were already going on, and there were some. We visited a border post that had a quarantine tent, is the way I can say it, like a quarantine area, which looked very questionable but--

Q: What do you mean?

PLUCINSKI: It was very improvised, let's just say that. Very improvised. But they had the chlorine wash station, they had a register, they had the basics. 00:47:00The problem though, and everyone told us this, was the border was very fluid. Of course there were border crossings, but it was literally a path out of the forest and then a post there. I don't think it would take too much imagination to realize that someone could go a hundred feet in one direction and open up a new path. These were not roads, these are just footpaths. It's the same people on both sides of the border, and it's kind of this--it's not like rain forest, it's more like swamp, bush, there's mangroves towards the coast. It's very 00:48:00difficult terrain to patrol, certainly. When we were there, we heard this story of this [International Federation of] Red Cross [and Red Crescent Societies] team that had prepared all these materials in Creole. You can write Bissau and Cape Verde Creole. They developed all these training materials and had these posters and had this spiel prepared, and they were doing these communications excursions throughout that area. They set out in the morning and would go village to village, distributing the posters, talking to the village chiefs, doing little animated plays about Ebola. Around mid-day, they looked down at 00:49:00their GPS [Global Positioning System] and they realized that they were like twenty kilometers in Guinea. They had at some point crossed the border, and they had spent the last few hours basically distributing Creole communications materials in the neighboring country. [laughter] They had to back track. No one had told them, they had been doing it for several hours and no one had--like (a), they didn't realize, and (b), none of the villages that they visited and the village chiefs ended up ever telling them they were in the wrong country.

Q: It sounds like the communication materials still worked because people still understood the languages to some extent, maybe?

PLUCINSKI: Yeah, I think that's an optimistic way of looking at it. [laughter] 00:50:00The other one would be maybe no one ever understood. The thing about the Creole is Creole is spoken in the cities and the towns. True Portuguese was spoken by a very small minority in Bissau, then Creole would be spoken by folks who traveled or certainly folks in towns and cities and in Bissau. But then beyond that, it was just local languages. I doubt that those communication materials were particularly useful in these villages on the border with Guinea. I think that spoke to a lot of the challenges to that. When we were in Buba in that area, we 00:51:00went to one of the hospitals there and spoke to some of the health staff there and the big question there was, next to Buba, going along the southern part of that bay, basically, of Guinea-Bissau, eventually you would reach this chain of islands. IOM, and I think to some extent all of us, were concerned with what was going on, on those islands that were only reachable by boat. Even once you reached it by boat, you had to either walk or take a motorcycle into the interior of the island. There were these questions, like if there was a case on one of the islands, what would the chances be that it would get recognized as an 00:52:00Ebola case, get reported, and then what would happen with that patient? These were islands that had, for example--and Guinea-Bissau in general had had lots of bad experiences with cholera, so cholera epidemics in the past. These were islands where a lot of the epidemics had started in these islands or ravaged these islands. The folks from the Ministry were certainly cognizant of the importance, the epidemiological importance of these islands. But there was this big unanswered question, how are you going to do surveillance in the islands, how are you going to do border screening in the islands. Certainly, in the back 00:53:00of my mind, as probably the case with most people was--Guinea-Bissau was not reporting cases, but the question was, to what extent was that just the fact they had no way of communicating at all? Some of these islands had no cell phone reception, so they were completely cut off from the mainland. Or there might a single spot on the island where if you climb the tallest hill on a clear day, you might be able to call the health authorities on the mainland. There are definitely challenges. All I could see--I could asset the challenges, I don't 00:54:00think any of us had really strong answers as to what to do. I think IOM, for them it was good to see what those challenges were. I really don't know how long their project lasted in Guinea-Bissau and what they were able to do. But the timing was such that by August/September, there's much fewer cases in the north of Guinea. In the next few months, the epidemic was ultimately controlled in Guinea. The timing was such that it was at the tail end, so who knows what 00:55:00would've happened had there been more cases in Guinea, the north of Guinea. Certainly, comparing the health systems in Guinea-Bissau and in Guinea, you could certainly--things were much less developed in Guinea-Bissau, even compared to Guinea. Even the main hospital in downtown Bissau was very under-developed and very provincial. Outside the main hotel there was--in one of the main 00:56:00streets in Guinea-Bissau, there was a pothole out of which a tree was growing. That was between the main hotel and the main hospital. You would routinely see, for example, herds of cows, cattle being herded through city streets. It was a very unique place.

