IDWeek 2014: Health infrastructure gaps drive Ebola crisis

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idweek2014The picture depicts a grim scene – a derelict room in a clinic furnished by a cot and a bucket; a blood splatter on the floor. The blood, from an Ebola patient’s gastrointestinal hemorrhage, was there for days after that patient’s death, Rob Fowler said today during an IDWeek presentation. Fowler showed the picture and others, of what he saw during his stay in Conakry, Guinea, near the beginning of the current West Africa Ebola outbreak, to illustrate his points. Back in March when the outbreak began, local health workers were unequipped to handle the emergence of this deadly disease that has taken the lives of more than 3500 in West Africa, he said.

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Inger Damon, second from left, and Rob Fowler.

Fowler, a member of the World Health Organization Ebola Clinical Team, shared another picture with a packed room of ebola patients lying on the ground in the courtyard of a clinic because there weren’t enough beds inside. This, he said, is just one example of how the medical infrastructure lacking in West Africa has contributed to the Ebola epidemic the region grapples with now.

At the beginning of the outbreak medical facilities had little access to the most basic necessities for healthcare:  running, clean water, soap, the basic personal protective equipment of gloves and gowns. They also had no capacity to monitor electrolytes or hemoglobin levels, Fowler said.

The outbreak was also fueled by a general disbelief in affected communities that the virus, and the epidemic it brought was real, and in their midst, Fowler said. That resistance has given way, he added. Now people are eager to get into care, but beds and resources at facilities are insufficient to take in all the sick.

While much has improved since international aid organizations, particularly Médecins Sans Frontières as well as Partners in Health, have stepped in to help, Fowler said, the need to improve healthcare infrastructures to control the epidemic remain great.

Add overburdened and unpaid healthcare workers and too few places to care for the sick and dying, and the outbreak response became even more challenging, Inger Damon of the U.S. Centers for Disease Control and Prevention, who also spoke today said.

Damon warned, “Without additional interventions we will see an exponential increase in the number of new cases.” But, she said, “we can break the outbreak” by providing quality care and support and by moving infected patients into isolation.

No specific treatments for Ebola exist, but some interventions have proven to be helpful, particularly oral rehydration therapy. While not often mentioned, Fowler noted, co-infection with malaria is also a challenge and antimalarial medicines must be available as well as antimicrobials, an intervention often administered during gastrointestinal complications.

Persistent gaps include human resources to identify cases and trace their contacts to prevent new cases, as well as provide better infection control training, both said.

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