Is Ebola a Game Changer for Global Health?


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.

Liberia’s Endangered Free Pediatric Healthcare Facilities

Since July 16, 2009, I have visited Island Pediatric Hospital in Duala three times to attend to the needs of a special child who was sexually assaulted. This hospital located in the northern community of Monrovia provides free healthcare services to children for burns, sexual assault, treatment of regional diseases, and other major or minor medical care needs. It is one of two pediatric and obstetrics specialized hospitals within the Monrovia area that are operated by Médecins Sans Frontières (MSF). These lifesaving facilities are endangered of closing their doors to impoverished children as MSF will cease their commitment at the end of 2009. MSF had announced early 2008 that they will transfer the responsibility to the Liberia government at the end of 2009.

Is this post-war, financially strapped government ready for such a task while it continues to struggle in providing sustainable services to over two-thirds of its population living in extreme poverty? Well, the answer is doubtful on whether they can provide the same level of care or even keep the doors open for the next few years.

MSF, an international disaster emergency relief non-governmental organization, has operated in Liberia since 1990. It has been providing healthcare services during the civil war and the first stage of the post-war recovery process. MSF/Belgium (MSF-B) has supported Island hospital since late 2002, first as an annex to the public Redemption Hospital and from March 2006, as a private children’s hospital. Also in Monrovia, MSF-B supports two primary health clinics in New Kru Town and Clara Town (both in Monrovia on Bushrod Island) which provide vaccinations, family planning, ante and post natal care, 24 hour delivery rooms and medical care for survivors of sexual violence. MSF Spain/Switzerland supports the pediatric ward at Benson Hospital in Monrovia and also provides maternity care and obstetric surgery as well as treatment for survivors of sexual violence at the hospital. In Saclapea in Nimba County, MSF supports a health centre providing both outpatient and inpatient services (Speech).”

The MSF facilities provide 80% of the pediatric healthcare in Monrovia. Island and Benson Pediatric Hospitals admit nearly 1,500 children per month and with their two clinics, they administer care to over 13,000 patients per month. In 2007, for instance, Island Hospital admitted 12,655 patients, an increase rate of more than 100% to the previous year. This demands for free inpatient medical care is much greater than the supply of available beds. Since 2007, the two hospitals have increased the number of beds to a combine total of 181; however, the occupancy rate is at 125% (Speech).

The free services provided by MSF hospitals for Monrovia’s growing impoverished community have saved numerous lives and ensured the physical and mental care of traumatized victims. In fact, during 2008, MSF recorded 11,700 first visits for natal care with 8,340 pregnant women test for HIV and 326 tested positive; 3,909 babies were delivered with no maternal death[1]; 9,100 first visits for family planning; 22,000 children were immunized for Pentavalent[2] vaccination; and 770 sexual assault victims received medical care and trauma counseling (Liberia). These statistics only give a small glimpse of the need for free healthcare services to children and pregnant women who are unable to afford medical care by government-owned or private-owned hospitals.

From my three visits to Island Pediatric Hospital I have witnessed attentive and quality care for children of all ages. The one concern that did not appear in the statistics above is the number of children who have been severely burned. As I have waited in the hallways of this hospital I have been overwhelmed by the number of small children who have first degree burns covering most of their bodies. During my last visit on August 7, one preschool-age boy, whose face was badly burned and his two small hands were wrapped in badges most likely missing fingers, came over to me to say “Hi.” As I held back my tears looking at this sweet boy’s face, I extended my greeting to him, and he smiled as he walked away. There is more to be shared about these special children about the cause for their burns, but that will be in later post.

It was during my last visit in August that I asked some of the staff at Island Hospital if the government was ready to take over the responsibility for their hospital. Their response was no. Their only hope right now is that government negotiates an extension to MSF’s commitment. So, if the government is unable to provide the same level of financial support as MSF, these remaining hospitals are in danger of having their doors forever closed putting more children lives at risk.

Liberia is a nation that is slowly recovering from a destructive 14-year of war, and one of the main casualties was its medical care facilities. So by losing these two pediatric hospitals that have provided free quality medical care to children living in extreme poverty would be a major catastrophe. From my own personal experience at Island Hospital, I would hate to see this place shut down because of inadequate support. Unfortunately, the fate of these endangered facilities is unknown. Therefore, I have written this post to alert those who are concerned with Liberia and the future well-being of its children in hopes that these two hospitals can be removed from the endangered list.

Notes:

[1] According to the Liberia Demographic and Health Survey conducted in 2007 it showed that there has been an increase to the already unacceptably high maternal mortality rate during period of 1987 to 2007. The rate in 1987 was 578 per 100,000 live births compared to 774 in 2000 and 994 in 2007. The rate in 2000 is estimated to be higher based on the Ministry of Health and Social Welfare’s inpatient mortality statistics showing 1,370 per 100,000 births (Liberia’s Progress Towards the Millennium Development Goals 2008).

[2] Pentavalent is a multi-dose vaccine consisting of the following 5 vaccines: Diphtheria, Tetanus Toxoid, Pertussis, Hepatitis B, and Haemophilus Influenza (Hib).

Works Cited:

Liberia: UNMIL Humanitarian Situation Report No. 163. United Nations Mission in Liberia (UNMIL). 11 Apr 2009. 17 Jul 2009. http://www.reliefweb.int/rw/rwb.nsf/db900sid/pslg-7r4j2p?opendocument

Liberia’s Progress Towards the Millennium Development Goals 2008. United Nations Development Fund and Republic of Liberia. 2008. 09 Jun 2009. www.lr.undp.org/documents/…/liberia-mdg-report-2008-small.pdf

Speech for President Ellen Johnson Serleaf’s visit. The Analyst. 22 Mar 2008. 17 Jul 2009. http://www.analystliberia.com/msf_speech_for_ellen_visit_mar24_08.html