THI MINH PHUONG NGO
UNICEFTAP THIS RESERVOIR: India’s large cadre of epidemiologists, laboratory scientists and medical practitioners can help support diagnosis, the training of health workers, or clinical services in Ebola treatment units. Picture shows health workers preparing for work outside an isolation unit in Foya district, Lofa County in Liberia in July.
UNICEFIn August 2014 in Sierra Leone, an outreach worker speaks with residents about the symptoms of Ebola virus disease (EVD) and best practices to help prevent its spread, in Freetown, the capital.
UNICEFIn July 2014 in Sierra Leone, a health worker, wearing head-to-toe protective gear, offers water to a woman with Ebola virus disease (EVD), at a treatment centre for infected persons in Kenema Government Hospital, in the city of Kenema, Eastern Province. A young boy stands nearby.
UNICEFIn July 2014 in Liberia, health workers, wearing head-to-toe protective gear, prepare for work, outside an isolation unit in Foya District, Lofa County.
With better connectivity changing the way emerging infectious diseases are spreading, India needs to be ready especially with decisive action in support of affected countries
It is a safe guess that many people in India would find it hard to tell whether Ebola is the name of an illness, a flower, or a Bollywood actress. The first answer is correct, and wide awareness of the facts is essential to fight this dreadful disease. What then is Ebola, why is it a concern for India and what should India be doing?
Ebola is a rare disease caused by one of five virus strains found in several African countries. There is no cure or vaccine against it — at least not yet. And the largest Ebola outbreak in history is currently spinning out of control in West Africa.
Increased human mobility and connectivity have radically changed the way in which emerging infectious diseases spread across regions and across the world. India is at risk and it is only a matter of time before cases of Ebola appear in the continent (45,000 Indians are estimated to be living in the affected regions of West Africa). The Indian government has some plans to ward off an Ebola outbreak. But the Ebola epidemic also demands that swift and decisive action be taken in support of affected countries.
The outbreak
The outbreak started in Guinea in late December 2013 and quickly affected Sierra Leone and Liberia, with which Guinea shares porous borders. Ebola cases and deaths have increased rapidly and started surging exponentially in recent weeks, affecting nearly all regions in Sierra Leone and Liberia, including (for the first time in the history of Ebola outbreaks) the densely populated capital cities of Conakry, Freetown and Monrovia. Ebola also reached the megacities of Lagos and Port Harcourt in Nigeria as well as Dakar, the capital city of Senegal (where it was brought by two persons travelling by road and by plane). Fortunately, it remains contained in these two countries. As of September 13, 2014, there were close to 5,000 cases — confirmed or suspected — and about 2,500 deaths in the three intensely affected countries. About half of them appeared in the preceding 21 days.
Ebola tends to create panic because it has a high case fatality rate: up to 90 per cent in past outbreaks and 35 to 64 per cent in the current one. However, early public health measures can greatly help to prevent the spread of the disease. Ebola can only spread after a person infected with the disease exhibits symptoms, and a healthy person comes in direct contact with his or her blood and body fluids (e.g. vomit, secretions, sweat) through broken skin or mucous membranes. This makes it easier for healthy persons to protect themselves from infection. The most affected people have been those who take care of, or come in close contact with the sick people once the symptoms have appeared (usually within two to 21 days of contracting the virus): family members, health workers, and in the case of West and Central Africa, family and friends touching the highly infectious body of the deceased during elaborate funerals.
Containment is readily achievable through supportive treatment and well-known preventive measures — isolation, infection control, contact tracing, surveillance, all complemented with raising awareness about prevention among local communities. Nevertheless, on June 23, 2014, the Ebola outbreak was declared “out of control” by Médecins Sans Frontières (MSF, also known as Doctors without Borders). On August 8, it was called a “Public Health Emergency of International Concern” by the World Health Organization.
Factors causing spread
The spread of Ebola in Guinea, Liberia and Sierra Leone and then across borders has been fuelled by a combination of factors. Both Sierra Leone and Liberia have recently emerged from civil wars and are among the poorest countries in the world, with abysmal human development indicators. Health systems in Guinea, Sierra Leone and Liberia have buckled under the strain of the Ebola outbreak. Prior to the Ebola crisis, health workers went on strike over delayed wage payments, low salaries and poor working conditions. When Ebola arrived, they found themselves in insufficient numbers, under-equipped (Malaysia is sending gloves) and underprepared to control the disease. In Sierra Leone and Liberia, treatment units are overwhelmed and have to refuse potentially infected patients. Inadequate infection control systems for health workers have meant that doctors and nurses have become infected during routine contact with patients and have died in numbers. Health-care centres have closed as fear has caused patients to keep away and medical staff to flee. Lack of treatment facilities, stigma and distrust push families to keep sick patients at home.
Ebola has already brought health systems and entire countries to their knees. The impact of Ebola goes far beyond its lethality. This is because although Ebola has a low risk of transmission, the lack of a cure and high fatality rates have created fear, panic and confusion, inflicting a disproportionate social and economic toll.
Can such a scenario happen in India? While risks remain low, a single imported case in a densely populated area with weak health systems and intense poverty can spark an outbreak, as it was feared in Lagos and Port Harcourt.. Many other countries, rich and poor, are also at risk: the Centers for Disease Control and Prevention in the U.S. is preparing health clinics and health workers on U.S. soil to control a potential outbreak. India’s high population density and crowded slums with extreme poverty and poor sanitation make it a particularly vulnerable spot. The world has proved unprepared to deal with a rapidly evolving health emergency in destitute nations with grave international implications. But the international community is finally mobilising. Over the past week or so, we have seen Cuba committing 165 health workers and China adding a mobile laboratory with 59 clinicians and laboratory technicians (in addition to 115 Chinese medical staff already on the ground) to support the fight against Ebola in Sierra Leone. In a major move, U.S. President Barack Obama decided to send 3,000 military personnel to Liberia to help train 500 health workers per week and build 17 Ebola treatment units. On September 18, the U.N. Security Council declared the West Africa Ebola outbreak “a threat to peace and security,” called on all Member States to contribute to the response, and established a special United Nations Mission (UNMEER) to coordinate the Ebola Emergency Response.
What India can do
India, too, can contribute to global efforts to quell the Ebola crisis. It has a large cadre of epidemiologists, laboratory scientists, doctors and nurses who are experienced in epidemic control and can help support diagnosis, the training of health workers, or clinical services in Ebola treatment units. It also has a large number of social mobilisers who have proved their abilities in health campaigns such as the polio eradication campaign. They could contribute their experiences in community empowerment (one of the cornerstones of the Ebola response), address rumours and fears and help communities regain trust in the humanitarian response.
These resources are waiting to be mobilised, both to help contain the crisis in West Africa and to ensure that India is prepared for a possible Ebola emergency in the near future. By stepping decisively into the fray, India will signal that it stands with other world powers in the front line of the global fight against Ebola as well as other emerging infectious diseases. It is only when the outbreak is controlled in West Africa that nations will have done all they could to protect their own citizens from a possible outbreak of Ebola on their shores.
(Thi Minh Phuong Ngo is a UNICEF economic and social policy specialist based in Dakar, Senegal.)
No comments:
Post a Comment