"There is a lot of talk but not enough action in the global response to containing the disease in West Africa. We need rational responses and not those fuelled by panic," says Médecins Sans Frontières (MSF) doctor Gem Patten.
(From left) Sarah Crawford-Browne, Gem Patten and Dr Kathryn Stinson speaking at a health sciences seminar on Ebola. (Photo by Michael Hammond.)
Patten and her colleague Dr Kathryn Stinson shared their experiences at a recent Faculty of Health Sciences seminar aimed at raising awareness and exploring ways in which UCT can bolster efforts to contain the virus in West Africa. Stinson, from the Centre for Infectious Disease Epidemiology and Research (CIDER) in the School of Public Health and Family Medicine, arrived back from the field barely two weeks ago after volunteering her services to MSF.
Both epidemiologists had been working in Sierra Leone's remote eastern district of Kailahun, the epicentre of the epidemic, which is 500 kilometres from the capital of Freetown and on the border with Guinea and Liberia, countries that have also been hard hit by Ebola.
At end of October, Sierra Leone had 4 202 clinical cases of which 3 624 were confirmed for Ebola. A total of 1 387 people have died from the disease there, so far. "We are nowhere near abating this epidemic and we need an extraordinary response," Stinson said.
The epidemiologists had to deal with community stress and the challenge of working in failing health systems, already ravaged by 11 years of civil war in Sierra Leone and 14 years in Liberia.
Stinson and Patten said that apart from the need for more doctors to be sent to the region, other challenges were the lack of treatment centres and supplies of chlorine, oral swabs and rapid diagnostic tests. It could take days to get Ebola test results – which often meant it was too late for the patient.
"There is no surveillance and other infectious diseases like measles are falling under the radar," Patten said. Early childhood immunisations for other infectious diseases were also not being monitored.
Innovation is needed: "We need to be using survivors in the treatment centres to help because they are immune to re-infection – but they are too traumatised."
The current population in Kailahun town is 30 500 and there is only one treatment centre and three holding units where suspected cases of Ebola are contained.
Patten said at first she questioned every headache and every tummy rumble for fear that she was symptomatic for Ebola but she realised her fears were irrational. There was also having to get used to the endless washing of hands between taking off each piece of clothing.
The perfect storm
Sarah Crawford-Browne from UCT?s Primary Health Care Directorate – who was a trauma counsellor in the district after the civil war ? spoke about the social, historical and political factors in Sierre Leone that "have come together as a storm, a perfect storm right at the moment" of the Ebola outbreak.
She said the dynamics of the Ebola crisis, including stigmatisation and fear, echoed the experiences of the HIV pandemic in Southern Africa, which South Africa was familiar with and whose expertise could be drawn on to understand and assist with unfolding events in West Africa.
"Many of the psycho-social drivers of the epidemic have congregated in this eastern district."
Global capital moved to the three countries after civil war and as a result large mining and agricultural projects displaced subsistence farmers and miners. High levels of mobility meant rapid urbanisation and many people had also fled to the forests.
"When I was there, there was hardly a bird that sang – most animals had been eaten during the war," she said.
Crawford-Browne said Kailahun had been occupied by the rebels during the war and was looted. However, the infrastructure had not just been damaged by war. She said Liberia and Sierra Leone were similar historically to South Africa where the urban areas were different to the hinterland. The urban areas of Freetown and Monrovia were settled by free slaves with Freetown initially being declared a British colony and the hinterland later being declared as a protectorate. This led to two different health, legal and education systems – one for the elite in the city and another with poor infrastructure in the rest of the country. "Not many structures reached the Kailahun."
People did not trust Western medicine but relied instead on traditional medicine. "So there is little healthcare in general and people have faced several epidemics. Everyone has malaria at least once a year. Children are not named until they are five years old. They are not valued until then because of the high levels of child mortality," she said.
There is intense movement on the border between the three countries, and ethnicity, language and cultural differences; a complex economic environment; distrust of governments; and the international community have conspired to fuel the epidemic in the Kailahun district, she said.
What is UCT's role?
Seminar chair and director of the Primary Health Care Directorate Professor Steve Reid said UCT had done very little to date to support West Africa. "As a research-led university we need to respond urgently to the evolving epidemic." The seminar was meant to challenge public health experts, infectious disease clinicians, laboratory scientists and social and psychological scientists. He outlined what needed to be addressed including viral and immunological issues, vaccine discovery, the fast tracking of other therapies and psychological issues such as fear.
The seminar was followed by a robust discussion on how UCT could assist in the fight against the disease. It was suggested that children in the region who had been left abandoned because their parents had died or were infected should be targeted for intervention.
Those present were asked to volunteer their expertise either from Cape Town or, if the need arose, to travel to West Africa to assist other countries where possible.