Dr. Mateusz Plucinski

Dr. Mateusz M. Plucinski

Q: This is Sam Robson, here today with Dr. Mateusz Plucinski. Today's date is August 31st, 2017, and we're in the audio recording studio at CDC's Roybal Campus in Atlanta, Georgia. I'm interviewing Dr. Plucinski as part of the CDC Ebola Response Oral History Project for the David J. Sencer CDC Museum. Matt, thank you so much for being here with me. If you wouldn't mind, could you please state your full legal name and what your current position is with CDC?

PLUCINSKI: Sure. My name is Mateusz Plucinski and I am currently a CDC epidemiologist with the Malaria Branch.

Q: Thank you. If you were to give someone just a few-sentence description of what your part was in CDC's Ebola response, what would you tell them?

PLUCINSKI: I was an EIS [Epidemic Intelligence Service] officer who was deployed to Guinea in the second month of the epidemic, and then I worked in Guinea doing malaria control with the Ministry of Health [and Public Hygiene] over the course 00:01:00of the next two years. My final Ebola involvement was a deployment to Guinea-Bissau near the end of the epidemic as a team lead.

Q: Thank you. Backing up, can you tell me when and where you were born?

PLUCINSKI: I was born in 1986 in Warsaw, Poland.

Q: Did you grow up in Poland?

PLUCINSKI: I spent the first five years of my life in Poland, and my parents moved when my brother and I were five. We moved to Buffalo, New York, and I actually grew up in West Virginia.

Q: What memories do you carry with you from Poland?

PLUCINSKI: I spent summers in Poland, so I have a longstanding relationship with Poland. I still go there every year, almost twice a year. So it's not like I 00:02:00have a single memory. It's a lifetime of memories.

Q: There's kind of a lot, okay. [laughs] When you returned, would you go to Warsaw?

PLUCINSKI: Yes. My dad's family is from Warsaw and my mom's family is from a place called Kalisz, which is the oldest city in Poland.

Q: Did you spend time there, too?

PLUCINSKI: Yes. I know both cities fairly well, Warsaw better than Kalisz.

Q: What prompted the move when you were five?

PLUCINSKI: My dad was a researcher and got a postdoc [postdoctoral fellowship] in SUNY [State University of New York] Buffalo and then later ended up working at West Virginia University in Morgantown, West Virginia. That's how we ended up in West Virginia.

Q: When did you move to West Virginia then?

PLUCINSKI: I think my dad only spent a year or two in Buffalo, so I think I was 00:03:00six probably when we moved to West Virginia.

Q: What's it like growing up in West Virginia?

PLUCINSKI: Morgantown is a college town kind of like Athens, Georgia. Probably not your typical West Virginia town.

Q: I understand. What kinds of interests did you have growing up?

PLUCINSKI: Interests. Well, I was always good at school. I read a lot, as well. I have a twin brother, so I spent a lot of time playing with him.

Q: What did you read?

PLUCINSKI: I read everything from spy novels to mysteries to horror--everything. 00:04:00Michael Crichton--I liked Michael Crichton a lot as a kid. Recently, unfortunately, I haven't had time to read as much as I used to.

Q: Sometimes that's the way it goes, unfortunately. [laughs] Personal experience. You were good at school, you were focused on school in academics. Was there an area of school that you especially enjoyed or were drawn to?

PLUCINSKI: I always liked languages. And I was good at math. When I went to college, I ended up doing a minor in Portuguese, but my major was in something 00:05:00called "operations research," financial engineering, which is a unique path to epidemiology. It's basically applied statistics. I ended up later on doing a master's [degree] in biology, and then doing a PhD in ecology, also doing an MPH [master of public health degree] in epi [epidemiology], which is how I ended up at CDC. Two of my mentors in grad [graduate] school out in California had done EIS, so when the opportunity came for me to finish my PhD, they both kind of pushed me towards EIS. I actually had not heard of EIS at all prior to having 00:06:00that conversation as to what to do post-PhD. I went straight through from undergrad [undergraduate school] to master's to PhD, so coming here was actually my first job back in 2012. I'm pretty sure I was the youngest person in my EIS class, certainly the least experienced.

Q: Was there kind of a shift when you decided to do that master's in biology, or was there still some continuity with what you had studied in undergrad?

PLUCINSKI: I think there was some continuity because a lot of it was focused on the quantitative aspects. But yeah, it was a big shift. But I think when I was in high school, in retrospect, I probably most enjoyed the biology classes. I think it took me a while to realize that. That and the language. It turns out 00:07:00that's what I do nowadays, so it turned out quite well.

Q: Gotcha. And the PhD was in what?

PLUCINSKI: It was in infectious disease modeling, so very specialized, not particularly applicable to what I do now, but it was a good segue into public health.

Q: What schools were they? Were they different schools or were they all the same system?

PLUCINSKI: I went to undergrad at Princeton [University] and I did my one-year master's on a fellowship at [the University of] Cambridge in the UK [United Kingdom], and then I did the rest of my schooling at UC [University of California] Berkeley before coming here to Atlanta.

Q: Had you spent time in California before UC Berkeley?

PLUCINSKI: Nope.

Q: What did you think of it?

PLUCINSKI: It was good. I enjoyed the Bay Area. My brother at the time was at 00:08:00Stanford [University], so that had a factor to play in my decision to go out there. But it was good.

Q: You mentioned a couple mentors in grad school who had been in EIS. Can you talk about them a little more, like what they were like and how they influenced you, you think, looking back?

PLUCINSKI: Sure. One of them was Art [Arthur L.] Reingold, who was an EIS alum, and he's very involved in the EIS alumni community, or was, at least. And he runs one of the MPH programs at UC Berkeley at the School of Public Health, and I think is a mentor to a lot of people. He was my MPH advisor, and he was very helpful and was I think instrumental in pushing me towards EIS. And then the 00:09:00second person was Lee [W.] Riley, also an EIS alum. And he is someone who specializes in molecular epidemiology. One of my projects for my PhD was with him, and I remember actually when he told me to apply for EIS. When I got in--as you know, you have to go through two rounds of entry to get into EIS and the second round is to match with the program, and I remember turning to him for advice regarding which divisions to list. And he told me to do everything except for malaria. [laughter] As you know, I ended up matching with malaria. So I 00:10:00think that caused a fair amount of conflict between us. Just kidding. [laughter] But I think back in the day when he was doing EIS, malaria was very policy-oriented. That was before the President's Malaria Initiative, before CDC started playing a big role in modern malaria control. So I think that was his conception. But I had obviously a very good experience with the Malaria Branch.

