Friday, November 28, 2014

No Rosy Goggles Here

From the UK Telegraph:
 A few months ago I read a blog of an MSF volunteer who found himself shouting over the beautiful jungled canopy of Sierra Leone “Where is everybody”?
Today, four months after the World Health Organization declared an international emergency, I did the same thing.
I had gritted teeth and clenched fists and it came out as more of a squeak than a war cry but still, my fury and incomprehension echoed his.
I always knew I would find it frustrating being unable to provide care as sophisticated as I would like for patients suffering, but this isn’t only about the unavailability of intensive care units and swishy machines that beep.
This isn’t only about watching young people die in a terrible way and being able to offer nothing but time-honored words of comfort in badly accented Krio.     This is about people dying in triage tents with no access to any kind of medical therapy as there are no beds available. 
This is about having to put desperately sick people in ambulances for five hours as that is how long it takes to get to the nearest treatment center with space.
This is about laboratory turn-around times that mean that people negative for the disease sit in beds next to patients with profuse vomiting, diarrhea and bleeding for up to eight days, waiting for their test results.
This is about how the world knew that a nightmarish plague had hit west Africa and the world waited over six months and then sang a song about it.
Of course, I know that many agencies are contributing and working as fast as they can, and that there are some on the ground who have been advocating and campaigning for action for months.
I only arrived a fortnight ago so I can’t imagine how much more furious and frustrated they must be. Perhaps during my time here progress will be made and there will be improvement.
There are many dreadful things about the Ebola epidemic - the suffering, the squalor, and the undercurrent of fear that you could be next. For me at this point, by far the most terrifying is that nothing will change and the status quo of international turpitude will continue.

The pitifully few "treatment" facilities in Sierra Leone are overwhelmed.
They provide exactly no "treatment".
The labs are slow, overwhelmed, and help to ensure those uninfected on arrival are infected in short order, thus "treatment" = infection.

Given all of that, and the fact that health care workers certainly talk to people too, is it really that surprising that the epidemic continues unabated, while the infected or merely suspected infected stay away in droves from such medieval levels of "medical care"?
This is the kind of medical malpractice that put Florence Nightingale on the map in the Crimea, and the same for Clara Barton in the Civil War.

Of course the "official" numbers most places are dropping.
People in West Arica are illiterate, perhaps even backwards and stupid.
But they aren't all barking mad.

Faced with those prospects, anyone with a lick of common sense, who heard the ominous tones of "We're from the government, and we're here to help" would

Amazing how that lesson crops in in history pretty much universally.


  1. From the MSF worker you quote: "This is about how the world knew that a nightmarish plague had hit west Africa and the world waited over six months and then sang a song about it."

    If this account is to be believed (and it has the ring of truth), that's not really true. The diagnosis of Ebola in Guinea was delayed for at least 3.5 months first due to false positives in a field cholera test, and then assuming the cases were caused by endemic Lassa fever. Once recognized, "When the international community responded to the Ebola outbreak, it did so with astonishing speed. One reason for this was the effective coordination by groups such as M.S.F...." and it then goes into many details of a very serious international and local response. Of course:

    [...] But people in Guinea were as frightened by the response to Ebola as they were by Ebola itself. As the international community started to make significant progress against the epidemic, people in the Forest Region and in the capital were starting to shut health workers out. Fear was proving to be a contagion: You want to hide from the disease. You want to deny that you have it. You want to retreat to your village behind a phalanx of family members, and when the men in space suits come looking for you, you want to crawl under the bed. And you do—and your family members throw stones at the people in space suits, and so they leave.

    Or worse, albeit after the locals in Guinea could no longer hide it, killing aid workers, resulting in a big pullback in at least that country.

    [Local "Ebola Magnet Centers of Excellence"] provide exactly no "treatment".

    That may be overstating the case. From reading several treatment accounts, I think a key threshold is whether the patient's gut shuts down. If that occurs, the only way they'll survive is with aggressive input of IV fluids, per that case in Germany. Short of that, if they can be made to drink sufficient ORS replacement fluids, I gather they have a much better chance to survive, as did this Nigerian doctor who basically saved herself by doing that (that's her personal, first person account of it all, highly recommended).

    Sound like it's an open question whether these centers can provide that level of very very basic supportive treatment.

  2. Is this perhaps the biggest take-away from that Doctor's account:

    I reassured myself that my contact with him (Patrick Sawyer, the first Ebola in Nigeria) was quite minimal.

    She, a doctor, says she had minimal contact with him but she contracted the disease!

    The CDC seems to be lying.