Diagnosing an international health crisis: A structural exploration of Ebola 2014

The Ebola crisis of 2014, though concentrated most heavily in three small countries in western Africa, awoke the international community to its lack of effective health crisis infrastructure. As the disease rocked the globe, multinational groups scrambled to help those directly affected and protect the overwhelming majority of people not directly affected. Most preventative measures failed, and pre-existing initiatives to stem the flow of the disease only served to open the floodgates more. After careful examination of the literature surrounding medical, cultural, financial, national, and global circumstances enabling Ebola to flourish, as well as applying individual analysis and examination, it is evident certain changes must be made. DIAGNOSING AN INTERNATIONAL HEALTH CRISIS 1 Diagnosing an International Health Crisis: A Structural Exploration of Ebola 2014 On December 6, 2013, a two-year-old boy died in Guéckédou, a small border town in Guinea, in western Africa (Grady & Fink, 2014). Though unfortunate, the death at the time was not newsworthy. However, long after his passing, scientists around the world searched for him, calling him by a name he had never known: Patient Zero. This Patient Zero was the catalyst for a devastating outbreak of Ebola virus disease, an illness with no known cure or vaccine that kills up to 90% of infected persons (“Ebola virus,” 2015). Unfortunately, this diagnosis was not made until March of 2014, after dozens of Guinean towns and cities had already been affected as well (Grady & Fink, 2014); by that time, the disease had also been discovered in Liberia, Sierra Leone, and elsewhere in western Africa, with no signs of slowing or stopping. The incurability of Ebola and illnesses like it suggests outbreaks such as these are unavoidable. Further problems associated with disease outbreaks are equally difficult, if not impossible, to solve: most of the affected countries are infamous for poor health infrastructure, sporadic and fruitless communication, and a general distrust for formal doctors and hospitals. Development and improvement of health infrastructure in the region is often ineffective because of rampant corruption. Though Liberia was declared free of Ebola on May 9, 2015, the threat of new cases hangs over communities (“The Toll,” 2015). Due to suspicion surrounding modern medicine and poor rural connection, estimates of those affected are difficult to obtain; still, the World Health Organization, or WHO, found over 28,000 confirmed cases and 11,000 deaths since March 2014, with more likely to come (“Ebola Virus,” 2015). DIAGNOSING AN INTERNATIONAL HEALTH CRISIS 2 Thus, an international health crisis was born. Yet, this was not Ebola’s debut on the international stage. In 1976, it struck the citizens of Yambuku, Democratic Republic of Congo, near the Ebola River from which the disease gets its name (“Ebola Virus,” 2015). Since then, scientists have tracked twenty-four other controlled and uncontrolled outbreaks, with some as few as one confirmed case (“Outbreaks Chronology,” 2015). Their report reveals the 2014 outbreak includes more confirmed cases than every past outbreak combined (“The Toll,” 2015). This comparison of past to present Ebola outbreaks poses an important question: if the medical aspects of the virus remain the same with few variations (as Ebola has since its discovery), how could the consequences of one epidemic differ so dramatically from another? That is, the problem surrounding Ebola 2014 was its ability to defy medical and structural history and theory about how epidemics affect countries, communities, and individuals; how did 2014 break the curve? The international community has a responsibility to consider these large-scale impacts, even in outbreaks like Ebola 2014, where only a handful of states were significantly impacted. Tens of thousands of lives have already been lost; who knows how many more will be at stake if this crisis is allowed to go on without careful analysis? In answering, the international community must then ask: what has changed in terms of the political and social factors surrounding the 2014 outbreak? The circumstances surrounding Ebola 2014 spoke volumes to the preparedness, or lack thereof, of local communities, nations, and even the global community when an epidemic strikes. As participants in an increasingly globalized international community which will likely be affected by another outbreak of Ebola 2014’s caliber, doctors, DIAGNOSING AN INTERNATIONAL HEALTH CRISIS 3 politicians, leaders, and citizens alike have a responsibility to consider potential changes made to how we respond to epidemiological disasters, prompting the research question: What could have prevented the 2014 Ebola outbreak, and what can it teach us about future outbreaks? Literature exists on the 2014 Ebola epidemic that explains certain aspects of the outbreak as they apply to different spheres of understanding, five