MUST READ Ebola: how is the continent coping? Opinion by Dr Susan Mboya-Kidero, President of The Cola-Cola Africa Foundation West Africa is dealing with the worst Ebola outbreak in history. The latest figures show there have been 4 445 confirmed or suspected deaths in the worst-affected West African nations of Guinea, Liberia and Sierra Leone. Eight deaths are linked to the haemorrhagic fever in Nigeria, and one in the US. In total there have been over 8 900 confirmed or suspected cases, mostly in West Africa. The World Health Organisation (WHO) says that while the Ebola strain in West Africa is not the deadliest on record, it is by a large margin the most widespread outbreak to date. The organisation has confirmed that up to 70% of patients who contract Ebola are dying – and ultimately more than 1.4 million people could be infected by 2015 if the disease progresses unchecked. There has been an unprecedented response to the Ebola outbreak – worldwide governments, relief organisations and NGOs are doing everything they can to help prevent the virus from spreading by treating patients and providing support to healthcare staff who, at huge risk to themselves, care for those who are infected. The global response, while initially slow, is accelerating to the point needed to begin to slow this epidemic. Once the disease slows, and more aid comes in, I believe that it can be controlled. But the global response must continue to accelerate. The sheer size of this outbreak means that containing the disease is a continuously moving target, and the world needs to work harder to get ahead of it. The Ebola outbreak is growing exponentially, with over 1,000 new infections a week. In Sierra Leone the government recently recorded 141 deaths in a single day. WHO estimates that by December, we may be seeing upwards of 10,000 new cases each week. Clearly more resources will be required to contain it. The outbreak, which was first detected in March this year, is a humanitarian crisis with far reaching social, health, ethical and economic implications for Sierra Leone, Guinea and Liberia – the hardest hit nations in West Africa. Calculating the costs Governments and economists are estimating that this outbreak will have a tremendous economic impact and pose a significant economic threat to the three affected countries and even beyond. The World Bank estimates that Ebola could cost West Africa US$32 billion over the next year and that economic growth next year could be reduced by 2.3 percentage points in Guinea and 8.9 percentage points in Sierra Leone. In Liberia, which has been the hardest hit country, the economy could lose up to 11.7 percentage points in growth next year. These are extremely worrying statistics. Africa as a whole is seeing a reduction in tourism, as nervous travelers choose to avoid the region. In West Africa, the outbreak is having a direct impact on productivity, due to isolation and quarantine measures, as well as fears of infection. The result is a slowing of regular economic activity and cross border trade. As well, governments are having to stretch their already limited resources to provide additional funding to shore up their weak health systems, to provide treatment, and to isolate suspected new cases, and also to fund specialized burial teams to go out into the communities to bury Ebola victims. Governments are also having to undertake and fund labour-intensive contact tracing processes to track people who had close contact with infected individuals. This is turning out to be a difficult task – CNN reports that in Sierra Leone only 20% to 30% of available addresses can be tracked. According to the United Nations, only 16 of 44 zones in West Africa have sufficient contact tracing. The inability to trace everyone who has had contact with an Ebola patient is cited as one of the main reasons why the disease is spiralling out of control. Healthcare systems under review The Ebola crisis is also putting the spotlight on the readiness of African countries to deal with serious health threats such as Ebola. Many African countries have a mixed scorecard when it comes to readiness to deal with a potential outbreak. Being prepared for an outbreak is so critical to quickly arrest and prevent the disease from spreading. An outbreak of this magnitude and complexity would be a challenge for any country to manage – even for the most advanced healthcare systems as we are seeing in the US, where despite having top notch facilities, two nurses have been infected while caring for an Ebola patient. However, Africa has been particularly hard hit. Weaknesses exist in relatively new health systems in countries which were only beginning to stabilise after years of civil war. Keep in mind that many countries have stretched resources and as a result of competing priorities healthcare is unfortunately left behind. In Liberia, Sierra Leone and Guinea there are only one to two doctors available per 100 000 people and these doctors are concentrated in urban areas. Add to this the fact that a large number of fatalities are among healthcare workers – more than 200 health workers have died of Ebola this far. Sierra Leone has lost some of its top Ebola specialists to the disease, which only compounds the crisis. The World Health Organisation reports that in order to avoid the “doomsday scenario” and turn the tide on this outbreak, up to 70% of those infected will need to be isolated and in treatment by the end of the year. Only then will we begin to see a reduction in the number of cases. However, despite the strong global response, we are still far from being able to achieve that goal. The reality is that currently only 18% of those infected are isolated in treatment centres, leaving more than 80% of infected Ebola victims being treated at home by family and friends who are then also at risk of catching the disease. In recent weeks, however, aid organisations have begun to distribute home care kits containing personal protective equipment to enable caregivers in the home to protect themselves while caring for a loved one with Ebola. This, along with a rapid increase in the number of beds available in isolation wards, will be our best chance of containing this outbreak. But even as we discuss the seriousness of this situation, I believe that it is important to highlight the success stories of where Ebola has been contained, and learn from those countries who have been able to successfully stop the spread of Ebola. According to the Centres of Disease Control and Prevention (CDC), Ebola in Nigeria has been virtually contained as a result of that country’s rapid response and excellent contact tracing system. The Nigerian Ebola response was a coordinated effort by Nigeria’s Emergency Operations Centre including Government and Healthcare workers, and international partners, including the CDC. Nigeria remains vigilant, but their successful response to a single case of Ebola shows that with the right systems in place, it is possible to rapidly contain the disease Senegal’s preparedness and prompt cross-border communication meant that this country avoided an Ebola epidemic entirely, after confirming and successfully treating its first case in August. A social dilemma Ebola presents a number of social dilemmas rarely seen before. West Africa is struggling with fear and stigma around Ebola, a natural human reaction to any disease, particularly one that is highly infectious and has no known cure The psychosocial ramifications of an Ebola death in a family are far-reaching and complex. The fear of stigmatization is having the unintended consequence of driving Ebola sufferers underground, and/or people claiming that an Ebola death was due to some other cause, putting the entire community in danger. Given that the most virulent stage of the disease is immediately before and immediately after death when the viral load is at its highest, if a community believes that a person did not die of Ebola, they may be encouraged to continue with their normal burial rituals which involve touching and bathing a corpse. This has tragic consequences The impact of Ebola on orphans is particularly devastating. According to UNICEF, at least 3,700 children in Guinea, Liberia, and Sierra Leone have lost one or both parents to Ebola since the start of the outbreak. In Liberia alone, almost 2 000 children are known to have lost their parents in the outbreak. The impact is doubly hard on these children. Not only do they lose their parents, their extended families and communities reject them out of fear of the disease. In Guinea, aid workers are focussed on preventing widespread panic by providing life-saving information to communities so that they can have a better understanding of the disease and of how to best protect themselves and their families. How do we respond ethically? The crisis also presents one of the most difficult ethical dilemmas that we as an African community could ever face. We all know that Ebola can spread very quickly once it enters a country, and that the first line of defence is our borders. The Ebola crisis also presents African leaders with one of the most difficult ethical dilemmas possible. Cross border trade and air travel has been one of the primary mechanisms of spreading of the disease across borders, and so a logical first step for any country is to close its borders to protect its citizens. However, doing this may deny fellow African countries desperately needed aid in their hour of greatest need. Leaders have to grapple with the dilemma of protecting their own citizens without causing undue harm to neighbouring African countries who desperately need aid. In some instances, aid corridors are being set up where flights containing much needed health care and food supplies are allowed in to the affected countries at controlled intervals. Lessons learnt The speed and the ferocity of this particular outbreak have taught us of the need to be prepared. As a global community, and Africa in particular, we should learn from this outbreak to emerge stronger and more able to cope with such health crises. Nigerias success in quickly containing Ebola once it entered its borders came out of a stained, and well-coordinated multiagency effort. The Government created an Emergency Operations Center to coordinate and oversee the national response. Schools were immediately closed, and large gatherings prohibited. Educational information was made available to the public. A presidential decree enabled officials to access mobile phone records and empowered them to lean on law-enforcement agencies where necessary to track down people at risk. Thereafter, a strict system to monitor potential cases was put in place by the Lagos state government. The operations center used a variety of resources, including phone records and flight manifests, to track down nearly 900 people who might have been exposed to the virus and each contact was monitored for symptoms for 21 days. During this contact tracing process, officials made a staggering 18,500 face-to-face visits. It is this unprecedented response that enabled Nigeria to avoid what would unquestionably have been a disaster for the country and the continent. Africa’s medical resources are still very much focused on treatment, which is usually the most urgent need. But this unfolding crisis has taught us that we need to invest more in prevention and building health systems that enable us to cope with any eventuality. This is why healthcare has always been an area of strategic focus for The Coca-Cola Africa Foundation (TCCAF). In fact, initially the foundation came about as a response to the HIV/AIDS crisis in Africa. But recently TCCAF decided to switch its focus from healthcare and prevention to health systems strengthening. We are providing resources to help strengthen health systems in affected countries to make it easier for them to fight and bring such issues under control. The Foundation is using Coca-Cola’s advanced logistics systems and expertise to help strengthen health systems in Africa, and our Project Last Mile initiative is an example of how we are leveraging our internal expertise in supply chains to help the Medical Supply Department (MSD) in Tanzania to optimize procurement of key medicines and to reduce out of stock risks. I truly admire those who continue to risk their lives every day to help bring this humanitarian crisis to an end. The exceptional global response to the Ebola crisis shows that we have not lost our humanity. Sierra Leone, Guinea and Liberia cannot overcome this crisis alone and it will take a concerted global effort to bring this epidemic under control. The African community and the rest of the globe has to come together to offer those on the frontlines of this battle all the support and resources they need. I believe that there is hope – the outbreak can be brought under control with the right equipment and sufficient resources. The world can win this battle.
Posted on: Fri, 17 Oct 2014 08:39:16 +0000
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