P&G scientist: Ebola outbreak signals poor health system, lack of investment

Factors that contributed to its rapid spread

Alhaji N'jai is a Procter & Gamble scientist. His work on Ebola is done as the founder of Project 1808, a not-for-profit dedicated to improving communities in Sierra Leone and elsewhere.

Although it was three decades ago, as a little boy in my village, Ganya, located in northern Sierra Leone, the sight of a man with a high fever and bleeding from his eyes and face has stuck with me over the years.

I remember my mum whisking me away quickly saying the man had been bewitched. He was abandoned and left to die. We subsequently learned other members of the same family had died, including his sister. Ever since the current outbreak of Ebola began in Guinea, I have wondered if what I saw as a child could have been some form of a viral hemorrhagic fever like Ebola.

Today, as a biomedical scientist, this and many questions linger in my mind with the current Ebola outbreak in West Africa spreading rapidly. So far, more than 900 deaths are reported in Guinea, Liberia, Sierra Leone, Nigeria and Saudi Arabia, with potential for global spread as the U.S. Centers for Disease Control declares a level one alert.

The deadly nature of this outbreak raises many questions. Why and what is so different about this outbreak? Has the virus always being circulating in the region undetected? Or is it possible that the virus may have always been around and that we are only noticing an outbreak when it hit health centers and workers, who in turn affected their patients and relatives? And if it’s been around how have people dealt with it traditionally and what conditions precipitated the current deadly outbreak? And will Ebola now become a mainstream disease with its widespread geographic range and how does this influence natural resistance to virus?

How and where it started

Our knowledge on containment strategies in Africa have been restricted to outbreaks in remote villages of East and Central Africa. The earliest outbreaks of the viral hemorrhagic disease occurred simultaneously in 1976 in Nzara village, Sudan, and Yambuku village, Democratic Republic of Congo, near the Ebola River from which the virus was named. Like previous outbreaks in East and Central Africa, the first case in West Africa was first reported in forested border regions, first in Guinea, then it quickly spread to neighboring Liberia and Sierra Leone.

Fruits bats that inhabit the forest regions and are eaten as delicacies by locals are believed to be natural reservoirs of the Ebola virus. Although the bats are unaffected and show no symptoms of disease, human infection generally occurs through direct contact with body fluids of bats, through fruits contaminated by bats or indirectly through exposure to body fluids of an infected individual or nonhuman primates, who are also victims of Ebola virus.

Although deadly, Ebola is neither airborne nor highly contagious and so can be quickly contained with adequate public health infrastructure. The inability to contain it, and the deadly nature of the West Africa outbreak can be attributed to several factors including, poor health care in a region that is just recovering from a 10-year war and a virtually nonexistent public health system in Guinea, Sierra Leone and Liberia.

Life at the outbreak's epicenter

The epicenter of this outbreak, the border regions of Guinea, Liberia and Sierra Leone, lie close to large urban centers with fluid movements of people and are close to the country’s capital cities. Family ties span these borders and cultural practices of washing or touching the dead and taking care of the sick are also believed to foster human-to-human spread of the disease.

The deadly nature of this virus evokes fear and misconception, which is exacerbated by seeing medical personnel in white space suits arriving in their villages. This is a region where war, politics, and ethnic rivalries have created distrust. These problems, along with a lack of quality education and knowledge systems further aggravates mistrust and fuels conspiracy theories that hamper appropriate public health intervention.

Significantly, the United Nations World Health Organization, the international organization at the forefront of the intervention, has not adequately integrated local approaches for effective workable models for community intervention that build trust and confidence.

Indeed, on a broader scale, the Ebola outbreak in West Africa speaks to much bigger issues of health, lack of capacity and an inability to effectively use resources for sustainable development. Despite recent economic gains, Sierra Leone is ranked 184 out of 189 countries in the 2014 United Nations Human Development Index report.

In the outbreak region, rapid urbanization, mining investments and widespread deforestation have brought human populations much closer to once-forbidden areas to search for food, wood, or eat bat species. Sierra Leone, a major exporter of rice in early 60’s, now depends on imports and aid for food security, hence bats and wildlife become valuable sources of protein.

To curb bat eating and other practices, these countries require investment in food security, nutrition education and sustainable agriculture. African governments have failed to invest in building technical capacity, infrastructure and institutions, and education that would enable its populations to better respond or anticipate changes in their environments.

Beyond mining, industrialization, big corporate buildings and glitter, the true mark of development comes when we can integrate our African values with science, technology, engineering, mathematics, politics and health. An inward thinking with an outward global outlook should form the basis of a sustainable path to development.

Alhaji N'jai is a Procter & Gamble scientist; his work on Ebola is done as founder of Project 1808, a not-for-profit dedicated to improving communities in Sierra Leone and elsewhere.

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