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Thursday, October 1, 2020

Ebola and the fragility of sub-Saharan health care systems

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The Ebola virus was first diagnosed in 1976 and has since made its impact felt on the African continent with sporadic bursts of virulence over the last four decades. These outbreaks, which have until now mainly been centered in East and Central Africa, have marked the virus out as one of the most deadly and feared communicable diseases on the continent.

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Its track record since its discovery in the mid-70s bears this out. With a fatality rate of nearly 90 percent once contracted and death via hemorrhagic (internal and external bleeding) fever, Ebola has struck fear into the hearts and minds of not just those who inhabit the tropics but of people all around the world.

You might think with an average death toll of a couple of hundred people or less anytime there is an outbreak wouldn’t be much of a cause for alarm among most people except for maybe hypochondriacs. However, you don’t have to be a hypochondriac for a disease like Ebola to cause a slight shiver to go down your spine. Apart from the very high mortality rate and the fact that there is no vaccine or cure for the disease, there is also the very nature of the disease itself. 

Ebola causes hemorrhagic fever that affects multiple organ systems in the body. Early symptoms include weakness, muscle pain, headaches and sore throat. Later this progresses to vomiting, diarrhea, impaired liver function and finally internal and external bleeding.

This to say the least is not an easy and pretty way to make your exit. No one wants to make their final exit while bleeding from all orifices and being totally dehydrated. This is compounded by the fact that there is no cure or vaccine to effectively combat the disease making an initial rapid spread of the virus inevitable. All this contributes to an atmosphere of fear and dread which, it would be fair to say, outweighs the actual impact of the disease on the wider society.

Ebola, which kills most patients within 10 days, and its variants like the Sudan virus and the Reston virus have never killed more than 280 people at a go. This has to do with the fact that the virus is usually easily contained because of the areas where outbreaks usually occur.

These are usually remote areas where communicable diseases like Ebola have a limited range in terms of their propensity to be passed on from one victim to the next. It’s a case you could say of the environment acting as a natural quarantine area where victims can be isolated from the rest of the population who are kept a safe distance from the virulent virus.

Unfortunately this is not the case with the current outbreak in the West African sub-region. Even though Ebola generally gestates in forest animals like bats and monkeys, these animals are eaten by various tribes around Africa as local delicacies. This permits the virus which is carried by these animals to enter the human population and in this case the human population infected by the virus, were not located in far off, isolated, heavily forested locations.  

These cases which were first reported in Guinea Conakry were located in areas that were close to congested urban areas and because the Ebola virus was not detected early enough this unfortunately enabled the disease to spread to the towns and cities before adequate containment measures could be put in place. The presence of the disease in urban areas, a new phenomenon, meant that it could now spread at a much more rapid rate than ever before because of the increased incidences of infected people coming in contact with other people who otherwise would never have contracted the disease if it were just restricted to forest areas.

This meant that Guinea Conakry served as an ideal jump off point for the virus to make inroads into the neighboring countries of Liberia and Sierra Leone and   eventually into Nigeria and Senegal. This and the fact that West African countries had never had to deal with the disease before has made the magnitude and scope of its spread unprecedented in the history of the Ebola virus.    

The number of infections and the death toll have exposed serious shortcomings in the health care systems of the West African nations that have been affected by the outbreak. Apart from Nigeria where the virus has been, to some extent, contained so far there has been almost an air of desperation to the way health services in Guinea Conakry, Liberia and Sierra Leone have sought to come to grips with the disease and its spread.

Ebola far from being the most communicable disease in the world is quite difficult to spread from one person to another. It is neither airborne nor waterborne and has to be spread through direct bodily contact and specifically through coming into contact with bodily fluids and secretions like sweat, blood, saliva and urine. However, because of a lack of awareness among ordinary people about how the disease is spread and what precautions should be taken, many individuals who should have been able to avoid contracting the disease have been infected.

