At this writing the Ebola epidemic has stricken West Africa for more than one year. There has been significant progress in controlling the epidemic, but these gains have come at great cost in human suffering and national treasure. It has become apparent that the most effective countermeasures are preventative, such as public education about Ebola and its transmission, isolation of patients, safe burial practices, contact tracing, and improved hygiene. Serving recently on a medical outreach team sponsored by AmeriCares that staffed an Ebola Treatment Unit (ETU) in Buchanan, Liberia, it was often frustrating to accept the constraints on medical care in treating this deadly virus. The well-trained health care professionals on our team were accustomed to applying the high tech therapies of modern medicine to improve patient outcomes, yet we soon discovered that in this setting our toolkit was quite limited. Although each one of us volunteered to fight Ebola in hands-on combat on behalf of patients in specialized units, we came to realize that the greatest achievement was not in the successful treatment of its victims but in the prevention of new cases.
As a responder to a number of disasters resulting from nature, war, or disease, I am subject to my own personal frailties that are possibly possessed by others who share this calling. Oftentimes, the joy and satisfaction might seem most profound when arriving on the front lines and overcoming the acute suffering of victims. However, true victory demands correcting the conditions that allowed the disaster to occur and its effects to spiral out of control. The task of those who stay on to build infrastructure that prevents a recurrence may be seen as less glamorous or exciting and certainly less publicized than the role of the initial responders, but it is by no means less important.
Each country that is struck by a disaster has its own unique needs, depending on pre-existing cultural, social, economic, and political conditions, as well as the nature of the catastrophe. Health care workers volunteering to serve on medical outreach, whether as part of a disaster relief team or responding to a call to provide routine medical care, need to be prepared to help ameliorate the structural weaknesses of the region they serve. Perhaps no event in recent memory has made this truth so evident as the Ebola epidemic in West Africa.
As the number of Ebola cases decreased weekly in Liberia, the attention of our team turned towards capacity building outside the confines of the ETU. One of the immediate tasks was to strengthen the local governmental medical facilities that provide primary care to the population. Many of Liberia’s best trained healthcare workers had perished as they treated the early victims of Ebola. Staffing these clinics with trained professionals, providing them with modern equipment, and restoring public confidence are crucial steps in the prevention of future outbreaks.
There has been much discussion about the future use of the ETU’s once the epidemic ends. These are very specialized, complex and expensive structures that are not easily converted into traditional medical facilities. ETU’s have been built in strategic locations around Liberia. One possible use of these structures is to function as a training site for health care workers, not only for education about Ebola but as a kind of university in medicine, nursing, and public health. Such a facility could also reach out to the general public and provide classes on essential topics such as child care, sanitation, and prevention of diseases. To make this concept a reality requires the participation of the many skilled expatriate health care professionals currently serving in West Africa.
There are so many other needs that must be addressed that are a large part of our mission to Ebola-stricken countries. Some of them are social, such as insuring the care of young children who have been orphaned by Ebola. Others include women’s health programs, long-neglected for lack of funding, such as prevention, screening, and treatment of domestic violence, obstetric fistula, sexually-transmitted diseases, and gynecologic and breast cancers. AmeriCares, its volunteers, other NGOs, and the Liberian government are partnering to address these issues.
All who strive together in this endeavor should be careful to avoid past mistakes in disaster assistance in which there has been a massive response to the immediate devastation but a lack of capacity building to minimize the impact of future emergencies. The momentum that has grown from the initial stage of this battle should not falter. The ultimate success of our response to this crisis will be achieved not when the last case of Ebola has passed but when the infrastructure is in place to prevent its return and to make compassionate, modern health care available to all.