September 18, 2014.
By: Farouk Martins
Whyhas Ebola epidemic overwhelmed Doctors-Without-Borders? There is a contradiction even with the best of intentionthat food and water must be sourced from donors. The United States Military deployed to Liberia with its capacity for humanitarian aidcan learn from it. Local food production and water (ORS) must be freely available in health centers to encourage and attract people to stay before Ebola epidemic is contained. It is one of the reasons Nigeria succeeded.
How can any government or organization quarantine suspected Ebola cases without adequate supply of food, clean water and shelter even schools converted to clinics and hospital in an epidemic? People that are supposed to be in quarantine are fleeing to look for food and water in Liberia and Sierra Leone. Those infected and hungry, with some energy left, not adequately provided for deserted in search of food and water elsewhere. No force can hold them back.
African countries that could hardly feed their hungry before Ebola have the audacity to pack poor people like sardines in an areawithout basic food for sustenance and beds and we expect those coming to help not to get frustrated and leave as infections increased. Their skill is public health and specialty in infectious diseases. Some have drawn their experience from the Ebola outbreak in 1976 in East Africa. This time, we are facing greater populations that defy normal control.
Experience always shows that no matter how prepared the international organizations are, there are little inconveniences and surprises they were not prepared for even when they are trained to expect them. Medical teams do not usually bring local food and water. Temporarily, their military may need to supply humanitarian supplies just as if they are in the war zones.
This is where the help of African countries, with Nigeria in the lead, comes in. It means enough food and clean water must be prioritized for those suspected of Ebola infection. It becomes a policy decision to feed those quarantined first so that they can remain where they are and not escape to infect others. The focus must be on prevention to reduce the amount of people that need treatment. Even vaccines are for preventionnot a cure, population control is needed.
Nigeria was lucky that the zero infection happened in Lagos State where the medical team and others in contact with Ebola virus were skillfully managed without experimental drugs but with old fashioned established treatment by volunteer local and international experts in virology and public health. Shelters available were upgraded or replaced with better ones with adequate supply of food for those that could eat and freely availableoral rehydration salts (ORS).
Yes, we may say if food becomes the attraction, those that are not suspected of Ebola infection would line up just to get food. Sure, the cost of feeding one hungry person must be weighed against the cost of one that was not fed infecting many others. Policy in this case may not be taught in medical schools but physicians can learn administrative and financial skills. In the case of epidemic one has to balance many factors, Africans are not short of the administrative skills.
Nobody needs to lecture us on the importance of balanced diet to keep up our immune system strong, and help during the period we cannot eat very well while sick. During sickness especially when accompanied by diarrhea and vomiting as in cholera and Ebola, six teaspoon of sugar and half a teaspoon of salt in one liter of water can be a miracle saver. Oral rehydration therapy or salt are commonly sold in corner store pharmacies as they contain other ingredients like zinc.
Nigeria’s survivals praised the medical treatment they received, the kindness of attending staff and medical colleagues but also their own faith in whatever God they worship. Even when the body is diseased (weak) and the spirit is strong, the immune system is boosted from positive thinking. We may rely on our Incantations, Psalms from Bible or Koran. Each of them strengthens belief in Orisha, Ogun, Mohamed or Jesus, whichever works for individuals.
United States has rightly decided to launch the fight against Ebola in Liberia before it gets near. There are different organizations from Africa and outside that are already making it to Liberia and Sierra Leone. No matter what their good intensions are, they must learn from Doctors-Without-Borders. No one can build public health or medical treatment on empty stomach and unclean water. Just as these are basic to life so are they basic to public health and treatment.
We have a problem if Doctors-Without-Borders are overwhelmed in Africa. It boils down to the subtle difference to us between Public Health practitioners and medical practitioners. While public health treats a community; physicians, pharmacists and nurses treat individuals. Diseases that are beyond community health workers fall on the shoulders of physicians. In short public health is prevention. We cannot get enough physicians to cure overwhelming Ebola infections.
Many of these organizations are aware that some of these logistics are not readily available in the countries they are going. But a few of them are surprised that basic necessities taken for granted, are needed where they want to provide medical services. The further they are to the cities, the greater their needs for essential commodities. One of the examples is the conversion of schools to clinics and hospitals, when it gets to the point where schools cannot remain open.
Logistics are very critical. It is very important to make available a secure area for medical and social team to stay. In cases where they have to travel long distances, some of them bring ambulances and Sport Utility vehicles with them. Whatever the case, people cannot be dying in a country where vehicles needed by medical staff can be temporarily loaned from ministers with two or three cars. Those rich enough must also lend their cars or donate it for medical use.