Q: So he thought, I really want him to get on-the-ground experience? Was that kind of--

PLUCINSKI: I think so. I assume that he had a vision in mind that tracked with what he had done, and he had been in foodborne disease or waterborne. The folks who did E. coli. He did a lot of the original work with E. coli--the one that 00:11:00causes severe disease like HUS [hemolytic uremic syndrome], I believe. He did some of the initial investigations around that, and that was a big program back in the day, investigating those deaths related to E. coli and contaminated foods. But I wanted to do global health, so that's why I put malaria.

Q: Oh, you actually did put it down?

PLUCINSKI: Oh, yeah. Definitely. [laughter] I was very keen on doing global health. Specifically, I actually wanted to work in Lusophone Africa, and the Malaria Branch has a fair amount of projects in Angola and Mozambique. Within 00:12:00six months of joining CDC, to EIS, I'd been to both countries and done projects in both countries. I guess my wishes had been granted.

Q: Can you tell me about those projects that you were doing in Mozambique and Angola?

PLUCINSKI: Sure, I have done several projects in Mozambique. The initial ones focused on looking at bed nets and malaria. So the impact of bed nets on malaria transmission and malaria prevalence. In Angola, since 2013 up until even this year, we've been doing surveillance for anti-malarial resistance. We looked to see if the drugs that we currently use for treatment of malaria continue to be 00:13:00efficacious. The malaria parasite has a pernicious ability to develop resistance just like bacteria do. It picks up resistance to anti-malarials. So every once in a while, you have to change anti-malarials, and you have to make sure that the ones that you use continue to be effective. That's one of the reasons, for example, why we don't use chloroquine anymore for treatment of malaria. It's because most parasites in Africa are almost completely resistant to chloroquine, so you can give a child with malaria chloroquine and it's just like giving them a placebo--no effect whatsoever. In Angola, we've instituted a network of sentinel sites where we test the efficacy of our anti-malarials.

Q: Had you been in Africa before these trips?

PLUCINSKI: Yeah, I had been to Africa once in 2009 and once maybe in 2011, both 00:14:00times as a student. Once was for a workshop and then once I went for like a two-month internship in Kenya during my MPH. But fieldwork-fieldwork, that was definitely baptism by fire.

Q: Is there a particular experience that comes to mind with that?

PLUCINSKI: My first EIS deployment or trip was to Madagascar. This was within two months, maybe three months of joining EIS, and at the time I told my division that I spoke French, which I did not speak it very well. That was a 00:15:00challenge during that trip. Realizing the limitations of my French was an unpleasant experience, especially since it was my first trip abroad with CDC. But it did motivate me to actually learn French, which I have over the last five years had to work more and more in French-speaking Africa, in addition to Portuguese-speaking Africa. That was one of the reasons why I ended up being sent to Guinea during the Ebola epidemic.

Q: Right. Just because I know a little bit about some things that happened early 00:16:00on in Guinea and especially speaking with Jim [James A. Zingeser] yesterday about community resistance to malaria messages and outsiders coming in to sometimes rural areas. I'm wondering if you had ever experienced anything like that? Any kind of community resistance to public health campaigns before Guinea?

PLUCINSKI: Oh, before Guinea? No. Before Guinea, I hadn't really worked with communication or sensitization or messaging. I'd done a few surveys working with the community, but more in a research setting. There are definitely people who 00:17:00specialize in how to do communications for malaria. I had not been involved in that. The thing about malaria is that it is very non-controversial. There's really no controversy. It's a mosquito. Most people know that it's a mosquito that carries it. No one is on the side of the mosquito. No one is arguing for more mosquitoes. No one is arguing for more malaria. The interventions that we have are not controversial. It's sleeping under a bed net, having your house sprayed, getting treated. It's not HIV [human immunodeficiency virus], there's no stigma associated with having malaria. It's a disease of poverty, but for the most part, everyone--like the donors, the governments, the communities, the healthcare workers, everyone--wants to diminish the burden of malaria. I think 00:18:00that's clear. I think Ebola is very different from that perspective. But from the perspective of malaria, I think we're very lucky in the sense that it's a very united effort against the malaria parasite.

Q: It's an interesting perspective.

PLUCINSKI: Which is one of our oldest parasites, malaria. It has been with us for millions of years. Some of the species have. It's one of the few parasites that has left its mark genetically on us. There is very clear evidence that a lot of our--there has been selection for human genetics just purely based on the 00:19:00pressure from the parasite. And that's clearest for malaria. It has probably happened for other diseases, but with malaria, it has been with us for such a long time.

Q: Right. It's a known thing. It's not like Ebola, discovered in '76 and people just aren't used to it, especially in West Africa. Interesting. So you finish up in 2014 then?

PLUCINSKI: Yes.

Q: Were you involved in Ebola at all while you were still in EIS?

PLUCINSKI: The Ebola epidemic was, I think, first declared or signaled in late March 2014. I actually remember getting a call from Ilana Schafer, who was the EIS officer with the Viral Special Pathogens [Branch] in our year, and I 00:20:00remember her alerting me to the epidemic early on, even before she deployed, and asking me if I was available to go in the first wave, and I was not. I can't quite remember why. Probably because I had a presentation at the EIS conference which was to take place at the end of April 2014. So I was not in the first wave of CDC folks. But Ilana did go, and she went with Meredith [G.] Dixon, who was a first-year EIS officer, and I think they were joined shortly thereafter by K. P. [Kpandja] Djawe, who was an EIS officer in my year, together with a Ilana. He 00:21:00was with--I want to say domestic HIV. Could be domestic TB [tuberculosis]. I don't remember. He's Togolese. They were part of the first wave, and they went together with Pierre Rollin to Guinea.

I ended up being signed up for the second wave, which was basically right after the EIS conference, or actually in the middle of the EIS conference. Mary [J.] Choi was an EIS officer with me. She was posted to Minnesota. She and I flew out at the very end of April to Guinea for a four-week deployment. I can't quite 00:22:00recall if--I think Ilana had left by the time we arrived, but Meredith was still there, as was K. P. We were joined there by Jim Zingeser. He was the team lead at the time, and he was coming in from Europe--I think Rome, where he was based as a CDC secondee to--the World Food Programme?

Q: FAO [Food and Agriculture Organization]?

