8 Ebola lessons for South Africa

2014-10-21 15:00

There is a step-by-step solution to fighting the disease. Wilmot James advises

We are blessed with being Ebola-free. Now that we better understand its epidemiology and the repertoire of medical and health interventions required to curb its spread, it will take some doing to keep it that way.

Health Minister Aaron Motsoaledi is working tirelessly and doing the best he can, but he must be supported and pressed to do a great deal more to ramp up our state of Ebola readiness.

What lessons have we learnt from the Ebola crisis so far?

First, there is no such thing as being overprepared.

Before the current outbreak began in December last year, west Africa had no recorded Ebola deaths. Between March 22 and October 8, 8?399 cases and 4?033 deaths were recorded.

The precarious health systems in Guinea, Liberia and Sierra Leone were rapidly overwhelmed by Ebola’s spread.

Second, as the infection of Spain’s Teresa Romero and that of Thomas Eric Duncan in the US illustrate, Ebola’s spread begins in an Ebola-free zone in health settings where errors of human judgement occurred.

Romero did not wear protective gear and critical information about Duncan’s stay in Liberia did not reach the treating physician. Both were sent home and came into contact with friends and family.

Third, screening is not enough.

Early Ebola symptoms are similar to those of malaria, typhoid and Lassa haemorrhagic fevers, bedevilling distinctive diagnosis.

Although screening is reassuring to the public, there is a weak scientific case that it will help keep Ebola out of Ebola-free countries. Only highly trained specialists, assisted by screening technology, have the sophistication to optimise diagnostic recognition.

Fourth, it is important to constantly assess risk.

It is possible that infected individuals can reach South Africa by air, boat and land travel. Contingency plans to populate every port of entry with Ebola specialists (and screening technology) must be made.

Motsoaledi’s newly appointed advisory committee must be alert to those provinces where there are significant migrant movements from neighbouring countries.

Fifth, healthcare workers, those who work on the front line of the epidemic, must be protected with appropriate personal protective gear (the basic gloves, gowns and face masks will do) and trained to comply with total fidelity to the various infectious disease medical protocols including, where appropriate, when pregnant mothers, individuals requiring surgery and children are involved.

Sixth, ambulances?–?where appropriate, helicopters and planes?–?must be geared with on-board facilities that clinically isolate patients and be made ready for deployment to?and from??ports of entry and Ebola treatment hospitals.

The scale of required logistical coordination is such that the US rightly turns to its military to run its operation in west Africa, as other countries should too under epidemic conditions.

Seventh, enough hospitals with enough beds in wards that provide clinical isolation to patients and protect physicians and health workers from the contagion must be set up in anticipation of various worst-case scenarios that can be epidemiologically modelled.

Motsoaledi identified 11 Ebola treatment hospitals (one in each province except Gauteng and Eastern Cape, with two each) but not all are in a state of readiness.

We are particularly concerned, as he must be, about those in North West, Limpopo and Mpumalanga; and alarmed about Free State’s Pelonomi.

Eighth – vigorous leadership matters.

Motsoaledi seems to be alone in his efforts. President Jacob Zuma mouths platitudes. Zimbabwe’s President Robert Mugabe, the head of the Southern African Development Community, a body with the capacity to lead Africa’s efforts, is as somnambulistic as he is self-absorbed. Nkosazana Dlamini-Zuma, the head of the African Union and a medical doctor herself, has no defining presence in the effort.

Are we ready to deal with Ebola? No we are not, but with leadership, effort, determination and resources, we can be.

Our under-resourced National Institute for Communicable Diseases already provides world-class pathology testing services for the epidemic.

Cabinet has set aside R33?million for the effort. According to the health department, we need R250?million. It has called on the private sector to make contributions. All of us should support this effort. The time for talking is over.

Let’s get the job done. All lives will depend on it.

James is a DA MP and the party’s health spokesperson

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