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Originally published Wednesday, August 6, 2014 at 5:12 PM

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Guest: What’s really behind the spread of Ebola

The failure to control the spread of Ebola was not due to “uneducated” African populations, as some media have reported, writes guest columnist Elinor A. Graham.


Special to The Times

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Wait... The good doctor actually wrote "Worse yet, if loved ones die, families cannot see or touch the body...?" Isn't... MORE
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AS a physician who has volunteered to teach and work in Liberia for several years, I have watched with dismay the Ebola virus outbreak. What started as a major regional epidemic in Africa will likely spread globally. The human toll is already larger than any past Ebola epidemics, and medical personnel are being decimated in countries with far too few health workers.

The failure to contain this outbreak months ago is due to an underestimation of the mobility of people in the areas of West Africa where outbreaks began, a limited focus on isolation and contact tracing of known cases by the international aid community, and the fragile health care in countries confronting Ebola’s spread.

Failure to control its spread was not primarily due to “uneducated” African populations, as some media reported, who distrust health-care workers and refuse to cooperate with tracing and isolation of cases.

If Ebola is suspected, families are separated from their sick loved ones, who are placed in isolation. If infection is confirmed, victims are taken away to a treatment center, where odds of death are high. Worse yet, if loved ones die, families cannot see or touch the body, or bury them. Given the deep gash that Ebola makes in the fabric of human connection, it would not be surprising to see suspicion and attacks on hospitals and health workers even in so-called educated societies.

Leaders failed to strengthen the existing health-care systems and to support medical workers as urban outbreaks erupted.

Liberian health workers have very limited personal protective equipment to form a shield between their bodies and the virus. Sixty health-care workers currently have Ebola, and the death rate among confirmed cases is 90 percent in Liberia. U.S. physicians working in Liberia have been horrified as our Liberian colleagues — precious few faculty, newly trained medical officers and residents — contracted Ebola because they lacked basic personal protective equipment such as gloves, gowns, caps, face masks and shoe coverings.

Supplies of protective equipment have been shipped from U.S. supporters to front-line Liberian health workers, but not nearly enough to provide the full protection required.

It was only in the past month, after repeated outbreaks among health workers at multiple hospitals, that officials closed hospitals, conducted trainings and set up procedures to decontaminate areas where sick patients are initially evaluated and treated.

These closures have severely limited access to basic health care. Preventive treatment such as vaccinations, prenatal care and ongoing care for chronic illness have been disrupted.

International aid organizations have focused on establishing isolation and treatment centers for confirmed cases. These, and more, are clearly needed.

But infection control at first contact for all sick patients is also crucial to decreasing spread. It prevents spread within the health facilities and it also prevents deaths from other diseases with similar symptoms.

Treatable diseases such as malaria are not being diagnosed because of lack of health personnel and personal protective supplies. Protecting health workers addresses their legitimate fears. It allows them to provide needed health services and education that rebuilds community trust.

The final battle to control this epidemic will be won by a disciplined public health campaign with legal and international monetary support behind it. There must be coordinated logistics and training in collaboration with health-care systems and civil societies of countries involved. Effective vaccines and medications are far in the future.

The World Health Organization has pledged to raise $100 million from member countries to conduct this campaign. The U.S. government must fully commit to this effort. The recent announcement by the World Bank to make $200 million available to strengthen health and social support systems in West African countries most impacted by the epidemic is a major step in the right direction.

The grieving people of West Africa need to hear the message that they have the support of the world in this battle because countries with ample resources see that West Africa’s problem is our problem.

Elinor A. Graham is a doctor and associate professor emeritus of pediatrics at the University of Washington. She works with the Academic Collaborative to Support Medical Education in Liberia.



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