PLUCINSKI: Yes, FAO. One of those. I think we probably arrived in Guinea either at the very end of April or the first few days of May. I remember we arrived to the Palm Camayenne Hotel--that's where we were staying--which had recently been 00:23:00renovated. It was completely deserted at the time. This was before it was a big story in the US, but it was definitely a big story in West Africa, and a lot of companies had pulled out their staff. A lot of the flights had been stopped. There were rumors that Air France was going to stop their flights. Air France actually was--at that time, the pilots and the flight crew, so the stewardesses and the pilots, had refused to spend the night in Conakry. What they were doing at that time is the plane would land in Conakry and then [they] would deplane, 00:24:00and then I think they were flying to Dakar at the time and would sleep in Dakar. There were rumors that Air France would actually stop those flights, in which case the country would be completely cut off from Europe at least. I remember there were negotiations with the French ambassador to try to maintain those flights as a necessary lifeline to the country. But when Mary and I got there, as Mary and I traveled together from Atlanta, the hotel was completely deserted. I think it had less than ten guests, most of which were CDC. I remember the way the hotel is set up is that all the rooms face the beach or the coast, and there 00:25:00is a pool there and then there is a restaurant, which is called the Paillotte. You can see basically all the rooms from the restaurant, from the Paillotte. I remember being there just looking, and all of the lights were off, and the only lights that were on were in the top left corner of the hotel where they had placed all the CDC staff all together. Ironically, I've gotten to know that hotel very, very well, and I remember all the rooms where we were in. The CDC team lead always had a suite and then they put us in these very small, narrow rooms. Actually, Jim might have had a room as well, not a suite at the time. I'd 00:26:00never been in such a deserted hotel, and it was kind of a surreal experience. I mean very, very surreal.

At the time, there was a fair amount of movement with WHO [World Health Organization]. WHO at the time was spearheading the effort up until the end of the epidemic, but the Palm Camayenne was walking distance to the WHO office at the time, which I assume is why they ended up putting us there. When Mary and I arrived, they decided to send one of us to the field, to Gueckedou, and then one of us would stay in Conakry to basically man the fort in Conakry. At the time, 00:27:00most of the transmission was in Gueckedou, and there had been transmission in Conakry in the preceding weeks, but there had not been any new cases for a while. But there were still those two foci, if you will, Conakry and Gueckedou. I ended up spending the first two weeks of my deployment in Conakry, and then Mary went out to Gueckedou right away. I overlapped a few days with Meredith Dixon, but things were very quiet in Conakry at the time. There were no new cases. There might have been maybe one person in the ETU [Ebola treatment unit] in Donka Hospital, and I think they were released maybe during the time when I 00:28:00was there. And there was this mood that the epidemic had been curtailed, at least in Conakry. And even in Gueckedou, cases were going down, so people were fairly optimistic. I was in Conakry with Jim Zingeser at the time. Actually, there was so little activity in Conakry that I think within two weeks, they decided to send me to Gueckedou, where there was still some ongoing transmission. I took a flight to Gueckedou. At the time, it was a two-day drive and still is a two-day drive to Gueckedou, but there were these random flights. 00:29:00This was before the scheduled flights by UNFPA [United Nations Population Fund]. This was just a random private plane that someone had chartered, and I flew to Kissidougou. There is like a dirt airstrip in Kissidougou where I flew in maybe a six-seater airplane. I don't remember the other passengers very well. There was one guy from the European Union. He was also traveling to--we were all flying to Gueckedou, and were all somehow tangentially related to the response, which at the time was a WHO response. Mary and I had both gone through WHO in 00:30:00for our deployment. We were being paid for by CDC, the travel was being organized by CDC, but technically, we were there under the auspices of WHO.

Q: Did WHO have their own kind of training or anything that they put you through once you got there?

PLUCINSKI: No, certainly not when we got there.

Q: In Conakry, no?

PLUCINSKI: No. Prior to deployment, we had to go through some WHO online trainings, but that was mostly related to the fact that we were being deployed by WHO, which is somehow affiliated with the United Nations. They had their own bureaucratic processes. But I don't recall a specific training, per se. Mary and I had met here in Atlanta with the Viral Special Pathogens group. They had given us papers to basically read and had walked us through Ebola Control 101 at the 00:31:00time, because this was prior to all of this new information that we learned during the Ebola epidemic in Guinea. We learned pre-West Africa epidemic Ebola control, which had three major components. One was safe burials. So, prevent transmission during burials. The second one was preventing transmission in the healthcare setting. So, rapid isolation of patients with signs of Ebola. And then removing community transmission. There are three modes of transmission. You 00:32:00had transmission during burials. You had transmission in healthcare settings. And then you had transmission in the community. Transmission in the community, the easiest way of stopping that was contact tracing and daily fever monitoring or symptom monitoring for any contacts, and then as soon as someone was symptomatic, to send them to the ETU for testing and isolation if positive. That was the canon, if you will, of Ebola control prior to the West Africa epidemic, and that's what we were briefed on here and those three things had worked in however many Ebola epidemics they had done before. At that point, Pierre had 00:33:00gone through--I don't know how many epidemics he had seen. But even Ilana in her two years as an EIS officer had probably done half a dozen responses, each following that same pattern, and it had worked in each of those cases very efficiently. One thing I remember very well, at least what I took home from discussions here and also just the mood in Conakry, was that what we had--those three things--were sufficient to stop the epidemic. And correctly implemented, it was going to stop the epidemic and stop transmission and basically curtail it in Conakry and Gueckedou, basically. That's how I came into Conakry. That's what 00:34:00I thought for the first two weeks.

But when I was leaving Conakry at the end of April, my mood was very, very different, and the mood had really changed just drastically in both Gueckedou and Conakry. I left extraordinarily pessimistic, and I have spoken about this many times with Mary and it's something that was an eye-opening experience. Things changed very, very quickly in that month that we were there. When I first went to Gueckedou, which was--so remember, I went to Gueckedou because there was 00:35:00literally nothing to do in Conakry. Or not nothing to do, but there was no active follow-up necessary in Conakry. I went to Gueckedou to help fill the gaps there, and when I was there, there was this sentiment that things were under control.

Q: How did you get that sentiment?

PLUCINSKI: Well, the cases were going down. They had managed to scale up contact tracing. They had a system going. There were fewer and fewer people in the ETU. There were fewer and fewer active cases being detected, and there was this sentiment that things were really progressing.

Q: Was that across organizations that you were getting that?

PLUCINSKI: Yes. At that point, there was no real differentiation between organizations because everyone was under the auspices of WHO in Gueckedou. We were all staying in the same hotel, Fatou Rose in Gueckedou. It was one team, and people were in a good mood. I remember actually, interestingly enough, at the end of my first few days--we would have morning and evening meetings. The entire team would. So a briefing at the beginning of the day and at the end of the day where, for example, we would get introduced, and that's what happened when we arrived. Then whenever people would leave, they would say people are leaving, and also during these meetings obviously we would get an update of how many new cases, how many people were in the ETU, if anyone had died overnight, 00:37:00and if anyone had tested positive. The epi team would speak up. The people doing community case tracking and investigation would speak up. The lab would always give their take-home. MSF [Medecins Sans Frontieres] would also brief everyone--[International Federation of] Red Cross [and Red Crescent Societies]. Actually, I should have probably said that--so MSF was very much a part in Gueckedou.

