A tenfold increase in current donations is required to deal with Ebola virus
Opinion: Existing technologies and organisational structures could prevent a widespread outbreak in Ireland
‘A comparative Irish context could be Carndonagh in Donegal or Ballybay in Monaghan, in 1830s. There is a strong belief in the ‘cure’, faith in traditional healers, loud and long wakes around the body of our loved dead, and a pre-enlightenment animist view of the world.’ Above, girls look at a poster, distributed by UNICEF, bearing information on and illustrations of best practices that help prevent the spread of Ebola virus disease, in the city of Voinjama, in Lofa County, Liberia. Photograph: Ahmed Jallanzo/UNICEF/Reuters
Ebola is terrifying. It brings fever, fatigue, oozing blood and forebodings of dying. Since December 2013, an outbreak of Ebola virus disease has spread in west Africa. Control interventions have failed. Ebola is spreading to new villages, new counties, and to other countries; last week to Nigeria.
Many health workers have caught it through work and died. Those left behind are tired, exhausted and loosing hope. They have seen their peers and their leaders dying while trying to help, with inadequate resources, lack of staff, and overwhelming failure.
The traditional subsistence farming families who live in the border districts in rural Guinea, Liberia and Sierra Leone, come from places called Gueckedou, Kailahun, Kenema, Koindu and Kono. A comparative Irish context could be Carndonagh in Donegal or Ballybay in Monaghan, in the 1830s.
Traditional healersThere is a strong belief in the “cure”, faith in traditional healers, loud and long wakes around the body of the loved dead, and a pre-Enlightenment animist view of the world. The old chiefdom families try to hold on to power in the local courts. MPs make laws in an unknown language. A paid police force is thrown in from faraway. There is a distrust of the national forces of law and order and an aversion towards centralised power. There are powerful secret societies – the Bundu and the Poro, for women and for men – each with initiation rites, songs, dances, lore and drama. The Kankoran, the dancing, hunting devil, inspires fear, respect and conformity, but also reassurance – it will protect people from all harm, as it has done during the civil war.
While the culture and social structures are attractive in some ways, there is widespread poverty. There is unmechanised, hard, physical work, with Iron Age tools for some, growing rice, cassava or maize. The youth dream of successful emigration and try to travel across to Spain, London or New York.
Healthwise, west Africa is dire by modern standards, again not unlike Ireland in 1830s. One woman in 100 dies during each childbirth. Five years ago, a Sierra Leone ministry of health presentation I attended described how six in every 100 pregnant women going into the Princess Christian maternity hospital in Freetown died there, due to the six traditional perinatal killers: sepsis, pre- eclampsia, ante-partum haemorrhage, post-partum haemorrhage, obstructed labour and ruptured uterus.
Last resortThe basics of scientific obstetric care were absent in the hospital. Most mothers deliver at home. Going to the state-run hospital is a last resort for the desperate.
Food insecurity occurs annually. During the hungry season people die, first the little children and elderly. There is rarely clean running water, reliable electricity or good roads. This is one of the least-developed places on our planet.
Presidents Ernest Koroma, Ellen Johnson Sirleaf and Alpha Conde of Sierra Leone, Liberia and Guinea have appealed for help to deal with the Ebola outbreak.
What have we done? Some courageous, and in my view heroic, Irish people are working there. For example, three Missionary Sisters of the Holy Rosary, from Artane, Bridget Lacy, Mary Mullins, and Anne Kelly, are working in Liberia. Médecins Sans Frontières has planted new healthcare workers and new hospitals. The Department of Foreign Affairs has staff there. The World Health Organisation and the European Union, of which we are part, have been giving technical help, funding, equipment and staff to help the governments of the three main affected countries.
Based on data and analysis of several previous Ebola outbreaks – in Uganda, Angola, and Congo – we can stop this epidemic. There is a control procedure that includes communications, early identification of cases, contact tracing, quarantine, barrier nursing with gowns, gloves and goggles, and preventative isolation. These have not yet been widely applied in west Africa due to lack of infrastructure, equipment, staff, money, organisation and knowledge. As described above, there are barriers.
There is a small chance this new Ebola strain has already developed abilities to spread in new ways, but I think this is unlikely at present. If an Ebola virus-infected person came to Ireland, our national plan for dealing with such outbreaks would be put into action and existing technologies and organisational structures could prevent a widespread outbreak.
So what should we do?
In my view, it is wrong and evil that people live in such poor conditions in 2014 on earth. The inspiration towards merciful compassion of the monotheistic faiths and the pro-poor socialist movements of the 19th and 20th centuries may motivate us to act to change things.
Based on self-interest, we in Ireland could benefit from the more peaceful, happy and wealthy world that would come from sharing in common with everyone the goods and knowledge for basic needs, of shelter, food, water, health, security and education.
Tenfold increaseWorking with EU and WHO partners we should help provide equipment, staff, money, knowledge, administration and logistics to west African countries to assist them deal with this Ebola outbreak. A tenfold increase in current donations is required, in the order of €100 million - €200 million. In the longer term we can form partnerships to teach people skills and knowledge to get health, food, water, education, justice and security for all. We can encourage business links. We can support and encourage the Irish people who are there. We can lead with a vision of a world in which everyone has their most basic needs met.
Prof Sam McConkey is head of department of international health and tropical medicine in the Royal College of Surgeons in Ireland. He has held posts in the Serabu Catholic Mission Hospital, Southern Province, Sierra Leone, 1993- 1994, and the MRC Gambia, 2000-2005