When Sierra Leone’s first Ebola patient came through the door of the Kenema Government Hospital in Freetown, Issa French was there to admit her. Since that day, Issa has tended to more than 500 people, all victims of the epidemic that engulfed his country. Ebola killed many of his patients, as well as dozens of his colleagues.
Like most of his fellow nurses, Issa is essentially a volunteer, one who is 20 to 30 times more likely to become infected than any of his patients. Although he has escaped infection with Ebola, he suffers in other ways, most clearly in the social isolation that cuts his family off from any interaction with their fearful neighbors.
Ironically, Kenema Government Hospital, where he works, is the one place in West Africa that should have been prepared for an Ebola outbreak. The small facility held an internationally funded laboratory, with the means to diagnose Lassa Fever and other viral hemorrhagic fevers, including Ebola.
But all eight lab technicians contracted the disease, probably from exposure to the blood of patients they were tasked with analyzing. Mohamed SK Sesay, the sole survivor, returned home to his village to explain the disease to a community that had rejected efforts to impose control measures. The trust Mohamed inspired would eventually save lives and lead the village to be declared free of infection.
Issa and Mohamed have played heroic roles during the terrifying epidemic, but their stories reveal a dangerous and often-overlooked weakness in the fragile health care systems that allowed the Ebola epidemic to spiral out of control.
Health care workers in Guinea, Sierra Leone and Liberia, as well as in many other parts of Africa, work under extremely challenging circumstances given the huge disease burden and lack of adequate staff, along with other limited opportunities for professional development.
The World Health Organization reports that the most basic level of health care requires at least 23 doctors, nurses, and midwives for every 10,000 people. Globally, the average is approximately 44 health workers per 10,000. In contrast, Sierra Leone reported fewer than two health care workers—including volunteers—per 10,000 people. Liberia and Guinea are not much better off.
So it’s not enough to take care of West African health workers who are already in the system. Our research suggests that the shortage of trained staff—protected with adequate infection prevention and control systems—to provide basic health services could prove more lethal than Ebola.
At a UN-sponsored pledging conference in early July, governments and other funders committed more than $1.5 billion to implement evidence-based strategies for ending the epidemic and for helping the West African nations recover from their terrible ordeal. But the recovery will cost far more if it is to address the devastating impact on the economic health of the region.
According to the World Bank, the affected nations—already among the world’s poorest—lost nearly 5 percent of their combined GDP in 2014, and their economies are expected to shrink further in 2015.
This means that the needs of people like Issa and Mohamed could get lost in the debate over what to fund first. But we would ignore health workers’ plight at our own peril. Our experience with Ebola suggests that if we fail to address the needs of health care workers as a core part of strengthening health systems, we will fail to adequately repair the health systems of West Africa and may only have a fragile “Zero Cases” situation.
We know that 28 other national health systems around the world are just as fragile because they face the same human resources problems. What happens next in West Africa, for better or worse, could set the modern standard for health systems development.
Getting to zero cases of Ebola is still our goal. Staying at zero after getting there will be essential. The recent reports of new Ebola cases underscores the need to remain vigilant always. In this last phase of the epidemic, decision makers need to prioritize the economic and physical health of the workers on the frontlines. And we need to make sure there are enough of them to do the job.
Once we achieve the goal of zero cases, the world must join forces with national health authorities and political and religious leaders of Guinea, Liberia and Sierra Leone to deliver essential health services that are resilient. Trained professionals who provide these services can respond quickly to emerging threats and prevent another outbreak from becoming an epidemic.
We cannot rely on goodwill alone to keep Issa at his post, nor luck to protect Mohamed from the disease that killed his seven colleagues. The people who provide the care that protects all of us must be the foundation of West Africa’s recovery.