The evening of Tuesday, 14 October, 2014 saw an enormous turnout for a presentation and question-and-answer session hosted by a multitude of St Andrews University student groups including the St Andrews Foreign Affairs Conference (SAFAC), St. Andrews Economics Society, Medsin, and Medecins sans Frontières (MSF). The discussion focused on the topic of the current outbreak of the Ebola virus affecting the West African countries of Guinea, Sierra Leone, and Liberia, presented by Dr. Janet Cox-Singh, a senior infectious disease specialist in the School of Medicine at the University of St Andrews, and Ms Gunnhildur Arnadottir, an MSF nurse who recently returned from two missions to combat Ebola in the summer of 2014; one in Guinea in May, another in Sierra Leone in August. The spectre of the Ebola virus, and its spread, loomed large over the evening’s proceedings, as both Dr Cox-Singh and Ms Arnadottir cited grim official statistics of Ebola’s death count, 4,024 at the time of writing, and the likelihood of much higher figures due to widespread unreported cases and deaths.
Dr Cox-Singh, a biologist and senior researcher in the field of Malaria, traced the history of the Ebola virus, its causes, and recent developments in its treatment and, importantly, containment. From first recorded classification of the disease in Zaïre in 1976, Ebola has flared up across the equatorial region in central Africa. A commission set up to understand the virus after its discovery focused on several key components: stop transmission of the disease; control epidemics; establish national control centres for affected countries; document clinical features; extract serum from survivors; and search out natural reservoirs of Ebola. In 1983, clinicians discovered that carers for those with Ebola were at a high risk of contracting the disease, prompting a re-evaluation of tactics to combat the disease in hospitals and clinics. Cases of Ebola have been mostly self-contained in places like the Democratic Republic of the Congo and Uganda, with transmission of the disease limited to several hundred individuals. Part of this containment can be attributed to an aggressive public health strategy devised in the wake of sporadic outbreaks, initiated by the World Health Organisation (WHO) and with support from the Centres for Disease Control (CDC). For example, an outbreak in Uganda in 2007 affecting 149 people was contained due to effective use of outbreak ‘swat teams’ to seal off affected areas, quickly ascertain case identification, protect patients and carers, and isolate further spread of the disease.
Dr Cox-Singh underscored several critical points as to why the Ebola outbreak in West Africa is different than previous ones, as well as why the system of containment has failed the region in question. First, this is a region that has never seen an outbreak of the Ebola virus, and its people are subsequently ill equipped to understand its symptoms or combat its debilitating effects. Second, Dr Cox-Singh pointed to a lack of action on behalf of the international community, despite 111 cases of infection in March 2014, and the worry of greater numbers of disease reservoirs due to jungle diversity in West Africa. Third, and perhaps most important, the infrastructure and healthcare systems in Guinea, Sierra Leone, and Liberia are crippled, underfunded, and inadequate due to an intense state of poverty and civil wars that have ripped these countries apart. Finally, Dr Cox-Singh highlighted that an initial lack of international involvement and protection by WHO and CDC have exacerbated existing problematic conditions like porous borders, miscommunication between healthcare systems, and widespread poverty.
Ms Arnadottir’s presentation put Tuesday’s audience firmly into the shoes of a MSF nurse, and to the front lines of the fight against Ebola. Discussing her first mission in Guinea, Ms Arnadottir described an almost surreal calm before the storm, punctuated by a lack of urgent cases (indeed, just one confirmed case in her three weeks stationed there) before a wave of patients arrived with symptoms just two days before her departure. Within what seemed to be minutes, MSF and other first responders in Guinea had lost total control of the patient chain, and were unable to trace cases back to their point of origin.
Ms Arnadottir’s second mission to Sierra Leone focused on the increasingly dire Ebola crisis. Numbers of infected individuals mount rapidly, and the logistical, sanitary, and resource-intensity of front-line operations are stretched. Ms Arnadottir successfully depicted the human impact of Ebola for her captive audience: entire families devastated, children – many of them sole survivors – orphaned and adrift in medical camps and without a clear future, in countries equally devastated by disease and without a clear solution themselves. Again, the lack of good healthcare, and specifically no surgery capabilities and low accuracy diagnoses bore the brunt of blame for Ebola’s spread. Ms Arnadottir also noted a tendency for many Guineans, Sierra Leoneans, and Liberians to mistake the symptoms of Ebola to be those of the other ‘Big 3’ sub-Saharan maladies: Tuberculosis, Malaria, HIV/AIDS, as well as Dengue Fever and Yellow Fever; delaying treatment and spreading misinformation. Treatment of the aforementioned diseases, already deadly and difficult to control in their own right, is made more difficult with funds and services diverted to control the spread of Ebola. Ms Arnadottir spoke convincingly of the need for greater access to information in the affected countries, and that widespread misbeliefs, rumours, and lies made treatment and case detection all the more difficult for first responders.
Throughout the presentation and Q&A session, both Dr Cox-Singh and Ms Arnadottir provided a persuasive and prescriptive set of possible solutions to slow Ebola’s spread and death count. Dr Cox-Singh brought a clinicians perspective, arguing that traditional tools and established methods must be used more widely to improve survival and rationalise costs in these poor areas: supportive care, electrolyte monitoring, and scrupulous contact tracing. Ms Arnadottir likewise supported the need for better care management, trace management and 6,000 beds rather than 600 to serve the areas hit hardest. Ultimately the lack of capacity in the healthcare system is severely undercutting current efforts to combat Ebola.
Cox-Singh and Arnadottir offered a call to arms for current and future efforts. The need for a ‘Marshall Plan’ of global health on behalf of international actors and wealthy countries, used to lift these countries out of crisis and protect them for the long term. The need for innovation, political bravery, and most of all financial resources to make governmental and non-governmental aid a continued reality on the ground. The need for reasoned discourse, not fear mongering, to support sound and proactive policy decisions. Though most came away from Tuesday’s presentation with the understanding that the Ebola crisis will get worse before getting better, the opportunities for a positive solution are in sight, and in mind.