Q: Yeah, that was my guess.

PLUCINSKI: As was the Red Cross.

Q: As was the Red Cross? Okay.

PLUCINSKI: Yes, to some extent. They had been working there for a long time and MSF had been working in Gueckedou for years, ironically enough, with malaria. So they kind of had their own headquarters and their own sleeping quarters and all 00:38:00that stuff. And there was always that tension between WHO and MSF for sure. A lot of it related to PPE [personal protective equipment]. WHO and MSF had their own guidelines for PPE, for personal protective equipment for the ETUs. I remember being privy to some of that discussion but certainly not involved.

Q: Do you remember what specific disagreement there was about the use of PPE?

PLUCINSKI: Yes, WHO had a less restrictive--or obstructive, if you will--setup. Whereas MSF erred much more on the side of caution and had much more robust PPE. To me it seemed almost an academic discussion. But I wasn't directly involved. 00:39:00But I know that people who, for example, were in the ETU, there was a difference in terms of just how much you would sweat, depending on which PPE you were using.

I arrived there around the same time as a few others because there was this constant rotation. There was a British doctor, Simon--I have no idea of his last name, but I think he might have even been in private practice somehow; I have no idea how he ended up there. And then there was Frederique [A. Jacquerioz] who was Dan [Daniel G.] Bausch's wife. She was Swiss, and she was also working in 00:40:00the ETU at the time. Anyway, I was telling you about the meetings. I remember one of the first days I was there. A lot of the WHO staff had come in from the AFRO [African Regional Office] region, and a lot of them were Congolese because they had so much experience with previous epidemics. I have a recollection of a few of them. One was Libama, who K. P. knew very well. Then there was--I'm not sure where he was from but there was a WHO consultant maybe, or kind of like me, 00:41:00a deployer, Dieudonne. He left shortly after I arrived, but I remember when he was announcing his departure during the meeting, they were saying goodbye to him and he had been there for probably since early in the beginning, and I remember him being so extraordinarily happy. I had never seen anyone happier than when he was leaving. He was--I want to say dancing at the meeting, when they announced that he was leaving. People were under a lot of stress at the time. I don't 00:42:00think it was uncommon for people to have that reaction upon leaving. Other key people who were there--there was a data manager who ended up playing a very important role in the whole epidemic who was Boubacar Diallo, and he was there as a STOP [Stop Transmission of Polio] polio deployer. I think he's originally from Mali. He at the time was the data manager in Gueckedou, and to a large extent was kind of the mastermind of their response. He ended up later playing a key role in the WHO response full stop, based out of Conakry. And then Dr. Pepe 00:43:00was there, who was from the national level. He was an extremely smart and calm guy. I think he was from the national level. I ended up running into him maybe a year--year and half later, and he was based out of the EOC in Conakry. I remember at least when I was in Gueckedou, he was kind of running the show. He was the one who would run the meetings. I think when I was there, Sakoba Keita came as well for a short visit. He was accompanied by Daouda, who is a French physician who at the time was working for the French government or maybe Inserm 00:44:00[Institut national de la sante et de la recherche medicale] who is someone who I ended up interacting a lot with for the next few years who ended up doing a lot of the clinical trials later on. From locally--a lot of those were international or national staff, but there was also staff from Gueckedou itself. There was Dr. Alexi, who was from the DPS [Direction Prefectorale de la Sante] or Prefectoral Health Authority, and he to some extent had a leadership role in the response, at least from the local side. He was devoted specifically to Ebola.

Basically what Mary and I would do over the course of the next two weeks, we were working with contact tracing and case investigation. So anytime there was a new case, we would help with doing the initial investigation of the case. So the interview to list all the contacts, and then we would do the supervision of the contacts, basically the three-week contact follow-up. Most of the heavy lifting was done by community healthcare workers in Gueckedou who were the ones--they would get a list every morning of all the contacts that they had to see, and 00:46:00then they would fill out that form and then see who was febrile, who was not febrile, who was symptomatic, who was not symptomatic. They would have to do that on a daily basis for three weeks for each person. So the response, to a large extent, at least the response that I was involved with, was managing that follow-up--getting an exhaustive list of contacts, which at that time could have been in the hundreds a day, and making sure that they were followed up. Again, the majority of the work was done by community healthcare workers, but what we would do is we would supervise and make sure that things were running smoothly because it is a complex organization. The number of people and the people that 00:47:00you need to visit changes because some people drop out, they finish their three weeks. Others get added to the lists. It is a big operation, and we were involved in basically the implementation of the managing of that. In practice, what that meant is every morning we would get a list from Dr. Pepe of community healthcare workers in villages that we had to visit and make sure that the follow-up was being done correctly, and then every once in a while we would get a request or command to do an investigation. Anytime someone tested positive, we would have to go in and do an interview and figure out who that person had been 00:48:00in contact with from the moment they were symptomatic to the moment they got isolated. That period of time is when we had to account for exposure to other people.

I remember doing one early on with Dr. Libama in this village called Kailahoun. So Kailahoun at that at that time, in the preceding weeks, had been a hotbed of transmission where there had been a fair amount of cases, probably around ten or more cases in this one village, and that's where I remember doing an investigation in that village with Dr. Libama early on. So that exhaustive list 00:49:00of figuring out who the contacts were. There was still obviously a lot of ongoing contact tracing during that time in Kailahoun, which is actually on the main road from Kissidougou to Gueckedou. But one person that I'm sure you've heard talked about before was Madame Sia, who was a nurse I want to say in Gueckedou prior to the epidemic, and she played a very pivotal role at least in taking care of all the CDC deployers in Gueckedou. K. P. had worked with her when he was there in Gueckedou, and then Mary and I later worked with her. 00:50:00Obviously, we would never work alone. We were always paired with someone from WHO or a Guinean from the Ministry of Health or a community healthcare worker. We were never alone. Whenever we would get sent out into the field, sometimes we would use a US Embassy vehicle, and sometimes we used a WHO vehicle, but we were never alone. Madame Sia is someone that I learned a lot from, and I think later deployers would also work often with her, at least in Gueckedou.

Q: Did she come with you to Kailahoun?

