Those individuals who were infected with the Ebola virus, as well as those who were potentially infected, during the most recent outbreak which impacted Sierra Leone, Guinea, and Liberia (among other nations) faced many difficult decisions even before obtaining treatment.
Parents infected with the virus, for example, had to weigh the risks of leaving children at home while they received care. Those with ill children, meanwhile, had to face the prospect of doing something not normally done in most tribal cultures: leaving their offspring in the care of healthcare workers while they themselves returned home. And, of course, there were the dangers associated with traveling to locales where care was available, given the ongoing military conflicts in many of the affected countries.
“These were impossible decisions for our patients even before they ever presented and extremely challenging for us once they were admitted,” recalled Patricia Carrick, a family nurse practitioner who has worked intermittently with Doctors Without Borders/Medecins Sans Frontieres (MSF) since 2001 and has been on five assignments in Sierra Leone, South Sudan, and Malawi.
Carrick’s recollections were among the many highlights of a Doctors Without Borders/Medecins Sans Frontieres (MSF) webcast
entitled, “Ebola’s Aftermath: A West Africa Update,” presented February 23rd. The webcast, led by four MSF aid workers who were on the ground in Africa during the 2014-2015 epidemic, was held in conjunction with the publication of MSF’s new book The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic
Other panelists for the event, all of whom also worked on the book, included Armand Sprecher, MD, MPH, an emergency physician and epidemiologist who has worked with MSF since 1997 and with the International Medical Corps and the Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service; Michiel Hofman, MSF Senior Humanitarian Specialist as well as a long-time freelance journalist and cofounder of the Antares Foundation, a Dutch non-profit organization that provides psycho-social support for staff working in high-stress environments; and Mike White, MSF Deputy Operational Manager for Haiti, Ethiopia, Sudan, South Sudan, and Liberia, who worked on the organization’s emergency desk as an operations advisor on South Sudan and Ebola. They discussed the lessons learned in coordinating the provision of care in active conflict zones and in developing education and communication programs that effectively delivered the messages regarding prevention and treatment of Ebola to audiences with different languages, cultural traditions, and societal norms.
In all, MSF treated
more than 5,000 Ebola patients during the epidemic (after evaluating more than 10,000 for the virus) and more than half of them survived. In the years since the outbreak, the organization has been leading efforts to develop a vaccine, including coordinating ongoing clinical trials. Until the end of 2016, MSF also operated three “survivor clinics”—one in each of the most-affected countries—that assisted survivors with symptoms such as vision problems and pain, which often linger even after successful treatment.
The panelists also discussed Ebola-related threats that persist since the resolution of the 2014-2015 epidemic, including the ongoing military conflicts in the region and the challenges associated with working within the resource-poor healthcare infrastructure in the affected countries. The hope, panelists said, is that MSF’s new book will serve as a template for healthcare relief organizations as they respond to future disease outbreaks as well as a call to action for continued efforts to develop a vaccine and/or drug treatment for the troubling virus. The speakers acknowledged that MSF and others were a bit slow to initiate clinical trials during the last outbreak, and they strongly urged the global health community to be better prepared in the event of a future crisis.
“We have to be ready to continue this work, with the next outbreak,” noted Whyte, referring to the process of initiating vaccine and drug trials. “Because in the long run what we’d like would be to have licensed, demonstrably effective therapeutic agents that we can purchase [to treat patients] like any other medicine. But to get there we have to finish the work that got started [in 2015]. We’ve got some homework to do before the next outbreak, otherwise we’ll be equally unprepared.
“A lot of things that can be done in advance,” he added, citing the groundwork required for setting up drug and vaccine trials (necessary government approvals, licenses, etc.), “and we need to start working on [them].”
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.
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