Ebola responders returning from West Africa told members of the House Foreign Affairs Committee on Tuesday that strengthening healthcare systems in Ebola affected countries must be a priority in the global response to the outbreak, both as part of recovery and long-term strategy.
“People are not just dying from Ebola, they’re dying from malaria and other diseases, and those are not being addressed,” said Rabih Torbay, of International Medical Corps, the California-based humanitarian nonprofit organization which has 800 staff members, about 85 percent of whom are from the affected areas, providing care and treatment at Emergency Treatment Units in Liberia and Sierra Leone.
“Some of the most serious side effects of the Ebola outbreak occurred when basic health care delivery systems failed nationally,” he said. “Sierra Leone and Liberia, which have already experienced some of the highest levels of maternal and child deaths, now face conditions where there are no available facilities for women to have C-sections or children to be immunized,” Torbay said. “Children are dying from vaccine preventable illnesses.”
More people will die because other health conditions are not being addressed, he said, and “a vigorous effort must be made to restore access to primary and secondary health services as quickly as possible.”
Brett Sedgewick is the technical advisor in Liberia for the Ebola Taskforce at Global Communities, a non-governmental organization specializing in water and sanitation in Liberia.
“Significant, long-term investments must be made in the health system of the country, particularly in the capacity of the Ministry of Health and Social Welfare which is critically important to preventing other outbreaks of disease in the future,”
Because the United States Centers for Disease Control and Prevention estimates that up to 70 percent of infections originated from contact with the dead, Global Communities has focused on safe burial practices in Liberia, with 47 burial teams and 32 disinfection teams active throughout the country. “Safe burials are risky but can be done,” he said, noting that not one of their staff of 500 doing safe burials has been infected.
Calling the men and women on burial teams “the heroes of this crisis,” Sedgewick said “team members work while covered in impermeable materials in very high temperatures, often hiking through thick jungle, taking boats or assembling make-shift bridges over bodies of water. They enter communities stricken with grief and fear and carry out an incredibly sensitive task.”
Currently their burial teams are collecting 96 percent of bodies within 24 hours of death, he said.
“The most critical challenge is addressing the scarcity of health workers needed,” Torbay said. There’s one doctor per 100,000 people in Liberia, and that was before 324 healthcare workers died from Ebola, he said.
“We face a severe shortage of adequately trained health professionals,” Torbay said. “The difficult work environment, the personal risk, the need for 21 day self-isolation in some circumstances, all make it difficult for us to recruit volunteers.”
“The growing restrictions on travel to and from West Africa will only isolate the affected countries further, compromise the supply chain and inhibit efforts to recruit qualified staff,” Torbay said.
The Obama Administration has made a $6.2 billion emergency funding request to Congress for the response to Ebola in West Africa and at home.
The request includes $2.89 billion for the State Department and USAID to fund a range of activities including the construction of 17 Ebola Treatment Units, the mobilization of health care workers and safe burial teams, social mobilization and community outreach activities, funding to ensure food security for affected communities, and the establishment of Community Care Centers, medically safe places for individuals to receive basic care to help control continued transmission. Resources to expand the State Department’s medical support and evacuation capacity in U.S. embassies in the affected region are also being requested.
Under the President’s proposed program, the CDC would receive $2.43 billion to control the epidemic in the hardest hit countries in Africa through activities like infection control, contact tracing and laboratory surveillance and training. CDC would also receive funding to conduct evaluations of clinical trials in affected countries and to assess the safety and effectiveness of vaccine candidates. The National Institutes of Health is slated for $238 million in the request for clinical trial support. CDC would also be financed to improve Ebola readiness within state and local health departments and laboratories and to purchase personal protective equipment for the Strategic National Stockpile.
More controversial components of the Administration’s request are contributions to the new United Nations Mission for Ebola Emergency Response and the World Health Organizations since some congressional members don’t support these multinational bodies and others believe their response to the epidemic to date has been wanting.
While members of the Senate Appropriations Committee at a November hearing did not offer significant resistance to the request, questions remain about whether Congress can be persuaded to honor the request as an “emergency”, meaning that the funding will not require cuts to other federal programs commensurate with the amount of funding approved.
You can find the White House request here: President requested additional funding