TIME ebola

Attention, World: The Ebola Fight Isn’t Over

Dr. Joanne Liu MSF
Natacha Buhler—MSF

Doctors Without Borders/Médecins Sans Frontières international president Dr. Joanne Liu reminds the world that the fight against Ebola is not over

The race to contain the largest Ebola epidemic in history has been a marathon, not a sprint. One year ago I arrived in West Africa and found the virus tearing through the region. It was destroying families and ripping apart the very fabric of society, while national authorities and a handful of aid organisations desperately struggled against this unrelenting, invisible foe.

Returning to Liberia, Guinea and Sierra Leone three months later, hundreds of people were still falling sick each week. It was impossible to identify how they had become infected, or to work out who they had been in contact with and might themselves have infected. But international support had finally begun rolling in, whilst preparations for starting clinical trials of experimental treatments and vaccines were underway.

Last week I returned to the region, and am relieved to see just how far we have come. Although we still have some way to go, today we collectively have the means to bring the epidemic to an end.

For months there have been 20-30 new cases of Ebola each week. Last week there were just three. New chains of infection are now more quickly and efficiently investigated and we can track the virus’ spread in communities. The national authorities are demonstrating strong leadership and maintaining the momentum to end the outbreak.

Although we all crave a sign that the end is in sight, the only reliable forecast in this epidemic has been its unpredictability. It has waxed and it has waned; often, just as it seems to have been extinguished in an area, one missed sick person or one unsafe burial has caused it to flare up again.

But in the most encouraging signal so far, the interim results of an Ebola vaccine trial in Guinea were published ten days ago– and were very promising. While the VSV vaccine alone will not bring the outbreak to an end, we hope it will be an additional tool to help finally stop the virus in its tracks.

Although we feel more hopeful than ever before, we are scared to let down our guard for even an instant. The goal is to get to zero patients for 42 days – twice the incubation period of the virus – after which a country or region can be declared Ebola-free.

To cross that finish line, perseverance – if not sheer stubbornness – is needed, continuing to thoroughly trace every person in contact with an Ebola patient, to identify and respond to new cases early, and to make sure that burials are carried out safely.

The ultimate key to success lies in gaining the trust and confidence of local people. Our health promotion team in Forécariah, Guinea, told me how, since Ebola flared up again this summer, they go from house to house every day to explain to each family how the virus is transmitted, what the symptoms are, what to do if someone falls sick and how to care for them safely.

The stories they hear from some villagers may sound surprising this far into the epidemic: scepticism that Ebola is real, rumours that the disease is spread by foreigners in spacesuits, or that it can be cured with traditional medicine. But taking the time to listen and respond on a personal level has been proven to work.

The truth is that the impact of Ebola will be far more long-lasting than we could have imagined. The health systems of Guinea, Liberia and Sierra Leone, already weak before the outbreak, lie in tatters. Hundreds of health workers are tragically dead. Meanwhile Ebola survivors need our continued support. Beating the virus has turned out to be their first hurdle, followed by medical complications we don’t yet fully understand, all while coping with stigma from their communities.

Four out of ten people in Sierra Leone know someone who has died, been quarantined or survived the virus. These nations are grieving, yet continue to show tremendous courage and determination.

Ebola may have faded from the headlines, but it hasn’t gone away. We don’t know how far away the finish line is, but we do know that to reach it, everyone involved in the response – both national and international – needs to channel all their energies into keeping up the momentum. And by accelerating use of the new vaccine in the affected countries, we can help break chains of transmission and protect frontline workers.

Our teams were there at the beginning. And like long-distance runners, we will stay to the end.

Dr. Joanne Liu, international president of Médecins Sans Frontières/Doctors Without Borders (MSF)

TIME Infectious Disease

1,400 Are Dead From Ebola and We Need Help, Says Doctors Without Borders President

Workers prepare the new Doctors Without Borders (MSF), Ebola treatment center on Aug. 17, 2014 near Monrovia, Liberia. Tents at the center were provided by UNICEF.
John Moore—Getty Images Workers prepare the new Doctors Without Borders, Ebola treatment center on Aug. 17, 2014 near Monrovia, Liberia. Tents at the center were provided by UNICEF.

