BY Jim Harding
The Ebola epidemic started in Guinea, West Africa in March, 2014 and soon spread to adjoining Liberia and Sierra Leone, all countries left with a huge infrastructure deficit after decades of civil war. A half year later people everywhere are becoming aware that the epidemic constitutes an unprecedented worldwide threat. Yet many still don’t yet grasp why the threat developed.
By early October 8,000 people had been infected, 4,000 had died and the World Health Organization (WHO) was reporting that those infected could double monthly. But the WHO has no operational capacity and its resources are already stretched by unprecedented global humanitarian crises. And there is no known treatment or vaccine for Ebola, though some drugs are now being fast-tracked for testing and use. Without an effective response there could be 64,000 people infected well before Christmas, mushrooming to perhaps a million after that. The death rate is approaching 70%.
Health models of epidemics account for rate and response. Without an effective response, the spread of the Ebola virus can’t be curtailed. So the most relevant UN statistic is that 20 times the existing resources are immediately needed to curtail the spread. Nigeria’s quick identification and vigilance seems to have kept the 19 identified cases from multiplying. And this had more to do to do with their public health capacity than with the virus. Ironically it was a medical project not at all related to Ebola funded by the Gates Foundation that helped Nigeria immediately redirect its capacity to quickly confront the disease.
Things have gone very different in Liberia, the hardest hit country. Nearly six months after the infection started, less than one in five Ebola patients get treated within a medical facility. Health care workers continue to turn infected patients away. They are left to suffer, probably to die with family that is not protected from the virus.
OUT OF CONTROL
The virus got its name from the Ebola River after it was first identified in 1976 in the Congo and Sudan. The virus comes from tropical bats which can contaminate large monkeys and humans from droppings or bites. Since the infection was identified thirty-five years ago around 1,500 people have died; the last short-lived outbreak was quickly contained in Uganda in 2012. There has never been an Ebola outbreak on the present scale, with 4,000 already dead within six months
The epidemic has spread largely because the wider world had been so slow to respond. Until recently, when cases developed outside Africa, the international media was more interested in geo-politics. But by late June, Doctors Without Borders was reporting that “the epidemic is out of control”. Four months ago, on the ground members of this courageous physicians’ group were already saying they were “no longer able to send teams to the new outbreak sites”. By then there were 60 separate locations where the disease had taken root and the physician group only had a few containment teams. Most significant, for the first time the virus had spread to congested urban areas, like Freetown and especially Monrovia.
Cultural practices like touching the infected body during funeral rites didn’t help. Clinics are even viewed with suspicion, as the place where you contract the disease. Some families have even “liberated” their kin from clinics, which puts more people at risk. But the overall lack of capacity to medically contain and trace the virus has been the most vital factor in its unprecedented spread.
Ebola spreads through bodily fluids: urine, sweat, blood and even mother’s milk. It can incubate for up to 21 days which makes the monitoring of it so challenging. The Liberian man who recently died of Ebola in the U.S. showed no symptoms until after he arrived, and even then his symptoms were not initially accurately identified. Despite containment protocols a health worker has contracted the disease from him. A similar thing is happening in Spain.
Recent news has focused on the spread of Ebola outside Africa. Western medical specialists continue to reassure the public that our more sophisticated medical systems will contain the virus. Airport monitoring of travelers to and from West Africa is slowly tightening up, further reassuring the public. Monitoring the temperature of travelers who may not yet exhibit symptoms during the long incubation period, is, however, not at all fail-safe. Also seemingly healthy travelers from West Africa may tell a few white lies so they can visit relatives abroad. People in “Little Liberia” on Stanton Island New York have expressed fear that the virus may get to their community in this way.
Meanwhile, resources are urgently needed on the ground. Yet, in spite of the dire projections, front-line workers continue to be overwhelmed. After a half-year of warnings there remains a huge scarcity of protective equipment. In Liberia over 200 health workers have already contacted Ebola and nearly 100 of them have died. The government has offered hazard pay to entice workers to carry on, but the incentive is not working well, especially since the amount initially offered had to be lowered.
Average pay for Liberia’s health workers is only two or three hundred dollars a month. Nurses get only an additional $400 in hazard pay, half that received by doctors. Liberia’s health workers threatened to strike over these inadequate conditions and inequities, which would have put the larger population at even greater risk. Most healthcare workers stayed on the job. But is it reasonable to expect health workers to make the “ultimate sacrifice”, while knowing that they remain poorly equipped and that their efforts are failing?
New challenges arise as more regions are quarantined and international travel disrupted. The stressed healthcare system can’t deal with other ailments; treatable diseases can turn into other tragic deaths. It could become more difficult to get essential equipment to areas where the virus is spreading. Local economies are already detrimentally affected; a shortage of goods is pushing up prices, making life even more difficult for those already facing desperate times. It’s revealing to contrast how efficiently the military can send equipment into a war zone. Obama sending U.S. troops to help in Liberia may become one of the decisions warranting the Nobel Peace Prize. Some are now calling for the creation of an international Rapid Response system.
Liberia has deep family significance because my parents worked on a UN (Kpain) project in interior Liberia in the early 1960s. We still have canes in our house gifted to my father from local Chiefs. My mother wrote a book Top Hats and Head Loads based on their transformative experiences. At the time of their stay Ebola had never been heard of. I try to imagine how I would feel if they were alive and doing their UN service there now, in the midst of the Ebola crisis. I wonder how many members of their tribal neighbour’s families have fallen to the disease.
My mother continued corresponding with friends and colleagues in Liberia. Communication began to break down after the 1980 coup, as the region entered decades of unrest. Fraudulent elections were held in Liberia in 1985 and civil war started in 1989. There were elections again in 1997, after a ceasefire in 1995, but in 1999 civil war renewed, now with the involvement of Guinea. By 2001 Sierra Leone was also involved in the conflict.
This regional conflict involved more child soldiers, on all sides, than any previous African conflict. The conflict was compounded by the use of drugs during combat and the merging of mysticism with militarism. It took a broad-based, multi-faith, woman’s peace movement to return to a saner path and Liberia ended up electing the first female head of state in all Africa.
But the Ebola epidemic risks returning the region to even more devastating chaos. With such deficient healthcare and the panic that can ensue, distrust for government can escalate quickly. Aljazeera reported Sept. 24, 2014 that, “Liberia has spent a decade recovering from the ruinous back-to-back civil war which ran from 1989 to 2003, leaving a quarter of a million dead and the economy in ruins”. It continued, “The world cannot wait for Liberia, Sierra Leone and Guinea to slip back into conflict, which could be the result of this slowness in response.”
The virus is clearly the immediate threat. But beneath this threat lies the degradation of West African tribal societies by colonialism, slavery, war and perpetual inequality. And the failure of wealthier countries to quickly help build up the medical capacity! In our shrinking world we are quickly entering a time when “be thy neighbour’s keeper” applies across oceans and history.