Getting The Real Ebola Crisis Under Control

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As the above chart illustrates, the epidemic remains a serious public health crisis in parts of West Africa. Nonetheless, Helen Epstein sees signs that the tide may be turning in Liberia, where “the number of new cases each week … is falling, not rising”:

In August, the streets of Monrovia were strewn with bodies and emergency Ebola clinics were turning away patients. Today, nearly half of the beds in those treatment units are empty. I’ve been here a week and have yet to see a single body in the street. Funeral directors say business is off by half. Of course, the situation remains very serious. More than two thousand have succumbed to the disease here since the outbreak began—along with thousands more in neighboring Sierra Leone and Guinea, according to the CDC—and Liberia faces looming economic and political crises. This fragile country urgently needs help—both for the well being of its own people, and for the safety of the rest of this interconnected world. But the epidemic is far from the cataclysmic disaster currently on display on American TV screens.

How did things get so bad in Liberia in the first place? Shikha Dalmia blames “a hopelessly dependent political class that stays in business by ignoring good governance and appealing to its Western benefactors”:

Unlike Nigeria, Liberia’s immediate reaction was not to marshal its domestic resources but to hold press conferences and appeal for international aid, points out Johannesburg-based Yale World Fellow Sisonke Msimang. Liberian President Ellen Johnson Sirleaf, a Nobel peace laureate, even penned an open letter to the “world” this week, plaintively crying that Ebola wasn’t a domestic problem but a global one that “governments to international organizations, financial institutions to NGOs, politicians to ordinary people in the street in every corner of the world” had a “duty” to combat through “emergency funds, medical supplies, or clinical capacity.” But the “world” has been supplying all of this and more to Liberia in spades. Indeed, Liberia is among the largest aid recipients on the continent, with about 75 percent of its budget supplied by aid agencies. It receives $139 per capita in loans and grants, according to World Bank figures, compared with Nigeria’s $11 per capita.

If Liberia has indeed reached a turning point, that’s likely in part because the extremely poor communities where the virus has spread most rapidly, and whose residents often mistrust the government and aid workers (recall August’s attack on an Ebola treatment center in Monrovia), are becoming more knowledgeable about the disease. Abby Haglage profiles a UNICEF initiative called Adolescents Leading an Intense Fight Against Ebola, or A-LIFE, which has put some very dedicated Liberian teenagers on the front line of the information war:

UNICEF’s group was formed in 2012, with the intention of teaching young girls how to protect themselves from sexual violence. The worsening of the Ebola epidemic forced them to teach the girls about a new enemy. They learned what the disease is, how people get it, what happens then. Most important, they learned what they could do to protect themselves. Learning that gave them something the rest of their community, still reeling from the violent government-imposed quarantine, did not have: knowledge. So they walked. From house to house, day by day, teaching the community what they had learned. Ebola is real. It is deadly. Don’t shake hands. Wash them. …

The impact, to [UNICEF’s representative in Liberia Sheldon] Yett, is one only these girls have the authority to make. “They are far more powerful as spokespeople and educators than a public-health official could ever hope to be because they come from that community, they’re known by that community,” he says. “People understand where these girls are coming from, and people believe their messages.”

Yet even if things are looking up for Liberia, Keating cautions, there is still a ton of work to be done to get the regional outbreak under control:

All the same, we’re far from out of the woods in the fight against the disease that has already killed in the neighborhood of 5,000 people around the world. There have been no similar reports of drops in the other countries affected by Ebola. In fact, the number of cases has risen sharply in Western Sierra Leone this month. The disease also may have spread to yet another country—82 people in Mali who came in contact with a toddler who died of Ebola last week are currently being monitored for signs of the disease. The collateral damage from the outbreak—including the impact on the economies and political institutions of some of the world’s most fragile states and the setback in the fight against diseases like malaria—will continue to mount.

Update from a reader:

I work at a large hospital associated with a famous university and medical school. Both hospital and the university are routinely listed toward the top of all rankings of such institutions. My hospital has carefully laid out practice and policy set up for handling Ebola patients. Both my hospital and the university have long traditions of public service, and are not-for-profit. Both entities are renowned for commitments to humanity, education, research, and the elevation of the impoverished. Justice, beneficence, and respect for persons, as it were.

And both have explicitly forbidden any medical staff from traveling to West Africa to participate in Ebola treatment, public health, and eradication efforts. Nevermind quarantines and pay for time off. It is forbidden even if we have the time and don’t want the money (Though, I’m a researcher and not a clinician, so I’d have little to offer on the ground on site in West Africa.).

We talk about the need to prevent this epidemic from growing by addressing the situation at the heart of the outbreak. And it seems that people with the currently active strain of Ebola who are treated from the onset of symptoms with competent and comprehensive medicine are very likely to survive. Yet the death rate in Africa has been as high as 70% in places, because access to even basic medical care, must less excellent care as we have here (access to that care being a conversation for another day), is deplorably lacking. We will not contain this epidemic, and Ebola will become a daily fact of life in many places, unless more resources are brought immediately to bear at the source of the outbreak.

And yet, our esteemed institutions of medicine and science are issuing edicts that thwart any discussion of that possibility, regardless of our federal policies.