Q: Those are good examples of how you see the lack of development in comparison to even a place like Guinea. I'm wondering if you could describe the driver, Cubana, a little more. Did I get his name right?

PLUCINSKI: Yeah. Cubana was from Guinea-Bissau, he was very skinny, very dark, 00:57:00and I would say a man of very few words. But very kind, and very--I think certainly someone I liked a lot and grew to trust a lot. I would say very kind. He was the driver for all the CDC deployers the whole time we were there.

Q: How would he demonstrate that kindness or the trustworthiness?

PLUCINSKI: One example I can give you is fast forwarding to when I was leaving back to Dakar, I had been booked--so I'd flown in on ASKY, which is one of the 00:58:00larger planes that would come. It was a 737 that they would send in from Dakar, but they only flew one or two times a week, a few times a week. Not all days. I had to be back in the US I think on a Monday, because I had a personal trip scheduled, a vacation scheduled to leave. I had this itinerary that had me leaving Bissau on Saturday, flying to Dakar, spending a day in Dakar, and then 00:59:00flying out that night to Paris. The story is I had to fly out on a Saturday, otherwise I was going to miss my connecting flight, and there was no ASKY flight that day. I ended up having to get a ticket on Air Senegal, which I had been warned not to do, but it was my only option. It was one of these things you pay for it in cash, you can't book it from the US, you can't book it using the internet, you have to book it in cash in the office in Bissau. It was very 01:00:00strange because they originally wouldn't even sell me the ticket, but eventually they sold me the ticket and it was for a 9:00 am flight from Bissau to Dakar. I showed up to the airport with Cubana at like six or seven am, and Cubana is very accommodating, and I would always tell him, you can leave me here at the airport. But he would always make a point of it to stay and make sure everything goes okay. I got to the airport and there's about maybe twenty or twenty-five people who are waiting for the same flight. I knew it was the only flight that day from the airport. It was one of those places. We were supposed to leave at 01:01:009:00 am. Around 1:00 pm, they announced that our plane wasn't coming, that there was bad weather that had prevented the plane from coming. You look outside and it's beautifully sunny. Again, Bissau and Dakar are very, very close. But they're like, no, there's storms, we can't come. And you have to leave because we're closing the airport because it's the only flight. So they literally kick us out, and I'm sitting on the curb at 1:00 or 2:00 pm because they've literally closed down the airport and turned off the generators. But fortunately, I called Cubana and he very quickly came and picked me up. I'm like, what do I do? I'm 01:02:00not sure what to do. I go back to the hotel, there's really nothing to do. Maybe I can get a flight the next day, but I wouldn't have made my flight to Dakar. It was very stressful, and what was made worse is that when they kicked us out of the airport, they had taken our phone numbers, like our cell phone numbers. I was like, "Why are you asking that?" And they're like, "There's still a chance that it might come." I remember it was one of these things like they asked for it and you dictate it to them. I'm like, "Do you want to double check that you have my correct cell phone number?" And they're like, "No, we got it." Very strange. But anyway, he drove me back to the hotel and I told him, "Cubana, 01:03:00listen, I don't think I'm going to fly out. You should just go home." And then I ended up crashing in someone's hotel room, waiting in stand-by mode. Then I actually fell asleep and I woke up with my cell phone ringing at like 7:00 pm. I'd had dinner and all that stuff. It was from the airline company, Air Senegal, that the plane was on the tarmac and that I had to come to the airport immediately. [laughter] Very quickly, I called Cubana, and fortunately--I thought Cubana had gone home, but it turned out Cubana was actually in the car outside the hotel waiting. I think that he had just waited there all afternoon. 01:04:00So fortunately, because he was there, we got to the airport very quickly. But of course, as fate would have it, as we were driving to the airport there's this thunderstorm that's building. And of course, the plane that had been delayed because of bad weather, of course it's about to take off into the middle of a thunderstorm. It was a very, very strange experience. Most of the people from the morning were still not there, but they all shoved us into the plane, which was this small propeller plane, an Embraer Brazilian plane, so an eighties 01:05:00Brazilian-made plane without any logo, probably a Russian pilot. A white plane, not emblazoned with "Air Senegal," nothing. Just some wet leased plane. It was around 7:00 or 8:00 pm, so twelve hours after the original time. I made it, fortunately, because Cubana had been there. The moment I get there, they pushed us into the plane and the plane took off, I assumed to avoid the storm, but it also flew straight into the storm. Who knows what kind of hurry they were in. That was my last day in Guinea-Bissau.

