Last week I attended a conference where the Ebola outbreak was covered by addressing rapid needs assessments and identification of potential cases, the effect of Ebola on Health Workers, lessons learnt from the Ebola outbreak, hazard vulnerability assessments to prioritize treatment, electronic data management during Ebola, flying patients with Ebola, isolation during an Ebola outbreak, mass gatherings and Ebola, the thermal burden of Ebola and a qualitative analysis mapping the intervention efforts.
Approximately 11 000 people died from this highly virulent virus making this the largest outbreak recorded. Hardest hit was Liberia, Sierra Leone and Guinea and in these three country’s hundreds of people was dying per week in late 2014. Ebola devastated their frail health and economic systems. The first cases was reported in late 2013 with the media interest peaking August 2014 when two Americans became infected (WHO report), and in September 2014 there was still no coordinated global response.
I noted two things during the presentations:
Who is talking about Ebola?
The program revealed that of the fourteen Ebola talks; seven was conducted by USA researchers, three European (Sweden, Switzerland and Italy), two Australian, and two African (South Africa and Zambia).
The Health Workers from the country’s most severely affected by Ebola had no presentations and no mention was made about initial progression, the realisation that it’s Ebola, early available resources, how the communities learned about Ebola, setting up the first isolation units and so forth.
The WHO has acknowledged that the formal global response to Ebola was delayed. In resource poor settings local systems are easily overwhelmed making early international support imperative. The delayed response means that Guinea, Liberia and Sierra Leone struggled to contain Ebola for months prior to coordinated global support. Prior to the outbreak Liberia had 51 Doctors, 978 Nurses and Midwives (ratio of 0.1 doctors per 10 000 population). How many is left? Their healthcare workforce faced unimaginable adversity attempting to contain the disease whilst lacking basic infrastructure, equipment, supplies and personal protective gear. How about hearing their stories, lessons learnt and their ideas on how to prevent a next time.
According to reports the Ebola outbreak lead to unprecedented levels of funding for research. Why was no research presented by the Healthcare workers that faced the hardest challenges? I’m assuming a few reasons to be:
- Lack of funding for local researchers, especially during the early phases
- Lack of human resources, all hands on deck to deliver clinical care
- Lack of public health experts and epidemiologists in Africa
- Lack of virologists or facilities to isolate and research the virus
Media reports are not objective or unbiased enough to make deductions so can we trust their reports that local research facilities in the affected countries was unable to secure research grants for the disease? Based on who were talking about Ebola, a question is: are these media reports true and was the local research input disregarded and unsupported by major international funders?
Economic impact on access to care
The economic burden created by the outbreak has a direct impact on the access to basic health care. Considerations that are worth mentioning include:
- The World Bank estimates that the three countries most affected will lose 1.6 Billion Dollars income and more than 12 % of their combined income.
- According to the Agricultural Ministry of Sierra Leone, their economy has suffered a 30% deflation
- The impact of imposed restrictions and border closures had a dire impact on international and regional trade, including cross-border trade that accounts between 20 – 75% of the GDP in West Africa.
- The outbreaks occurred over two planting seasons affecting crops produced, this will drive the price and inflation
- Schools closed and scholars lost six months’ of schooling. It is believed that some will not return to school as they are now sole breadwinners
- People with other healthcare problems stopped attending clinics for important preventative concerns such as vaccinations against Measles (still a bigger killer than Ebola) and Cholera. Not attending clinics due to fear of contracting Ebola are predicted to affect infant and maternal mortality rates.
- There was an outflow of foreign worker taking their expertise with them in industries such as mining.
Government expenditure on healthcare rose dramatically during the early phase and none of these economies are resilient enough to buffer this and recuperate losses. Attempts are likely to directly impact on the cost of living and thus direct and indirect costs to access care.
Obtaining funding for research can be difficult and time-consuming. Perhaps as part of disease outbreak preparedness there should be some preparedness for research, enabling the capturing of “early” data prior to international response. I have no idea if that would be feasible. Many of these healthcare workers died, and we need to hear the survivor’s stories to prevent future outbreaks in the vulnerable populations of the developing world.
The WHO states that countries with weak health systems and few basic need infrastructures are unable to withstand sudden outbreaks. A question should be asked, how sudden is sudden? Was it really sudden? Or was it ignored until it spread outside of Africa?
And as the world’s attention is gravitating away to “newer” disasters, West Africa and it’s vulnerabilities should not be forgotten.
MSF 2014 Ebola report: www.msf.org
www.worldbank.org (World development indicators: health systems)
http://news.sl/drwebsite/publish/article_200527522.shtml Keynote address by Sierra Leone’s, Deputy Minister of Health and Sanitation on Malaria day 25/04/2015