Measles has been everywhere in the media these days (and everywhere literally if you live in California). Vaccination is a hot button issue, and everyone seems to have an opinion. It’s important to think for Americans to think about public health issues, and West Africa may be on the brink of a worse measles outbreak than we could ever imagine. West Africa just can’t catch a break.
Wait, but the title says this is about Ebola? Bear with me, I’m getting there.
Justin Lessler, PhD and assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, and his team looked at the potential health effects of the Ebola outbreak (other than, you know, Ebola). Specifically, they studied increased susceptibility to a measles outbreak in the countries hardest hit by the Ebola epidemic.
These countries are less equipped to combat a measles outbreak because of increased susceptibility. Some parents did not vaccinate their children for fear of catching Ebola at clinics and there are “some reports that, at least during the height of the epidemic, there were increases of malnutrition,” Lessler told Global Citizen.
Lessler’s study is important to prepare for and potentially stop an impending outbreak, but it has serious implications for how the world should view Ebola.
First, we need to continue the conversation about the Ebola outbreak, what happened, and why. Second, his study reminds us that Ebola is bigger than the outbreak we saw erupt. The international community needs to think long and hard about the real causes of the outbreak. If we don’t, it’s only a matter of time until the same countries,or others, and ravaged by another deadly disease.
This leads us to the five real causes of the Ebola outbreak...
1. Where are all the doctors?!
Most wouldn’t be surprised that he US has a better health care system than the Ebola-affected countries, but the scale might surprise you. According to the World Bank, the US has 2.5 doctors per every thousand people. When you put it that way, it sounds like we don’t have very many doctors at all. At least, that’s how it seemed to me. Let’s jump to Liberia and Sierra Leone for comparison. They have a 4.2 million and 6 million population, respectively. What is their doctor ratio? Well, for a population of 4.2 million, Liberia has 51 doctors. Sierra Leone has 136. Total. If you combined the number of doctors between Liberia and Sierra Leone and packed them into one of New York City’s smallest bars, no one would have to call the fire marshal.
What does this mean for Ebola? In Liberia, for example, there have been 9,249 confirmed cases of Ebola. Let me do the math for you real quick in case you’re not reading this with a calculator on your lap. That means there were over 180 times more cases of Ebola than there were doctors in Liberia at the time the epidemic struck. The numbers are similarly shocking for Guinea and Sierra Leone. Good thing we made it difficult for medical professionals to volunteer in these countries, huh?
2. Building hospitals is hard
Actually, investing in the health of citizens is always tough on governments (shout out to the second Supreme Court challenge to Obama Care). First, I do have to give credit to Sierra Leone and Liberia. They’ve been working hard to provide low cost or free medical services, mainly to children, pregnant women, and new moms. They’ve been trying, but obstacles abound. More on that further down the page.
Health spending in West Africa wasn’t where it needed to be a year ago to quell what we saw happen in September. A 2015 report by the NGO Save the Children looked at how much West African countries spend on health care. Guinea spends about nine bucks per person on health care. That’s about the cost of that industrial sized bottle of aspirin you’ll need after reading the statistics in this piece. Apologies for the headaches, friends. Liberia spends about $20 per person.
With so few dollars spent on health care, it’s no wonder people in these countries weren’t educated on how to avoid Ebola when it struck. Also, the health workers who died by the masses, especially at the beginning of the outbreak, were a sad side effect. They needed full protective gear, and many were working with latex gloves…if they were lucky.
“The biggest challenge is to have sustainable general improvements in health care,” Lessler said.
As always, it’s better to address a problem before it occurs, and it’s important that countries can sustain themselves as much as possible.
3. Health care culture exists, and it complicates things
Hopefully cause number 2 gave you some context for the health care situation in the Ebola affected countries. Let’s try to go a little further with the Mr. Rogers-approved tool of imagination. Imagine you are going to the doctor today. You walk into her office and sit in the waiting room. What does it look like? Is there a 2004 issue of Elle magazine? Was the receptionist nice or does he clearly need to take his lunch break? Look around. If you’re lucky, everything is clean, and maybe the entire room has a vague hint of lemon hand sanitizer.
