Ebola epidemic facts from Doctors Without Borders
As the Ebola epidemic escalates there is a lot of confusion and uncertainty about the disease. Confusion and uncertainty can often spread ill-informed information. To get all of the facts on the Ebola virus and the current situation on the ground, Alec Hogg spoke to Daniel Berman, General Director of Medicins Sans Frontieres (Doctors Without Borders) of Southern Africa. Daniel shares his expert insights on the inner workings of the disease and the practical aspects of it, as West Africa deals with an epidemic that requires international support to treat and curb its spread. – LF
ALEC HOGG: Keiji Fukuda, the Organisation's Head of Health explained how the WHO reached the conclusion that this is indeed an international health crisis. Let's take a look.
KEIJI FUKUDA: This Ebola virus outbreak is a public health emergency of international concern in that it met those criteria. I want to explain to you why they came to this conclusion. One reason is that, simply, we are dealing with a very large number of cases and death. Secondly, these cases are widely distributed and we're dealing with quite a severe disease but importantly, one of the critical parts is that we are seeing community transmission going on. This is what emerging infectious diseases that we have dealt with recently, but in this instance, a majority of the infections are occurring in the community among families etcetera, and this is an important underlying factor. In looking at this outbreak, there are a number of challenges, of course. One of them is that, if we look at the area in which this is occurring (in Western Africa) that this is an area, which has had civil unrest in recent years.
One of the results is that it has left the health systems relatively weakened and relatively fragile and it's a theme that I want to come back to, over and over again. The Ebola virus – this outbreak – really underscores the importance of having strong health systems. It is really the poster child for why those things are important and why they're not theoretical. This outbreak has basically exploited the fact that it's occurring in an area with weak health systems and by that; I mean that there are shortages of health workers. There is a relative lack of training. When we talk about health workers, we're talking about people who directly give care to the patients, as well as people who take care of the hospitals – clean the rooms. etcetera.
ALEC HOGG: That was Keiji Fukuda, the World Health Organisation's Head of Health. Well, we carry on with our discussion on Ebola now with Daniel Berman, the General Director of Médecins Sans Frontières (better known in English as Doctors without Borders). He's the General Director here for Southern Africa. It's good to have you on the program Daniel. I guess you must be a little concerned about colleagues of yours. You have doctor all over the continent who are no doubt, exposed to the Ebola virus. Are you taking any particular precautions?
DANIEL BERMAN: Before I tell you about the precautions, perhaps I could tell you about what we're actually doing. We have about 700 staff in the three countries and we have every possible aspect of the outbreak response that we're working on. We have isolation centres. We have an isolation centre in Sierra Leone that has 90 beds. Perhaps it's the biggest Ebola hospital that has ever existed. In terms of the massive effort that we're doing, even with all of this work we are very, very glad that WHO has declared an International Health Emergency. Why? It's because it means that that response can be scaled up. It set the first step to declare an emergency, but what we need in terms of implementation is massive deployment of experts and supplies. I'm talking about things like infectious disease doctors, epidemiologists, and people who can run labs.
It's not going to be enough just to give money and to train people. We actually need countries that have this capacity to release those people and send them to this region, to mount the response.
ALEC HOGG: Daniel, we spoke earlier with Sarah Barber from the World Health Organisation. She said there were 1711 confirmed cases of Ebola, of whom 932 have died – 55 percent death rate. Have any of your doctors/staff on the continent, contracted the virus?
DANIEL BERMAN: I'm glad to say that because of protocols that we have developed over many years, none of our staff has contracted Ebola. The reason for that is we take extraordinary precautions. People have seen the suits that staff wear (with the boots, full covering, and masks) and not only do they wear that protective gear, but it's also, about how they work. For example, they work on a 'buddy' system. No one is ever alone in an isolation unit, meaning there are always two people working together, so that if somebody starts to get tired, or if they're not at the top of their game, then their buddy can suggest that they leave the hospital. By taking this very, very seriously, we know that we can prevent infection and that goes for the communities as well. What's happened is that people are afraid because there are deaths in their communities, and so they're not going to treatment centres.
One of the things that needs to happen, is people need to know they have a better chance to survive if they do get into an isolation unit. Another big thing we've been facing is the burial rites in Western African countries: people normally – out of respect and to give the person who's died, dignity – they clean the body. However, in an Ebola outbreak, this cannot happen because when people are very, very sick (at the end stage of the disease), that's when they're the most contagious.
ALEC HOGG: Daniel, when we look at the visuals of your staff and as you say, with the uniforms and the precautions that have been taken, in a perverse way, that is also of concern to the public because if you're going to such extraordinary lengths… If somebody who has Ebola were to come into closer contact… There's just a perception that it would be easier for the disease to be transmitted. Can you tell us categorically how the disease is transmitted or how a member of the public can ensure (by just being careful) that they will not contract it?
DANIEL BERMAN: You make a very good point and we've actually discussed this amongst ourselves, that the actual protective gear looks scary and may scare people. The most important thing to say is this is not an airborne disease. Unlike the flu or other diseases, you can't get this from someone sneezing. You can't get this from just being in the same room. How you get this disease is through direct contact: either touching a person or touching bodily fluids. When people get very sick, they vomit and they lose control of their bowels. That's why we use the protective gear. It's because when people become very, very ill they become very contagious. I think I can say categorically that even in most African countries, people are not at risk because unless you come into contact with someone who is already very sick, you can't get this disease. I think it's important to say that.
What's happened in these communities is there's been a sort of tipping point. In other words, there are so many people in the community, the health services didn't respond quickly enough and effectively enough. Back to what the WHO is saying today, it's not about an International Emergency (meaning that there are many, many countries impacted). They call it International because we need an international response. In this particular case, the Doctors without Borders have to be humble. We can do a lot, but we can't manage this. We can't run the response. WHO has to do this and we are overwhelmed. Even though we have a lot of capacity, right now the situation – especially in Liberia and Sierra Leone – calls for many more organisations and experts, not necessarily from humanitarian organisations, but it needs to be a Government response.
ALEC HOGG: Daniel, very quickly, the East African outbreak (or alleged East African outbreak): is that accurate? Have you had any information on it?
DANIEL BERMAN: I'm sorry. Can you repeat the question?
ALEC HOGG: The outbreak in East Africa: is that accurate or is it, at this point in time, still unconfirmed?
DANIEL BERMAN: I have not heard anything about that, no.
ALEC HOGG: Let's hope that it is, and remains unconfirmed. Daniel Berman, one of the good guys, General Director of MSF Southern Africa (Doctors without Borders).