Death of medical workers a major blow to West Africa’s public health

The Ebola outbreak continues to sweep across West Africa on an unprecedented scale. Since the epidemic was first reported in March, more than 300 local health workers, including doctors, have contracted the deadly virus in three hardest-hit countries: Guinea, Liberia and Sierra Leone. Out of 4,963 confirmed cases, at least 2,453 people have died from Ebola, according to the latest World Health Organization (WHO) estimates. Although local health workers are being infected at an alarming rate (largely due to underequipped health facilities, a shortage of protective clothing and other needed equipment), the stories of a few American and European aid workers infected while responding to the crisis have received much of the global media attention. Moreover, fewer African health workers have had access to experimental treatments such as the ZMapp serum that may have saved the lives of the first two Americans infected in July. Three Liberian doctors are the only Africans to have received ZMapp treatment; of those, one still died.

The Ebola epidemic has been wreaking havoc across West Africa for seven months. But it was only in late July, when two American volunteers working at a Liberian hospital contracted the virus, that global attention turned to the story. Beyond questions of attention, the focus on the lives of Western aid workers has brought the inequalities in the medical treatment of expatriate and local health workers into stark relief. While American and European workers were evacuated to better care in developed countries, the locals have been left to die or struggle under a lower standard of care in their home countries.

On Sept. 13, Sierra Leonean doctor Olivet Buck became the latest victim as the WHO refused to evacuate her despite pleas from Sierra Leone’s government and a commitment from a hospital in Germany to provide her with the best possible treatment available. Buck is the fourth Sierra Leonean doctor to die of Ebola since the epidemic reached the country in May. Her tragic death has long-term ramifications for Sierra Leone, a tiny nation of 6 million that has only about three doctors per 100,000 people.

The loss of skilled health workers and physicians is a huge blow to the region’s short-term efforts to fight Ebola as well as its long-term public health goals. It means further deterioration in already-weak health sectors. For example, many people in Ebola-affected areas are afraid to go to a health clinic to seek medical treatment for other illnesses. Pregnant women are risking possible complications to give birth at home rather than delivering in a hospital, for fear that they or their infants might contract the virus. Most of these countries already have severe shortages of trained doctors and nurses to address several health challenges, including HIV/AIDS, malnutrition, malaria and tuberculosis. African health workers are on the front lines helping save the local population from not just Ebola but countless other health problems.

So why, given the urgent work they’re doing, are those infected with Ebola being denied equal access to evacuation and the quality of care it entails? The short answer is that their employers, mostly the local governments, lack the resources to pay for it themselves.  The evacuation of European aid workers was largely financed by their home governments, while employers paid for the evacuation of at least two of the Americans infected with Ebola. West African governments, whose finances are already stretched, cannot mobilize the kind of resources needed to pay for evacuation to a hospital abroad in a specially designed aircraft. 

This is a gross injustice. Frontline African health workers responding to the epidemic deserve equal access to the same quality of care afforded to their Western colleagues. To deny them the same level of care available to foreign aid workers is immoral and inexcusable. It also contradicts every global ethical norm on equality of health care access, nondiscrimination and basic human decency. 

In addition, there is still no clear, unified international response to provide the level of resources needed to stop Ebola’s spread. To its credit, on Sep. 4, the U.S. Agency for International Development pledged an additional $75 million in aid funding to support efforts to fight the outbreak, bringing the total U.S. commitment to nearly $100 million. On Sept. 16, President Barack Obama announced plans to deploy 3,000 troops to Liberia in an effort to provide training programs for health care workers, help construct new health care facilities and bring badly needed supplies such as protective gloves and clothing to the region. The effort will cost up to $750 million over the next six months, according to the White House.

The renewed U.S. commitment to contain Ebola, while welcome, is too little effort too late to save Buck, her peers on the front lines, and thousands of other Africans who have died. That it took the infection of white people to get donor governments and nongovernmental organizations to pay serious attention to the outbreak is a ringing indictment of the West’s prejudice against African lives. It is too late to fix the failure to commit needed resources that should have happened six months ago. But the long-term consequences of having waited so long to intervene at an appropriate level will be dire for the region’s public health.