Saturday, October 31, 2015

Ebola Outbreak: A Much Needed (And Largely Missing) Perspective: The "Local" Front Line Doctors' Take, In Africa

While I sip some hot fresh coffee, bright but chilled orange juice and eat my banana, on a cool rainy Saturday morning here -- I thought I'd help the Aspen Institute New Voices program get the word out. [There was also a piece in The Guardian (UK) this weekend, of a similar bend (though slightly more strident, to be fair).] They (and we, both) think world needs to hear from more African doctors, on the ground -- about ongoing Ebola efforts. This is not primarily the story of some lilly white do-gooders/ rescuers -- no, this is the story of local people, helping local people -- to end a scourge.

But first, the middling good news: there were only three more new cases in all of Guinea reported this week, in the W.H.O.'s latest Situation Report, and those three are all from the same household as the three reported a week earlier. Good news -- to be sure. But there are still many, many contacts in both Guinea and Sierra Leone that have been lost to follow up. So we may yet see a few more nodes of viral outbreak emerge. [And Pauline Cafferkey continues her recovery in London's Royal Free.]

Even so, I think hearing from Dr. Samuel Kargbo, the doctor who was in charge of safe burial practices in Sierra Leone -- at the very peak of the crisis. . . is vitally important -- do go read it all, for lessons learned (and the yawning infrastructure needs still remaining), courtesy of the Aspen Institute:

. . . .For five months last year, I led the national team responsible for the safe burials of victims of Ebola, which was being transmitted as family members cared for the sick or grieved the dead. At the height of the epidemic, about one hundred people a week succumbed to the disease and it was hard to see the future or remember the past.

Fast forward 15 months. The first week of October marked the third consecutive week in Sierra Leone with no confirmed cases and all contacts of people previously diagnosed with Ebola have cleared as disease free. However, the risk of new cases remains, particularly in Guinea, where public health workers are following 509 contacts. . . .

[E]ven once a vaccine is approved for widespread use, it will be no silver bullet. The gaps in our health care system that allowed Ebola to advance so quickly must be filled if this new vaccine — or any vaccines — are to realize their life-saving potential.

When Ebola hit Sierra Leone, we had fewer than 500 doctors for a population of 6 million. We had five ambulances, and 16 specialized obstetric care centers for the whole country. Perhaps most telling, life expectancy at birth was a mere 45 years, a number brought down by high rates of maternal and infant mortality. . . .

[W]hen Ebola hit, we also had a vision of a better health system. In 2010, President Ernest Koroma and the government had put in place a health care initiative that provided free treatment and medicine to pregnant women, lactating mothers and children under the age of five. Alongside this initiative, doctors and nurses received pay increases, from between 200 and 400 percent. . . .

So it goes -- there is still much basic health care infrastructure work needed, in all of Sub-Saharan Africa, as the above eloquently attests.

Now. . . go be spooky -- in the best of ways, all you. . . spectres!

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