CMAJ News

Ebola epidemic outpacing response: MSF

ore international action is needed to quell the West M Africa Ebola epidemic, says Dr. Joanne Liu, international president of medical relief organization Méde- cins Sans Frontières (MSF). “The situ- ation is deteriorating faster than the response is being brought.” Recently, the World Health Organi- zation (WHO) declared the outbreak a public health emergency of interna- tional concern and the United Nations Secretary General appointed a special envoy to coordinate global efforts to fight the disease. But without immediate, practical action and more boots on the ground it won’t be possible to turn the tide, says Liu, a Montréal physician. “We need more people to do the legwork in terms P.K. Lee/MSF of health promotion, surveillance, data The West Africa Ebola epidemic will not be contained without a massive deployment on collection, tracing people who have had the ground, says Médecins Sans Frontières International President Dr. Joanne Liu. contact with the infected, and ensuring funerals are done in safe ways, but it’s of any other Ebola centre] and already now is to come in with a space suit and not happening.” it’s overcrowded. work in isolation wards, but [the big- Ebola outbreaks in Guinea, Liberia, gest shortages are in nonclinical roles]. Sierra Leone and Nigeria continue CMAJ: Why has this outbreak been … In Kailahun [in Sierra Leone] we unabated. WHO confirmed Aug. 27 so much larger and more deadly than know there are 2000 people who have that the epidemic has also spread to the any on record? been in contact with our patients, but Democratic . As Liu: In the past, the outbreaks hap- we’re only able to follow up with 250 of Aug. 22, nearly 1500 people have pened in isolated villages and the of them. That doesn’t require special died. chain of transmission stopped fairly equipment or training, but it’s not hap- Families are being wiped out, health quickly. … Now it has hit big cities. pening because we don’t have the services are overrun, and MSF is at the … There are more people who are manpower. limit of its capacity to help, says Liu. exposed [to the virus]. She joined CMAJ by telephone to CMAJ: Does MSF plan to scale up share what she witnessed on a recent CMAJ: Do you share WHO’s con- efforts in the region to meet these trip to Guinea, Liberia and Sierra cerns that the current epidemic may be shortages? Leone. bigger and more serious than reports Liu: There are so many other crises indicate? in the world right now — in South CMAJ: What’s the status of the epi- Liu: We know that the capacity for , the , demic and response from what you data collection is suboptimal. We often Syria, Gaza and Iraq — it’s not possi- saw? hear about deaths in the community, ble for us to scale up more. … The Liu: Guinea has been dealing with but we cannot go and verify [those response and solution won’t come from the outbreak since March and … their reports] so we have a strong feeling one organization. State governments main challenge is to remain vigilant [that the true scale] is underestimated. from rich countries, plus the UN agen- despite the fact that the numbers are cies, need to step up to the plate. stabilizing. For Sierra Leone and Libe- CMAJ: What are the upshots of the ria, we are still somehow in the upward current human resources shortages in CMAJ: What do you think about swing, particularly in Liberia. … We the field? ’s contribution of 1000 doses recently opened a big centre in Monro- Liu: Everyone thinks that the only of an experimental drug to fight the via with 120 beds [four times the size way to do something for Ebola right disease?

© 2014 Canadian Medical Association or its licensors CMAJ, October 7, 2014, 186(14) E523 News

Liu: It’s good because it’s going to CMAJ: Are there other pressing CMAJ: Are you concerned for the be a catalyst in terms of moving for- social consequences that are over- safety of your own personnel? ward research and development. But looked in current efforts? Liu: I can’t deny we have concern, we need to be realistic. For this epi- Liu: What’s most distressing is the especially as our facilities are so over- demic, it’s very unlikely the use of fact that [patients with Ebola] face a soli- crowded, and that’s why we’re asking those few doses will make a difference. tary death, without their loved ones, sur- more players to come to the field and rounded by people wearing space suits. take some responsibility. CMAJ: What immediate next steps … This is why people are so scared, why would you like to see in an interna- they don’t come to hospitals, and why CMAJ: Is international “Ebola hys- tional response? there’s such an issue about safe burial. teria” making it more difficult to curb Liu: We need to restore basic health the epidemic? care access. … Right now in Liberia, CMAJ: Health personnel in the field Liu: Having fewer airlines coming there’s no place to consult for general have reported unsafe working condi- in is an issue. Of course I understand medical problems. In Monrovia, all the tions, for example, not enough gloves why people are doing that, but I don’t hospitals are closed. … This week, six to go around — is this something you think it’s helpful. The best way to con- pregnant women walked around the heard about on your visit? tain the epidemic today is to increase city for hours to find a place to deliver Liu: This has been brought to our the means to respond to it locally, not and ended up at our Ebola centre, attention. People were not completely closing borders and barricading our- which was not the right place to be, and aware of what was going on at first, so selves. — Lauren Vogel, CMAJ by the time they got there, had lost their health care personnel didn’t take the pregnancies. precautions to protect themselves. CMAJ 2014. DOI:10.1503/cmaj.109-4890

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