Risks of Tolerance

When everyday there is a new perceived crisis, sometimes people stop taking them seriously.  The same thing happens when there is an ongoing crisis that may not be a sudden natural disaster, but in every way is as potentially dangerous and far reaching.  What do you call a crisis almost 50 years in the making?  What do you do about it? What steps to you take to manage it? Well, unfortunately local governments and health officials worldwide just waited and hoped that the crisis would just go away.  That is the crisis of Ebola.

In 1976 there were two simultaneous outbreaks of Ebola in Sudan and the Democratic Republic of Congo. At that time there were 318 cases of Ebola and 280 deaths.  In the beginning of the outbreak very little was known about the disease.  Information about the mode of transmission, susceptible population and other factors were not known at that time.  However it was observed that pregnant women seemed to a population at high risk and that there was an apparent link between the disease and exposure to hospitals and funerals.  Despite the infection arose from contact with products of animals (which is reservoir for the disease), it was not discovered until later that the use of unsterilized needles and local ritual burial practices was crucial in the spreading of the disease during the first outbreak. Fortunately through changes in health practices in regards to use of needles and public health measures (such as isolation and contact tracing), the epidemic was controlled.

Over the decades there have been subsequent outbreaks, each being controlled but depleting local health care systems each time. During March 2014 the first cases of Ebola were notified in West Africa; however it is believed that there were isolated cases as early as December 2013.  Unlike previous outbreaks, what lead to there being more than 20000 reported cases was a combination of failures in decision making and avoidable errors.  The outbreak came at a time when health care systems in Africa were weak from previous epidemics and countries recovering from Civil War.  Political instability along with the initial denial by governments, allowed the problem to grow.  This compounded by the indifference of the international community of another “crisis in Africa” only made the situation worse.  Even when public health officials began to address the problem, due to local beliefs and lack of confidence in conflicting information from local governments, local communities were not receptive public health initiatives.

Not until Ebola had swept across several countries in Africa, claiming countless lives was it taken seriously.  Despite pleas from NGOs such as Doctors without Borders and others, the WHO did not raise alert levels until much later. It was not until, Ebola seemed to become a potential risk to Europe and the Americas did the international community saw a need to “help” and seemed interested in controlling it.  However over a year and the crisis continues, even though the situation has somewhat improved, it appears that controlling Ebola mainly meant confining it to Africa as the rest of the world looks towards another crisis.

Crisis 4 Dummies