The Real Fear

by Dave Schuler on August 17, 2014

The real things we should be afraid of in the ongoing Ebola outbreak are that it will cause the fragile healthcare systems in West Africa to collapse under its weight and that it will spread to Nigeria:

Last week, my brilliant Council on Foreign Relations colleague John Campbell, former U.S. ambassador to Nigeria, warned that spread of the virus inside Lagos — which has a population of 22 million — would instantly transform this situation into a worldwide crisis, thanks to the chaos, size, density, and mobility of not only that city but dozens of others in the enormous, oil-rich nation. Add to the Nigerian scenario civil war, national elections, Boko Haram terrorists, and a countrywide doctors’ strike — all of which are real and current — and you have a scenario so overwrought and frightening that I could not have concocted it even when I advised screenwriter Scott Burns on his Contagion script.

Inside the United States, politicians, gadflies, and much of the media are focused on wildly experimental drugs and vaccines, and equally wild notions of “keeping the virus out” by barring travelers and “screening at airports.”

Let’s be clear: Absolutely no drug or vaccine has been proven effective against the Ebola virus in human beings. To date, only one person — Dr. Kent Brantly — has apparently recovered after receiving one of the three prominent putative drugs, and there is no proof that the drug was key to his improvement. None of the potential vaccines has even undergone Phase One safety trials in humans, though at least two are scheduled to enter that stage before December of this year. And Phase One is the swiftest, easiest part of new vaccine trials — the two stages of clinical trials aimed at proving that vaccines actually work will be difficult, if not impossible, to ethically and safely execute. If one of the vaccines is ready to be used in Africa sometime in 2015, the measure will be executed without prior evidence that it can work, which in turn will require massive public education to ensure that people who receive the vaccination do not change their behaviors in ways that might put them in contact with Ebola — because they mistakenly believe they are immune to the virus.

The former concern is already dangerously close to happening:

At the same congressional hearing, Dr. Frank Glover, a medical missionary who partners with SIM, a Christian missions organization, and the president of SHIELD, a U.S.-based NGO in Africa, warned that Liberia had fewer than 200 doctors struggling to meet the health needs of 4 million people before the epidemic. “After the outbreak that number went down to about 50 doctors involved in clinical care,” said Glover.

I myself have received emails from physicians in these countries, describing the complete collapse of all non-Ebola care, from unassisted deliveries to untended auto accident injuries. People aren’t just dying of the virus, but from every imaginable medical issue a system of care usually faces.

Liberia, population 3.5 million, for example has a single medical school with another in the planning stages. Each doctor or nurse there that dies of Ebola is not just a tragedy but a disaster. We are complicit in the desperate condition of African healthcare by tempting African physicians away from their home countries to the fleshpots of western medicine and Western volunteer organizations are completely inadequate to make up the difference.

{ 11 comments… read them below or add one }

steve August 17, 2014 at 5:00 pm

Link at bottom demonstrates severity of issue. That said, I have a NIgerian working for me. I asked why he left. Safety for his family was his number one concern. Having a choice in what he wanted to do and being able to do it was second. As long as African countries are both poor and unstable, not sure there is a great answer.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001513

Steve

Dave Schuler August 17, 2014 at 6:05 pm

Physician emigration from sub-Saharan Africa is a topic I’ve touched on with some frequency since the beginnings of this blog.

Physician emigration from sub-Saharan Africa to the U. S. is just the tip of the iceberg. While the U. S. may be the preferred destination for Liberian docs, the United Kingdom is a far more likely destination for Nigerian docs while France is likely for emigres from former French colonies. Germany takes its share of foreign-born and -trained physicians as well.

I think there’s a real moral issue here. Many of these countries train their physicians at public expense. That means we’re behaving in a predatory fashion towards some very poor countries.

steve August 17, 2014 at 6:11 pm

So those docs should risk their lives and the lives of family? I don’t really see a good solution here.

Steve

PD Shaw August 17, 2014 at 6:26 pm

Nigerian Murder Rate: 17.7 per 100,000
Rate of Fatalities for U.S. police: 11.0 per 100,000

... August 17, 2014 at 7:06 pm

So those docs should risk their lives and the lives of family?

Why should the doctors and their families be treated any differently from anyone else from Nigeria?

And if everyone with talent and training leaves Nigeria, what will be left?

PD Shaw August 17, 2014 at 8:10 pm

I think NPR had a report on a doctor from Nigeria a few years ago who had stopped practicing medicine and drove a cab, for which he could actually make more money and he wouldn’t be blocked by his the government from migrating to Europe. He wanted a better life for his family. It’s a tough issue. Perhaps Americans should send more college students to Third World countries to learn medicine. Some will stay, and those that don’t won’t have the language / culture barrier when they practice here.

jan August 17, 2014 at 11:32 pm

Many of these countries train their physicians at public expense. That means we’re behaving in a predatory fashion towards some very poor countries.

So, do we ban physicians from coming here, in order to reverse any kind of predatory insinuation?

I’m at a loss on what to think of this Ebola outbreak.

Discussions on how contagious it really is differ, while the incubation period remains about 3 weeks. This gives caregivers, family members, travelers plenty of space to be carriers without symptoms for a good amount of time. I’ve also heard some pretty devastating predictions of deaths that will eventually occur by the rampant, uncontrolable spread of Ebola amidst substandard health care available to people, along with the primitive conditions allowing for an easier passage of the disease from one person to another.

Between the militarization of ISIS in the ME, Putin continuing to advance on Ukraine, Libya in chaos, the lack of containment or treatment for Ebola, our border being flooded with illegal entries by unknown people, one has to wonder why Congress and the executive branch has time for summer vacations.

... August 17, 2014 at 11:55 pm

Come on, Jan, you know the story. Our lords and masters are getting the world they want, so why wouldn’t they take some time off to gloat? Seriously, you canbe certain they will continue to accrue power and money just the same.

It’s not like we see a bunch of poor ex-politicians running around begging for scraps.

steve August 18, 2014 at 6:33 am

jan- I think it is mostly because they take vacation no matter what. OTOH, none of those issues are things they can do much about. The number of immigrants coming across is less than it has been through most of the 90s and the early aughts, the separatists are losing in Ukraine, our actions against ISIS are the appropriate ones, we can’t force the African nations to take appropriate actions and no one knows what to do about Libya.

Steve

Janis Gore August 18, 2014 at 8:23 am
Janis Gore August 18, 2014 at 8:25 am

Of course, you’ve been writing about health policy. That’s why you have so many healers of different types reading your blog. Besides just liking you, Dave.

Leave a Comment

Previous post:

Next post: