Twenty Thousand

Apparently Ebola Viral Disease (EVD) was "invited" into Sierra Leone in May 2014 by a healer living in a border village in the Kenema District. That healer, it is reported, claimed that she was able to cure the disease. A little boy, across the border in Guinea, sick with the infection, took her on her word and presented himself at her door. It is here, it is believed, that it all began. Both patient and healer subsequently died, and the rest, as they say, is history. 

Now, right in front of our eyes people are dying everywhere. The disease seems beyond control and still, no definitive treatment is available. And, looking at the trend of new cases during the month of August in Sierra Leone, it is easy to see that the projection of 20,000 cases in 6 months is not fanciful.

According to the Sierra Leone Ministry of Health's daily Ebola updates, there have been, on average, 16 new cases a day, with a case fatality rate (CFR) of between 36 and 40 percent. The surviving 60- 65 percent almost certainly have a message for us in their survival. But it is likely a while before we can decode that message. For now we are trapped in this catastrophe that is so awful that the authorities have had to resort to medieval measures. The President of Sierra Leone on July 30 ordered that "epicenters" of the disease be quarantined and that localities and homes where disease is identified be quarantined also. In addition, he ordered house-to-house surveillance and searches to trace and quarantine suspected Ebola victims. Wow!

To be sure, the authorities can argue the case for such measures. The history of quarantine is probably longer than we realize. Although I can find no biblical references (my usual source for ancient history), quarantine was a measure applied as early as the 14th century in Europe during the Black Death's reign of terror. Then, ship passengers arriving from Asia were not allowed to disembark at European ports until they showed no evidence of the plague. The duration of that quarantine was set at 40 days. (If you know Italian, you will be able to see the connection). The tactic may not have been that effective because the epidemic raged on across the continent for a decade and a half.

But could quarantining for Ebola be a good idea? Only if it is total. A total quarantine requires draconian measures that could impinge on civil liberties, creating new problems of its own. Anyway, no quarantine procedure can be truly total. So the spread from one region to the other continues. 

So, can we avoid reaching that 20,000 peak? Or to a number even beyond? But whatever number is reached, there has to be a proportionate number of healthcare workers to treat, manage and comfort the afflicted.

What can the rest of us do to help their work?

Tell Fren Tru

Eating the Ebola Cake and Having It

Last week I wrote that  the Ebola epidemic was running out of control because of ignorance and low education levels in the affected areas. I also thought that some in social media out there, for unknown reasons, were deliberately fanning flames of confusion.

Six centuries ago, the Black Death descended on Europe and took lives on an industrial scale, around 60 million, if we are to believe those 14^th century stats. We were not there, so we can't really tell but, in any case, our connection with that holocaust is not as immediate as with the current Ebola outbreak. Also, we can’t know the people who were dying then but now, with only a few degrees separating each one of us, we are every bit as terrified as 14^th century Europeans must have been when they had to deal with the plague.  Fourteenth century Europe knew little about the cause of plague. All they knew was that it led to death on a massive scale and that there was nothing they could do to stop people dying horribly. Six centuries on, in spite of the spread of education to most parts of the globe, there are still some stubborn pockets of ignorance that are a block to understanding how an infection like Ebola arises and is transmitted. The idea that Ebola is caused by a virus is beyond the imagination of the ordinary man or woman living in his or her village. But that is something that we can make good. We can teach and inform the merely ignorant. This is why it is worrying that some of those who can do not engage in the required teaching.

Even more troublesome are those who misuse their education and position to deliberately misinform, scare and confuse. They begin by blaming governments for not “sealing” the borders shared by the three countries first affected by the epidemic, Guinea, Sierra Leone and Liberia. As if it was that easy: A quick look at maps of the area reveals the forested nature of the entire region. People living in that environment move about without the slightest regard to the lines drawn by 19^th century

Forest Canopy

colonial map makers. Shutting down official border crossing points would not contribute much. The border markings are not only irrelevant, they lie within the  domain of the witch doctor whose knowledge of Ebola is almost certainly no more sophisticated than that of the ordinary person's. And this is the environment in which the virus makes its transition from its natural host to humans.   

And, talking about the origin of Ebola, the gossip-spinners have come up with the extraordinary notion that the epidemic is part of a sinister plot engineered by US scientists experimenting with biological warfare agents on poor Sierra Leonean villagers. And all this, it seems, because, at Kenema, the centre of the fight against the Ebola, there has been, for years, a hospital treating patients with Lassa fever, another highly infectious hemorrhagic viral disease for which there is also no known cure. That hospital is there because Lassa fever is endemic in the area and is, therefore, an excellent place for learning how to diagnose, treat and control it. I have met the director of the programme, Dr Robert Garry. He speaks openly about what he and his team from Tulane University are doing at Kenema. He was also open about the source of funding for the project, namely, the US government. I could detect no trace of deviousness in what he said he was doing, but then, I’m no Edward Snowden.

And, interestingly, the voices that are claiming that biological warfare is being waged against defenceless villagers are the same ones that now clamour for using “secret serums” to treat Africans suffering and dying from Ebola. They  become even more strident when they demand to know why is it that only American Ebola victims get the serum treatment when hundreds of Africans dying across four countries are denied it. But those voices must know it is not as simple as that. Trying out untested treatments on the poor and powerless is an ethical minefield that few would gaily venture into. The same voices remind us of horror stories, such as Tuskegee, as reasons why we should not go there. It seems they want to have their cake and eat it.

So, in spite of it all, I can detect the traces of common sense running beneath all the bluster. The trick, therefore is, how we go about squaring this particular circle. Very carefully, I would imagine

Tell Fren Tru