Twenty-one days: the maximum incubation period for Ebola Virus Disease. That means if you have come into contact with the virus but have no symptoms by day twenty two, then you are clear.

Forty two days: the incubation period x 2, and the period it takes for a country to be officially considered clear of the disease. If no new suspected cases are reported for 42 days, the outbreak is over.

Today, Wednesday 13th August 2014, is a big day for me ... it has been twenty-one days since I left Liberia, and for the first time I know beyond a doubt that I am Ebola-free. Not everyone is so lucky. In my first 14 days of incubation in the comfort of my Southampton home, the number of cases in Liberia more than doubled from 249 on 23rd July to 554 on 6th August. Of these cases, 294 people had died. The country is in a state of emergency, schools are closed, roads are blocked, communities are quarantined and attempts to bring the disease under control are being crippled by widespread fear.

So for another 21 days I am going to write a blog post every day to raise awareness of the grim challenge confronting Liberians, and to raise funds to support the Red Cross, who I work with collaboratively in my normal life as a PhD social researcher, and who are at the front line fighting the worst known Ebola outbreak in history.

Friday 22 August 2014

Supply and demand

There was a great debate on Ebola this week hosted by the Thompson Reuters Foundation (http://www.trust.org/spotlight/ebola-when-will-it-end/) which brought together experts who are part of the response across West Africa.  One of the major areas of discussion was, despite funds that are being made available, why are resources lacking to enable an effective response to the Ebola outbreak?  The main things that were named as missing were cars, personal protective equipment (PPE) and skilled workers – in particular, doctors, nurses and infection control personnel.

The lack of cars on the ground did not come as a surprise.  When I was in Monrovia I was astounded to find that even a small, second-hand vehicle that would never pass an MOT in the UK costs around £2500-5000 (that is $4000-8000).  I genuinely looked into whether it would be cheaper to have my £500 faithful old banger shipped to Liberia than to buy or rent a vehicle in order to conduct my fieldwork there.  Even the Red Cross, reliant on having heavy-duty vehicles to reach its offices all over the country struggles with insufficient transportation.  Now that the Ebola outbreak has spread so widely in the country, the need to get people around, particularly in the rainy season, is an enormous challenge.

I find it hard to understand and accept the lack of sufficient personal protective equipment (PPE).  After all, what is it but boots, gloves, boiler suits, masks and aprons?  These all seem to be things that should be common place.  I can only assume that the economic principle of supply and demand applies – there is not usually the level of demand for these items (which need to comply with specific standards to be used for Ebola), so manufacturers are not prepared for a sudden increase in orders.  Or procurers do not know where to source the quantities that are now needed.  Still, this surely is an issue that international organisations should be able to resolve – and they had better do it quickly, as it is closely connected to the question of personnel.

In relation to the staffing needs, Jorge Castilla of the European Commission for Humanitarian Aid (ECHO), based in Guinea, lamented during the debate,

“The gap between needs and offer is big.”

One contributor suggested that potential volunteers from the US might be put off as insurance companies refuse to provide medical protection for Ebola.  I can well believe that – I was recently refused mortgage protection insurance myself because I said I was planning to travel to Liberia.  Perhaps there are also issues of the speed of recruitment processes and capacity to advertise for positions, or the specific profile of volunteer that is needed, particularly those with experience in managing infectious diseases.  But I wonder if the most overriding factor is fear.  Ebola is a terrible disease, and both local experts and international health workers have been infected.  And as we know, there is no ZMAPP left for next time just yet … we also know in theory that Ebola can be controlled when proper procedures are followed, but this is hard to reconcile with the knowledge that people you would not expect to take any risks or deviate from procedures have nevertheless contracted the disease.  I wrestle with this, being married after all to an intensive care doctor.  His work commitments would not enable him to go at present, so it’s a futile dilemma in any case.  But if they did, and if he wanted to, would I entertain the risk of him going?

The potential for impact if foreign medical staff make themselves available is hard to overstate.  The right infection control procedures can enable staff to do their jobs safely.  And in addition to the direct clinical benefits of having the personnel that are needed on the ground, as Jorge Castilla observed,


“Foreign medical staff can create confidence in national staff and show that it is possible to deliver services with no risk because there are adequate measures in place.”

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