30 Jul 2014

Poverty is at the root of west Africa’s ebola crisis

The fact that the foreign secretary is chairing a Cobra meeting on ebola on Wednesday is the reason the deadly disease is unlikely to take hold in the UK. It’s also an explanation of why it has spread so fast in west Africa.

Highly contagious, spread by contact with bodily fluids, ebola can be contained by standard infection control methods which are easy to implement in a developed country like the UK and almost impossible in Guinea or Sierra Leone. There is a danger that an infected person could arrive here by plane from west Africa and infect other members of their family, but we are lucky enough to live in a country with a modern public health system and effective government institutions.

Dr Peter Piot, the scientist who discovered ebola hemorrhagic fever, recently returned to the remote villages of what was then Zaire, now the Democratic Republic of the Congo (DRC), where he did his research in 1976.

What horrifies me about his account is not the descriptions of the gruesome disease but that facilities have not improved in the intervening 37 years. There is no running water in Bumba, the nearest town to the village of Yambuku where ebola started. Electricity is supplied intermittently by generator. The state provides nothing so patients have to pay for all medicines – not that there are any in the crumbling public hospital.

A health worker with disinfectant spray walks down a street outside the government hospital in Kenema

How many hospitals have I visited in Africa where patients lie two or three to a bed, lackadaisical (often unpaid) nurses and doctors watching them suffer because there are no medicines let alone disinfectant and rubber gloves to stop infection from spreading?

In many they don’t even have soap. Needles are re-used because they are in short supply.

War, state collapse and corruption have all taken their toll so the people return to the witch doctors who give them herbs, which may or may not work, or cut them and rub in magic potions which are more likely to spread disease further.  In some places heroic health staff – some local, some foreign – provide the best care possible under the circumstances. Aid agencies and mission hospitals help, but state systems have failed across much of the continent.

No wonder ebola is spreading through Guinea, Liberia and Sierra Leone, all desperately poor countries where conflict has destroyed what little infrastructure there once was. People often only go to hospital as a last resort, so their experience is that hospitals are places where people go to die not where they are cured. Such is the terror of the disease, and lack of education about how to contain it, that villagers in parts of Guinea have attacked health workers, blaming them for the contagion.

“Villagers flee at the sight of a Red Cross truck,” reports the New York Times. “When a Westerner passes, villagers cry out, ‘ebola, ebola!’ and run away.”

The disease is not the problem. Under-development, poverty and the lack of state institutions are the problem. Sadly, years of development aid have done little to remedy that.

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