After my first “Ebola friend” spent six weeks in Liberia back in August, she returned to Texas at almost exactlly the same time as Thomas Duncan, the first Ebola patient to be diagnosed on United States soil. My friend stayed at home and away from people for the 21 day incubation period, as a precaution despite being asymptomatic. This was mostly to assuage the fears of friends and family, who connect “Ebola” to fear of widespread death and destruction, as has happened to the unfortunate West African nations of Sierra Leone, Liberia and Guinea. A couple of months after her return, this friend and her husband went out for dinner with a couple who she described as “possibly in line for friendship”. However, when the wife started berating Duncan as a Jihadi terrorist, bent on bringing Ebola to the US as a terrorist act, their friendship plans were quickly terminated! Since then, friends and colleagues from Australia have been arriving and bumping into each other in Sierra Leone, eliciting mixed feelings of relief, guilt and jealousy in me from afar! The global community and the Australian government appear to have finally grasped that they need to get involved in this public health emergency.
In my experience, infectious diseases always evoke panic and crazy (P&C). My first memory of this was the discourse during revelations about HIV as a newly discovered virus in the 1980s, when homophobia and conspiracy theories abounded. Public panic was best illustrated to me in 2009 when we found ourselves responding to the Swine Flu pandemic at a time when noone was sure of the virulence of this newly evolved virus. Initially Swine Flu had a higher mortality rate than the usual circulating Influenza strains, and it spread quickly from it’s origins in Mexico, arriving in Australia two months later. Most of our time was spent responding to the Worried Well, with phone calls coming through from people no doubt meaning well, but causing an unnecessary “clog” on our telephone lines and obstructing our ability to cope with the actual response required. It was a stressful, chaotic time which will stay with me as one of my “career traumas”.
From my time working on Swine Flu, the story which had the biggest impact on me as a public health worker trying to impose sanctions on an unwilling public, is one which came out of Hong Kong during the SARS outbreak in 2003. A concentrated outbreak of SARS occurred in a specific housing complex in HK and the whole complex was placed under quarantine. After quarantine had been imposed, police attended the complex to discover over half of the apartments were empty. This is a perfect example of the effectiveness of health systems. Even in well resourced countries, mass scale epidemics can be difficult to contain due to public response, and infectious diseases are always closely connected with public behaviour, both in the way that they spread, and the way in which they may or may not be contained. Public health workers need to be versed in psychology as much as infectious diseases in order to provide adequate responses to the human hosts of these diseases. We are not just doctors, nurses, epidemiologists etc, but we are also, always (admittedly unqualified) social workers, counsellors, psychologists, anthropologists and politicians!
It is well publicised that the current Ebola outbreak devastating large parts of West Africa has received a very poor international response. Fears of sending foreign nationals to these areas and false beliefs that national border control measures could protect the international community appeared to me, to be behind this shockingly inadequate response. Thankfully, as is usually the inevitable case, common sense is eventually, albeit slowly, winning out. Not before over 7,000 people have lost their lives. The epidemic has continued unabated for so long that it will take a huge concentrated effort to contain it now.
Dr Paul Farmer from Partners in Health said it best, as he always does, when he wrote an opinion piece in the Washington Post in August. Remembering the Western experts of 15 years ago who said there was nothing which could be done to help HIV/AIDS patients in poor countries, and outlining what has since been done to turn the tables on the AIDS epidemic, he expanded this to outine the take-no-action excuse which has been used in Drug Resistant TB, Malaria and many other “poor peoples'” diseases. He then says, as I have quoted before, “The Ebola crisis today is a reflection of long-standing and growing inequalities of access to basic health care”. For those who don’t understand the practical significance of this statement, an example from a recent media report explains it well in one single scenario. Kenema, Sierra Leone – Alex Moigboi was panicking. He was preparing to enter the Ebola ward wearing just a pair of gloves and a plastic gown over his scrubs. It was totally inadequate—like a firefighter entering a burning building wearing a pair of Ray-Bans—and Alex knew it. But he couldn’t find the rest of the protective gear he needed: goggles, a Tyvek waterproof suit….. Alex was angry, crying, desperate. But his patients, piled three to a bed in the ward, needed him. He steeled himself to go inside. Alex later became one of dozens of health workers who died from Ebola here at Kenema Government Hospital this summer. http://www.wired.com/2014/12/sierra-leone-scientists-research-why-some-survive-ebola/
Clearly, situations like this, which occur daily elsewhere, are unheard of in rich countries. This is exactly why the Ebola crisis will never be more than an odd sporadic case in places like Australia and America. While Influenza which spreads so much easier than Ebola, kills more than 1,500 Americans every year, Ebola so far this year has killed one American. Yet compare the public’s indifference and even opposition towards Influenza vaccination with the panic over Ebola and you get a good illustration of the way in which human behaviour and infectious diseases are so interconnected.
Even if we reject the global-citizen view of our place in the world, today’s Ebola crisis and the risk it places on all of us when public health in faraway locations is threatened to the point of causing economies to collapse, surely demonstrates a need to act for the good of us all. That is not to say that Ebola itself could be our downfall, but the effects of Ebola are so far reaching that the decimation of already-crumbling health systems elsewhere could easily impact upon the world by affecting our economies and political stability.
As Christmas approaches and I watch the crowds in shopping centres, or walking local streets loaded with bags of gifts, I wonder how different it could be if we all directed a fraction of what we’re currently spending on unnecessary luxuries, towards an Ebola cause such as Medecins sans Frontieres, Partners in Health or Red Cross? A list of charities responding to the Ebola crisis can be found here: http://www.charitynavigator.org/index.cfm?bay=content.view&cpid=1794#.VJmZZcAKA