It is also an indictment of the health care systems of the Mano River states that they were not able to identify suspected cases quickly enough  to isolate and quarantine them. Medecins Sans Frontiers (Doctors Without Borders) the biggest independent medical organisation working in the affected areas released a statement which said: “Lives are being lost because the response is too slow.”

Well, with over 2000 lives lost and the virus creeping into new territories, you can’t get a more accurate description of the current situation. It is clear that because of factors like inadequate funding, misallocation of resources and general ineptitude the health care systems in most affected countries simply can’t cope with the gravity of the situation.

An official statement released in July by the World Health Organisation (WHO) puts things in stark terms. “The possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns and the weak health systems in the currently affected most at risk countries,” the official statement said. 

The obvious lack of an effective strategy to combat the Ebola outbreak has led to a great deal of fear and trepidation on the part of sections of the public in West Africa. This fear is now on its own beginning to have an impact on the spread of the disease itself with the unfortunate African custom of rumor mongering and spurious story telling leading some individuals to take certain courses of action that only serve to put themselves and others around them in further danger.

The raiding of a quarantined Ebola treatment centre in the poor Monrovia suburb of West Point last month is a perfect example of what the spreading of false information about Ebola can lead to. In this case a bad situation was made potentially much worse when stories started to circulate within the economically deprived community that the Ebola treatment center within their area was in fact a plot by the government and aid agencies to test run some kind of biological weapon in their locale.

Thus, the strange and perplexing scene, of inhabitants of West Point storming the treatment center chanting “Ebola is not real” while carting away medical equipment and infected blood stained bed sheets as well as freeing Ebola infected patients. This resulted in the quarantining of all of West Point, however, it is still unknown how much damage was exactly done when the treatment center was raided and the patients escaped last month. All we know is that there has been an escalation in the number of reported cases of Ebola in the last three weeks or so with Liberia being the epicenter of this intensification of the spread of the disease.

Keiji Fukuda, assistant director of health security at the World Health Organization, warned of the debilitating effect that fear could have on the overall effort to curb the spread of the disease. “Fear is an impediment to getting treatment and this helps spread the disease as infected people do not get treatment as and when they should,” he said.

Ellen Johnson Sirleaf, Liberia’s president describing the scale of the task facing her and her beleaguered government, recently posited: “The scope and scale of the disease now exceed the capacity and statutory responsibility of any one government agency or ministry.”

A ninety day state of emergency has been declared in Liberia but this is clearly inadequate to tackle what is quickly becoming an alarming situation. The World Health Organisation (WHO) put out a report at the end of August, which estimated that 20 000 people could be infected by the disease before it is effectively contained. This is to say the least frightening, as the current mortality rate, post-infection, is about 60 percent, which means that if the WHO is right with its estimate 12,000 people or so could die before the disease runs its course.

Even as things stand now the current outbreak easily outstrips all other Ebola outbreaks in terms of its scale and impact. This West African outbreak is by far the most severe on record since the virus was first detected in Central Africa back in 1976. In terms of the numbers of cases and deaths this outbreak already outnumbers all the previous outbreaks combined.    

A concerted effort is needed in all affected countries to make sure that the virus’ spread is curbed and lives are saved. Words by government officials in Liberia, Sierra Leone, Guinea or Nigeria are not enough to assuage what could become a dire and harrowing situation. Resources need to be pooled together, and strategies honed and synchronised at the sub-regional level in order to tackle and neutralize a virus that has done so much damage not just to the lives of people but to the collective psyche of whole nations.

There also needs to be an international response coordinated by the United Nations and complimented by regional bodies like the African Union and Ecowas which seeks not only to augment what is being done by the independent health organizations but also to act as an extra bulwark against the virus to ensure that the logistics and modalities are in place to put an end not just to this outbreak but to ensure that all future outbreaks are better prepared for and dealt with.     

 

David Jas-Ikpeme Jr is a writer and lecturer at Stratford College, Westfield, Serekunda, The Gambia.

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