Paul KeenanThe virus is thriving amid a disjointed response to infections, writes Paul Keenan
For want of a glove, the doctor was lost, for want of a doctor, the village was lost, for want of a village, the nation was lost, and all for the want…
The crude reworking of a well-known rhyme serves to sum up a key factor in the current and rapidly growing outbreak of Ebola in West Africa.
As it continues its relentless pace through Guinea, Sierra Leone and Liberia, it is the serious underfunding of (now nearly depleted) health services that has facilitated the thriving of the dreadful virus, spreading at a rate of five new victims every hour.
For the want of rubber surgical gloves, people are dying. Those people include medical personnel locally who continue to be the first line of defence against Ebola. Sadly, at least 100 must be numbered with the nearly 3,500 official deaths to date, with more now infected.
One of the lucky ones in this category is Will Pooley, the British nurse infected in Sierra Leone in August who was subsequently flown home for successful treatment. Speaking to the assembled delegates for the Defeating Ebola conference in London on October 2, Pooley confirmed the implications of attempting to deal with Ebola without the maximum safeguards.
Dying siblings
In his harrowing account of the deaths of a young brother and sister in his care, the nurse related how he had led the already dying siblings to an isolation ward where he worked with “the limited materials available” to no avail and ultimately at near-fatal risk to himself.
Despite such risks, hundreds of medical professionals continue to work directly with those presenting with Ebola symptoms, but as the infection rate surges, those numbers are increasingly inadequate to meet the challenge. Médecins Sans Frontières (MSF), which has almost 700 volunteer staff on the ground, reported as far back as August that its workers were stretched to the limit by the outbreak. That same month, the World Health Organisation (WHO) declared a public health emergency. MSF has since taken to berating both the WHO and the international community’s woefully inadequate response to the crisis.
The frustration felt by MSF is echoed by Professor Peter Piot, one of the scientists who first identified Ebola in 1976, and the man who gave the virus its name – after the Ebola river in the Democratic Republic of Congo where the virus first appeared. “Cuba and China have done more than some EU countries,” he said in an interview last weekend.
Returning to the issue of funding, the professor contended that poverty and health service dysfunction were the seedbed of the current crisis. “The outbreak was completely avoidable,” he insisted on this basis.
But it has not been avoided and now the WHO is warning of an infection figure of some 20,000 in the coming weeks, and possibly one million by January unless the international community gets its act together.
Yet this need for greater international action – now being met belatedly as Ebola jumps to Europe and America – is just one requirement. At ‘ground zero’, there is still a mammoth challenge facing any hope that medicines or experts might bring, another front, so to speak, in the battle.
In his assessment of the current outbreak, Prof. Piot pointed to local beliefs as being an obstacle to medical responders. In cultures where villagers have long practised burial traditions involving the touching and embracing of the dead, a huge measure of suspicion has greeted Western medics who insist on ‘hiding’ victims in body bags and burying them without ceremony. (Even within Christian communities, the early days of the current outbreak were marked by members of evangelical congregations bringing ill family members to the local church to be ‘healed by touch’.)
Ingrained suspicion has often led to open hostility to those approaching communities with the intention of saving lives. MSF has reported obstructions to its accessing communities and threats of violence against medics, forcing them to flee areas of contagion.
While clinics have been overwhelmed by the sick and dying, countless more have concealed theirs or a family member’s condition, with devastating consequences. One community reportedly went so far as to demolish a bridge to deny doctors access to its village.
This points to the fact that medical education of the populace is key, though admittedly, the struggle to convince communities so steeped in magical beliefs that Ebola is not some result of sorcery is no easy task.
“The West’s attitude should be acknowledged in allowing Ebola to flourish”
Before any rush to look pityingly at ‘darkest Africa’, however, the West’s attitudinal response to the West African outbreak should be acknowledged in allowing Ebola to flourish.
It is a fact that, since its discovery in 1976, Ebola has claimed approximately 1,500 lives in total in a number of separate outbreaks before the latest. It is also true that the virus was confined to the African continent. These realities appear to have led to a Western view that whatever virus might eventually pose an existential threat to mankind, Ebola is not it. (According to WHO, until the July spike, Ebola was claiming four lives per day, against 552 daily to malaria.)
On the medical front, in terms of all previous outbreaks, as Ebola flared and subsequently waned in poorer African countries, Western pharmaceutical companies clearly saw no profit in investing in the search for a durable cure, hence the shortage in stocks of drugs to stem Ebola’s advance.
The famed ZMapp, which proved a lifesaver for nurse Pooley, is genetically engineered from tobacco plants, but at such a slow pace that there is no hope of enough stocks in the near future.
This reality, coupled with the pace of infection, has caused something of a scientific rethink: in early September the WHO gave its blessing to the bypassing of certain pharma safeguards – such as the supply of as yet unproven medicines – in an effort to stem the virus. Victims and medical staff in the field are now guinea pigs in the search for the Ebola answer.
Virologists
More worrying, part of the race for that answer is prompted by knowledge among virologists that, as it continues to pass human to human, a virus such as Ebola gains increased opportunities to mutate, offering a potentially far worse version of itself to an ill-prepared world. Were Ebola to become an airborne virus, for example, a dire emergency situation would be created internationally.
One small indicator of the potential panic in this comes from the announcements of America’s first Ebola fatality, Liberian Thomas Duncan. Public health officials in Dallas were forced into direct action and the issuing of calming statements as terrified parents pulled children from a school, fearing Mr Duncan had spread the virus to other children there.
Now Europe, too, has seen its first case, with Spanish nurse Teresa Romero; Britain has begun scanning arriving travellers, France has had one scare in which an entire apartment block was sealed off, likewise a hotel in Macedonia and, for the first time, observers are speaking nervously of a threat akin to AIDS in the 1980s.
This week Ebola continues its dreadful advance in West Africa, eroding old certainties there and beyond.