Wednesday, October 8, 2014

Ebola Panel: Action Now and in the Future

On her way out of the medical auditorium, Dr. Christiana Hena taught us the Liberian handshake. As you pull your hand away, you snap your finger against the other persons. But now in Liberia, people don’t shake hands like that anymore. They give each other a thumbs up. The reason: Ebola.

Today’s panel discussion allowed us a more intimate understanding of the effects the viral epidemic has inflicted upon West Africa over the course of a few short months, beyond the commonly cited numbers in the media. The loss of intimacy in everyday life cannot be as easily quantified as mortality statistics.

As Dr. Hena and the other panelists spoke (virologists, a WHO consultant and two anthropologists), they opened up how the epidemic is not merely an isolated outbreak. It has roots not only in the civil war that devastated the nation over a decade ago, destroying 242 of the 290 health centers, but also in the policies that have resulted in the inadequate restoration.

The problem has not been lack of international investment in health in Liberia, Sierra Leone and Guinea, explained anthropologist Dr. China Scherz. Rather, money poured into projects and vertical pharmaceuticals, instead of building basic infrastructure and education, has not lead to sustainable solutions.

In the region where Dr. Hena works, for example, there were only three physicians for 200,000 people at the time the epidemic began. In July, clinics were closed, and nurses took it upon themselves to care for patients. Thirteen without access to proper PPE equipment died.

Meanwhile, ex-patriots and NGOs fled. While no one could fault them as individuals, the gaps they left at all levels of basic service delivery show the problems in failing to train capable local individuals.
At the moment, resources must be aimed to contain the unimaginable disaster and develop therapies. Drs. Frederick Hayden and Judith White explored the current therapeutic and prophylactic options under development, explaining the molecular basis for the Zmapp, siRNAs and experimental vaccines under development.

The panel left me reflecting on the conditions that allowed the Ebola epidemic to develop. As Dr. Christina Hena said, the national and international organizations should have known this would happen in a country with fragile health infrastructure. In March, when the first cases were reported, nobody did anything. March went by. Then April, and nobody did anything, except Ebola songs ( ) started coming out and people danced to them. Because they didn’t know what Ebola was, so they danced to the music.

Given the delayed response, absence of health care and witnessing horrific consequences of the disease, it is hardly surprising that the public do not trust those who come in the “space suits” to provide them aid. Rather than blaming people for eating bush meat or their funeral practices, perhaps the better question is what public health practices have led people to not trust those who come to help at this late hour.

I cannot help to think what the implications will be even in the best-case scenario. The few hospitals there are empty, many health workers have died, schools are out and the social fabric made up of handshakes, hugs and family closeness have dissolved. Chronic health conditions and mental health sequela of the epidemic are unlikely to be resolved in the short-term. These all lead us to question how public health is carried out and how such enormous disasters may be prevented.

For now though, the escalating emergency calls for the investment of health care resources. During the session, the question was posed as to when UVA can return to West Africa. Pethreree Norman, a Liberian nurse and student here at UVA, had a response. UVA does not have to leave West Africa, but can participate in the efforts through fundraising. She has already collected 1705 dollars and 2000 units of medical supplies to send to Liberia. Your donation will help alleviate shipping costs to the organization Aid for Ebola Liberia.

You can contribute at: Now is the time to stop this epidemic from devastating the lives of the thousands it continues to kill, 40% of which have died in the last 21 days.

But at the same time as we contribute in solidarity, the panelists urge us not forget about Liberia, Sierra Leone and Guinea once Ebola is out of the news. The solutions of empowerment and capacity building they offered are relevant in all of global health. If we do not want a next disaster, we need to fix the way we do public health.

1 comment:

  1. This was such an amazing event. Having worked in Kenema District, Sierra Leone over the last 18 months, much of what Dr. Hena discussed is very real in Salone too. To add to the richness in this post, I would like to share some articles:
    There’s was a GREAT article written about this in Newsweek a month ago… it did a good job highlighting the community impact on all levels…

    I read an article recently that it is spreading so fast in the city of Makeni ( and they weren't at all prepared to handle it. I don't know if there's a way to have more deploy-able resources, human and material.
    Another article ( discusses the corruption, politics, ridiculous nature of government bureaucracy that is halting/slowing the most basic control measures and resources. I don't know what can be done on this front.