Skip to main content
Home
     
  • Our Story
    • Our Founders
    • Our Mission
    • Governance
    • Partnerships
  • Our Impact
    • Countries
    • Programs
    • Impact
    • Research
  • Support Our Work
    • Donate
      • Inspired Giving
      • Monthly Donations
      • Gifts of Stock or Securities
      • Donate in Honor or Memory
      • Planned Giving
      • More Ways to Give
      • Manage Your Online Giving
      • View Your Contribution History
      • Leadership Giving Society
    • Join Us
      • Fundraise
      • PIH Engage
  • News

Donate Now  

Share

PIH Leaders: Care Must Accompany Containment in Ebola Response

Posted on Jul 23, 2019
Doctors and nurses provide care to Ebola patients in West Africa
Photos by Rebecca E. Rollins / Partners In Health
PIH clinicians care for a 3-year-old boy who arrived at the Ebola Treatment Unit in Port Loko, Sierra Leone, in January 2015.

The world’s latest Ebola outbreak now has spread for nearly a year in the Democratic Republic of the Congo, where the virus has infected more than 2,500 people and killed nearly 1,700.  

PIH has sent two of our top Ebola clinicians to work with partners in the conflict-torn region to help care for the sick, support response efforts, and share lessons learned during the 2014 to 2016 outbreak in West Africa, where the virus infected more than 28,000 people and killed more than 11,000.

Our efforts to rebuild the public health care systems continue to this day in Sierra Leone and Liberia, where we work alongside each country’s Ministry of Health to support comprehensive primary care.

Dr. Paul Farmer, PIH co-founder and chief strategist, and Dr. Sheila Davis, PIH CEO, were deeply involved in PIH’s contribution to the Ebola response in West Africa five years ago. Following last week’s WHO declaration of the current outbreak as global emergency, Farmer and Davis share their thoughts on the necessity of ensuring that patients receive quality care, along with containment efforts, as the international response continues to develop.

Paul Farmer cares for child with Ebola in Sierra Leone
Dr. Paul Farmer visits the pediatric ward of a public hospital in Port Loko, Sierra Leone, where children who survived Ebola were referred for follow-up care in January 2015. 

Joint Ebola statement by Farmer and Davis

Last week, not long after two of our most Ebola-experienced clinicians returned from the Democratic Republic of the Congo, the World Health Organization declared the country’s Ebola outbreak a “public health emergency of international concern,” or PHEIC. 

That brought to mind the last such declaration, made on August 7, 2014. Partners In Health arrived in Sierra Leone and Liberia that fall, to join the global response to what remains the world’s deadliest Ebola outbreak thus far. Over the five years since that time, both of us have played significant roles in PIH’s work in Sierra Leone and Liberia, and learned a great deal from our colleagues in both countries.

We wish to reflect on that ongoing experience, and share some of the lessons we’ve learned, in contemplating the potential significance of this new PHEIC declaration and the dangerous, unstable conditions in the DRC’s North Kivu and Ituri provinces. We seek not only to share lessons, but also to address some of the pressing issues we saw tardily addressed, or not at all, after the last such declaration, in 2014.

In West Africa at that time, the greatest tensions, and much open conflict, stemmed from the unnecessary and wrongheaded elevation of containment over care. Both must be top priorities for responders in DRC, as must the cultivation of trust within communities where there are scant reasons for having much trust beyond the immediate bonds of family and small communities of worship and work.

This opposition of containment and care tracks closely with tensions between public health and clinical duties. In past outbreaks and pandemics, such tension has served us poorly, whether we look at past epidemics of Ebola and Marburg, Zika, or SARS, or reflect on colonial-era epidemics of plague, Spanish flu, or trypanosomiasis. The list goes on. But we both learned this by coming of age as clinicians during the years AIDS came to be the leading infectious cause of death among young Americans. 

Prevention and care are meant to be complementary and, indeed, mutually reinforcing tasks: High-quality and respectful clinical care can help build trust, especially when it is offered for all ranking health problems as opposed to just one. An Ebola response that ignores other causes of premature death, whether in childbirth or from trauma, has usually engendered mistrust and loud complaint, as is now the case in the DRC. 

A control-over-care paradigm is announced whenever case fatality rates (CFR) are high. In the current DRC outbreak, which has gone on for a year, the CFR is well over 50 percent. It can likely be reduced to lower than 10 percent, given the human and material resources of a modern intensive care unit. However, Ebola outcomes in DRC are also shaped by the following:

• Quality of care (which biosecure emergency care units known as ALIMA cubes and new therapeutics are helping to address) and attention to all medical problems, which are neglected side-by-side with these new Ebola interventions and are key to building trust. 

• Widespread resentment, not only to 25 years of armed conflict in the region, but also to more than a century of (neo-) colonial extraction. 

• Blaming the continued spread of Ebola on people’s disbelief in the virus, which posits cognitive deficiencies as the root of problem. Rather, we should view mistrust as an inclination, a cognitive tendency, or a structured disposition towards eluding depredation.

• The employment of Ebola survivors, which fosters community engagement and improves the quality of expert mercy.

• Blaming the WHO for an underpowered response, which is illogical when their—and the current epidemic’s—funding needs have been slow to materialize.

A PHEIC declaration may or may not solve any of these things. Where this one leads will depend on political will, expert mercy and the resources to back it, and a much bigger dose of humility and social justice.

Sheila Davis departs helicopter during Ebola response in Liberia
Dr. Sheila Davis descends from a United Nations helicopter during the Ebola response in Monrovia, Liberia, in October 2014.

 

Country
Sierra Leone, Liberia
Programs
Ebola
Related Categories
Advocacy, Human Rights and Justice
  • General donation ask

    We're redefining what's possible in health care, but we need your help.

    Take a stand.
    Donate now
  • General sign-up ask

    We're on a mission to transform global health, one patient at a time.

    Join the movement.

You may also be interested in

  • protestor in New York City marches for univeral health care
    Dec 11, 2019

    On Universal Health Coverage Day, 'We th...

  • Books in Cange, Haiti
    Dec 3, 2019

    PIH Staff Picks: Essential Reading, Watc...

  • Pediatric clinic at Kirehe District Hospital in Rwanda
    Sep 26, 2019

    PIH Leader in Devex: UN Health Declarati...

Sign up for email updates

88.4% of your gift goes straight to those in need.

Donate Now  

Donations can be made by Mastercard, VISA, Discover, American Express or PayPal.
Partners In Health, 800 Boylston Street, Suite 300, Boston, MA. 02199
Phone: +1 (857) 880-5100
info@pih.org
Partners In Health (PIH) is a 501(c)(3) nonprofit corporation, EIN 04-3567502.
PIH® is a registered trademark of Partners In Health.
© 2009 - 2019 Partners In Health. All Rights Reserved.

Charity Navigator Four Star Charity

  • Contact Us
  • Join the Team
  • Media Coverage
  • Information for Suppliers
  • Press Releases
  • PIH Canada
  • PIH Alumni Network
  • Terms of Use
  • Cookie Policy
  • Donor Privacy Policy
Discourse & tools for global health professionals:
Knowledge Center