of which will be broken down here. It is paramount to consider these challenges through a solutionoriented lens, which necessitates consideration of certain epidemiological changes made over time; however, the overwhelming majority of this analysis will discuss and suggest solutions rather than causes or effects. Examining these works by breaking analysis down into five areas of literature review mixed in with investigation enables a more cohesive and thorough appreciation of what Ebola 2014 looks like from medical, cultural, financial, national, and global perspectives. Medicine Ebola 2014 is, at its most fundamental, a medical catastrophe created by poor health practices. It is worth noting that though the strain present in Ebola 2014 being a particularly virulent one, the disease has not developed or changed much over time (Fauci, 2014). Despite Ebola’s resistance to inoculation and cure, it is entirely preventable and in some cases very treatable. How did prevention and treatment slip through the cracks to enable the disastrous medical consequences of Ebola 2014? First and foremost, though Ebola is nearly impossible to root out because of its ability to infect multiple types of animals, it is avoided by implementing healthy daily DIAGNOSING AN INTERNATIONAL HEALTH CRISIS 4 routines, such as handwashing and sanitation of food and water. Proper sanitation procedures were not in place around the time the outbreak began (Garrett, 2014). Ebola is an extremely highly communicable disease and should be treated as such (Arwady et. al., 2015); taking small but effective precautions such as antibacterial soap is the first step in stemming the spread and growth of any illness. Additionally, part of the answer lies in a lack of trained medical professionals in the area. In terms of raw numbers, there simply were not, and are not, enough nurses, doctors, and volunteers to go around. The United States, for example, enjoys about 245 doctors per 100,000 people, whereas Guinea only has ten per 100,000 (“The Toll,” 2015). This is a funding issue, so the specific implications of the lack of doctors will be more effectively explored later in this document. Not only did these countries suffer from a lack of doctors, they also dealt with a lack of proper training for those few medical professionals. Unsurprisingly, countries like Guinea and Sierra Leone did not sport the highest-paid or most renowned medical schools or staff, making it difficult to draw talent to the area. Doctors Without Borders noted one of their biggest projects in Guinea particularly was establishing a then-absent component of the Ebola 2014 response – infection surveillance and control protocol (“Ongoing Challenges,” 2015). The presence of Doctors Without Borders here spoke volumes to the lack of preparedness in medical training and personnel in and of itself, and the challenges were only further exacerbated by poor training. Officials with training, therefore, must be present in later outbreaks, such as Dr. Thierno Souleymane Diallo, a Guinean doctor once infected with Ebola now treating those with the disease (Aribot & Horowitz, 2015). Dr. Diallo’s insight as a doctor DIAGNOSING AN INTERNATIONAL HEALTH CRISIS 5 and survivor makes him an invaluable asset for future battles against Ebola, but most importantly, he is valuable because of his training and willing presence. Similarly, the poor state of medical offices and hospitals were partly to blame as well. Keep in mind Sierra Leone, Liberia, and Guinea, the three most affected countries in Ebola 2014, were also battling other endemic health concerns, such as malaria and diseases that bear close symptomatic resemblance to Ebola (Fauci, 2014). Experts assert large-scale threats from occurrences like Ebola 2014 are limited primarily to countries with weak public health systems; this is due to the poor health system itself, as well as the fact that they are often based in countries made up of small, ill-connected communities (Siedner et al., 2015). Connecting these small communities is particularly important, as rural communities tend to be at particular risk because of their lack of connection to formal health infrastructure (McGinnis, Williams-Russo, & Knickman, 2002). Laboratories are a necessary part of local health infrastructure, as they provide testing and short-term treatment options for patients; however, the lack of lab capacity during the early stages of Ebola 2014 was most definitely a contributing factor to the early and rapid spread of the disease (Goodfellow, Reusken, & Koopmans, 2015). This is particularly pressing given the fact that other pathogens were circulating around West Africa at the time and also deserve lab attention. In the meantime, several countries have provided resources from twenty-seven labs around the world to test patients, and were able to conduct tests with the very limited resources in local labs; yet, the doctors and technicians in these labs advocated for a ‘post-Ebola legacy’ of sustained laboratory