Ebola control

Published October 26, 2014
The writer is a public health physician and the author of So Much Aid, So Little Development: Stories from Pakistan.
The writer is a public health physician and the author of So Much Aid, So Little Development: Stories from Pakistan.

WHEN first confronting the prospect that the Ebola virus might hitch a ride from West Africa and wind up in the US, American authorities were sanguine about their ability to prevent or at least contain it.

Two Americans infected with Ebola were treated safely at Emory University, in Atlanta, after all, increasing confidence in the American health system’s ability to handle such a situation. Recent events have shaken that confidence and exposed a series of flaws in the system that made it possible for a man to first go undiagnosed and then die of Ebola, for two nurses to fall sick and then travel. Now, a New York City doctor recently returned from Guinea has the virus.

The panic in the normally placid American public is overstated, but a country like Pakistan should take careful note of these events. The health system at its best being much, much weaker than that of the US, Pakistan would have a very different experience in the event that a traveller brings Ebola into the country. The experience here would be much closer to that of Sierra Leone, Liberia, or Guinea, where the virus is infecting thousands and killing many, creating panic, where health systems are failing to cope, and where the virus is wiping out years of hard-fought achievements in other areas.

Hopefully, Ebola will not enter Pakistan. But the fact remains that it can.

The experience of the US has only highlighted what we already know is needed to address an outbreak of Ebola. These things are, mostly, unglamorous and mundane: mechanisms for coordination between government agencies at all levels; accountable management; training and supervision for health workers; clear and accurate guidance from health authorities on protocols and procedures pertaining to all aspects of patient care, including transportation and waste disposal, that must be followed meticulously; availability of equipment and supplies and the resources to obtain all these.

Though the containment measures sound simple, they need a serious amount of coordination, dedication, resources, planning and practice.

Ebola is more dramatic, more horrifying and more frightening than most communicable diseases, but the things needed to contain it are, by and large, the same ones that any health system should have in place to address any communicable disease. What is required to achieve this goal is the same as it has always been: knowledge, sensibility, and effort. There is no silver bullet — a fact that Ebola, for which there is as yet no vaccine and no cure, makes all too clear.

The good news is that the Pakistani government, displaying some forethought, has put together a comprehensive plan, so that “Ebola will not be allowed to have its say.” This plan calls for steering committees headed by provincial chief secretaries, the appointment of point persons, screening at airports, and directives to create isolation wards at hospitals.

The bad news is that these are the same measures Pakistan has tried to contain other routine communicable diseases — eg measles and polio — and the track record on that front is abysmal.

Steering committees and point persons sound good on paper, but the ‘comprehensive’ plan, as always, does not mention resources, coordination mechanisms, or accountability. Add in the almost total breakdown of local administrative structures, and the lack of faith people have in the government’s ability to care for their health and protection — or even its interest in doing so — these pronouncements begin to seem like bluster and posturing, PR moves that inspire cynicism rather than confidence.

Hopefully, Ebola will not enter Pakistan. But the fact remains that it can, that it might, since it is not particularly difficult for it to do so. The government should see that possibility as a call to improve all aspects of its disease-management systems with specific, detailed, coordinated actions that address the massive weaknesses in the current systems — in everything from coordination, to skilled and safe nursing, to triage systems, to the disposal of highly infective waste, and to reasonable health education for the public. As always, the donor community has a role to play, by ensuring that the government delivers on its promises and by not rewarding it for failure.

Even if, after all the effort, Ebola does not come to Pakistan, we hope, still, no one will argue that such efforts were wasted. Not only would they help Pakistan finally make real progress in addressing other communicable diseases — these efforts would be, for a population accustomed to grand gestures and pronouncements that amount to nothing, a welcome gesture of responsibility and commitment.

The writer is a public health physician and the author of So Much Aid, So Little Development: Stories from Pakistan.

Published in Dawn, October 26th, 2014



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