Our hearts go out to our students,
colleagues and everyone else in those countries affected by Ebola. There’s very
little we can do except to say that we are thinking of you, and to put pressure
on our government to offer more help. David Cameron yesterday pledged a further
£80 million to Sierra Leone, meaning that the UK has pledged £205 million. This
is more than 19 other EU countries combined. The company IKEA has donated 5
million Euros, more than 18 EU countries have.
What Cameron didn’t say when he announced the monies pledged, was that
his government cut aid to Sierra Leone by 20% last year. Some might argue that donating
money isn’t the answer, but it must surely help. Sadly though, of the new £80
million donated by the UK, £10 million of that will go to burying the dead and
paying for their funerals. There surely never was a more poignant case of too
little, too late.
The run-down and poorly resourced WHO has said
that it needs $260 million to combat Ebola; the UN has said it will take $1
billion to bring the outbreak under control in the next six months. The WHO communications
officer, Fadela Chaib has said that 3.3 million items of high quality personal
protective equipment is needed. So far
only two countries, Cuba and Timor-Leste have ‘punched above their weight’,
according to Samantha Power, the US Ambassador to the UN, in that they have
actually put in place their aid efforts and given far more than what would be
expected from relatively poor countries. Clearly we are seeing an emergency
response that is late, and also doesn’t take into account the capacity of the countries
most affected by Ebola to actually spend the extra resources - it also needs logistics, personnel, and a
whole host of infrastructure in order to be able to use the funding
effectively.
It looks as though there are about 1,000
new infections each week, and the capital cities of Freetown, Conakry and
Monrovia are especially affected. Today there’s the first case in Mali. Another estimate says that we will soon be seeing
10,000 cases each week, and the WHO has given out very different estimates of how
many could be dead by Christmas.
Ebola is a test of the strength and
resilience of communities but it’s also a test of the strength of the global
contract that asserts that our health is all interconnected. We cannot be
healthy – morally and socially – whilst others do not enjoy health. This is a fundamental
principle of health promotion and is behind its commitment to tackling health inequalities.
That ‘there can be no health without that of my brother or sister’ may seem
trite and it certainly trips off the tongue. The global North only seems to
remember that health is interconnected when its
people’s health is physically threatened rather than being merely morally threatened.
There has been as much coverage in the western media of the few cases in Spain,
the USA and the UK as there has of the thousands of cases in Africa. Ebola
fuels the fears of those in the global North that Africa is a source of disease
and that it threatens our own wellbeing.
Africa remains the Dark Continent in so
many people’s minds; when people knew I was travelling there recently, they asked
whether I was worried about Ebola. They had no idea that they were almost as
near the epicenter here in the UK as I would be below the Tropic of Capricorn.
The continued use of the Mercator projection of the globe gives no clue of the
vast space that is Africa. Few people would know where the countries affected
are. They would also perhaps be unaware that these countries are among the poorest
in the world. The latest Human Development Index Report shows that out of 187
countries, Sierra Leone is ranked at 183, Guinea Conakry 179, Guinea Bissau 177
and Liberia 175. These are fragile states even before the rise of Ebola, but it
is precisely because they are fragile states that Ebola has been able to gain
such a grip. To prevent occurrences of Ebola becoming major disasters needs
either the more usual type of outbreak – such as in the Congo where outbreaks
are more common and occur in remote forest communities and tend to die out
fairly quickly – or it needs strong public health systems, where medicine is
free or subsidized, and it needs strong national government, a well-resourced
local government structure and a strong public sector. These aspects of good governance
do not exist in many poorer countries.
In response to the Ebola crisis, the global
North has adopted its usual siege mentality. The UK has put in place a
screening process at a cost of £9 million, though again, experts say that it
won’t pick up those who have the virus but who are not yet symptomatic.
Travelling in various parts of Africa recently, I’ve seen the measures put in place
to try to stop the virus entering new countries. At Gaborone airport I was
asked to fill in a questionnaire asking if I had certain symptoms. Of course
this is completely ineffectual, especially when Ebola takes 21 days to show
symptoms. But what steps can a
country take? Dr. Stella Ameyo Adadevoh has just been recognized in Nigeria’s
National Honours award list. She was the person credited with stopping a
disastrous outbreak in Nigeria – Africa’s most populous country – by taking
swift action in the case of Dr. Patrick Sawyer, who brought Ebola to Nigeria
from Liberia. Sadly she and seven others died after being in contact with
Sawyer. There is a plan to rename the Infectious Diseases Hospital in Lagos
after her. It highlights the danger to front line health workers and indeed
many have given their lives to this virus. Front line health workers are those working
way downstream; what is clear is that the global community has failed to work
upstream to do something about all
those states that have languished for decades at the bottom of any index of
poverty or development.
Sierra Leone is still reconstructing after
its civil war; communities and infrastructure were just beginning to recover
from its systems and institutions being destabilized. It’s noticeable that of
the handful of European victims of Ebola, many have survived – when your body
is well nourished and you received excellent health care, you obviously stand
much more chance, let alone having access to experimental treatments. Where
people do not have enough food anyway, where immune systems are under threat
simply from day to day living and where there are not hygienic conditions,
those infected are so much less likely to survive. People in Sierra Leone
already spend between 60 and 70% of their income on food; with the effect on
the food supply chain and a breakdown in other services, families are now going
without food. I cannot imagine the impact on the normal routines of hospitals –
what’s happening to all the usual cases of illness that would be treated in
those hospitals that have now been overwhelmed by Ebola?
Margaret Chan, director general of the WHO
has said of Ebola, “I have never seen a health event threaten the very survival
of societies and governments in already poor countries. I have never seen an
infectious disease contribute so strongly to potential state failure”. Ellen
Johnson Sirleaf’s letter to the world is an extraordinary dignified and
passionate appeal to the world to help. I urge you to listen to it. It can be
seen at:
And the text can be found at:
It would be good to think that this
disaster will show the world the true conditions of life in Guinea, Liberia and
Sierra Leone, will help to bring about the realization that global health really
is interconnected, and that our ethical responsibility is to improve the health
of the unhealthiest – not just when it threatens our health, not just when it
suits us, and not just in an emergency, but as an ongoing commitment.
