Nurse Rina Kumari, 26, is the only one who's heard of Ebola among six nurses at Dhanarua Primary Health Centre (PHC) in the outskirts of Patna in Bihar. She takes a while to place the word 'Ebola', but when I prompt her with 'virus', she says, "yes, yes, I know. It's a deadly disease that is killing everyone in Africa."
Her source of information is television. The word 'Ebola' has never been mentioned at Dhanarua PHC, which is part of India's frontline health delivery system. The older nurses haven't heard of it because they spend less time watching television.
Kumari hasn't bothered to find out more. She's busy delivering 5-10 babies a day at the six bedded PHC. For her, an virus in Africa is as alien as the little green man on Mars.
Her boss, Dr Uday Pratap Narain Singh, PHC head and joint secretary of the Bihar Health Services Association, is better informed, but not worried. "Yes, we've got some information from the Centre, but the virus hasn't come to Bihar," he says.
His reaction pretty much sums up preparedness outside India's half a dozen metros. "We'll deal with it when it reaches us. And till it does, it's not my problem. I have enough of my own."
Given Bihar's disease burden and high fertility rate -- the average number of children a woman has in her lifetime -- of 3.6, Singh and his team have their hands full with births, infections and vaccinations. Which is what makes it vital to keep frontline doctors and health workers like him informed.
For if an infected passenger slips through airport screening and surveillance, it will be the Kumaris and Singhs in the healthcare service who will be expected to battle the infection with rubber gloves and soap for protection. And by the time the cavalry arrives from New Delhi with hazmat suits and diagnostic kits, the infection would have spiralled out of control.
If nothing is done, a person with Ebola typically infects about two more people, so tracking people who've been in contact with an infected person and isolating them the moment they develop symptoms that begin with fatigue, fever and headache -- people becomes infectious only after symptoms begin -- is the only way to stop it. Ebola has infected 523 healthcare workers and killed 269, so establishing airtight medical protocols is equally vital.
The West Africa outbreak is believed to have begun in December last year, when a two year old boy died of a mysteries illness in Guinea, but it wasn't till March 22 that the disease was identified as Ebola. By then, 50 people had died.
Since then, Ebola has infected 13,567 and killed 4,951 in eight counties, with only Nigeria and Senegal being declared Ebola-free after they did not have any new cases in 42 days -- twice the incubation period for the virus.
What stopped the virus in Nigeria, Africa's most populous country with 174 million people, and Senegal, one of Africa's poorest countries was systematic tracing, isolating and treating the patients and all their close contacts in isolation wards to stop spread of infection. What also worked in Nigeria were intense awareness campaigns -- quite like India's Pulse Polio campaigns -- that included using hoardings, radio and television spots, text messaging and house-to-house calls.
Till there's a vaccine, what we know for sure is that treatment works. People dying of Ebola virus disease have plummeted from 90% of those infected at the beginning of the outbreak to 35%. This means that symptoms management is now saving the lives of two in three patients, instead of one in 10 just six months ago.
India has its contingency plan ready. Passengers from West Africa are being screened and tracked, isolation wards have been set up in designated hospitals, rapid response teams from each state have been trained, Biosafety levels 3 and 2 laboratories have been identified for diagnosis, but the tracking plan still depends on infected persons reporting symptoms to designated hospitals. If they inadvertently fail to do so -- as they did in the H1N1 'swine flu' outbreak -- the virus will create havoc in populations where 'mystery diseases' are more common than two meals a day.