PLUCINSKI: Yes. Definitely. She and I were there together, at least on one of the visits. The thing is we would often go to different villages, depending on the day. My recollection is that at least the first week that I was in Gueckedou, things were relatively calm. Again, the cases were still coming in, but there were not that many and there was this conception that things were more or less under control. People were in good spirits. I found it very, very interesting. One of the groups at the hotel--the Europeans were running the lab 00:52:00in Gueckedou. They had a lab in a box, basically, for Ebola testing, PCR [polymerase chain reaction] testing, and they were rotating them out just like the CDC and the WHO deployers were. At the time I was there, there were a few Germans, but the head of the lab was an Italian, Antonino, and we were all staying in the hotel, in Fatou Rose, and we would all basically come back around the same time and gather around the pool in Fatou Rose. The pool was bright green--it was very dirty. [laughter] Fatou Rose is a U shape, and there was a pool in the middle, but it was obviously not maintained. A lot of mosquitoes. We 00:53:00were exposed to a lot of mosquitoes outside, and Gueckedou does not have power. The hotel did have a generator, though. At least in my room, there was no real running water.

I remember I actually slept extremely poorly, at least for the first few nights, until I got used to it in Fatou Rose. What would happen is they would turn the generator on at night for only a few hours, so what would happen is you would be outside talking after you had dinner. Everyone would eat at the hotel and then you'd hang around outside, but the mosquitoes--and people are tired, so you'd go 00:54:00to your room and there was nothing to do but sleep. You'd sleep, and it's hot. It's been baking all day. I slept naked on the bed, and you don't want to open the windows because there's a ton of mosquitoes outside. So you're baking, you're in this oven. You try to fall asleep, you fall asleep, and then they turn on the generator and that's a horrific noise. [laughter] That's the first wakeup. But it's good, because then at least the air turns on. Then the way it's set up is the air conditioner, of course, does not have a remote or anything. It just runs on full blast. A few hours later, you're really, really cold. So you climb under the covers. You wake up because you're cold and climb under the 00:55:00covers. So that's your second wakeup. And then in the middle of the night, they turn off the generator, so it only runs for maybe two hours. A few hours later, the air hasn't been running and you're under the covers, so you wake up because you're sweating profusely because it's back to being eighty degrees in your room. Then you climb out of the covers and lay on the bed again. That's your third wakeup. And then your fourth wakeup is the rooster at like 5:00 a.m. [laughter] It was not the best of conditions. But surprisingly, I ended up sleeping very well after a while, after a few days. But that was Fatou Rose, a very definitely memorable hotel. That was probably the first week when I was in Gueckedou.

There wasn't that sense of dread or panic or anything like that. It was fairly under control. And once you got used to the routine, it was fine. But I would say in my last week there, things took a turn for the worse. This is more than three years ago, so I don't remember the exact sequence. But I remember a few things happening very quickly around the same time. One was that there was this 00:57:00itinerant preacher who had been coming to the DPS, to the Ebola headquarters, which by the way, were set up in the hospital in Gueckedou or right next to it. Or maybe it was next to the MSF headquarters. Anyway, he had been coming by. I had never met him, but people would talk about this preacher who would come by and say, "There is this village, Botema, that has a lot of cases." Well, he didn't say cases, but he said, "You guys need to go this village called Botema because there are a lot of people dying there." He's like, "I've been there and 00:58:00there's just a ton of people dying." And this is a village that had had cholera outbreaks in the past. I mean, the DPS knew of the village. They were always slightly skeptical of what the preacher said, to the point where they were like well, you know, we're not hearing it from anyone else. This is a village that has cholera. It sounds like cholera. And they were, to some extent, reluctant to follow it up. I don't know to what extent they actually did follow it up themselves. But the preacher was very insistent, and one day in the morning I was told that I was to go to Botema for an investigation that would be led by Boubacar Diallo, who at that point was probably one of the more competent deployers. He had been there since the beginning. He and I and a few others went 00:59:00to Botema, and I remember one person refusing to go because--you actually had to hike to the village, so it was quite far in the bush. We took a few people from Red Cross as well for it, in case we needed to sample and also do any burials. I think we probably went in two cars.

I don't remember really going into it with any conceptions or any idea of what to expect. For me it was just any other investigation. But over the course of 01:00:00the day, it was obvious that something was not right. We did the typical thing when you go into the village, you kind of stop along the way. Before you go to the village, you go to the health center and pick up someone from the health center to take you to the village. When we went to the health center, they told us this person died here, and they confirmed that there were a lot of deaths in Botema. I remember this growing sense of dread over the course of the day. As we talked to more and more people, it was obvious that something was not right. So to get the Botema, we had to hike maybe for like twenty minutes through the bush, and you had to cross a very narrow footbridge over a river that had a 01:01:00handrail, a one-person kind of thing. We get to this village, which is on a mountain in the middle of the bush, and we sit there and we're talking to the community, but within where we're sitting there's a house and there's a body in the house of someone who had died earlier in the day. Turns out, we found out that that person had been transported on the same narrow bush track that we had walked through like thirty minutes before. A dead body being hoisted. This was a guy in his early twenties who had died suddenly. It was a very strange 01:02:00discussion that we had with the village community and the chief, where basically they told us that yes, people had died. But the way they told the story was--so a very typical sequence of events for Ebola is one person dies, there's a funeral, and then two weeks later a bunch of people die. You have an index case and then you have the second wave and then the third wave and so on. But from what they were telling us, it seemed like that had not been the case. A few people had died, but the timing didn't make sense with Ebola, and also the community was very adamant, and in retrospect it was probably self-denial, that 01:03:00it was cholera. In previous years, they had had a cholera epidemic, and cholera is something that can kill adults. There's very few infectious diseases that can kill an adult very quickly, and cholera is one of them. And they had actually had a cholera epidemic in that particular village. So the chiefs were quite adamant that it was not Ebola. They were aware of what Ebola was, but they were like, no, this was cholera, the people had diarrhea, they didn't have any bleeding, they didn't have any of the other symptoms of Ebola, it was just profuse diarrhea. They had seen cholera before and they were sure that it was cholera. I remember we even went down and looked at their water source, which was at the bottom of the hill, which is conducive to the transmission of 01:04:00something like cholera. They were saying please, we need a well. If you want to help us build a well. But nevertheless, this was a village of maybe a bit over a hundred people, and they had had ten deaths in adults or something around that number in the preceding days. I remember this very strange set of thoughts and emotions in the sense that there was this feeling of dread that something was not right, but at the same time, I remember myself and then everyone else kind of latching onto this idea that oh, it was cholera, probably just cholera, nothing too serious. I remember falling into this state where as a group, we 01:05:00were like it's probably cholera, and kind of being relieved by this idea that it was not Ebola. But nevertheless, there was this dead body that was right there.

