There are positive signs that West Africa is recovering from the Ebola epidemic. But more must be done to create a healthcare system that can withstand the next attack from deadly disease, says Professor Mukesh Kapila.
Sierra Leone is at war again, as are Liberia and Guinea. This latest war is against Ebola, a nasty virus that kills most of its hosts.
The impression of war is reinforced by the Joint Sierra Leone/UK Task Force command centre, from where an impressively co-ordinated civil-military operation is chasing the virus. Off the Sierra Leone coast lurks RFA Argus, a British naval ship with sophisticated hospital facilities. Co-incidentally, she was here before – in 2000/01 to support the UK’s military intervention to dislodge rebels during Sierra Leone’s lengthy civil war.
I am also returning to the region for the first time in many years. I was there in the 1990s with the UK Department for International Development. Travelling again along the highway from Freetown to Makeni, the checkpoints bring a sense of déjà vu. But the police are friendly as they direct a temperature scanner at my forehead to check that I am not showing Ebola symptoms. This is a vivid contrast to the drunken or drugged militia of earlier years who pointed guns at us along the same road.
Local health staff – supported by nurses and doctors from the UK National Health Service and American and other hospitals – are fighting this war against Ebola every day. They work with the International Medical Corps at its Ebola Treatment Centres in Sierra Leone and Liberia. IMC is an experienced humanitarian health organisation that I have admired in Afghanistan, Kosovo and other countries mired in disaster and war.
There is no cure for Ebola Virus Disease, but the special treatment centres have become more practiced at keeping people alive with supportive therapy – including rehydration and a cocktail of anti-malarial, antibiotics and vitamins – to treat other possible co-infections and boost the body’s own defences.
Survival rates have improved to about 60%, as the sick seek earlier care and specialised ambulance services fetch them quickly and safely. The virus thrives on fear, prejudice and anger. Burial teams and public health workers have been attacked and the sick hidden away.
But this is changing as community outreach and public awareness measures achieve impact. Walls are plastered with graphic cartoons of people feeling feverish, vomiting copiously, extruding diarrhoea, bleeding horribly, breaking out in rashes, or contorting in pain. This is part of nationwide campaigns to educate the public on Ebola disease symptoms.
Perhaps attitudes are also changing because of the shocking impact of so many loved ones dying around you – as I witnessed during the earliest days of AIDS in Africa when some communities lost a third of their population. The director of the IMC treatment centre in Bong, Liberia, walked me to the nearby Ebola graveyard. Recently turned mounds stretch out under tall trees, each with a rough wooden cross.
But I was taken next to the Survivors Wall. The survivors’ count is growing. Discharge ceremonies declare survivors to be Ebola free and then given an impressive certificate to say so. This is important for people to get their jobs back and to reassure family and friends. Before they go, survivors leave their palm prints on the Survivors Wall. This rite of passage is also important – signalling gratitude, defiance and optimism.
A positive spirit is vital for recovery as the socio-economic consequences are immense. A commonly used word is “boredom”. With schools and colleges shut, social gatherings frowned upon, trade and commerce disrupted, employment-generating investments suspended, what is there to do? Perhaps, get drunk, pregnant, be anti-social? Some describe their lives as “frozen”, or “going backwards.”
The psychological trauma is profound – a mixture of shame, guilt, fear and isolation. Mothers can’t cuddle their suspected sick babies; the dead can’t be seen-off in traditional ways. “No touching” and “no handshaking” posters are everywhere. This is hard for West Africans who are a warm and affectionate people.
“We are now chasing the virus instead of the virus chasing us,” I am told. While new Ebola cases are dwindling, deaths have increased from other serious problems – treatable but unattended conditions such as malaria, typhoid and pregnancy complications – because normal clinics and hospitals were shut down and protective immunisation programmes suspended. Basic services must get going again without reducing vigilance on Ebola because this can flare up again.
The choices made now are vital. The scientists from Public Health England explain to me: “The Ebola virus is not particularly robust. It quickly kills most of the people it infects. Thus it also commits suicide. This is not smart for organisms that are normally primed to propagate themselves maximally.”
The virus did manage to exploit the institutional weaknesses of a health system that had long since broken down. This is not the time to say anything other than to call for unity and determination against a common enemy. The sentiment is echoed on giant billboards everywhere: “Ebola must go. It is our own responsibility”.
However, questions must be asked soon and the right lessons leant. Simply to restore the status quo ante is to be deaf to the wake-up call that Ebola has provided. And our notions on how to help fragile states are deeply flawed. Shortcuts and short-term thinking lead to short-lived results.
And a further niggling thought comes from past experience: will the current harmony among international actors – based on mutual self-interest – prevail or will this be overtaken by recriminations and competing development ideologies?
A longer version of this blog is published by E-International Relations