Ebola, an unnecessary epidemic

Africa

A few years back I attended a seminar by a colleague who had worked as a volunteer dentist in a hospital in Uganda. Conditions in the hospital weren’t great. She frequently worked out in the open air to get enough light to do basic dental procedures. Any 30+ year old school dental clinic in New Zealand has a light the dentist can position so they can see what they are doing. This hospital obviously didn’t have one.

She was told to bring all the surgical gloves she would need for her stay. The hospital didn’t have them. I’m guessing that many medical personnel in New Zealand would have no idea how many gloves they would go through in 6 months as they are there just to use. In Uganda they are really needed. There were many HIV positive people using the hospital at the time. She told the heart-breaking story of counselling a women with AIDS about the risks of having a tooth extracted. She was in pain and wanted the tooth out despite the risks. Days later she was dead. An infection from the extraction had killed her. These stories were common in her talk.

Hospitals all around Africa lack much of the basic equipment we take for granted. And for health care workers personal protective equipment is vital. Gloves, aprons, face shields etc. These are the basics that health care workers routinely use in New Zealand, and most developed countries. There is a culture of using them, and they are readily available.  Because of this, we can handle flu epidemics, SARS and plenty of other outbreaks of infectious diseases.

By comparison to these, Ebola isn’t that hard to quarantine. People are only infectious when they have the symptoms of the disease, and it’s only spread through direct contact with bodily secretions. An Ebola outbreak in New Zealand would be easier to contain than flu or SARS. And the basic equipment to protect health care workers are already present in our hospitals. While there are risks to healthcare workers, they would be less than with other infections they have dealt with.

The situation in Africa is very different. Some hospitals even lack running water. Personal protective equipment as basic as disposable gloves are luxuries in many areas. Their scarcity makes it almost impossible to have a culture of good barrier nursing.

There are many factors behind the current Ebola outbreak in Africa. The most important is the presence of a natural reservoir for the disease. There are cultural practices with burying the dead. There is a mistrust of the government in some places. And many of the healthcare workers in the areas currently affected have never dealt with Ebola before. But healthcare workers shouldn’t be getting sick. Sixty have already died, including one of Sierra Leone’s most respected doctors.

Governments are now responding and basic health equipment is starting to get to the areas that need it. Charities have been on the ground the whole time caring for the sick and dying, in conditions that put themselves at great risk.

We have to look hard at the role the developed world has played in it. A lot of ‘medical’ equipment has been supplied to Africa in the past. Even barrier equipment. But nothing that would help with the current epidemic. We have been supplying them with condoms for years, and telling them that they need to use them. It’s not the barrier for this epidemic. There isn’t a lot of hard evidence that they have ever stopped any epidemic. And we have supplied a lot of other contraceptives too. Apparently these are more important than running water. Are condoms more important than having enough needles so they can use one per patient, instead of reusing them, which still happens in some parts of Africa?

For too long we have been happy for modern contraception to be available everywhere, but do nothing for basic healthcare in Africa.

We have had the chance to do something about the problem. There have been many conferences on population and development. They tend to spend a lot more time talking about reproductive health than about development. There has been a push to make abortion a human right, following the old slogan “Abortion should be safe, legal, and rare”.  How do you make any medical procedure ‘safe’ in a hospital with a dirt floor, and no running water?

African slaves contributed much to the wealth of both the British Empire, and the United States. Before the West was taking African’s as slaves, the East was doing it. Africa hasn’t had a fair break in centuries. Now the developed world is obsessed with getting contraceptives and abortions in Africa. You would think that we desperately wanted there to be less Africans in the world.

Now thanks to Ebola, that morbid desire is coming true.

We owe Africa real help with their medicine and their development, not this imposition of a culture of death.

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