We were with Red Cross. The Red Cross sterilized the body, or at least the house where he was. Sprayed the inside of the house, and they also took a buccal swab for testing for Ebola--PCR testing in the lab. I remember, they did that and then we left. I remember everyone, as we were walking down, we were now aware that a dead body had gone through that entire very, very narrow track where we 01:06:00had walked through the bush. I remember when we had to walk back over the bridge on the way back, which had the handrail, someone from WHO standing there, or one of the deployers standing there, squeezing hand sanitizer onto everyone leaving--whether it was bleach or hand sanitizer or whatever--after touching the handrail. But of course, we hadn't done that on the way there, because we didn't know that there was a dead body being transported along the same track.

Later in the day, after leaving Botema and getting back to the cars, we drove around a bit and I remember we drove by one or two funerals that were taking place, which was I feel like another piece of the puzzle. I mean, funerals 01:07:00happened, but not so often. It's something that was obviously, in retrospect, was a warning sign. I remember us stopping and being like oh, this person died? And they're like no, he was sick already, and there was this sense that people knew about Ebola and there was this very, very natural human reaction to say it's not Ebola. Trying to latch onto the possibility that it might not be Ebola, because to admit that your village has Ebola is very serious. It's something that you have to come to terms with, and it's very difficult to accept that. Even for us.

Q: Can you tell me what the funerals looked like?

PLUCINSKI: Funerals basically were just masses of people. We saw the masses of 01:08:00people. It was obviously a funeral. We didn't stop, for example--we could have stopped and tried to argue for a safe burial where the body is put into a plastic bag and buried, but in that case we didn't have the gear or anything to do that. So for us, it was just stopping and just asking how the person had died, kind of noting. We also walked into--we were in one village where there were people who were very sick. I remember there was this girl that was very sick that ended up actually being transported to the ETU, and again in retrospect, the signs were there because she had been staying in Botema in that 01:09:00village where we had been. But we were like no, maybe it's cholera. Who knows? But she was actually transported back to the ETU, we called for an ambulance.

It was a very, very long day, and I remember getting back to the hotel. The swab that we had taken on the dead body, or that Red Cross had done, was submitted for analysis. The Europeans, they would run the tests every evening after the close of business, if you will. I remember we went back to the DPS and we went home to the hotel, it was a few of us that had been to Botema. I remember this sense of unease, thinking about the day, but then there was this discussion that 01:10:00it's probably cholera. Because again, the conception was that things were under control. This case in Botema was completely unlinked to any of the other villages. We had asked during the contact--during the investigation, a lot of our questions were like, have you had any contact with these villages that have had Ebola? Has anyone traveled to any funerals? Anyway, the village was like no, no, no, no. But we had those tests pending and we're like oh, they're probably going to be negative. It will be fine. I remember late at night, we were actually waiting for the Europeans, specifically Dr. Antonino, to come back with the results. I remember him coming back later than usual, probably closer to 01:11:00eight or nine, and sitting down and telling us, "All positive." I remember a chill definitely going down my spine because it meant that (a), we had another focus of transmission that was completely unlinked to anything else, and then (b), there was that aspect of personal exposure--the fact that we had been on this--proceeded by a body that was positive for Ebola. The conventional wisdom at the time, which I think is still true, is that the worst thing, the most infective thing is someone who has just died from Ebola because they have such a high concentration of virus in their body. I remember having a very uneasy night 01:12:00that night. The worst thing is that there's no running water in the hotel. You're using bleach to disinfect everything. You really have to come to grips with your level of exposure, which in retrospect for me, I don't think any of us was ever in any personal danger, but it does weigh on you for sure, especially out in the field when all you're doing is thinking about Ebola. That was a really bad sign.

It turns out that a few days later--it could have been even the following day--I 01:13:00actually did not go that time, but a team went back to Botema and told them, hey, this is Ebola and a lot of you have been exposed to it. A lot of people died from Botema. Regardless, when the next team came back, they finally managed to get the full story from the village. The village had to some extent lied or misled us in terms of the history of the deaths in their village. It turns out that the second story they gave was completely consistent with what we'd expect with an Ebola introduction into the village where a woman had aborted and died, 01:14:00which is a classic sign of Ebola. Then all of the people who had attended or had helped with the abortion then died two weeks later, or a week later. If they had told us that story, we would have been very--it would have been very obvious that it was an Ebola outbreak in that village. But it turns out that basically it was a whole new transmission chain. We tried to figure it out, and I don't think we were able to figure out how to link it with other cases, which was 01:15:00scary. Which basically meant that there was this whole chain of transmission that we had no idea about. We had heard about Botema. How had we heard about Botema? We had heard about it from an itinerant preacher who had visited and then happened to be insistent enough to force us to go there. So the question was, how many other villages were out there like that? In retrospect, there were a lot, and it was bad. We had no idea. We weren't even close to containing it at that time. So that was one thing that happened the last week there.

