10 September 2014


The world is currently in the midst of the greatest Ebola epidemic in history.  As of August 30, over 3000 cases have been reported, including 240 health workers, and an estimated 2000 have died.  Many feel that these numbers are a great underestimation.  The most frightening aspects of the disease are its non-specific early symptoms, its high mortality (50 to 90%), the risk taken by health workers and caregivers, and wide spread misunderstandings about the nature and the cause of the illness.  It is estimated that when the epidemic runs its course, over 20,000 people will be infected.
According to a UN report, Ebola has recently changed from a public health emergency into a threat to international peace and security.   Several governments with troops and police serving with the UN mission are considering pulling out because of the risk of infection.  International air flights have been suspended, preventing shipments of equipment and medical and humanitarian supplies.  Concerns have been raised about the threat of spread to developed countries, including the US.  According to many experts, these concerns are unfounded.
The World Health Organization has emphasized the importance of education in this crisis, stressing that Ebola is not airborne, and transmission requires direct contact with body fluids of an infected person.
This epidemic started in a rural area in Guinea, and first spread to Sierra Leone.   The epicenter of disease is now clearly in Liberia, and has spread to cities throughout West Central Africa.  According to WHO the virus has continued to spread, “fueled by fear, denial, and lack of public trust.”
The African Union has decided to deploy “ a military and civilian humanitarian mission, combining health and military personnel”.
We need to be reminded that there are currently no vaccines or cures for Ebola.  Treatment is entirely supportive, and requires an intensive care unit to be effective.  Prevention of spread can be achieved by strict isolation measures, but without gloves, gowns and effective sterilization, this can be extremely difficult to achieve.   Another problem is that the disease is extremely difficult to recognize in its early stages, as Ebola presents  with nonspecific  “flu”  or malaria like symptoms, and the incubation period is extremely variable (2 to 21 days).
The inability to control the epidemic underscores the ineffectiveness of local health systems to handle an epidemic of this proportion.  These systems suffer from understaffing, underfunding and undertraining.  They also have a lack of monetary and administrative support from their own governments, and also from developed nations and from the World Health Organization.
Dr. Paul Farmer, the famous humanitarian and infectious disease expert, bluntly states that local health systems do not have “the staff, the stuff, or the systems that they need to fight the epidemic”.
According to a recent editorial in Lancet Infectious Disease,  “ The epidemic reinforces the need for nations to invest in health infrastructure and disease surveillance to keep pace with other developments in Africa.  Efforts to contain Ebola should not divert resources from more mundane infections, such as malaria and HIV, which have a far higher long-term disease burden”.
What message does this epidemic have for us as mission volunteers?  We can do little to provide direct services.  We can support UMCOR’s efforts to provide needed support to Methodist Churches in the affected areas.  We can also support Ganta Methodist Hospital, which provides the only source of hospital care for a large section of Northern Liberia.  We can take to heart the profound lessons learned from this epidemic,  and do everything that we can to support, strengthen and help develop local health systems in these countries.

Submitted by Roger Boe MD

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