Ebola: heartbreak, stupidity and bravery

This month, most of the avoidable and unnecessary setbacks in the fight to stop Ebola can be linked to stupidity. Unfortunately, history shows that stupidity is a pandemic, and, like Ebola, has no cure.

It’s been another month, and West Africa continues to make the news for the wrong reasons. Ebola continues to take lives, but is gorging on ignorance and stupidity, maintaining a steady (and in Liberias case exponential) increase in infections and fatalities..

ebola avenue

Ebola Avenue, Mesa, Arizona – just off the Superstition Freeway. Coincidence? I think so.

More of a lumbering juggernaut than a raging infection or uncontrollable outbreak, Ebola has killed 100 Guineans, 550 Liberians and 200 Sierra Leoneans in the last month. The trouble with things that lumber is, that once they pick up pace, they’re very difficult to stop. The window to stop the Ebola outbreak in parts of West Africa may very well have closed and, as an example, it has started to take apart the (already struggling) infrastructure in Liberia.

Don’t be fooled by the apparently small numbers. Unless you live under a rock you’d be aware that the horror of Ebola is its unforgiving efficiency infecting people it manages to physically contact. This is coupled to its breathtaking conversion of infections to kills. The 850 deaths (and the other 850 infections) from ebola this month has the same mortality ‘footprint’ as a cholera outbreak infecting about 60,000 people or malaria infecting 1.15 million people. With a mortality rate of 54%, ebola is twice as likely to kill you as a knife or gunshot wound in the USA.

The horror of Ebola is almost impossible to comprehend, as is trying to imagine what life has now become for the people of Liberia, Sierra Leone and Guinea. For a front line view of an Ebola treatment centre, read this article (any many more like it on the Guardian webpage).

In the name of impartiality, this article presents a statistically unsupportable review of mortality in the USA from other causes vs. Ebola. Perhaps not so ridiculous. As a disease spread by contact, what is the real threat to anywhere other than West Africa right now?

Back in West Africa (and perhaps the USA) awareness of the disease is increasing steadily. People have accepted that ebola is real and are avoiding contact – understanding the transmission pathway (admittedly sometimes there is no choice because they’ve been quarantined).

It remains difficult to be too judgmental on people who have had no opportunity to know any better. They have lived a cycle of ignorance (limited access to education, no access to news, poor health services (sometimes in conflict with traditional beliefs) all often aggravated by an enthusiastic civil war in the last 20 years. A toxic situation maintained by long histories of corruption, cronyism and administrative impotence. There may not be a lot these people can do about the circumstance they’re in.

It’s a lot harder to be non-judgmental of the system. A system that embezzles money, has not developed infrastructure, has failed to generate trust amongst the people it represents, has underfunded education and health care and has struggled to implement proactive community awareness. Here is a good read on the political history of Africa that has led, potentially, to a perfect storm.

But it’s impossible to fathom the actions some people have taken to undermine the efforts to control Ebola – a combination of ignorance, arrogance and stupidity. So (my opinion) the main development this month has been a transition from the disease spreading because of ignorance (which it still does) to the disease taking advantage of stupidity.

The standout stupid events include:

  • The unbelievable decision of an ECOWAS diplomat (who you will note has not been named and is therefore probably influential or related to someone who is) who was in contact with the American Patrick Sawyer (the guy who brought Ebola to Nigeria) then sought treatment from a doctor in Port Harcourt instead of going into isolation in Lagos with the other 12 identified contacts. Cruel irony saw the diplomat recover. Crueller irony saw Nigeria come within one quarantined individual of beating the disease.To top off his families attempts to ensure Ebola gets established in Nigeria, his sister who had nursed him while infected tried to run away.
  • The arrogance and ignorance of the doctor, Iyke Enemuo, to attempt to treat the ECOWAS diplomat rather than inform health authorities. He died in his clinic, exposed a hotel to infection, exposed the well-wishing congregation of his church to infection, and was not identified as an Ebola victim for a further 6 days while lying in the mortuary of the clinic he worked in. Now 370 people are in quarantine, his wife is dead, and his daughter is an orphan. Good work, stupid.
  • To top off his families attempts to ensure Ebola gets established in Nigeria, his sister who had nursed Iyke while infected tried to run away rather than being quarantined. Unbelievable! It must be genetic!? However, full credit to the brother (clearly the black sheep in the family) who recalled his sister back to quarantine.
  • Stupid does not recognize country boundaries! Next is the Guinea national, already on a watch list for Ebola after being in contact with Ebola as it flung his family off the mortal coil. He crossed the Senegal border having never been there before (tragically 2 days before they closed the border). He made it to Dakar. As yet there are no other reported cased. I can understand the presidents view. This guy has also recovered.
  • The ‘Darwin Award’ worthy deathwish of a group of rioters who broke into an ebola clinic in Monrovia, Liberia, and forced the patients out of the clinic and back into society for 2 days. Just to ram home the message that these are Olympic-grade idiots, they looted the clinic of its (presumably Ebola-infused) bedding and equipment. And go figure, there is a massive surge in Ebola cases in Monrovia?! Must be the bats!
  • The 5th AWOL Ebola sufferer (from the same clinic as above) who went to get something to eat from a nearby market. He’s made the media because someone videoed his shopping trip. While the actions are indeed stupid (at best remarkably ignorant) the circumstances are also tragic and awful. The article attached is worth a read. The video is not particularly disturbing – It documents a confused (and clearly hungry) person. And yes, he looks just like any other person really. No blood or staggering or jabbering fever yet. Infectious, though.
  • The rumour in Nigeria that drinking and bathing in hot salt water repels ebola. A heady cocktail. Equal parts paganism, gullibility and salt. 12 pointless fatalities.

