Responding to Ebola in West Africa: Farmer calls for staff, space, supplies, systems

Paul Farmer, president and co-founder of Partners in Health, has dedicated his life to the idea that the problems of the world’s poorest people are humanity’s problems writ large. Having recently returned from West Africa, Farmer spoke at Harvard Medical School and appeared on the Colbert Report last week, calling for a stronger response to the Ebola outbreak.

“We want to have a radical inclusiveness,” Farmer told the Harvard Medical School audience. “We readily acknowledge that we are overwhelmed by this.”

Ebola was first recognized decades ago, when the disease began to spread quickly in hospital settings due to poor medical care and poor infection control. With aggressive supportive treatment, the majority of patients survive, but getting healthcare workers on the ground during the recent epidemic in West Africa has proven challenging.

Because of Ebola’s extreme contagiousness—Farmer calls it a “caregiver’s disease” since it often spreads to those aiding infected persons—foreign governments have been reluctant to provide healthcare personnel. Protocols in the U.S. around re-entry of direct-care clinicians have become notoriously extreme, and the unfounded fear of Ebola spreading in America has diverted attention from the real crisis.

Yes, the number of people with Ebola in West Africa is overwhelming: 17,800 cases in Sierra Leone, Guinea and Liberia as of December 6. But effective treatment is not incredibly sophisticated or expensive, said Farmer. It largely consists of rehydration to replace lost body fluids. “[Ebola] is not foreign to us,” Farmer emphasized. “Even without a specific antiviral therapy, there’s no reason mortality should be above 10 to 20 percent.”

What these plagued areas need is a much larger influx of health care workers—doctors, of course, but especially nurses trained to administer intravenous hydration. “Patients are losing up to 10 liters of effluent a day,” says Farmer. “There’s no way to keep up with oral rehydration.”

Compounding the problem are issues related to public health education:

  • Unsafe burials: A person who dies from Ebola is infectious for weeks after death. It is very common for family members or friends to contract Ebola while assisting in the burial of a loved one.
  • Distrust of Ebola treatment units: Many West Africans in areas ravaged by Ebola want nothing to do with an ETU. They see friends, family and neighbors shipped off to these clinics, many times never to return. Establishing trust in the medical system is essential if there will be any success in stopping the spread of this disease.
  • Delayed diagnosis in community health clinics: While nurses and doctors who work in an Ebola treatment unit, or ETU, know that their patients have Ebola, medical staff in a community clinic see patients before they are diagnosed. These facilities desperately need more clinicians who are trained to recognize and properly treat Ebola until the patients can be transferred to an ETU.

Farmer’s prescription for the Ebola epidemic goes beyond immediate attention to acute cases. His vision is to establish a strong, self-sufficient health care system in West Africa so that future crises do not wreak similar havoc.

“The impact of Ebola on the primary care delivery system is devastating,” said Farmer. For example, with nearly all medical personnel now focused on Ebola, rates for measles vaccinations in children have fallen drastically.

Farmer called for more of the “four S’s”—staff, space, stuff (supplies) and systems—to address needs ranging from medical waste management to reliable electricity to better blood pressure monitoring systems. He noted that in Liberia, a country with the world’s largest rubber plantation, it’s difficult to get latex gloves.

Despite the gravity of the problem, Farmer left his audience infused with optimism. The Boston biomedical community has a lot to offer in the fight against Ebola. Although we are already one of the largest sources of direct clinical staff, we can and must do even more.