Amidst growing concern about the Ebola outbreak in West Africa, Dr. Wafaa El-Sadr, director of ICAP, moderated a symposium at the Mailman School of Public Health (MSPH) entitled “Confronting Ebola: Crafting a public health response. To date, more than 10,000 individuals have been diagnosed and close to 5,000 have died from Ebola virus disease (EVD). The symposium was part of an effort taking place across Columbia University to disseminate accurate information about the disease, to mobilize resources and leadership in order to confront this public health threat.
Guinea, Liberia*, and Sierra Leone are the three most severely-affected countries where EVD cases currently are doubling every 16, 24, and 30 days, respectively. The magnitude of this outbreak has highlighted the weaknesses in the health system in these countries and the need for concerted efforts to respond to both current and future challenges.
One example of the frailty of the health systems in these countries is the paucity of health care workers. In Guinea, there are four nurses and 10 physicians per 100,000 compared to the United States with 250 physicians and 978 nurses per 100,000 inhabitants. Liberia and Sierra Leone have a similarly constrained health workforce. This shortage has also been exacerbated by the impact of the Ebola outbreak on health workers themselves, hundreds of whom have succumbed to EVD.
Susan Strasser, associate director of ICAP’s nursing programs, stressed the need for more investment in nursing education. “Nurses are the heart of the health system in Africa,” she said. “We need to graduate more nurses and offer the long-term support they need to remain at the frontlines.”
Strengthening health systems and building sustainable health infrastructure in sub-Saharan African countries has been at the center of ICAP’s work supporting the scale-up of HIV programs. Scale-up of the response to Ebola crisis will require similar attention to the gaps in the health system.
Another similarity with the HIV epidemic is the stigma associated with Ebola. Stigma can delay seeking of health care and can limit the affected person’s ability to gain community support. Stigma and suspicion is something that even immigrants from West Africa are currently facing in New York City.
“Home health aides, many of whom are from West Africa, are being told not to come to work,” said Kim Nichols, co-executive director of “African Services Committee”:http://www.africanservices.org/, a community-based organization serving African immigrants in New York City. “There’s this dance between educating, helping, getting the community invested, and containing this epidemic, and scaring people away,” she said.
“The response to Ebola is very reminiscent to the early response to HIV,” said El Sadr. “You can see it in reactions by some that call for isolating people and isolating communities,” she said.
In a recent “video”:http://bit.ly/103TEUS, El-Sadr discussed the lessons learned from HIV and how it is important to rely on those most affected by Ebola to build a sound public health response. “People once infected with Ebola who have survived can be an asset to the community,” said El-Sadr. “We should think about the lessons we learned from peer programs for HIV and keep that in mind as we move ahead.”
“That’s part of our responsibility, as people who are engaged in public health,” said Dr. El-Sadr. “We are the army that needs to be at the forefront to provide accurate information about this outbreak and to make sure the response is commensurate with the problem rather than directed at things that will have no effect on the outbreak or actually may make things worse.”
To learn more about Ebola and how this outbreak is unique, listen to ICAP’s recent webinar ““Ebola: This Time is Different,””:http://bit.ly/1pVhXdv with Dr. Stephen Morse of MSPH and Dr. Estrella Lasry, tropical medical advisor at Medecins Sans Frontiers.
*According to WHO, recent evidence suggests the epidemic may be slowing in Liberia.