“Shut out of modernity, they have been left on their own.”
Earlier this month, Paul Farmer, founder of Partners in Health (PIH) addressed a group of close to 100 leaders from the public, private, and social sectors, representing organizations that included UPS, General Electric, Western Union, the State Department, the Centers for Disease Control, USAID, and the White House Office of Ebola Response, in addition to nonprofit organizations like Points of Light, PSI, PYXERA Global, and International Medical Corps (IMC). The crowd gathered before him were all committed to finding ways to better coordinate the web of response to the Ebola pandemic, and to align resources and investments to attempt to improve health delivery systems to ensure that such an outbreak does not happen again in the future.
In closing, he stated his hope for what lies ahead. “I am full of optimism about how we are going to turn this around.”
To do so requires clarifying the reality of the challenge facing the wide array of partners and health professionals responding to the crisis. As someone not very connected to the pandemic except as an average American consumer, I found that the day’s speakers provided eight clarifying lessons about the reality on the ground and what you can do to help.
1. People are dying from shock more than the disease
Farmer, one of the greatest public health defenders and practitioners of all time, flew all the way from Sierra Leone the day before to provide the convening’s opening keynote address. Seeking to provide those attending with a clinician’s perspective on the disease, he emphasized that most people are not actually dying from Ebola, but from the inability of local health systems to appropriately treat people for the physical shock they experience when the disease begins to advance. In the United States, for example, Ebola survival rates are high because our strong health systems allow people to be diagnosed quickly and with relative ease. In the more rural areas of Liberia, Guinea, and Sierra Leone, the ability to provide even basic treatment—like a saline IV or a climate-controlled hospital bed—is far more limited. In Liberia, less than one percent of the population has access to electricity.
Dedicated aid workers have been fighting the outbreak with limited supplies for more than five months. Photo credit: European Commission DG ECHO
Farmer summarized this problem perfectly: “These are people dying of untreated shock. That means it’s a supply chain problem.”
Yet, the fatality rates in those who contract the disease continue to contribute to the perception that the disease represents the kiss of death. Poor infrastructure is increasing the virus’s fatality more than the deadliness of the disease itself.
2, More people will die from Ebola than of Ebola
In countries where basic health service provision was already limited, the Ebola pandemic has destroyed health infrastructure in Liberia, Guinea, and Sierra Leone. Many more women and infants will die during childbirth due to hospital’s inability to treat regular patients, because they are so overwhelmed with the challenge of responding to the pandemic.
Aerial photograph of the Kerry Town Ebola Treatment Centre in Sierra Leone. Photo credit: DFID UK Department for International Development
According to the Disasters Emergency Committee based in the United Kingdom, “one in seven women could die during childbirth in the West African countries most impacted by the Ebola crisis.” While Ebola Treatment Units (known on the ground as “ETUs”) are providing some support, there are not enough healthcare professionals to provide the amount of care for which there is demand, beyond the critical needs of those who are suffering from Ebola.
3.The average person sweats up to three pounds of water in a PPE
The Personal Protective Equipment (or PPEs) worn by health workers in the hot zone are air-tight, and most people cannot wear a PPE for longer than 40 minutes at a time. The suits are not designed for the hot and humid conditions of West Africa; in the suit, an individual can sweat up to three pounds of water, which pools in the bottom. Managing this effect means health workers have to be extremely careful about staying hydrated and not staying inside too long as removing a PPE from someone who has lost consciousness poses significant health risks to all involved. This simple fact speaks to the enormous stamina and determination required to be on the forefront of fighting this disease.
4. It takes 31 steps to remove a PPE
According to Dr. Lynn Black, an Associate Physician at Massachusetts General Hospital and the Chair of the Board of Last Mile Health, this is one of the most grueling and overlooked realities of providing direct patient care in the midst of the crisis. Not only is removing the suits a protocol-driven task, but there are people whose sole responsibility is coaching exhausted health workers (who have likely sweated out three pounds of water!) through this laborious process, directing their actions one step at a time.
As one of the Ebola epicenters, the district of Kailahun, in eastern Sierra Leone bordering Guinea, was put under quarantine at the beginning of August. Photo credit: European Commission DG ECHO
Video broadcast of the response to the outbreak often focuses on the process of donning PPEs, but rarely shows the doffing process, as it is known, when health workers face the greatest risk of exposure, and when their care and attention is most critical.
5. The Ebola outbreak has slowed Sierra Leone’s economy by 13 percent; six million children are out of school
Most of the coverage of the Ebola epidemic has been caught up with the immediate effects of the disease. Few media outlets are commenting on the dramatic effects this level of disruption is likely to have in countries directly affected by the disease. In Sierra Leone, the economy has contracted by 13 percent, from an 11 percent rate of growth in April 2014 to a two percent economic contraction in November. Such effects are significant and persistent. More than six million children will likely miss an entire year or more of schooling, which will affect their development and their ability to contribute economically later in life.
Children in the district of Kailahun, in eastern Sierra Leone. Photo credit: European Commission DG ECHO
6. Last week, Sierra Leone had more cases of Ebola than any other country
While the contagion seems to have stabilized in Liberia and Guinea, Sierra Leone continues to report new cases every day, and the government is concerned that the numbers may be underreported. Last week, the WHO reported 8,069 total cases had been reported.
7. An Ebola vaccine won’t end this pandemic
Many people and pundits have begun to speak anxiously about the need to develop and quickly vet an Ebola vaccine. But at the December 3 convening, most experts insisted that a vaccine would deliver only secondary benefits in responding to the current crisis. While a vaccine would contribute to containment within the countries already affected and might protect against future outbreak, it won’t help anyone currently infected by the disease. Instead, PPEs, gloves, single-use IV pumps, therapeutics, and stronger health systems are the resources needed to address and ultimately end the current outbreak. (Here’s a list of all the supplies the WHO is currently using to address the disease).
8. The best way for you to help
How you can help is best summarized in two words: generosity and grace.
Consider lending your computing power to the innovators seeking solutions to various aspects of the problem. You can sign up with IBM’s World Community Grid, and your computer or mobile device will help power scientific research on health, poverty, and sustainability.
As always, donations are critical to the success of the relief and rebuilding efforts. There are many organizations mobilizing to support those suffering as a result of Ebola, but here are two that stand out: Donate to Partners in Health, and help Paul Farmer’s efforts to strengthen health systems, or give to International Medical Corps, which is fielding a growing number of ETUs in Guinea, Liberia, and Sierra Leone.
Lastly, you can help overcome the horrible stereotypes that are affecting so many Africans from countries not affected by the disease. Recognize that on a continent of 54 countries, inhabited by 1.11 billion people, the Ebola pandemic is largely only affecting the 22 million people living in Sierra Leone, Guinea, and Liberia. During the December 3 event, some speakers reported incidence of people leaving taxis in the United States with Ethiopian or Nigerian drivers, for fear of “catching Ebola.” Help overcome these stereotypes and share the truth about this disease.
You can even start by sharing this article.
Feature photo credit: DFID UK Department for International Development
Alicia Bonner Ness
Alicia Bonner Ness (@AliciaBNess) is the editor of the The New Global Citizen, where she seeks to showcase the impact of beneficiaries and implementers alike, empowering all those engaged in furthering social good to learn from one another. She is also the Communications Manager at PYXERA Global.
