Image credit: European Commision (EC/ECHO/Cyprien Fabre).
Image credit: European Commision (EC/ECHO/Cyprien Fabre).

The Ebola epidemic in West Africa is the largest ever, projected to reach 170,000 cases if nothing is done. So far, the international community has failed to implement an effective and coordinated response, extending the devastation and sacrificing thousands of lives. “It is not a matter of choosing whether to do it or not. It’s just a question of when we pay the price for it,” said World Bank President Jim Yong Kim. The international community is responsible for helping, but instead of taking decisive actions abroad, we have been closing our borders and treating our heroes like lepers. We are creating an epidemic of fear and spreading it with words.

“Fear makes the wolf bigger than he is” – German proverb

The situation in West Africa is dire. Transmission within families is rapid; people catch the disease from nursing their sick family members. People search for help from treatment centres so overextended that they can only admit a few new patients each day to fill the beds vacated by those that died the night before. Lucky survivors carry memories of a disease that crystallize the keen fears of the community. Their neighbours regard them with suspicion and fear.

The delayed sounding of alarm bells by the World Health Organization (WHO) gave the disease four and a half months to spread before calls for aid were broadcast to the world. Grandiose pledges of assistance poured in, but with lackadaisical indifference these words failed to translate into action. Six months into the epidemic, Médecins sans Frontières (MSF) was still providing the majority of tangible relief efforts. In exasperation, Dr. Joanne Liu addressed the UN: “Generous pledges of aid and unprecedented UN resolutions are very welcome. But they will mean little, unless they are translated into immediate action.” This scenario bears an upsetting similarity to the 2010 earthquake in Haiti.

After the earthquake in Haiti, pledges to the UN fund dedicated to providing relief generously poured in from countries around the world, but most nations never followed through. Flash forward to Ebola: by mid-October only $100,000 of the total $20 million pledged to the UN fund had materialized. Countries directed the rest of their donations directly to non-governmental organizations (NGOs) or branches of the UN implying a distrust of letting the UN direct their money. This distrust has undermined the ability of the UN to direct a coordinated response. Instead, we have created a many-headed beast that is flailing haplessly against a problem increasing in complexity.

Ebola infects macrophages and monocytes, using these cells to hitchhike around the body and infect endothelial cells lining blood vessels. There aren’t any approved Ebola-specific treatments and there will be no magic bullet with appropriate production capacity to stem this outbreak. Health care providers are limited to treating concomitant infections, alleviating symptoms, and providing counseling to terrified patients whose families can’t be there to hold their hands. Diagnosis is complicated by the fact that it presents with malaria-like symptoms: fever, headache, nausea, and fatigue. Malaria and Ebola patients arrive and wait side by side for diagnosis at treatment centres. Those who don’t have Ebola have run the risk of acquiring it by seeking medical attention.

[pullquote]”We are not in danger of an Ebola outbreak but North American media coverage of stories goading people into irrational panic is derailing the already feeble attempts to help.[/pullquote]Attempts to quell the Ebola outbreak have seemed hopeless because they are insufficient, not because Ebola is unconquerable. North Americans have lost perspective. We are not in danger of an Ebola outbreak but North American media coverage of stories goading people into irrational panic is derailing the already feeble attempts to help. With well-equipped medical facilities, better nutrition, and well-trained medical professionals Ebola is not a death sentence; eight out of the nine patients treated in the States were diagnosed early, received quality supportive care, and have now recovered. The ninth patient, Mr. Thomas Eric Duncan, was initially misdiagnosed and sent home with antibiotics, only to return to hospital 3 days later in dire condition.

After the treatment of Duncan resulted in the infection of two nurses, the nurses of Texas Health Presbyterian Hospital Dallas released a statement revealing a dangerous lack of preparedness after the treatment. The nurses said that “no one knew what the protocols were or … what kind of personal protective equipment should be worn and there was no training”. When Mr. Duncan was admitted he was left for hours in a waiting area with other patients even though he was suspected of having Ebola. While being treated, hospital officials allowed nurses caring for Mr. Duncan to continue with normal patient care duties. Despite this lack of appropriate quarantine procedures, only two nurses were infected.

[pullquote]“Closing borders will not prevent the spread of Ebola, but it will bolster unfounded fear.”[/pullquote]These are problems that can be avoided through proper preparation. Toronto is especially well prepared with a specialized negative pressure isolation unit designed after the 2003 SARS outbreak, packages of personal protective equipment distributed to emergency departments, and ongoing training that ensures employee comfort with the new protocols. In addition, coordinators of the Ebola preparedness response plan have been maintaining open communication channels with staff, soliciting feedback on any improvements that could be made to improve the safety protocols. If an Ebola patient arrived tomorrow, staff would be able to contain and treat the case with the minimal risk possible. Canada is prepared. And yet, the Canadian government has violated the International Health Regulations that they helped draft by suspending the issuance of visas to citizens of Ebola-stricken countries. Closing borders will not prevent the spread of Ebola, but it will bolster unfounded fear.

“Money and materials are important, but … human resources are clearly our most important need,” states the Director-General of WHO, Margaret Chan. We need healthcare workers to volunteer their time, skills, and courage in West Africa to help reverse the tides of this epidemic. As fear permeates our media and our politics, nurses like Kaci Hickox return from Sierra Leone to be greeted with suspicion, a 3-day involuntary quarantine, and court proceedings to confine her to her house. Hickox is “not willing to … let [her] civil rights be violated when it’s not science based”. This suspicion towards returning aid workers threatens to derail the good intentions of prospective volunteers and discourage them from going.

The longer the Ebola epidemic is allowed to continue, the greater the problems will be in the future. This is only the beginning of the challenges that lie ahead, and only the beginning of the international community’s responsibility. The outbreak threatens to fray the peace in countries that are still healing after years of civil war. According to the UN World Food Programme (WFP), prices of staple food items have gone up 24% and are still climbing. The fear of working together and the fatality of farm workers have disrupted agriculture and food shortages will worsen. With a media that has trouble paying attention to things that don’t involve Taylor Swift’s ex-boyfriends or a trending Twitter campaign, will we remember West Africa after the infectious threat passes? I hope so.

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Heather MacGregor

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