The Ebola epidemic in West Africa is unprecedented. The deadly virus, which passes through contact with bodily fluids and causes severe fever, nausea and hemorrhaging, has not previously been reported in the region, and the current outbreak is the largest on record. Amid fears that infections are widening, the disease has been reported in Guinea, Liberia, Sierra Leone and Nigeria. Since the virus was first reported, in Guinea in March, 672 people have died out of the 1,201 Ebola cases identified, according to the World Health Organization.
There is no sign that the spread is slowing. Last week the virus was reported in Nigeria for the first time. Authorities said a symptomatic man was quarantined immediately upon arrival in Lagos after flying from Monrovia (he has since died). Between July 21 and 23 more than 100 new Ebola cases were reported in Guinea, Liberia and Sierra Leone.
Even front-line responders are falling ill. On July 25, a Liberian doctor infected with Ebola died. The chief doctor combating the disease in Sierra Leone died this week, and two Americans working with the aid organization Samaritan’s Purse in Liberia — one a doctor — have become infected. Of the first 70 Ebola-related deaths reported in Guinea, four were of health workers. While consistent with previous epidemics, illness and deaths among the few health workers available to treat patients is deeply concerning.
The epidemic has highlighted a lack of resources, preparation and infrastructure at both the regional and international levels. In the countries affected by the current epidemic, limited resources are constraining the response to the crisis. All three countries severely hit in the latest outbreak have poor health care infrastructure. In two surveys conducted by Afrobarometer in 2012 and 2013, a large portion of citizens in Guinea (77 percent), Liberia (52 percent) and Sierra Leone (48 percent) said accessing a public health clinic or hospital was difficult. Moreover, those numbers capture only the challenge of reaching a clinic — not the condition of the clinic and whether it is adequately staffed. These countries already struggle with serious health worker shortages. For example, Liberia has just 0.014 doctors per 1,000 people.
Consequently, in responding to the latest Ebola outbreak these countries had to rely on assistance from international agencies including technical expertise, equipment, supplies and medical personnel. But even international agencies are stretched; the medical organization Doctors Without Borders (Médecins Sans Frontières, or MSF) has called on the international community to provide more resources, repeatedly warning that it has reached the limit of its capacity to provide care.
The world, in short, is being told that it is not up to the task of responding to this epidemic. Closer study should provide valuable lessons for resolving the crisis and preventing future outbreaks.
People who are navigating the epidemic are — unsurprisingly — frightened, mistrustful and upset. Ebola is deadly and has no vaccine or cure. The context of weak public health care provision means people have limited experience with formal health care. In some areas the infusion of health workers from abroad (or domestic health workers from other parts of the country) has fueled rumors that the plague came with the medical personnel treating the infected. People are fearful and suspicious of medical staff working in clinics where they have watched many ill people enter and few leave. It doesn’t help that health workers must don head-to-toe protective suits.
Healthcare workers treating Ebola patients shown in full protective clothing.Tommy Trenchard / Al Jazeera
Such fear and mistrust has led to violence at clinics treating Ebola patients. In April, a crowd attacked a clinic in Guinea, accusing MSF health workers of bringing Ebola to the country. Last week thousands in Sierra Leone marched on an Ebola treatment center, threatening “to burn it down and remove the patients,” reportedly following comments by one of the clinic’s former nurses, who allegedly said, “Ebola was unreal and a gimmick aimed at carrying out cannibalistic rituals.”
Locals are also protesting the regional governments’ handling of the epidemic. On July 23, a Liberian man set the country’s Health Ministry offices on fire in protest of the government’s handling of Ebola, reportedly after losing his sister to the disease.
The protests and the violence are no doubt counterproductive to eradicating Ebola, but it is instructive to view the situation from the perspective of those living in the midst of the worst-ever epidemic. Most of these countries have never experienced Ebola before. As such, the death of patients at clinics treating the disease may force people to wonder whether white doctors covered in odd suits are in fact the cause of the problem.
This is not to say the efforts by medical staff — both domestic and international — should bring negative responses from the public. But it is important for the health care providers to recognize why it is crucial to work with local communities to combat this epidemic and minimize the potential for fear and suspicion. Such practice has already proved effective. For example, in Guinea, when local community organizations worked closely with MSF to fight Ebola, the survival rate was 75 percent. In the long run, provision of adequate public health services will reduce the mistrust of medical staff and also increase human resources to handle future epidemics without such strong dependence on foreign assistance.