Thanks for reading.
Oh, wait, what? Ah. Rob Verkerk wants to add his peerless insight. Let’s see how that goes. Advance notice: there is a word I am really struggling not to use here. It is a very short word, beginning with C and ending with -unt. Read on, and be prepared to be very very angry.
Visiting Sierra Leone amidst the Ebola crisis is an experience that will remain deeply etched into my memory. The single most outstanding feature is the resilience of the people. Villages like Kigbal have lost about half their population to Ebola, yet the villagers still greeted us with warm, broad smiles-even the now mostly orphaned children. Only when reminded of their loss do the cracks appear and the depth of their loss emerges. One woman has lost four children and her husband to Ebola, while her two remaining children are still fighting for their lives. Despite her pain, she still stood proud and strong, ready for another day.
Rob, one simple question.
What the fuck were you doing in Sierra Leone?
Seriously. What the fuck?
You have no medical qualifications. You are not a doctor. This is a health emergency, and every single person in the area is at risk. Every single Westerner has to be watched and monitored to prevent them bringing the disease back. A westerner who gets infected has to be evacuated, which is a monstrous cost in resources that are already stretched to breaking point.
Have you ever heard of Dr. Martin Salia? Nina Pham RN? Dr. Craig Allen Spencer? Thomas Eric Duncan? Do you read newspapers? Listen to the radio? Watch TV? Do you have access to the internet? Because, and I am really struggling not to shout here, it is blindingly obvious that this is no place to play doctor.
You have gone to a disaster zone, basically as a fucking tourist, and you have gone without the only thing they ACTUALLY NEED: medical skills. You have imposed a cost and a burden on an area already groaning under the weight of a crisis that is barely under control. For what? To boost your own ego and your own profits? Or because you are actually so dangerously deluded that you think your facile remedies for the worried well are a valid intervention?
I am really struggling to think of a third option here, and neither makes you look good.
I also won’t forget the international presence-the logistics personnel organizing medical supplies and protective equipment, the foreign, especially British, army presence, and the fleets of World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) and Medecins Sans Frontieres (MSF) vehicles and staff.
Indeed. People with, you know, relevant medical expertise. The world’s religions have sent doctors and money. The worlds quacks have sent quacks. And the people of Sierra Leone, assuming good faith, let them in, only to discover that they were there for propaganda.
To the endless credit of the locals, the quacks were not lynched but sent home.
There’s also the sharp contrast between the elaborate foreign aid-built Ebola treatment centres and those built with local money, sometimes with the help of smaller non-governmental organizations. These are often built around vacated schools and community centres, with wooden frames made of tree branches, and walls and ceilings of UNICEF tarpaulin. There are around 200 of these around the country.
Yup. Sierra Leone is dirt poor. Send money, some of the cash you make from the legion of the credulous worried well.
These centres and the logistic operations are the only proven medicine against Ebola so far. They allow people with signs of fever or other symptoms of the deadly virus to be removed from their communities by ambulance, often within minutes of trained health workers-who are monitoring communities continuously-dialing the 117 emergency number on their mobiles.
And let us not forget what a staggering logistical achievement this is, given the infrastructure challenges. It’s a good job no tourists are clogging up the roads. Except you.
Once extracted, these people no longer pose a threat to their community, but are generally facing a 70 to 90 per cent certainty of death if positive for Ebola. Following death, burial is ideally within 24 hours, and a huge countrywide government campaign has been largely successful in re-educating communities to avoid their traditional practices for honouring the dead, which include touching the corpse.
25% to 90% depending on outbreak. Medical care has got survival to around 50/50 in Sierra Leone, which is average for outbreaks with good medical support, thanks to actual doctors (not vitamin pill salesmen, Rob, people with actual medical qualifications).
And the local religious communities have been doing an amazing job training people that this is a bad move, and trying to work out ways of protecting the living while honouring the dead.
Think about that for a minute. Your response is less reality-based than the religious community.
If a person brought to a holding centre tests negative, and has malaria or cholera or even morning sickness from pregnancy-which has similar symptoms to Ebola in the early stages-that person is discharged. Once discharged, though, the sad reality is that the person is now more likely to die of those other diseases or in childbirth, as the country’s healthcare system is stretched to the limits dealing with Ebola.
Correct. That’s why they need more doctors and nurses, not quacks. How many doctors and nurses did you take with you, Rob, and why did you not just send them and stay at home yourself, not being a doctor or a nurse?
Would now be a good time to remind everybody that 365 PEOPLE DIED A BLOODY AND AGONISING DEATH BECAUSE A TRADITIONAL “HEALER” THOUGHT SHE KNEW MORE THAN THE MEDICAL FRATERNITY?