Another thing that happened was that in a different part of Gueckedou, there had been this report that one of the contacts that should have been being traced had 01:16:00hidden himself in a village and was refusing to be seen. It had reached the DPS and the Ebola response that this person was sick. I was sent, together with a few other responders from WHO, or--I think it was actually local responders, to go to this village to basically sensitize them and give them a heads-up and ask what was going on and see if we can talk to the person. I was part of that team. We were given a vehicle and told by probably Dr. Alexi to go to this village 01:17:00with that purpose. We were going in that direction and we passed by the health facility, so as always, we stopped and wanted to make sure everything was okay and asked if someone from the health facility could go with us to help us out. I remember getting a very, very bad feeling from the health facility. The health facility was closed, and the nurse who was there refused to go with us because he said that he didn't feel comfortable going to that village, which was a bad sign. I got a bad feeling from that. But we continued. We had a job to do, and I remember very soon after leaving the health facility, we saw another Ebola response car. I ended up waving them down, and it turned out that it was a car 01:18:00full of--this thing called "comite des sages." The response part of the communications arm was--they organized these basically old wise men committees. It was older gentlemen, oftentimes they were imams or preachers of some sort, who were respected in the community and who would go out and do these communication visits with the idea that this was someone who had some authority. They would do these general Ebola communication messages, comite des sages. This car that we stopped happened to be full of them, of these three guys in their fifties who was going on some kind of communication mission or sensitization mission. I remember asking them, "Hey guys, do you mind going with us?" I had 01:19:00this bad feeling about this village. "Would they mind going there and helping us out for this mission?" They're like, "Yeah." It wasn't far out of their way, so they're like, "Of course." We went with two cars to this village, and I remember getting to the village and right from the beginning, something was off about the village. But we drove in and parked the cars. By the way, at this point, there had been a few cases of violence against Ebola responders. Or not Ebola responders, but the Ebola response. There was this conception which I'm sure you've heard that the cars were spreading Ebola. There was this pervasive rumor 01:20:00that the white cars, so all of the WHO cars--most of the cars were white, your typical white USAID [United States Agency for International Development] or MSF Land Cruiser--that the exhaust was causing people to get Ebola. So that was what was spreading it. I can tell you why that would seem logical from the point of view of a typical villager. The SOP [standard operating procedure] at that time was--because certain teams had been threatened in the past, including a team that K. P. was on--was to park the cars pointing towards the exit of the village for a quick getaway. So they did that. We disembarked from the cars and then the cars parked pointing toward the exit. But there were like six of us because it 01:21:00was the three sages and then myself and the community healthcare workers, a few other people. We sat down in the center of the village. There was a tree there and a bench there that was set up for us, and we did the usual greetings, introductions, and then the sages just started their presentation. Of course, it was all in Kissi, so I didn't understand, but the community healthcare worker that I was with was doing a running translation or interpretation for me. Typical just general health messages, even prior to Ebola, but not talking about Ebola yet. I remember there was something off about the village, and basically 01:22:00the only people in the center of the village where we were were men. All of the women and children were back against the houses, which was unusual because usually in the village, everyone is running around all the time, and it's a very convivial atmosphere, whereas here it was the men who were with us and then everyone was in the back, but everyone was looking at us, which was unusual. Even the short amount of time that I had spent there, that was not how we were usually received in the village. I remember at one point, the sages were giving their health message, and at one point they had to mention Ebola. That was something I heard from even in the Kissi, it was still Ebola, so I remember then 01:23:00kind of the roar started from the crowd. Like the moment they uttered the word Ebola, people started murmuring basically, and almost instantaneously the women--especially the women--started screaming and yelling at us or at the men, who knows, I didn't really understand what they were screaming, and kind of banging and making noise. Then the men started yelling at the women, I assume to tell them to keep it down or to stop yelling. There was confrontation between the men and the women. Again, the men were next to us and the women were in the back. This went on for a few moments, and there was this sense of--it was this 01:24:00mob mentality where things just spiraled out of control. The sages were getting upset, and they were trying to talk to the men and ask, what's going on, why are you receiving us like this, and I remember I was still seated next to the community healthcare worker and I remember asking him, "Why are we not leaving?" He was like, "Yeah, we're going to leave, just wait. We can't leave yet." Basically what happened is the men encircled us almost, but not 360 degrees. They left like a space for us to leave the village towards the cars. The men 01:25:00were clearly giving us a hint to go, but it wasn't like they were necessarily threatening us. But the women were really raising hell, and at one point the women started--this happened in an instant--started throwing rocks at the cars, and then rushed the cars. The drivers were in the cars, and the cars just drove off because the women started chasing the cars, so the cars just took off. So basically, we were there in the village by ourselves. The cars had left us. I think rightfully so, probably, because otherwise who knows what they would have done had they gotten to the cars. And then it was really clear that the men were 01:26:00basically protecting us from the women, and I was like, "Are we going?" And the community healthcare worker I was partnered with was like, "Oh yeah. We're going to walk away. No matter what you do, don't run because if you run, they will actually give chase." I remember walking away briskly together with the sages and my team towards the road that we had driven in on. While we were walking, there were stones being thrown at us--large stones. Stones that definitely could have done some harm if they had hit us. But my feeling and my recollection is 01:27:00that they were being thrown around us, not necessarily at us. And they were waving machetes and so on, but it was clear that it was more of a show of force than any attempt to--I think they easily could have killed us, full stop, which happened in a village a few months later where they ended up killing a few people from the DPS in Macenta and stuffing their bodies in a well. But at least this day, it was more of a show of force, and they did drive us out from the village. I remember as we were walking away towards the vehicles which had 01:28:00stopped maybe half a kilometer away down that same road, the men had gone ahead and were chopping a tree down to block the road.

I remember coming back to--once we calmed down, we went back to the headquarters and obviously had to report back what had happened. The sages, the old men were extraordinarily upset--not scared or anything, but just extremely angry at the village because the chief of the village was a young guy. I don't know how he had become the chief of the village, but it was this very unpleasant and strange reception. And something that you wouldn't necessarily expect from a village in 01:29:00Gueckedou. The people in Gueckedou are very, very nice. It is very calm. At least I did not have the feeling that this was a common occurrence. I think it was an extremely extraordinary event. I remember there was this long discussion about what to do with that village because not only had they blocked the road, chased us away, threatened the team, but they were potentially hiding someone who had symptoms of Ebola and was a contact or was sick and symptomatic. That's the reason why we went there.

The way it was resolved was very interesting. Very interesting set of events. As 01:30:00part of the effort, there was a physician called Dr. Mathieu Loua. He was from Nzerekore, or one of the neighboring districts, and he was Guinean and probably in his forties or fifties, a physician. He worked for the Ministry of Health and was somehow attached to the response. He was kind of an unusual character, very smart and very unorthodox. What he did is, over the course of the next few days--this is really bizarre, and I think everyone was very impressed and also 01:31:00taken aback by what he did. He realized this is a big problem and could potentially derail our efforts, and obviously, we have to do something with this village; we can't just let this village fester if they have an Ebola epidemic. So Dr. Mathieu ended up dressing as a peasant. Dressing as a peasant. Because he's a physician. Decided to basically masquerade as a traveler from Nzerekore. He was not from that region, so he didn't speak Kissi, but he dressed himself as a villager and then hitchhiked his way or walked to this village, which everyone 01:32:00thought was the center of an Ebola epidemic--another Ebola outbreak. Went there and basically set up shop there. Convinced someone to sleep in their house as a traveler, disguised as this villager. And over the next few days, gained their trust. Ended up revealing that he was a physician, and ended up finally being able to talk to the chief and also finding the person who was hiding. I mean, this really incredible set of events. He was instrumental, and the village ended up opening itself up. I wasn't there, but I was told that the chief ended up 01:33:00begging for forgiveness on his knees to the team that finally went in and did the investigation and tested. It turns out that the person who was hiding actually didn't have Ebola, and I don't remember there being any cases from that village, but it did open up--this resistant village--and I remember when I spoke after Dr. Mathieu had come back and had showered and resumed his normal appearance, I remember asking him, where had this idea come from, and why did you end up doing this? He actually said that when he worked as a physician in Nzerekore or whatever district he was from, he worked a lot with Peace Corps 01:34:00volunteers. He said if an American twenty-two-year-old girl can come in and live in a village for two years, I can do the same. I remember that conversation very well. I remember also being very impressed by that dedication. But even in the team--even by his colleagues from the Guinea health authorities, he was considered to be a bit of an oddball. [laughter] He was very, very idiosyncratic and had his specific mannerisms. But also extremely effective and dedicated.

