Two doctors die from Ebola and lives of others under threat in West AfricaBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4895 (Published 29 July 2014) Cite this as: BMJ 2014;349:g4895
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I am writing in response to the article, ‘Two doctors die from Ebola and lives of others under threat in west Africa’ (BMJ 2014; 349: g4895), and comment generally on the media coverage of the Ebola outbreak.
Until recently I was working in Liberia on a maternity project aiming to train midwifes in advanced obstetrics. The project was postponed in mid-June when the Ebola situation in Liberia escalated suddenly having simmered for several months before.
I read the article with some hope that increasing awareness in high resource countries like the UK will help to galvanize the support needed to halt the spread of this deadly virus. The article rightly draws attention to the lack of equipment and resources available to many of the medical staff at the front lines of this epidemic, who are therefore endangering themselves and their families by doing their jobs. I have been disappointed, though, that in this article, and in other’s coverage of the outbreak, that the true cost to the people of the region has not been considered.
I worked in CB Dunbar hospital, which is Bong county’s only maternity hospital. Nearby Phebe Hospital, is Bong county’s only general secondary health care facility. Between them they represent all of the in-patient beds available to Bong County’s 350,000 inhabitants.
In June this year, 4 of Phebe’s nurses died from Ebola. They were infected at work while caring for an infected patient who had not disclosed her condition. Unsurprisingly, the poorly protected staff did not want to return to work, and so now Phebe and CB Dunbar hospital are closed.
Phebe and CB Dunbar hospitals, despite their limitations, provided hundreds of patients with emergency medical and surgical care every month. Now that they are closed, 350,000 people have no access to inpatient care.
This break down of health-care provision is occurring across Liberia. Monrovia, Liberia’s capital has 5 hospitals catering for its people’s medical, surgical, paediatric and obstetric needs. All of these hospitals are currently closed with the exception of a limited emergency obstetric service that has recently re-opened in JFK memorial hospital. The city’s 1 million inhabitants, therefore, have no access to secondary health care. Whether suffering from obstructed labour, severe malaria or heart failure, they have nowhere to go.
I agree with Margaret McCartney, who states in her article, ‘Courage is treating Ebola’ (BMJ2014; 349:g4987). This statement is true. However, it is not reasonable, realistic or advisable to expect improperly equipped health care workers to continue to work in an environment in which they may be infected with ebola at any time. By doing so they risk not only their lives, but also the lives of their families and their communities. Restoring health-care to the Liberian people requires not only direct management and isolation of Ebola patients and their contacts, but also adequate protection equipment and procedures for its general health facilities. Then the greater project of restoring public confidence in the Liberian healthcare system can begin.
The official death toll for the West African Ebola outbreak was as of the 11th August, 1069. The true extent of the death and suffering it has caused remains entirely unknown.
Alice Clack, MCAI
Competing interests: No competing interests