By that time, I had a colleague who had arrived a few days before, she was like the next deployer after me. Her name was Megumi Itoh, who was my colleague from the Malaria Branch. She was an ES officer at the time and had done a project in Brazil. She was to spend a few weeks in Guinea-Bissau as a deployer. I landed in Dakar and had a half a day, I guess, the next day before my flight to Paris. I met with Alex [Alexandre] Macedo [De Oliveira], who was also from the Malaria 01:07:00Branch and who was going to replace me as team lead in Guinea-Bissau. I remember debriefing with him in one of the dining rooms of the King Fahd [Palace] Hotel in Dakar that afternoon or late morning and giving him very little information on what was happening in Guinea-Bissau, just because things were mostly stalled. I remember having this very anti-climatic debrief with him, a victim I guess of the inactivity in this very, very sleepy town.

Q: Do you attribute that laxness to mostly the minister of health not being there or the other guy who was running the response who was being, as you said, "wined and dined" abroad, or what was it really? Was it the lack of ever having seen cases?

PLUCINSKI: Yeah. I think it would be a combination of the three. The truth is, certainly, by the time I had gone there, there was very little sense of urgency in Guinea-Bissau. And I never really got the feeling that there had ever been much urgency. A country like Guinea-Bissau and the Ministry of Health there has very few resources, very, very few resources. It's a strange situation in which 01:09:00you get a country that gets almost no attention from the outside world. Very, very little. All of a sudden, hosting twenty, thirty foreign global health consultants at the same time. Each of which with some funding and an agenda and the need for local staff to help run their project, starting up a several hundred thousand dollar project with this money from the Ebola response. It is a 01:10:00bit of a strange situation, and of course the amount of, or the number of staff or ministry staff, physicians, epidemiologists, surveillance officers that are in-country is limited. It's very difficult when you have multiple partners coming in and each vying for the attention of that same limited pool of staff. Each even trying to contract that staff and tear them away from the Ministry, which is to a large extent counterproductive. Again, you do get the feeling the folks who were there as consultants sent by these organizations probably had a much stronger sense of urgency than the government itself. A government that was 01:11:00stretched very thin and also had other pressing concerns. For example, a cholera epidemic, and a general lack of a chance to do much work in its own country beforehand.

Q: Did you ever get any impressions of the relationship between the Portuguese government and Dr. Rui Portugal and the Guinea-Bissau government staff?

PLUCINSKI: That's a good question. The Portuguese had a big presence for the Ebola response. They had by far the most amount of people there, but they also 01:12:00had a strong presence in-country. The Portuguese Embassy, for example, had a strong presence. For example, the Portuguese consul was--you would see them every once in a while in-country. In addition to the Portuguese bilateral assistance, there was also EU assistance from the larger European Union, although a lot of that was staffed by folks from Portugal, just from the language side. One, I'll say maybe emblematic example of the relationship was, 01:13:00one of the things that Rui Portugal was in charge of, or had to do, was a triage of sick patients that could potentially be eligible for transfer to Portugal for higher care. For I guess humanitarian reasons, the Portuguese mission or even--I think this was outside of Ebola, had a process by which they would evacuate very severe cases of ill people from Guinea-Bissau for treatment in Portugal. To understand that, you have to understand that the main referral hospital in 01:14:00Bissau was very basic. We're talking about very, very basic surgeries, if any; no resources, and often the patients would have to buy everything: gloves, bedsheets. If a patient needed an injection, the patient's family would have to buy the needle and buy everything. Which I don't think is necessarily limited to Guinea-Bissau, but I would say of all the places I've seen, this is probably amongst the poorest in terms of that. Certainly, there's little or no cancer 01:15:00treatment or surgery for trauma. But the Portuguese government does have a process by which certain people can fly out certain severe cases to Portugal.

Q: Is it dependent on the severity of the case or certain people? Who are certain people?

PLUCINSKI: That was the job for Dr. Portugal, which was to figure out which cases would be sent to Portugal. I saw one of his consults. It was very sad because there's a very limited amount of spots, and this is a country of several million people. There's a lot of difficult decisions that have to made. One of 01:16:00the consults that I saw by accident was a child who had cancer and ended up not being deemed eligible just because it was so advanced it wouldn't have made a difference, based on Dr. Portugal's consult, which again is difficult because it's not like he had all the necessary means to determine that. It's really a very difficult call for him. That was one of the things that he did. That, I 01:17:00think, maybe can provide some insight into what the conditions were like in the country and what kind of relationship the country had with its former colonizer.

Q: Can we talk a little bit more about the FELTP stuff? Did that take up the majority of your time when you were there? You said it was one of the main roles that CDC was involved in.