But that experience with that level of hostility from the village was I think a 01:35:00sign of things to come. As I said, later on there was actual violence towards responders or the Ebola response. But when you think about it, and later on, I think it took me a while to come to terms with it. But from the point of view of the villager, it actually makes sense for them to associate MSF or the Ebola response with Ebola itself. Because usually what happens is people in rural Africa die all the time, and it's not uncommon for an adult, a child, anyone, to 01:36:00die suddenly. It happens much more often than it happens here. But when you have an Ebola epidemic, what happens is someone dies in a village. At least with a mature response, what happens is someone dies in a village. The response hears about it because they are always in contact with the community, and anytime there's a sudden death, especially in a previously healthy adult, the response is activated and the teams get sent. From our point of view, the Ebola case dies--you would go there, we interview people, we figure out who were the contacts, and then we do the contact tracing. As soon as someone gets symptomatic, they get isolated, and people do die because they've been exposed during the first death and during the burial or taking care of the individual, 01:37:00but it ends at the second wave. So you have your index case in the village and then you have seven people who die or eight people who die, but there's no further spread because they're pulled out. They're taken to the ETU. Some of them do survive. But it ends there. And for us, that's a success. There's no more cases. Half the village doesn't die because we've been able to isolate the sick individuals. But from the point of view of the villager, what happens from someone from that village. Someone dies, which is a normal occurrence. Even an adult does die from other causes. So that in and of itself is not an unusual occurrence. But then what happens? Well, MSF comes. The Ministry comes with a 01:38:00car--and these are places that don't get cars. There's no police there. They have very little interaction with the state, the actual government. For them, for people to go to this village in the middle of Gueckedou, is unusual. It's much more unusual than someone dying, actually. So for them, the first unusual event is the arrival of a 4x4 with, for example, a European there. And then, what do these people do? They come in and then they create a list of people. And then for the next three weeks, these people--they ask these people, they talk to these people: are you sick, are you sick? Four or five of these people end up becoming sick, and then what happens when they become sick? An ambulance comes and there's people dressed up with face masks and gowns--dressed very strangely. 01:39:00The people who are at that point not very sick--they've reported having a fever, that's it. They get wheeled out into this ambulance, they get sent to an ETU, and they come home in a body bag. So from the point of view of the--if you look at the chronology from the point of view of someone from that village, it's very, very logical to think that the arrival of the WHO Ebola team is what caused these people to die. It took me a while, I think, to wrap my head around that. But for them--for people who haven't been exposed to the germ theory since they were kids, it's a leap of faith to accept that there is this invisible 01:40:00thing that is causing people to die. Whereas it's almost more logical to think well, actually, it could be this car that has never come before but now is coming, and then all these people die, and then you hear of the same thing happening in other villages. The conditions are there. They are very conducive to the spread of these kinds of rumors. It's very fertile ground for that.

Q: And you had said that some people link it directly with the exhaust that was coming from the cars?

PLUCINSKI: Yes. That was the prevailing rumor when I was there, which is that the cars, when they would drive in, would release the virus or Ebola through the exhaust. Again, the timing from the point of view of the villager, it makes 01:41:00sense. One person dies. A few days later, the car comes. There's all this exhaust, and the car comes every day because you're doing contact tracing so you get a lot of cars. Whereas, you might not have seen a car for the last three years coming into the village, but all of a sudden, you have this fancy car, and then people start dying and being taken away. Then, even when you get the body back, you're told, you can't actually see the body. You can't touch the body. Especially in these areas, they have these elaborate funeral rituals, which was from what I understand a large part of their culture. Being told that you can't do that is also unfortunate. So I think from their point of view, it's a perfectly logical response to respond in that way. But it took me a while to 01:42:00come to terms with that.

Anyway, a few of these things happened all at once. There was the case out of Botema where we discovered the new source of transmission. Then there was this case of community resistance. Basically, literally in the last few days before Mary and I left Gueckedou, there was a case of someone who tested positive in Gueckedou but had clearly come from Sierra Leone and had seen sick people in Sierra Leone, which was really one of the first indications that there was 01:43:00transmission in Sierra Leone and had been for a long time. All of a sudden, like out of Botema, Botema added ten cases to the total or something like that. At that point, the cases were in the low hundreds maybe. There had not been that many cases. Identification of a new transmission chain completely threw people out of sorts, and Gueckedou, which we thought had been under control, was clearly anything but. Around the same time, so Mary and I drove back to Conakry, and by the time we got to Conakry, there had been new cases detected in Telimele, which is a prefecture that had never had any cases before. They were 01:44:00able to be linked to cases out of Conakry. There were cases being discovered in Conakry. At that point, Conakry had supposedly been declared Ebola-free, which it clearly was not, and there was this large family that was implicated in the Telimele cases, which had obviously been hiding Ebola cases for a long time. Basically, there was a very strong sense that things were completely out of control, at least in my mind. I remember one of the last things that Mary and I 01:45:00did was we attended one of the early morning status meetings at WHO, and the head of the WHO response there at the time was a gentleman from Burundi--very, very smart and competent. I remember him clearly stating, "This is completely out of control." He was like, "I've talked to Geneva, and this is an emergency and there's no way we're anywhere close to controlling this." Because all of these things had happened at once, like Gueckedou had basically realized we had a ton of transmission that we had not been able to account for. Conakry had turned out to have never had a stop in transmission, just that we had stopped 01:46:00detecting cases. They were spread to Telimele, to new prefectures. It all happened in the span of a few days, and I remember--I want to say it was Jean Bosco saying, "This is an emergency." But Mary and I left the next day. And we were the last CDC people in-country. When we left, there was no more CDC presence, and it took surprisingly long for the rest of the global health community to realize how out of control things were. But for me, leaving Conakry 01:47:00back to the US, it was clear that things were just nowhere close to being under control.

Q: Did you feel the need to communicate to others in CDC that maybe CDC should commit more resources then?

PLUCINSKI: Yeah, I remember when Mary and I came back, we met with the Viral Special Pathogens folks and explained everything, and they understood. I remember having a map in front of us and just kind of plotting out where things were, and just the fact that there were these completely undetected chains of transmission. And again, the mantra of Ebola control was that as long as you 01:48:00know where transmission is occurring, you can stop it, right? But the moment that you uncover long chains of transmission that you can't link to any other chains, it means that there was a lot of stuff that was going undetected. While Ebola can kind of burn itself out in a rural setting, it's not going to do that in an urban setting. And West Africa, I mean, Guinea is very connected. The villages are close together. Travel is easy and there's a lot of travel. I don't think anyone really thought that it would just burn itself out without intervention.

Q: I've kept you talking for quite a while now. Do you feel like maybe you'd like to stop for today and then pick up later? Because if you're available, I'd like to keep talking. If not today, then some day in the future.

PLUCINSKI: Okay.

END