Gregory Damhorst, doctoral student, Medical Scholars Program; Student Director of the Global Health Initiative
I visited Sierra Leone last February around the time when the first cases of the current outbreak— across the border in Guinea—were beginning to make the news. From its capital, Freetown, I drove with other members of the Global Health Initiative delegation through Sierra Leone’s lowland plains to the Njala University campus in the northern Moyamba district. I met Sierra Leoneans Mohammed and Saffa, Njala agribusiness students, Rashid, a brilliant biologist doing infectious disease research in a tiny lab in Bo, and Roland, a champion of One Health throughout the country. I saw the construction of new roads and other infrastructure, largely driven by foreign developers, and I met expatriates working with NGOs on health and nutrition projects.
Today, it pains me to think of what a microscopic agent has done to Sierra Leone and other countries in the region during the time since my visit. We’ve learned that normal activities on the Njala campus are shut down, foreign developers and aid workers have returned home, and that many under-resourced clinics and hospitals much like the several I had visited are now overwhelmed with a disease that had barely been seen in West Africa prior to this year.
Chronic poverty, poor healthcare infrastructure, a critical lack of medical providers, and limited education have made this region a place where Ebola—typically a rare and preventable infection—has been able to take hold. Meanwhile, the response of the rest of the world has not made the situation any less complicated. The world media has largely failed to highlight the systemic disparities and structural inequalities that have made West Africa susceptible to such a crisis and attention has been focused on the few Westerners to be infected, while the global efforts to fight the infection in West Africa remain inadequate. As two missionaries—the first Americans to contract Ebola—were flown from Liberia to Emory University Hospital in August, I pondered the misfortune of a world where the country you’re born might grant the privilege of preferential treatment. This situation is even further complicated by the news of scarce experimental treatments made available only to these patients.
But as the first cases ever treated, diagnosed, and contracted on American soil emerge, generating unnecessarily panicked responses from much of the country, there is reason to have hope. First, other cases appearing in West Africa—particularly Nigeria and Senega—appear to have been contained, demonstrating that cases traveling between countries and regions can indeed be managed when identified early. Second, the fatality rate of the current outbreak appears to be lower than past outbreaks, which may reflect that—even in under-resourced settings—the degree to which healthcare facilities have actually been able to prepare may contribute to increased survival, even with only basic medical treatment available.
I just returned from a conference at which one of the first physicians to treat an Ebola patient on American soil spoke. It is clear that bringing these patients to U.S. facilities has created the opportunity to do some basic testing and monitoring that may provide useful information to understanding this mysterious virus. Despite the ethical controversy surrounding this situation, there are ways in which others may benefit from this information. As for the experimental treatments administered, there is a lack of data on safety or efficacy, without which it is impossible to know if they would actually be beneficial, or even do harm. Neither of these considerations, however, changes my opinion that no person deserves not to have access to the best care available, independent of their country of origin or how much they can afford to pay.
My hope as we move forward is that the global response grows to be commensurate with the need in West Africa. I hope the world realizes the chronic problems which go back centuries which have given Ebola the opportunity to gain a foothold. I hope that the world does not forget that the media never tells the whole story, that we choose intelligent dialogue over panic, and that we take this opportunity to recognize that health is a human right worthy of defending for one another.