PLUCINSKI: The thing is, the CDC, it's difficult to say what our specific role was because, for example, CDC cannot run a training because we don't have staff, 01:18:00we don't have a way to organize a training, we don't have a way to pay people to attend the training. At most, we can provide technical assistance for the training, or if we have partners that we can work through to organize a training, then we can help them manage it and then, for example, provide some of the slides and the technical trainings or technical training materials. One of the things I did was there was an FELTP training of some sort, and I gave one or two of the modules that I had prepared or translated maybe into Portuguese. That 01:19:00was maybe like a day-long training as part of that rapid short-term FELTP training program. The problem is if you don't have implementing partners in country and a dysfunctional or kind of non-functional ministry to speak of because of the political circumstances, CDC cannot take things into its own hands. Logistically it can't, and then politically it can't either. It wasn't 01:20:00just myself in that situation, WHO was, certainly the partners were. None of them really could go on and do things by themselves. The few times that that happened in other countries or even Guinea-Bissau, you would have problems because you can't have an outside organization running, training government staff on its own. Those were the circumstances in which we were. At least the few weeks I was there, it was just a holding pattern, waiting for things to restart.

Q: Is there anything I haven't asked about or we haven't covered when it comes to your time in Guinea-Bissau?

PLUCINSKI: Not that comes to mind, no.

Q: I feel like you've really provided a valuable and detailed portrait of the state of health in Guinea-Bissau, where the lack of health--did you have an overriding sense of the trip as you were leaving? A feeling about having spent your time there?

PLUCINSKI: I think on one level, it was very rewarding for me because it was one of the few, I guess opportunities I would ever get to go to Guinea-Bissau. There's no, or at least there were no formal diplomatic relations, so getting a 01:22:00chance to go there was probably a unique opportunity. I think on a personal level, that was good. I think there was, at some extent, a frustration with the fact that not much progress was being made. I think I was fairly aware of why that was happening, given the circumstances. That was the general feeling. From 01:23:00the point of view of Ebola, I think Guinea-Bissau was probably quite lucky that no cases had ever come in. Although, given the difficulties of travel within Guinea-Bissau, I don't know if no cases had truly occurred and then too, even if there were cases on some of the islands or some of the remote populations, I don't know how much room there would've been for spread within the country. It's much more fragmented than a place like Guinea where you had very rapid transmission from the interior to the capital. I don't know to what extent that would've happened in Guinea-Bissau. The thing is, Guinea-Bissau was--the poverty 01:24:00and the underdevelopment aside--a very fascinating place. Very beautiful, very nice people, very open people. We were treated very well by the Ministry even though they were working under their own constraints. But we were received very well. They had a very good community going. I maybe would've wished to have been able to contribute more, but having said that, it was still a worthwhile experience for me.

Q: While you were there, did you ever hear anything about work that Kristin Delea had done previously? She had been there before and I just happened to 01:25:00interview her, so I feel like I should ask.

PLUCINSKI: No.

Q: Do you have any other reflections though, this is our last interview after a series of three, just on your overall time responding to Ebola, looking at the effect that it had on malaria, purportedly trying to make sure that Guinea-Bissau was prepared when in fact there was very little you could actually do? Any reflections on that as a whole?

PLUCINSKI: In terms of the response itself, for me it was good to see so many colleagues maybe who had not traveled internationally or had not done these long 01:26:00deployments to West Africa, going to these places. There's differences between West Africa and the places I had worked in before, but the ultimate underlying currents of poor infrastructure, non-functioning institutions, low resources, lack of community engagement, mistrust between the community and the government, I think it was good to have my colleagues exposed to that. And I think for the agency as a whole, it was good to go through that just to see the reality on the 01:27:00ground. For me, personally, it was a two-year segment of my life where I was doing a lot of travel to those areas and grew quite familiar with those areas of the world and with that reality. Having said that, something that still I reflect on is the fact that for us, even if it's a short-term deployment, even if it's six weeks, ultimately you go there and you know in the back of your mind 01:28:00that you're going to go back, even though there was a moment when the prospect of going back meant spending three weeks in a tent at the airport. But at least you know that. For the folks, for our counterparts there, that's not true. I think that's something we shouldn't lose track of.

Q: Thank you so much for the time you've dedicated to this, to your vivid explanations. I'm really happy that we did this and it's going to be an excellent addition to the project as a whole, so thank you Mateusz Plucinski for being here.

PLUCINSKI: Alright, thank you.

END