The Ebola epidemic in West Africa in 2014 was perhaps one of the most well-known public health crises in recent memory. Even here in the United States, an entire ocean away from the outbreak, people panicked about the looming threat of Ebola at home. But public health experts, like Harvard physician and Partners in Health founder Paul Farmer, look back on the deadly outbreak as a stark example of how weak public health systems can lead to catastrophic human suffering.
Members of the UW health care community gathered last Thursday night to get a rare glimpse of acclaimed Harvard physician Farmer. The event, which was sold out far in advance, drew eager lines of spectators for an hour long talk entitled, “The Caregivers Disease: The History and Political Economy of Ebola in West Africa.”
Farmer’s work has revolved around improving access to health care in impoverished countries. He spoke about solving problems associated with the health care system during Ebola and understanding how the complex web of history surrounding the disease caused mass human destruction.
Ebola hit West Africa hard. According to the Centers for Disease Control and Prevention, over 11,000 people died between 2014-2016 around the world, mostly in epicenters in Liberia, Guinea, and Sierra Leone. A media frenzy fixated on the disease origins in primates and rodents, but Farmer chose to focus on the ramifications that spread beyond just patient zero and the systemic issues at play in the region.
“Clinical deserts, that’s why Ebola kills,” Farmer said. “Public health deserts, that’s why it spreads.”
The distinction between these two may seem academic, but it’s of vast importance to containing and preventing an outbreak. Clinics are for people who already have the disease to make sure they survive. Public health facilities are there to prevent the disease from spreading through personal protection for caregivers, screening facilities, and community outreach to limit transmission.
In countries like the United States, patients are far less likely to die from Ebola due to the presence of adequate health care and relatively stable sociopolitical atmospheres.
“Americans who got Ebola, who all lived, including a couple of my friends are to be compared with their African peers, about 70 percent died,” Farmer said.
He attributed the lack of public health care facilities to the lingering effects of British colonialism and the 11-year civil war in Sierra Leone, which ended in 2002. While Americans could fly home and get treated in large, modern hospitals, people in clinical deserts like Sierra Leone and Guinea could not.
“All of the money into peacekeeping and none of it into health care, education, and social systems?” Farmer said. “That’s the red carpet that got rolled out for folks and that’s why it happened there.”
Weaving narratives about patients and African doctors into his talk, Farmer discussed the intimate involvement of communities with their sick families and patients. Ebola is one of the most virulent and contagious diseases in the world, so in places that lack medical professionals, family and friends care for the sick and contract the disease themselves.
“Ebola is caused by caring about other people,” Farmer said. “Nursing, and what is the last act of caring all over the world? Burial.”
Intimate interactions like these, coupled with a lack of protection and sanitized health care facilities for those dealing directly with Ebola patients, directly led to the rapid and widespread epidemic we saw in 2014 and 2015.
There is a myth popular even among public health specialists that this was the first ever Ebola outbreak in West Africa, which led to the sluggish diagnosis of the patient zero and his family. Despite modern genomic evidence showing the disease has long been a part of West Africa’s history, it took several months for the public health community to realize Ebola had struck in 2014, in which time it had spread from Guinea to both Liberia and Sierra Leone.
“Ebola is real,” Farmer said of awareness campaigns in the region. “People who I saw who just lost a dozen family members, they were not arguing that Ebola wasn’t real.”
The media fixated on the origins of the disease: patient zero and West Africans eating bushmeat, but eating the primate meat often only plays a role at the beginning of the epidemic.
“Once it’s introduced to the human species it spreads person to person,” Farmer said. “All you need is one rat, one monkey, they’re not part of the equation anymore. It’s human spread because you don’t have gloves, face shields, systems and spaces to protect caregivers.”
Highlighting the vast discrepancies in human health care in West Africa, Farmer also cited the success story from his time working as a physician in Haiti. After the fatal earthquake that rocked the island in 2010, Farmer and his Partners in Health NGO worked with the government there to build a teaching hospital in Port Au Prince to grow the country’s medical human resources. Farmer’s logic was simple, if we’re going to rebuild, let’s rebuild for the future.
“This isn’t rocket science,” Farmer said. “Supportive care is nursing care, critical care isn’t rocket science either. But that never happens with crises — we don’t invest in things we need to know.”
While Ebola may be dormant in West Africa, the lives lost and families devastated by the public health failure still remain. Farmer is adamant that if we are ever to prevent another epidemic like this one, we must learn from history and prioritize health care in the region.
Reach reporter Samantha Bushman at firstname.lastname@example.org Twitter: @sammi_bushman