For many years Global Health initiatives have been focused on stopping the spread of HIV and AIDS or eradicating ancient diseases like Malaria. However, the recent Ebola outbreak in West Africa has severely tested the capacity of local and international health ageniess to treat their patients while protecting themselves from the onslaught of this deadly, but preventable disease. (View the Quartz interactive map to how this has spread so quickly).
In our last post "Wading through myths and facts of Ebola", we highlighted what was trending in the media that either terrified or mobilized people. In this post, we will explore the realities that are being faced in West Africa and its lasting impact on Global Health and International Development.
What we have learned so far, is that this six-month siege of the Ebola hemorrhagic fever has devastated entire families and rural villages. It has strained the economies of the three West African Nations--Guinea, Liberia, and Sierra Leone--to where impoverished people are forced to buy food and necessary supplies at inflated prices. It has also halted the progress of NGOs like ours. We all have had to shift our focus to awareness campaigns in order to protect our national teams and the communities we serve.
Now lets look at how Ebola is a game changer for Global Health? This was bluntly and succinctly expressed in the recent CSPAN video recording of Ken Isaacs, Vice President of Programs and Government Relations for Samaritan's Purse, as he testifies before the House Foreign Affairs Subcommittee. (Also read his New York Times Op Ed "Why Are We Ignoring a New Ebola Outbreak?" from July 24).
Here are the key facts and realities from his testimony that explains why this unprecedented epidemic has occurred and why more help is needed.
1) International Response Failure: he cited only two medical aid agencies--Samaritan Purse and Médecins Sans Frontières/Doctors Without Borders (MSF)--were on the front lines of this epidemic in the three bordering nations. While prominent agencies like World Health Organization (WHO) were stating things were under control for the last few months, MSF was stressing the opposite and pleading for more help and supplies. Recently the WHO has changed their stance by stating that "the West Africa's Ebola epidemic is an 'extraordinary event' and now constitutes an international health risk." (Read press release "Ebola: Official MSF response to WHO declaring epidemic an 'extraordinary event'" by Dr Bart Janssens, MSF Director of Operations, from August 14).
2) Unprepared Community Health Worker: one of the strategies of providing needed medical treatment of common diseases like Malaria and Typhoid, was to recruit and train local people to deal with basic and common ailments. These are moderately educated people, who were provided with some medical supplies and instructions on what medicine should be administered for what sickness or condition. Sadly these community health workers had no idea what Ebola was and were treating patients for what they thought were other illnesses such as Malaria that have similar symptoms. Many of these workers have contracted and died from Ebola, because they were uninformed of this rare and contagious disease. (Read a Thomson Reuters article "Ebola outbreak: High death toll among health worker 1st responders" posted in CBC News on August 9).
3) Stigma of the International Healthcare Worker: This is an issue on both sides of the spectrum. On one side, many of the MSF teams working in remote areas have been threatened by villagers with knives and stones believing the doctors are the cause of this disease. On the other side, Ken Isaacs testified the recently evacuated teams from Sanitarian Purse have struggled with returning home in their respective nations, because their families are unsure to hug them while others in the community have ostracized them.
4) No Mass Evacuations of Infected U.S. Citizens or International Workers: Ken in his testimony shared how he "recognized during the evacuation of our staff that there is only one airplane in the world with one chamber to carry a level 4 pathogenic disease victim." He was not able to know of any other plane except for this one in the U.S. So this greatly limits the U.S. capacity or any other country to do a mass evacuation of its citizens have been infected. (Read Mashable's article "The Obscure Airline That Evacuated the American Ebola Patients" from August 9).
5) The Cost of Corruption: The local healthcare workers have struggled in this fight, especially when their own needs to survive have been endangered. Ken testified that "I know for a fact that in Foya, the second largest center where Ebola is manifesting in Liberia, the workers at the Ministry Health clinic were not paid for five months even after the European Union had put money for it. The money just did not get downstream."
6) Lack of Understanding at All Levels of Society: A major obstacle has been sensitizing the general population of what Ebola is and how it is transmitted, especially when trying to get people to stop certain cultural rituals. A major one is washing the body in preparation for the funeral, which is when it is most infected. Another concern was how well-educated and highly credentialed people in medical and government positions openly denied the seriousness of this disease and mocked the work of organizations like Samaritan Purse as cited in Ken's testimony. This led to the deaths of two prominent people in Liberia who believed this was not real.
There are two more things that I like to add to this growing problem that need attention:
7) Inequality: It was decided recently that all the Peace Corp Workers in Guinea, Liberia and Sierra Leone must be evacuated as a cautionary preventative as efforts are made to contain this disease. Sara Laskowski working in Guinea wrote a powerful blog post about how the Peace Corp evacuations put western privilege at center stage during this epic medical mayhem in West Africa. She shares how she has been living with her host family since the outbreak started. The Peace Corp setup awareness campaigns for their volunteers and the community they served that has helped minimize the impact of Ebola. As she was preparing to leave, she felt the unsettling pain of knowing that her life can be easily saved by moving her out of the affected area while leaving her community behind who are not afforded the same opportunity.
She could see that the problem did not need to persist, but was instead intensified by stating: "Unfortunately, this outbreak has been severely mismanaged on two ends. Primarily, the Guinean government is not equipped to handle it but more tragically the Western world has chosen to feed the fire with sensationalized media instead of what we really need here in Guinea, Sierra Leone and Liberia – medical assistance, man-power, education, and funding."
8) Little to No Trauma Counseling: From the families to the health workers, they have witnessed the carnage of this disease on patients young and old. Many die from massive uncontrollable bleeding and other horrific ways that will haunt the surviving family members and the healthcare workers administering their care. It seems that there has been little to no attention on what aftercare is given to these people such as trauma counseling. The emotions and spirits of everyone is very much strained and without any supportive care, how will these people cope and manage with what they have seen and endured.
In listening to Ken Isaacs testimony several times and reading the reports about Ebola from MSF and other prominent medical organizations, I continue to learn more about how this disease can lead to global concern. According to the WHO Fact Sheet, Ebola has an incubation period of up to 21 days before its contagious symptoms emerge. Also, for men who recover from this disease, they still carry the virus in their semen for up to seven weeks. So with more people being able to travel around the world, the chances of this infecting other communities is much greater than previous outbreaks. This why some airlines have suspended service to this affected region while others have introduced screening for fevers and other notable symptoms.
Ebola definitely has uncovered gaps in how international aid organizations have operated and also strengthened the need for better education, sanitation and water systems, and healthcare as means to end poverty thus reducing such epidemics. This is why it is important for both Global Health organizations and other international NGOs to re-evaluate their programs and strategies to ensure that they are able to effectively serve and protect their communities to minimize the impacts of what Ebola has done in West Africa.