If you live in a “developed” country, you’re almost definitely inside, under a roof. Every instrument used on you is professionally cleaned, if not new. You’re most likely examined in a room alone. You probably aren’t picturing something like the Lungi Government Hospital, pictured below.
The meager amount spent on health care for each person in these countries creates a market of cheaper, more accessible health care. Citizens become dependent on less traditional forms of medicine because they see hospitals as dangerous. “Black bag doctors” in Liberia travel to people in need of treatment (already easier) and give them drugs in the comfort and safety of their own homes. Sure, these drugs are often fake or expired, but at least you don’t have to risk catching whatever anyone else walking into the hospital has.
Omaru Sissay, a Sierra Leonean risk analyst, told the BBC that as Ebola spread, people saw hospitals “as the most dangerous place to be.”
Making matters worse, many held the pervasive belief that if you had Ebola, there wasn’t anything to be done. Yes, there is no Ebola cure or vaccine, but rehydrating patients can increase the chance of survival.
4. Political unrest doesn’t lead to stable health care systems.
Liberia has endured two separate civil wars in the last 25 years. The end of the first one (1997) and beginning of the second (1999) were only two years apart. Guinea had its first presidential election in 2010 and saw violent clashes before its second election in 2013. Thanks to humanitarian hunk Leonardo DiCaprio’s 2006 movie Blood Diamond, you may already know that Sierra Leone was engulfed in civil war from 1991 to 2002.
It’s also worth noting that these countries were previously victims of savage and ignorant Western colonization.
These conflicts not only contributed to the poor economic standing of these countries, but also complicated and weakened governance structures. When these institutions are weak with little money, it’s difficult to build important infrastructure, disseminate information, quickly develop action plans, and communicate effectively across channels about crises. In other words, history already shook the can. Ebola was just the drunk guy at the party who opened it, spraying beer all over everyone and their smart phones.
5. Loans don’t just suck for students.
This is where breaking down the causes of the outbreak gets a little tricky. You’ll need some background information to understand this very important point. If you’re already familiar with the International Monetary Fund, you can skip to the next paragraph. The IMF attempts to help developing countries by providing loans to kick start economic development. The important phrase there is “kick start economic development.” They are interested in bang for their buck, as quickly as possible. This means that long term projects to spur sustainable solutions to complicated problems are almost always off the table. They want to see growth, and they want to get their money back quickly.
Whew, that was a lot. Thanks for sticking with me. A new study in the Lancet Journal of Global Health argues that the IMF “caused” the Ebola outbreak. The above causes show that it’s a little more complicated than that, but they have a point.
Required reductions in government spending, caps on public sector (government, public health services, etc.) wages, policy positions encouraging health care decentralization, and poorly structured repayment plans poised Guinea, Liberia, and Sierra Leone for poor health care systems.
It’s important to recognize that while this is not necessarily prevailing opinion, the study makes valid points and aligns with previously vocalized expert opinions.
Regardless of the magnitude of the IMF’s role in setting up the Ebola outbreak, we cannot ignore their influence over health care infrastructure in these countries.
The Ebola outbreak is nearing its end. The media storm is calming and life is beginning to creep toward normalcy in West Africa. While we should all breathe a huge sigh of relief that Ebola will soon be a memory, we need to keep it from becoming only that.
The most recent epidemic should serve as a call to action. It was not a random disease that popped out of nowhere and exacerbated problems. Instead, it is a symptom of many problems larger than Ebola.
The cause of Ebola is a complex scientific process. The cause of the outbreak is just as complex, but far easier to anticipate. While there is no way to entirely eradicate Ebola from the planet, the outbreak never should have grown to the size it did.
If we cheer for the end of Ebola, continue with our normal lives, and ignore the underlying causes of the epidemic, it’s only a matter of time until these problems manifest themselves in another devastating outbreak.