The West African Ebola epidemic has not led to any star-studded fundraising appeals, nor to donations adequate to meet the need for supplies and aid. Negative attitudes surrounding the crisis have included indifference, wilful ignorance, self-concerned panic and allusions to cultural inferiority instead of a focus on inferior conditions . Then yesterday, reports of the first diagnosis of Ebola made in the United States began to emerge and have since been confirmed.
Many people in first world countries were indifferent to the growing death toll in West Africa, primarily concerned that Ebola stayed “over there” and far away from “over here”. Others blamed the victims of this latest outbreak for having contracted the disease, suggesting that unhygienic burial rituals and the consumption of bushmeat constitute evidence of the disease being almost self-inflicted. This, despite the fact that almost one tenth of Ebola fatalities thus far have been healthcare workers.
While it’s true that unhygienic burial practices have advanced the spread of disease in regions where those rituals exist, it’s also worth noting the many other transmission and mortality factors.
Hospitals: Problems of staffing, funding, hygiene and equipment
Many hospitals are under-staffed, under-funded and ill-equipped. West African hospitals and healthcare centres don’t have the supplies to treat every patient. Some healthcare centres don’t have running water.
With disposable syringes constantly in short supply, some hospitals and healthcare centres have re-used needles or used unsterilised needles. As a result, a patient admitted with Malaria, may contract Ebola while in hospital, be discharged and unknowingly incubate the virus for several days before symptoms begin to appear, at which point the virus becomes contagious. The contaminant in this case would be a needle previously used on an Ebola patient misdiagnosed with Malaria, as often happens. Misdiagnosis could be reduced with sufficient funding for tests and screening.
These situations are also partially responsible for a general feeling of distrust and aversion to medical facilities in some areas, causing people to hesitate before self-reporting suspected cases. In a developed country, patients are more likely to self-report and willing to enter medical isolation but this wasn’t always the case. One only needs to look at past laws and practices governing quarantine to see how our relationship with hospitals and even quarantine has changed according to improved outcomes and quality of treatment.
During England’s plague of 1665, “Searchers of the dead” were those who sought not only for deceased plague victims, but also reported the households wherein they were found and the names of possible plague victims. These were then seen by a “plague doctor” who was by no means a qualified medical professional, but their decision could result in a family home being boarded up from the outside and marked with a red cross. That, once upon a time, was quarantine. The public were aware of this fate and self-reporting was understandably low, hence the existence of “Searchers of the dead”.
Of course this inhumane treatment is not found in West Africa, but the lesson remains: The more hope held out by hospitals and physicians, the greater the instance of self-reporting. So long as hospitals and aid workers continue to struggle with cross-contamination, poor conditions and low supplies, self-reporting will suffer.
Bushmeat is the meat from non-domesticated animals including mammals and reptiles, hunted in many parts of Central and West Africa. The consumption of cooked bushmeat is not a risk-factor in the spread of disease, but the handling of uncooked bushmeat is a danger. The risk therefore is to the hunter and the person responsible for preparing the meat for consumption.
In some areas it has been banned for environmental reasons as well as medical ones. Such bans are in vain however, where people have no other source of sustenance. Some areas are not entirely dependent on bushmeat, with other options available, but these options are not always reliable and sustainable enough to completely remove the necessity to purchase and consume bushmeat.
There are burial rituals that involve unhygienic contact with bodies and this is undeniably advancing the virus. There is an effort to spread awareness of the issue in the relevant communities, encouraging families to desist in the practice or wear gloves and so on. These efforts are meeting with some resistance and workers are faced with limited supplies of personal protective equipment including gloves, in hospitals and in the field.
However, Ebola can also cause a great deal of bleeding, vomiting etc. The bleeding occurs at a number of sites throughout the body, internally and subcutaneously. In other words, it’s not all burial rituals and bushmeat. There is a risk of contamination just by the very nature of the disease. In more privileged countries, with access to personal protective equipment, disinfectant, running water and with it, the capacity for frequent hand washing, this threat would be greatly reduced and more easily controlled.
And should a patient survive the virus, it stays active in semen for weeks to months. It’s not surprising that many people in affected areas don’t know this, given the communication barriers there may be in hospitals with international teams, the fact some people don’t report to a hospital at all and in some places, the absence of many centralised channels of information and general lack of accessible sex education.
Ebola Diagnosis in the United States
“Despite the tragic epidemic in West Africa, U.S. health professionals agree it is highly unlikely that we would experience an Ebola outbreak here in the United States, given our robust health care infrastructure and rapid response capabilities.”
Yesterday, news broke of the first diagnosis made in America. Before we consider what this means for a highly industrialised nation with all its advantages, let’s consider what further impact this might have.
Firstly, where empathy has failed, self-concern and fear will succeed. Those who have ignored the Ebola virus or looked the other way while West Africa and international aid workers endure “their problem”, suddenly care a great deal more about this virus.
From this, we will likely see an increase in the funding provided to the very few labs* currently researching the virus. This doesn’t immediately help those in West Africa, but in the absence of a united, global concern for their danger, further funding research would be an improvement, however self-interested it may be.
In addition, the drastic difference in living conditions between countries with very different economic outlooks, has a major impact on the spread of disease. Access to health care, medical supplies, disinfectants and personal protective equipment, accessible channels of reliable information, all of this is entirely different to the current situation in much of West Africa. And yet, much of the global reaction to this crisis has been the resounding cry of: What about us? What if it happens to us?
If that’s not how you feel, if compassion and not self-concern is at the forefront of your mind, the good news is that it’s easy to donate to Doctors Without Borders to assist in the immediate relief of suffering in West Africa. There are suggested amounts but you can also stipulate the amount within your means.
*Footnote on laboratories
According to GOA in 2007, there were only fifteen labs in the United States with the highest biosafety level (BSL-4) which is the required BSL for work on the Ebola virus. Not all of these labs are actively working on Ebola, some are working with other BSL-4 agents, some currently only work with BSL-3 agents and at least one is still under construction.
They are composed of four different sectors, as follows: 9 federal government laboratories, 4 academic labs and 1 state and 1 private lab, totalling 15 labs with the facilities and training necessary to do this work.
In contrast, there are 1,356 recorded laboratories in the United States with a BSL-3. The same is true worldwide, we have very few labs with the capability to work with BSL-4 agents like Ebola. To my knowledge, America has more BSL-4 labs than any other country.