The epidemic won't be contained without more treatment centers, coordinated action, logistical assets and health workers 

Entire families are being wiped out. Health workers are dying by the dozens. The Ebola outbreak raging in Guinea, Liberia and Sierra Leone has already killed more people than any other in history, and it continues to spread unabated.

And the death toll is being exacerbated by an emergency unfolding within an emergency.

People are also dying from easily preventable and treatable diseases like malaria and diarrhea because fear of contamination has closed medical facilities, leading to the effective collapse of health systems. While I was in Liberia last week, six pregnant women lost their babies over the course of a single day for lack of a hospital to admit them and manage their complications.

Over the past two weeks, there have been some welcome signs but not enough action: the World Health Organization (WHO) declared the outbreak a “Public Health Emergency of International Concern” and announced additional funds to fight the disease; the World Bank announced a $200 million emergency fund; and the UN Secretary General appointed a special envoy for Ebola.

But 1,350 lives have already been lost. To prevent more deaths, these funding and political initiatives must be translated into immediate, effective action on the ground.

We need medical and emergency relief workers to trace those who may be infected, to educate people about protection measures and to work in treatment centers. Many more people are needed in the field, right now.

Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams have treated more than 900 patients in Guinea, Sierra Leone and Liberia. We have 1,086 staff operating in these countries and we have just opened a 120-bed treatment center in Liberia’s capital, Monrovia, making it by far the largest Ebola center in history. But it is already overwhelmed with patients and we simply do not have additional response capacity. Others must enter the breach.

In Kailahun, Sierra Leone, 2,000 people who came into contact with Ebola patients must be urgently followed up. But we have only been able to trace about 200 of them.

Health promotion campaigns and body collections are stalled for lack of vehicles or fuel. Epidemiologists are unable to work because of a lack of logistical support. And pervasive fears among communities that had never encountered Ebola have provoked riots against health workers.

The epidemic will not be contained without a massive deployment on the ground. WHO in particular must step up to the challenge. And governments with the necessary medical and logistical resources must go beyond funding pledges and immediately dispatch infectious disease experts and disaster relief assets to the region.

Additional resources are needed to properly map the epidemic, implement efficient general hygiene measures in all medical and public places, run safe treatment centers, trace suspected cases, train health workers, set up functioning alert and referral systems and, crucially, spread accurate information about how people can protect themselves from infection.

Equally important is fighting fear. Quarantines and curfews will only breed more of it. People need to have access to information, otherwise distrust of health workers will only increase and provoke further violence. Communities and governments need to work together to control the epidemic and care for the sick.

Some measure of humanity must also be restored in the fight against Ebola.

As doctors, we have been forced to provide little more than palliative care because of the sheer number of infected people and lack of an available cure. The extreme measures needed to protect health workers, including wearing stifling protective suits, also means we cannot remain bedside with patients to ease their suffering, or allow family members to do so. In their final hours, many people are dying alone.

While we try to find creative solutions to enable families to communicate with their sick relatives, they should at minimum be supported to participate safely in the burials of loved ones. This would also help rebuild trust between communities and those trying to contain the epidemic.

At the same time, additional support is needed to prevent health systems in Liberia and Sierra Leone from further collapse. After years of civil war, these countries already struggle to meet the basic health needs of their people, let alone cope with a public health emergency of this magnitude. Sierra Leone and Liberia, for instance, have just 0.2 and 0.1 doctors per 10,000 people, respectively (a rate 240 times less than in the United States).

Last week, all of Monrovia’s hospitals were at one point closed. There is no surgical care available in the entire country right now. Pregnant women cannot receive emergency C-sections. Health facilities must be re-opened or established to treat common illnesses. We will otherwise face a second wave of this health catastrophe.

Slowing and then halting this outbreak requires much more than money and statements. The only way to contain the epidemic is to increase the response capacity in affected areas, not by closing borders and suspending air travel.

Meaningful and coordinated action is needed on the ground today if we don’t want to be reduced to counting the dead for many weeks to come, whether from Ebola or other far less sinister diseases.

Dr. Joanne Liu is the international president of Doctors Without Borders/Médecins Sans Frontières (MSF).

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