Ebola’s Public Health Remedy

Ebola has hit West Africa hard. As of this writing, the CDC reports that the virus has infected more than 8,000 people and claimed the lives of more than 4,000 in the West African nations of Guinea, Sierra Leone, Liberia, and Nigeria since April. With a case fatality rate higher than 50 percent, governments have been scrambling to contain the pathogen.

Liberia has possibly been hit the hardest. Whereas the virus has mainly affected rural areas in other regions of West Africa, in a recent forum hosted by Harvard’s Institute of Politics, the President of Liberia, Her Excellency Ellen Johnson Sirleaf, explained that her nation’s capital, Monrovia, has become the “epicenter” of the disease. And the virus isn’t just a health threat: “While we’re concerned about life…livelihoods will be at risk. We’ve seen a decline in our growth projection already. Where [economists] expected 5 percent this year, it’s now going to be reduced to 2.4 percent.” At this rate, the World Health Organization warns that once-prosperous Liberia could become a failed state.
The Ebola epidemic cannot be passed off as simply an African problem. “It’s a new day in this type of epidemic spread because of the more interconnected nature of the African countries to each other and the rest of the world,” Dr. Michael VanRooyen, a professor at Harvard Medical School and the Harvard School of Public Health and the director of the Harvard Humanitarian Initiative, told the HPR. “We as the West have to realize that it is not a very far stretch to imagine [Ebola] crossing borders. So it is no longer the case that a little Ebola epidemic in West Africa is no concern of the U.S. or Europe. It actually is a great concern and the investments in the public health infrastructure of these countries is an investment in our own safety as well.” In fact, with two ongoing cases and a death in Dallas, it seems increasingly obvious that United States and the world must ramp up aid or risk contamination.
Although the epidemic is frightening, especially for those living in West Africa, it could be best managed by improving West Africa’s public health infrastructure. Right now, governments should focus on containing the virus’s spread by enlisting NGOs, experts in epidemic management, and funding from the international community. In the short and long term, however, public health education for the general public of West Africa is the key. Investing in education would help create a more robust public health system better equipped to not just manage future epidemics of Ebola, but other diseases as well.   
A Cry Unanswered
Public health expenditures in West Africa cannot hope to keep pace with an epidemic of this magnitude. In Sierra Leone, for example, health expenditures amount to a mere 26 cents per person. With such low funding, many public health workers lack the supplies necessary to protect their patients and themselves. Without the appropriate equipment such as gloves, masks, and aprons, caregivers have fallen ill with the virus. President Sirleaf noted that at least 72 Liberian health workers have been infected, and more than 40 have died. Since her speech, these numbers have risen even higher. With a limited number of trained medical professionals to begin with, the loss of any health worker is serious. Not only are there fewer people to manage the Ebola virus in the region, but there are also fewer doctors and nurses to treat the myriad diseases such as tuberculosis, malaria, and the flu that constantly plague West Africa.
Given West Africa’s weakness, help from abroad is absolutely essential. But what’s frustrating for humanitarians like Dr. VanRooyen was the “slowness” of the response. In the recent outbreak, although cases began appearing in April, it wasn’t until many months later that the international community responded (save certain NGOs like Doctors Without Borders and Samaritan’s Purse). This was time wasted, time during which the infection spread and people died.
While the recent months cannot be undone, the rest of the world still can and should act. The WHO calls on the international community to provide $495 million for its “roadmap” to control the epidemic. These funds would be used to pay for simple yet lifesaving necessities including supplies and personnel to treat Ebola, as well as more familiar diseases currently left untreated due to the pandemonium. While expensive, it is nonetheless in the world’s best interest to come to West Africa’s aid as soon as possible, rather than allow the epidemic to fester, claim more lives, and continue to spread beyond its borders and invade other continents.
Yet money is not enough; the world must also provide expertise. A challenge in managing this epidemic has been coordination. At the forum with President Sirleaf, Dr. VanRooyen called for the help of uniquely trained experts—the “varsity” public health officials. It’s not enough to funnel money into the region and hope that Ebola will disappear; rather, experts from medicine and other professions must manage quarantines and the distribution of medical supplies. President Sirleaf expressed her own call for this form of aid during the forum, noting that with only “limited support” a quarantine imposed in a city in Liberia dissolved into chaos.
The Education Void
Community is interwoven with West African tradition, a serious problem when managing an infectious disease. As President Sirleaf explained, “We have deep-rooted cultural habits. The extended family system, getting together, sharing things, sharing homes, sharing facilities, being able to reach out to people, are all part of our culture.” Unfortunately, West African culture has also been partially responsible for the spread of Ebola.
Close contact between friends and family has been the cause of Ebola’s rapid spread. Ebola, which can only be transmitted via direct contact with bodily fluids of the sick or dead, thrives in these communities. Especially troubling are the traditional burial practices, in which the dead touched and kissed before being laid to rest. President Sirleaf commented that her people do not understand or accept how dangerous these practices are. While it’s important to respect West African values, there must be alternatives to these rites during a public health crisis. Officials, with the backing of West African governments, could teach burial practices, such as cremation, that would be far safer than current ones.
Public health education could also go a long way towards fostering trust between medical workers and West African citizens. The health worker, whose job it is to save lives, is too often feared as a killer. The situation is dire in Liberia, where President Sirleaf remarked that people have “even attacked health workers.” The issue comes down to a lack of communication. Without proper information, they see the healthcare system as a system of death, rather than of healing. As Dr. VanRooyen explained, “The issue of distrust with the medical system is somewhat predictable. If people were suspected to have exposure and they’re immediately quarantined, and then they die, then what happens really quickly is the people want to avoid that healthcare system.”
Recent public health awareness efforts show movement in the right direction. The U.S. State Department has supported the creation of billboards, posters, and radio and television broadcasts with information on prevention and treatment of the disease. In Liberia, local DJs have filled the airwaves with catchy tunes preaching the dangers of Ebola. One favorite pop song, “Ebola is Real,” can be heard playing in taxis and shops with lyrics such as “it’s time to protect yourself” and “wash your hair with soap and cook your food.” While these efforts are commendable, more can be done.
West African governments must do their part by prioritizing public health education—now and for years to come. Doing so would allow their limited public health resources to work more efficiently and effectively. Instead of having the ill hide from workers, they would actively seek help from medical professionals, receiving care while stemming the spread of Ebola. Furthermore, while education would certainly make the management of the Ebola epidemic easier, the same education would be invaluable for combating other infectious diseases. With a populace better informed about the fundamentals of public health, the spread of well-known killers such as the flu and tuberculosis that continue to claim countless lives could be reduced.
A Better Way Forward
Ebola is a horrible virus, having claimed thousands of lives in the past eight months. However, it is by no means the only disease in West Africa, and it certainly won’t be the last superbug to wreak havoc. West Africa is vulnerable because of its weak physical and educational public health infrastructure. Improving these two systems can only be achieved through government action. Unfortunately, with low funding and few experts, these goals are currently unreachable. Ebola will continue to spread within Africa and abroad without intervention.
It’s time for the world to bridge this gap. The international community can by no means end the suffering, but proper funding and personnel could certainly relieve some of the stress on West Africa’s public health system and be a humanitarian success. Let’s arm West Africans with the supplies and knowledge they need to control Ebola—for their safety and for ours.
Image source: The BBC