While I base myself in Cambodia on leave-at-half-pay, unsure what exactly 2015 will bring as I “stress” about how to spend my year off work, three of my colleagues from Australia’s Northern Territory are in Sierra Leone, working in an Ebola Treatment Centre. The standard duration of Ebola missions is six weeks. Considered to be high-risk and very tiring work, six weeks is the optimal time you can spend in this environment effectively before the chances increase, due to exhaustion, of breaching protocols and risking transmission of the virus. In other words, you are at risk of becoming so tired that you are more likely to make a mistake while donning or doffing your Personal Protective Equipment (PPE), or even while wearing your PPE (eg removing goggles to scratch an itch on your face).
After six weeks of working in an Ebola Treatment Centre, it is then recommended to spend 21 days in low level “quarantine”, ie staying away from public venues and having minimal contact with others outside your immediate family. Twenty one days is the maximum incubation period, being the time from virus exposure, to symptom presentation. Once you’ve been home for 21 days, the risk of becoming symptomatic expires. Without symptoms it is not possible to transmit Ebola to others, so keeping asymptomatic people isolated might seem like overkill but as I understand it, the concern is that from one moment to the next, symptoms may present. As such it is best, and least likely to result in public panic, to remain isolated from the general public throughout the incubation period, regardless of whether you have symptoms. The case of Kaci Hickox is an excellent example of the way media and the general public tend to panic when they don’t understand a disease or it’s transmission. She dared to go for a bicycle ride during her quarantine period – placing noone at risk by doing so – creating a furore in the process. Always sitting beside infectious disease outbreaks, waiting to rear it’s ugly head, is the epidemic of reactionist hysteria.
Working on an Ebola project results in being “away” for a total of nine weeks. None of which, of course, compares to being an African afflicted with Ebola, either physically or through the loss of loved ones. African health workers do not have the luxuries described above, of expatriate health professionals. We fly in for a finite time, fly home to a life of comfort and follow all recommendations to keep ourselves and our communities safe from harm, without any of the intense strain that locals have to live with until the epidemic dies out. These countries are already ravaged by poverty and Ebola has brought panic, crashed economies, demolished health systems and killed off hundreds of health professionals in an already-depleted workforce. It has exacerbated the suffering already experienced in these places on a massive scale. One of my options during this time off work is to volunteer at an MSF Ebola Treatment Centre and I have told MSF of my availability for this. For those of you who know my workplace requirements, if I do this, it will be without pay as my current employer is paying me a salary and I am not entitled to undertake paid work during this time. As such, I won’t be breaking any rules.
Some of the information being shared from West Africa is fascinating, albeit utterly tragic. Trying to read everything I can, particularly from those in the field experiencing it first hand, I’m becoming a little obsessed with it! “I Don’t Know If I’m Already Infected”, The Controversial Death of Ebola’s Unsung Hero is an illustrated article by Joshua Hammer which I read this morning, about Dr Sheik Hummar Khan. He was a tropical diseases expert from Sierra Leone who was not only known for his research of viral haemorrhagic fevers, particularly Lassa Fever, but also ran the Ebola Ward at Kenema General Hospital. Kenema’s first Ebola patient arrived at the hospital on May 23 and without adequate PPE or training many hospital staff almost immediately contracted the virus. Already-inadequate facilities crumbled under the weight of the epidemic, which killed many of Dr Khan’s nurses and colleagues before he succumbed to the virus himself, in July after working 14 hour days without a day off, for two months. He probably died due to a breach in protocol, thought to have occurred after doffing his PPE with a colleague who complained of feeling unwell. Tired and not concentrating, Dr Khan immediately touched his colleague to perform a clinical assessment. The colleague was diagnosed with Ebola and within days, so was Dr Khan. He died on July 29. A tragic and avoidable death which leaves the world bereft of a most brilliant and experienced infectious disease expert. The full article for those interested in reading it, is here https://medium.com/matter/did-sierra-leones-hero-doctor-have-to-die-1c1de004941e.
This is just one of the many stories emerging from West Africa at a cataclysmic time in the region’s history. Many other equally worthy articles can be found all over the internet but some of those that my colleagues have shared because they are particularly poignant, include:
A parody of The Kinks, Lola, singing about Ebola – very funny! Even at times like this it’s worth having a laugh.
An excellent article from People’s Health Movement worth reading but I’ll quote a brief paragraph under the heading “Why the Epidemic?”:
Why then are we confronted with an Ebola epidemic in West Africa? The answer lies not in the pathology of the disease but in the pathology of our society and the global political and economic architecture. It is not an accident that the present Ebola epidemic has affected three of the poorest countries in the world. Liberia, Guinea and Sierra Leone number 175, 179 and 183, respectively, out of 187 countries on the United Nation’s Human Development Index13. Their health systems are ineffective and almost non-existent in many regions. The present epidemic is one brought upon by poverty and, as summarised below, by ruthless exploitation of the region’s natural resources.
When I attended the Ebola Infection Control Training with ARM Network in Sydney in November, one of the guest lecturers was MSF Nurse Brett Adamson who spent an hour with us before leaving to catch a plane to his next mission somewhere in Africa. He was concise and eloquent in his criticisms of western governments and their inadequate response to the outbreak. In this article from January 6, in which he is quoted as saying “nothing prepares you for the sheer brutality of Ebola”, he talks of his experience as a Project Coordinator on an MSF Mission in Liberia, finishing with this worrying quote. “As a nurse I can only hope to never face such barriers to care again. Seeing the continued failure of the world to respond fast enough to the current situation I can only assume I will see worse. And this I truly dread.”
Probably more than any other epidemic in living history, I think West Africa’s Ebola outbreak has shone a very bright torch on the inequalities between rich and poor nations. A case of Ebola in a western country will certainly lead to public hysteria. Previous outbreaks such as Swine Flu in 2009 attest to this. But a single case of Ebola in a western country will not lead to uncontrolled spread of the disease. Simply because our health systems are more than adequate. Had this been the case for West Africa, then the world would not have lost Dr Khan or 840 other health professionals trying to contain the outbreak under impossible conditions. It’s time for us to care about our brothers and sisters in the developing world, to demand that corporations and governments change their exploitative behaviours towards poor nations and to seek political change. Ebola might be our warning call but the next disease outbreak may not be so kind on the Western world.