Sunday, November 2, 2014

Why Should I Care about Ebola?

I live in Maine.  I live in a beautiful, peaceful, orderly place where people pride themselves on their willingness to help their neighbors.  When I'm not putting in a 100-hour work week, I'm off hunting, renovating my old colonial home, or restoring my 1965 Pearson Vanguard.  Why should I care about a disease in West Africa?

Believe me, I would like to be able to ignore the troubled places of the world and just enjoy my life and my family here in America.  After all, that is what my parents got to do.  Unfortunately the technological advances of this century are eroding that privilege.  Whether or not I want it or agree with it, Mainers and Americans are no longer isolated.   Much of the equipment I work with is made from materials produced overseas.  When our ambulance is called to our weekly drug overdose call, it is the result of what's wrong in Mexico and Central America as much as what's wrong in the US.  At the 9/11 ceremony every year I am reminded that when segments of other people's societies become psychologically sick, they are often willing and able to reach out and harm American civilians.  I turn on the news at the station and it's a barrage of images of suffering.  I try to ignore them but they stick in the back of my mind.  We go on a call and the patient is coughing; we have to go through Swine Flu protocol at the hospital, or we have to decon the entire back of the ambulance to prevent spreading Enterovirus.   Now, we are developing special protocols, stocking extra PPE, and asking all our febrile patients if they've traveled to West Africa.  We talk about Ebola, we joke about Ebola, we answer the public's questions.  In the past months Ebola has become our constant companion.

Isn't it all hype?  Won't the epidemic burn out like past Ebola outbreaks?

I certainly hope so.  Our organization does not expect that to happen in the short- and medium-term for the following reasons:  First, past instances of Ebola were outbreaks, not epidemics.  It is a difference of scale.  Before 2014, the largest-ever outbreak of Ebola infected a total of 425 people.  As of 12 Dec, this epidemic has infected over 18,000 people according to WHO's Reported Cases count.   WHO estimates large-scale under-reporting means the real number may actually be closer to 30,000-40,000 cases.  Either of these numbers represents the first great epidemic of an acute, deadly, infectious disease seen during the Age of Globalization.
Second, location.  Past outbreaks generally occurred in villages and rural settings.  This epidemic is raging through cities, through some of the most crowded and impoverished areas of the African continent.  Liberia and Sierra Leone are recovering from long civil wars.  Widespread lack of access to infrastructure, health care, and education, distrust of government, and cultural traditions are all contributing to the spread of the disease

That's sad.  My country has its own problems.  I don't know anyone from West Africa. Why should I care about West Africa?

I believe that you cannot force change on people.  Whether it is my cousin who is fighting an addiction, my neighbor who is fighting for her civil rights, or my fellow healthcare worker in Mexico who is fighting to keep a hospital funded... the primary motivation and workload needs to come from the affected party, not from an outsider.  I will give my cousin, my neighbor, or my professional ally all the help that I can, but only if they are doing all they can to help themselves.

I want to help West Africans because I admire them.  Over 600 health care workers have been infected in the epidemic, largely due to lack of safety equipment.  Yet nurses, doctors, ambulance workers, and body recovery teams continue to do their jobs.  Liberian nurses receive just $500/month in compensation.   Contact tracing and public information teams head into affected areas, often with little protection.  They risk becoming fatally infected and leaving their families with no means of support.  Many of them have not been paid in months.  They are often stigmatized by neighbors and family due to their work.  Yet they continue to make their vital contribution; often inspired to do so because they have lost someone they love to Ebola. 

The news is full of truly inspiring tales of heroism in West Africa.  Gordon Kamara, a Monrovia ambulance driver, has isolated himself from his wife and children to protect them and has seen them only a few times in the past 5 months.  He drives one of only 15 or so ambulances that cover a city of 1 million.
Foday Gallah, another Monrovia ambulance driver, went back to work soon after being infected with EVD, suffering horrible pain, and watching others die in fear and pain in the ETU. 
In August, a key study on changes in the genome of the 2014 Ebola strain was published in Science.  Unfortunately, 5 of the 50 co-authors of the study died of EVD before the study was published. 
Dr Martin Salia, one of only 5 or 6 surgeons in the entire nation of Sierra Leone, dedicated nearly all his waking hours to treating patients and teaching in Freetown.  Dr Salia was married to a US citizen, who lived with his children in Maryland.  He had every chance to pursue US citizenship and a lucrative career in America.  Instead Dr Salia dedicated himself to bettering his home country, continuing to perform general surgery in Sierra Leone in the midst of a public health emergency.  In Nov 2014 he contracted Ebola, was medevaced late in the course of his illness, and died in isolation in Nebraska.
Nigeria is a country of 170 million, 3/4 of whom live on less than $2/day.  Poverty, crowded, impoverished urban areas, and political instability make Nigeria extremely vulnerable to epidemic EVD.  In July an EVD patient flew to Nigeria and presented with nonspecific symptoms at a local hospital.  After evaluating the patient, Dr Stella Adadevoh ordered an EVD test, which was positive.  Dr Adadevoh and several of her staff contracted Ebola and succumbed to the disease, but Ebola in Nigeria was halted at 20 total cases, due to Adadevoh's crucial recognition of the disease.

Local healthcare systems received a terrible blow, starting early in the epidemic.  Several of the country's leading doctors and researchers fell victim to the disease they were trying to stop.  Yet West Africans haven't given up.  They are still taking heroic measures to try to help themselves.  No country can fight a disaster of this scale alone, and I think West Africans have earned our help.  IMA will be focusing on enhancing West Africans' demonstrated ability to help themselves by hiring and training talented locals to assist us as frontline healthcare worker staff.

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