…And the inexplicable…

WHO, what is going on in there? My personal opinion counts for little against the combined intellect of World Health Organisation, but this is the internet, where peer review counts for nothing! Encouraging West Africa to reopen borders and suspend quarantine measures is surely madness when the affected countries are employing these measures as an admission that they can neither control or combat the spread of EVD with the systems and abilities they possess. Sure it comes at the risk of complication (like limiting supplies and increasing fear, mistrust and hunger) but there are relatively easy solutions for these – there is none for Ebola. It’s one of the very real lessons of living in Africa – life is not fair.

With ebloa clearly under control, - as demonstrated in this grapg - it's time to lift travel and quarantine restrictions in West Africa.

With Ebloa clearly under control – as demonstrated by this graph – it’s time to lift travel and quarantine restrictions in West Africa.

…and the alarming…

The toll on health services workers is remarkable. To date, 240 health care workers have been infected and 120 have died. That’s 1 infected health care worker for every 14 ebola patients. This is in countries where health professionals work at ratios of 1:10 000s of patients. Whole health jurisdictions are shut down. Hospitals, clinics are starting to fail (or be abandoned), upping pressure on a healthcare system already under duress. With no functional health system, what is the treatment response for all the other (non-Ebola) diseases and infections in the community?

… some Ebola culture…

There are a number of infectious songs (how droll) doing the rounds as mixed music/public announcement. I’m slow to comment on the musical merit, but people seem to find this one from Liberia, sung by D12 (clearly a bulldozer fanatic) to be a catchy tune, credited with helping spread the message against the disease. Sierra Leone isn’t going to be outdone either. And then there is this … Its real claim to fame is its Ebola themed band name and its blunt lyrics, including:

“You think you got a cold but the next day you spit out your innards” and “you cry bloodstained tears of the incredible pressure from your eyes”

I know what you’re thinking, and yes, you can download it as your ring tone.

…and, finally some ethics…

A review panel commented on the potential to conduct ebola drug trials outside of clinical conditions. The World Health Organization has always (until now) emphasized that ethical standards governing clinical trials must be respected, even in the midst of a terrible outbreak… but it appears that there is cause for an exception with the current Ebola outbreak in West Africa. That’s fine. But where is the debate? Let alone the howl of moral outrage? The silence is profound. In this scientific trial – who gets the placebo? And who decides?

But to end on a slightly more positive note, there are signs of encouragement. The US decision to send 3000 military personnel to Liberia, and train an impressive 500 health workers a week in addition to building 17 treatment centres (of 100 beds) is a step in the right direction. So too are the signs of education, that Ebola is real and treatment can save lives, and the decision by Sierra Leone to enforce a 3 day quarantine  (the short video in the link is worth watching). However in a country where many vendors rely upon daily sales to simply survive, enforcement of the quarantine will be challenging to say the least.

Seeing as we’re already half way through the month, I’m predicting September will see the realization by the international community that Ebola can’t be allowed to get further out of hand – that would be stupid.

To support the incredible and brave work of Medecins sans frontiers (MSF) click here.

[This post was written by my husband who has been following the Ebola epidemic closely. He also wrote one here and here. I (Chrissie) would just like to add my complete admiration of all the workers in the Ebola treatment centres. I know I am not brave enough to do what they do.]

One response to “Ebola: heartbreak, stupidity and bravery

  1. hi Chris and Will

    thank you for this post – the usual news outlets report at high-level principals and not at this coalface level. Agree – the medical personnel are the ones to be admired, not the politicians.

    M xo

    Like

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