A lethal epidemic and a lethargic global response

Published by The Independent (4th October, 2014)

Augustin was agitated and scared. After weeks spent hiding in his house with his wife and children, he had left the safety of its confines to take his aunt to a new Ebola clinic for testing. This poor woman had already lost two daughters, one son-in-law and two grandchildren in three weeks, tending them as one after another developed fever, then started vomiting and bleeding. Now she had three orphans in her care, another sick grandchild lying listlessly at the gate and she feared she might be the virus’s next victim.

But there was no room for her, despite the clinic opening just two days earlier in Monrovia, the Liberian capital. Nor was there room for the many others, seemingly in the throes of this condition, seeking testing and treatment. Already the unit’s 150 beds were full of desperately sick and dying patients, another 30 squeezed on camp beds. ‘We rehydrate them, we feed them and we pray with them – that is all we can do since their lives are in God’s hands,’ one doctor told me. ‘But this outbreak can only get worse when we turn away so many sick people.’

There are many layers of tragedy to the Ebola epidemic that is sweeping parts of West Africa. The way the virus has struck a region where it has not hit before, and one already shattered by conflict and corruption, and the fact that it took almost four months to identify it. The way it began in the border zone of three countries, a place filled with mobile populations that carried it for the first time into crowded urban areas. And, perhaps most terrible of all, the way the disease carves with such deadly cruelty through families and close-knit communities.

Standing beside the Island Clinic gates in Monrovia last week, I was aware of two simple yet devastating facts. First, that most of those displaying signs of the dreaded sickness will be dead by the time you read this. And second, that before dying they will have passed the virus to others in their homes and streets. Little wonder the number of cases doubles every three weeks – official statistics putting the death toll at more than 3,300 are thought to be just a third of the real number.

Ebola is comparatively hard to catch, yet fatal for seven in 10 of those infected. Patients die in agonising circumstances as their organs collapse; survivors told me of heads pounding so hard they could not sleep as they lost control of bodily functions. Have no doubt, this is an epidemic raging out of control and rapidly turning into a humanitarian catastrophe, even though Ellen Johnson Sirleaf, Liberia’s unpopular president, strangely claims it is stabilising.

It is not just the numbers – the worst-case projections say one in 10 people in Liberia and Sierra Leone could become infected – it is also the collateral damage as nations are placed in virtual quarantine; for instance British Airways has disgracefully suspended flights to Liberia, which makes it harder for health and hygiene experts to get there. Just one flight a week would help.

I found a country existing in the fearful shadow of fatal disease. Your temperature is checked upon arrival at the airport, the same precaution is taken even on entering a supermarket. There is a night-time curfew to cut down on social interaction, while schools are closed, sports events cancelled, elections postponed, hospital wards shut down and non-essential workers told to stay at home. People avoid the usual handshakes; parents said they have stopped touching their children.

A fast-growing economy has been sent into tail-spin; one shopkeeper told me that takings were down by one-third, while hotel staff said their hours had been cut in half. Yet Ebola can be constrained, even in a densely packed urban environment such as Monrovia – the key is to persuade people there is a real threat, then rapidly get patients into isolation

Unfortunately these are countries with decrepit health services and corrupt political systems, many of the few medical staff were among the early victims – and the world only woke up when Westerners became infected, such a damning reflection on the relative value placed on African lives.

Médecins Sans Frontières (MSF), the most active group on the ground, denounced the lethal failure of the international response last month, demanding military support for medical units backed by logistical and sanitation experts. It was the first time MSF has made such a demand. President Barack Obama soon fell into line, followed by the British Government, but for all the fine talk, the response remains sluggish. ‘Everybody, in their intentions, is moving fast, but in the field [they are] moving at the speed of a turtle,’ said Joanne Liu, the MSF president.

This is not about money. Nor, as some point-scoring MPs claimed, can it be blamed on foreign aid curbs – not least when their own report revealed that of £37m in health aid donated by the European Union, only £2.4m reached the ministry of health. It is about attitudes. For example, self-serving NHS managers should stop preventing doctors and nurses from volunteering for fear of a possible flu epidemic at home. It is also about speed and clarity of response. ‘There is no margin for error in managing an Ebola isolation unit,’ said one expert.

Ultimately, it is about compassion for human beings trapped in a hellish crisis. ‘Ebola needs to be nipped in the bud before it can flower,’ said David Kaggwa, a Ugandan expert working in Monrovia. ‘But it has flowered here and borne fruit – the tragedy is that there is so much suffering with this disease.’

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