Ebola kills – Underdevelopment and poverty kill more

by Oct 15, 2014Magazine

Sensational reporting on the Ebola outbreak in West Africa is spreading fear and stereotypes about the so-called “dark continent”. The disease has killed over 1,500 people in West Africa this year. With decent health care facilities, access to clean water and sanitation, many of these deaths could have been prevented.

The current outbreak is the largest since the disease was identified in 1976. Ebola thrives on rural poverty. It is thought to be transmitted from fruit bats to wild animals, which in turn pass it on to livestock and so to humans.

Although highly contagious, Ebola is not an airborne illness such as flu. It is spread by contact with bodily fluids. This means the disease can spread quickly through village communities, but less so in urban areas. Nevertheless, Ebola can be contained by standard infection control methods that are easy to implement in any country with a functioning health system.

As horrific as the descriptions of the gruesome disease itself is, the accounts of the state of the health facilities in many west and central African countries is almost as horrific.

Dr Peter Piot, the scientist who discovered Ebola, recently returned to the remote villages of the Democratic Republic of the Congo (DRC), where he did his research in 1976. Nothing has improved in the intervening 37 years. There is no running water in Bumba, the nearest town to the village of Yambuku where Ebola was first encountered. Electricity is supplied intermittently by generator. The state provides nothing, so patients have to pay for all medicines – not that there are any in the crumbling public hospital.

The Ebola outbreak is a reflection of the public health crisis in Africa: the lack of staff, medicines, equipment, or systems that could protect populations, particularly those living in poverty, from outbreaks like this or other public health threats.

It is not by accident or coincidence that Ebola outbreaks have spread in West Africa. Like other epidemics, Ebola spreads quickly in densely populated and poor countries where basic infrastructure has collapsed. Liberia, Sierra Leone and Guinea are very poor countries, their Human Development Index (HDI) rating is among the lowest in the world (174 for Liberia, 177 Sierra Leone and 178 for Guinea). In countries with a higher HDI such as Nigeria (153), the outbreak is still under control. The health systems in Liberia and Sierra Leone collapsed under the civil wars they experienced.

Despite a population of six million, Sierra Leone has fewer than 200 doctors in its entire public health system. Guinea has just one doctor for every 10,000 people — the worldwide average is 13 for every 10,000. Now, with a number of doctors and nurses working in infected areas having themselves contracted Ebola, what remains of healthcare is set to disintegrate.

Relatively simple measures could have stopped the latest outbreak from spreading. Washing with clean water and soap after contact with potentially infected animals would be sufficient to prevent most from getting and spreading the disease. Yet access to clean running water cannot be taken for granted in many poor West African countries.

Survival chances for those who are infected by the virus are poor. But the headline figure of 90 percent mortality rate hides the fact that quick treatment can improve the odds to 50 percent.

In the midst of the panic caused by the spread of Ebola, attention has turned to experimental drugs that could cure Ebola. In mid-July, Mapp Biopharmaceuticals, a small, privately held biotech firm based in San Diego inked a deal to finalize the commercialization of an experimental drug known as ZMapp, a cocktail of three lab-created antibodies that, when combined, can do what no antibody—naturally occurring or otherwise—had been proven to do just several years ago: neutralise the Ebola virus.

However fundamental questions need answering. Would the mass production of ZMapp be underwritten by a major pharmaceutical firm, given that it’s unlikely to generate a return on the investment? Will the U.S. government, or other rich nations, step in to fund the drug’s production? And is there a reason to expect that funds would be mobilised for an untested drug, when they have not been forthcoming for basic protective equipment and other simple tools that could significantly boost the survival rate of infected people and reduce risk to healthcare workers?

According to the World Health Organisation (WHO), health workers combating West Africa’s Ebola outbreak lack basic protective clothing such as face masks, gloves and protective body suits. Instead of deploying rapid aid, affected countries have been encouraged to deploy troops and police to enforce quarantine zones in the worst-hit areas.

Sierra Leone’s president, Ernest Bai Koroma deployed the army to work alongside health workers. They went house to house in areas hit by the outbreak to make sure infected people are moved to professional medical care. In Liberia, security forces have been ordered to “enforce” infection control measures, including the quarantining of “several communities”.

But heavy handed security measures aimed at controlling the outbreak have led to outbreaks of violence and resistance. An atmosphere of fear and panic is spreading as fast as the disease itself. In Monrovia, Liberia a quarantine centre was attacked and a number of patients suspected of being infected with Ebola fled back to their communities.

Health experts have argued that where involuntary quarantining is used to control the outbreak of life threatening diseases, it is largely ineffective because it causes people to mistrust authorities and to stay away from treatment facilities. Health workers working with Ebola have reported great difficulty in gaining the trust of local communities. Since most people placed in quarantine and treatment facilities have died, those thought to have contracted the virus or family members resist being placed in quarantine.

While it is difficult to guarantee human rights and compassion in a climate of crisis, panic and hysteria, it is vitally important to promote respect for the dignity of those infected with Ebola.

As Annabel Raw wrote so eloquently in an article published in Business Day (25 August 2014): “Human rights are indispensable tools in global public health emergencies such as the Ebola epidemic. A discourse of rights and a compassionate understanding of our shared vulnerabilities is the most pragmatic approach to resolve these types of crises and prevent epidemics.”

One should add that as long as poverty and inequality remain epidemics in large parts of the world, especially in regions like West Africa, we will continue to see Ebola and other diseases create social havoc that will have consequences for societies world-wide.

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