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.

Saturday 16 August 2014

The real cost to health

The number of cases continues to climb – as of 13th August, there have been 786 cases and 413 deaths in Liberia – that we know about. But I can’t help but think, horrific as the reality behind these figures is, it is the tip of the iceberg in relation to the impact of this outbreak on health in Liberia.

I was shocked to learn whilst in Liberia that the country has only around 150 of its own doctors – for a population of over 4 million people. At the best of times health care provision is limited – and many of these are working without all of the drugs or equipment they might need. It’s hard to imagine how demoralising it is for medical professionals to live in a context of overwhelming need and the skills but not the resources to help.

Unfortunately doctors and other medical professionals are one of the high-risk groups of contracting Ebola, due to their necessary contact with bodily fluids of patients with the disease. In fact, WHO Director General Margaret Chan reported on 12th August that so far in the outbreak as a whole 170 medical professionals have been infected, and 80 of these have died. That is a devastating blow to the health capacity of the region.

What about outside support, you may ask? Medecins Sans Frontieres has a huge presence in Liberia, but even this week their Emergency Coordinator in Liberia, Lindis Hurum, has announced,

“We have exhausted our available pool of experienced medical staff and cannot scale up our response any further ... We are Doctors Without Borders but not without limits.”

This of course is bad for the management of the Ebola outbreak, and we know that there are many more cases that never reach medical care than those that we know of. But what strikes me is, the usual health challenges that Liberia experiences are significant, and they have not gone away on account of the Ebola crisis. For example, the prevalence of Malaria is 50% higher in Liberia than in the Africa region as a whole, and it is the biggest killer of under 5s in the country. TB prevalence is more like 65% higher in Liberia than in the rest of Africa. Poor roads make road accidents common, often resulting in trauma. Where do you go, when health facilities are either overwhelmed with Ebola victims, or, in many cases, closed? Who will treat you when health workers are sick, dead, have fled due to fear and lack of payment for their services, or are busy in Ebola treatment facilities?

I wonder whether when all of this is done, someone will calculate how many extra lives were lost as a consequence of Ebola, even those that never contracted the disease? I wonder how many years health systems will be set back?
 

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