Sorry, I said I wouldn’t shout. But, well.
The care of patients in the treatment and holding centres is largely dictated by the WHO and CDC. But one stunning fact is that their guidelines don’t advocate the use of intravenous (IV) support. This is almost unthinkable, as most Ebola patients suffer chronic dehydration due to severe vomiting and diarrhoea. It’s no surprise that one British police officer who was managing the Ebola patient extraction system and burials referred to these centres as ‘death camps’.
Gosh, I am sure the massive interdisciplinary teams of doctors, nurses, virologists and other medical researchers will be profoundly grateful for your insight, because it’s clear that they won’t have thought about this at all. It’s not as if each health worker has the potential to save a large number of lives, making them a scarce and valuable pool of resource, after all. And there are almost no reports of health workers being infected by needle stick injuries are there?
Frankly, your facile pontifications are about as useful as Matthias Rath in an AIDS epidemic. No, actually less useful: at least he is actually a doctor.
Could more lives be saved? Could more be done to improve outcomes for those struck by Ebola? I believe the answer to both is a resounding’yes’.
No doubt the Nobel Prize is in the post. After all, the WHO only has a few thousand trained staff on the ground. They must be gagging for the input of vitamin salesmen.
The best clinical evidence comes from Sierra Leonean Dr Santigie Sesay, who runs the Hastings treatment centre outside Freetown. After receiving training from the WHO – which recommends no IV in Ebola patients largely because of the risk of needle-stick injuries and cross infection to nursing staff – he and his medical team decided to act otherwise. Given that dehydration is an obvious major issue in these patients, they decided to administer IV dextrose and saline along with broad-spectrum antiobiotics and multivitamins. These simple interventions are consistently saving a further 20 per cent of lives, with the death toll falling from 60 per cent to 40 per cent of confirmed cases of Ebola before and after, respectively, the introduction of these interventions.
They take the risk, they are the ones who may die. I am in awe of their professionalism and dedication. But the average death rate form controlled Ebola outbreaks is only 50%, so it’s a big risk: they are deeply vested in the community and they should be celebrated in the same way as other medical martyrs.
The entire point of a co-ordinated response is to place objective judgments ahead of emotion. And yes, it can look callous, especially to those who have an agenda and don’t bother to think it through.
One can only wonder what would happen if more elaborate nutritional protocols were introduced, ones designed to enhance cellular hydration, modulate the immune system, reduce virus levels in the body and support recovery.
Jesus fucking wept. The period from diagnosis to death or survival is typically a week or so from first symptoms, maybe only a few days from diagnosis, during much of which time the patient is typically emitting fluids from every bodily orifice.
Do you really think they haven’t thought about the role of hydration?
That is breathtakingly arrogant. Really, monstrous hubris.
Because, you know, there are some pretty smart people on the case. And your “insight” is pretty bloody facile when you consider that the standard of care has reduce fatality from around 90% to around 50% over successive outbreaks. The fatality rate in the Zaire outbreak was 88%, the Sierra Leone outbreak is, as noted, around 50%.
What could they have achieved if only they’d listened to you, eh?
But the current West African Ebola epidemic is as much a health and economic crisis for the region as it is a political tool being manipulated by Western interests. Would it be advantageous for the West to find an inexpensive solution to Ebola that could be administered locally to help break the transmission cycle?
Perhaps they could try talking sternly to it?
Or maybe, you know, they could try something really difficult, like developing a vaccine. And yes, that is staggeringly difficult for this disease.
Because in the end massive multidisciplinary medical teams are not bad at working out the best approach for dealing with a disease, it’s just that delivering the cure or preventative is normally rather harder than sitting in an office writing about it form the perspective of no realistic understanding whatsoever.
Surely not, as the high mortality rates drive fear about Ebola in both West Africa and everywhere else in the world. And bear in mind that GSK’ s vaccine, at the time of writing, is being prepped for release. Is this another example of that well-oiled business model favoured by pharmaceutical interests: first create the problem, then provide the solution? The ultimate travesty is that so many lives are being lost-and many of them perhaps needlessly.
Rob, you are an idiot. A fact-blind, agenda-driven idiot.
Vaccines are not profitable. Vaccines for rare diseases of dirt-poor countries are seriously unprofitable. Two companies have put substantial resources into developing a vaccine that will not make either of them very much money.
Did it not occur to you that they might be doing this because it’s the right thing, rather than for your own motives, profit and ideology?
No, of course it didn’t.