Tuesday, August 19, 2014

Ebola: The World's Response...

While sitting in The Netherlands after needing to leave Sierra Leone just over a week ago, I am not only pondering when and how I can go back to support the fight against Ebola but I am also reflecting on what the world's response is and should or could be during this current outbreak. Yes, there has been some response from leaders world wide, but is it adequate and appropriate?  Recent articles from The Guardian and New York times state that not enough is being done. Who should respond and what should that response look like?

In the initial phase of this outbreak, I think the disease could (should) have been contained and dealt with by the governments of the West African nations, with strategic support from experienced agencies such as MSF (Doctors without Borders), CDC (Center for Disease Control), Public Health England/Canada and the WHO (World Health Organisation). There are so many factors that have contributed to the fact that the situation is now out of control. I personally feel that more could have been done. Sierra Leone, for example, could have shut the borders to Guinea and Liberia immediately, districts such as Kailahun (and Kenema) could have been quarantined in a very early stage of the outbreak, training of health care staff and mobilisation of resources throughout the country could have been completed prior to the spread of the disease, enhanced security could have been enforced at isolation and treatment centres and a state of Emergency could have been declared weeks before it was. But this did not happen. Some of these measures have since been put in place, but is it too late?

Now, due to a variety of reasons, we have an outbreak, with 783 confirmed cases in Sierra Leone as of the 19th of August (MOHS statistics), that is seemingly impossible to contain. I do not think that the governments can solely be blamed for this, the behaviour of citizens has definitely played a role as well. 

Based on past experiences, many Sierra Leonean citizens did not trust the government or health care workers at the start of the outbreak leading to both a disbelief in the existence of Ebola and a lack of cooperation with health care professionals and government officials. This meant that high-risk cultural practices (such as washing bodies before a burial) continued to take place, confirmed cases escaped treatment centres or were pulled out by their relatives, patients were hidden in their homes and contacts of cases did not come forward. 

Various conspiracy theories concerning the origin of the outbreak added fuel to the level of distrust. Some people believed that Ebola was a way for the governing party to wipe out those in favor of the opposition party (the districts in the East). Others believed it was just another way for the government to gain foreign aid; a way for the rich to get richer with the thought "more cases = more aid". Some believed that the 'white man' introduced Ebola to wipe out Africans or to come and test their drugs. Some thought that health care workers were injecting people with Ebola. There are so many theories that have made it difficult to deal with this outbreak quickly. Rumors of remedies such as bathing in salt water or drinking special water sent by a Nigerian pastor have also compounded the matter.

Now, I think most people believe that Ebola is real. But are people informed enough? Do they realize the scope of the problem? Do people know what to do or not to do? Is the fear of Ebola going to keep sick people at home? 

People are afraid that if they go to a health facility they may contract Ebola from a doctor or nurse. Even for those that want to access health care, the situation has worsened to the extent that the health care system has basically collapsed. Due to fear of contracting the disease from patients or lack of protective equipment or colleagues succumbing to the disease, many health care workers are too afraid to work. Some hospitals are refusing new admissions and have basically shut down. What does that mean for someone with a fever seeking medical care? They may be turned away at the health facilities and forced to self treat at home for disease such as malaria or pneumonia. They may or may not get better. They may die at home of Ebola, meanwhile infecting their family members. People are afraid that if they have a fever and go to a hospital, they will be isolated immediately and be tested for Ebola. They fear they may be isolated with other people that may be positive for Ebola and they might even catch Ebola while waiting in an isolation unit. They are afraid that if they are positive they will be taken to a treatment centre, which for many, is seen as a death sentence. These are all realistic fears that need to be addressed.

The ripple effects of the outbreak include a collapse of the already fragile health care system leading to more men, women and children dying at home from preventable and treatable diseases. The outbreak has temporarily suspended formal educational systems and will have serious economic impacts as well, with a loss of trade, less investments and reduction in farming.  Fears now are that people may struggle to find food and that the risk of starvation may surface.

It is obviously time for a global response. International support is crucial. Governments from around the world need to work hand-in-hand with the governments of West Africa. Global leaders are needed to help with decision making on solutions to overcome this outbreak. 

However, according to The Guardian, "The international community has made "almost zero" response to the Ebola outbreak in west Africa, with western leaders more interested in protecting their own countries than helping contain the crisis that has now claimed more than 1,200 lives, a senior international aid worker said on Tuesday. "Leaders in the west are talking about their own safety and doing things like closing airlines – and not helping anyone else."

Is that the response the World is ready to offer? Or will they look beyond their borders and realize that their response needs to be directed to what is happening on the ground in West Africa? 

The operations director of MSF (Doctors without Borders) states that "the solution is not that complicated but we need to have political will to do so. Time is running against us. But you need very senior people with high profiles, the kind of people who can co-ordinate a response to a million people affected by an earthquake," he said. He also said containing Ebola was "not rocket science" identifying "contact tracing" and public communications as the key factors.

Can the world deliver this? I hope so because otherwise this fight seems very hopeless. 

Practically speaking, more doctors and nurses are needed to run treatment centres and isolation units across the country. There simply are not enough medical professionals in country to deal with this situation. Mobilisation of resources are needed to make sure that every health facility has the PPE (Personal Protective Equipment) they need - full PPE suits for isolation and treatment centres, and enough protective gear (gloves, aprons, masks, eye protection) on the wards of every hospital and health centre to enhance infection control measures. Training is needed to ensure that people use the protective equipment appropriately and do not infect themselves when taking it off for example.  People are needed on the ground to support contact tracing and surveillance systems. People are needed to go from house to house to follow up on those who have been in contact with Ebola patients. Coordination is needed to support all of these efforts. Communication needs to be effective. Unless this happens, the disease will continue to spread. It's time to work together, it's time for a global response. 

Dr. Liu, President of MSF said that "no matter how many patients her organisation treats, the outbreak will not end until other agencies can halt the progression of new infections."

This is a call for help from West Africa to the rest of the world. This is a please for individuals, organisations and governments to join the fight to end this outbreak. Who will step in?

Quotes taken from: 

1 comment:

Marcus said...

Hi Sandra, I'm an American ER Nurse and I've had the pleasure of working with your Mom and Dad in Haiti and in the Phillipians. I've long had a desire to volunteer and serve in Africa. When you do return to Sierra Leona, and if you need a volunteer nurse for 1-3 months I would love to volunteer at your clinic! Feel free to contact me anytime!
Marcus Bouma RN

~ Act Justly. Love Mercy. Walk Humbly. micah 6:8 ~