Ebola outbreak exposes West Africa’s existing public health woes

The Ebola virus has killed more than 2,400 people in four West African countries — spreading from Guinea to Liberia, Sierra Leone and Nigeria — in what the World Health Organization on Tuesday called an outbreak “unparalleled in modern times.” The United Nations, meanwhile, says it needs $1 billion to contain the outbreak before it infects up to 20,000 people and kills roughly half those potential victims.

But public health experts say that containing the virus is only part of a wider health crisis facing West Africa, a region where most childhood deaths are caused by preventable or curable afflictions like malaria, diarrhea and pneumonia.

As already limited resources are diverted towards stopping the spread of Ebola, a dire shortage of medical workers and a generalized climate of fear surrounding the outbreak may be preventing people from getting treatment for equally deadly, but perhaps more readily treatable, diseases.

“Ebola’s ripple effects are extending to everything else, from children unable to receive care for malaria to women unable to deliver babies in a hospital,” said Andrew Maccalla, of the medical aid organization Direct Relief, in a commentary for the Huffington Post. Preventable ailments like typhoid and dysentery, meanwhile, “might be killing more West Africans than Ebola,” he added.

Much of the problem is due to underfunded, understaffed health systems, whose deficiencies have been exacerbated by the Ebola crisis.

Nowhere is that more evident than in Liberia, which has seen more than 50 percent of the current outbreak’s deaths — 1,296 and climbing. Two decades of civil war, not unlike the violence seen in Guinea and Sierra Leone, decimated the country’s health system and other social services, leaving Liberia with around just 50 doctors for the country’s 4.4 million population.

“In Liberia, you have a health system that’s already underfunded, underresourced and underadvocated-for, and you’ve introduced a devastating epidemic that can destabilize the entire situation, leading to inability to provide basic health services,” said Andy Sechler, associate medical director for Last Mile Health, which builds community health infrastructure in hard-to-reach areas of Liberia.

While there isn’t yet hard data that would indicate that deaths from non-Ebola ailments are on the rise as a result of a shift of limited resources, aid groups say they have noticed very worrying trends.

Meredith Stakem, Catholic Relief Services’ regional technical adviser for health in West Africa, said her organization had preliminary evidence that vaccination rates could be falling in the region. According to a CRS survey of children who weren’t vaccinated since the Ebola outbreak began in May, 40 percent of their parents said the children had only missed vaccinations because of the outbreak. Regularly scheduled vaccination events, meanwhile, have been cancelled.

“I don’t think there’s been another outbreak that’s had such a massive impact on a country’s health care system,” Stakem said. “It’s more similar to what happens in a war zone, where services have been so disrupted that people aren’t getting the treatment they need.”

As in a war zone, the most pervasive factor hindering treatment across the region seems to be that people are afraid of leaving their homes for treatment. Many refuse to enter hospitals or clinics out of concern that a routine visit could expose them to the deadly virus.

According to Liberia’s Daily Observer newspaper, people “are dying … as a result of fear — fear of health workers who are afraid to touch anyone who is sick, fearing that that sick person has Ebola, and that the health workers might go the way of so many of their colleagues, including nurses and doctors — to their untimely death having contracted the virus they were trying to help.”

A study released this month by International relief organization Doctors Without Borders (DWB) found that while one-quarter of health facilities in and around the Liberian capital of Monrovia had closed since the crisis began, the patient load among those still open hadn’t increased. “This suggests that the epidemic may have an impact on the non-Ebola mortality,” DWB said in its report.

The DWB study also confirmed that health facilities in the Monrovia area are suffering severe shortages in supplies necessary to keep these health facilities and their dwindling number of employees safe. Most health facilities told DWB they had no or few supplies of gloves and protective masks, for example.

The WHO estimates that the worst-hit countries — Liberia, Guinea and Sierra Leone — need at least three or four times the number of health workers currently on the ground to contain the virus and properly treat its victims. The $1 billion requested by the U.N. would help cover human resource gaps until Ebola is contained, while international aid, such as that announced on Tuesday by President Barack Obama, will also provide secure facilities for treating Ebola patients.

But foreign aid for West Africa has come late in the game, said Sechler, of Last Mile Health. “There’s honestly been a paltry effort by the international community compared to the incredible need being presented by this outbreak,” he said. “They’re just now coming up to speed on how bad the situation is there.”

And West Africa’s health care deficiencies run much deeper, public health workers say. Providing adequate services for those afflicted with diseases like malaria — which kills one person in sub-Saharan Africa every 30 seconds — will require a longer-term overhaul.

“The emphasis so far has been on containing the Ebola outbreak,” said Stakem, of Catholic Relief Services. “But we’re hoping the international community is committed to strengthening health care systems in the long term.”