Where did the aid go?

Although Nigeria, Senegal, Mali and the Congo were all affected by the ebola epidemic , the real devastation occurred in Liberia, Guinea and Sierra Leone. Medical facilities were overwhelmed at an alarming rate, already-lean government purses were stretched to the limits, the courage of health workers was tested to the brim, and normal life was ruined. In Liberia, the outbreak left half the heads of households out of work, while women - who account for more workers in the non-agricultural, self-employed sectors - were among the hardest-hit. So the aid money started coming in. By July 2015, the United Nations announced that donors had promised $5.2bn, which far outweighed the $3.2bn the three countries said they needed to "return to the progress of their pre-Ebola trauma".

President Ernest Bai Koroma of Sierra Leone, speaking on behalf of the three Ebola-hit countries, said: "Humanity sometimes displays short attention spans and wants to move to other issues because the threat from Ebola seems over … The threat is never over until we rebuild the health sector Ebola demolished, until we rebuild the livelihoods it compromised."

The much-vaunted "rebuilding of livelihoods ruined by Ebola" is far from happening. The Liberian government, whose task force destroyed the belongings of Ebola patients, was providing no help as survivors struggled daily for decent food, housing and employment. As Josephine Karwah, one of only three pregnant women to survive the virus, told me, the government left survivors "in a limbo".

Liberia's anti-corruption watchdog audited only a fraction ($15m) of the funding, and found that $800,000, most of which passed through the defence ministry, could not be accounted for. Specific instances of corruption included the disbursement of $600,000 for fuel, feeding, daily subsistence allowance, communication, medical and training, tentage repair, repair and maintenance, without supporting documents; and the payment of $10,000 to 68 officers in 10 counties who could not be physically seen or whose names could not be traced in the daily attendance records.

In neighbouring Sierra Leone the report of the Audit Service of Sierra Leone unearthed a series of financial irregularities, most notably payments to thousands of fictitious health workers, and expenses running into several hundreds of thousands dollars without supporting documentation.

The Ebola Fund Watch report in November 2015 reveals that although Guinea had received donation worth $330m as of November 4, 2015, there is not one audit report on the use of the fund. The "reports of mismanagement" suggested in this report are given credence by the former prime minister Cellou Dalien Diallo's description of Guinea as a country where "contracts aren't signed and investments aren't made".

In all three countries, no individual has been tried, much less convicted, for their role in the mismanagement of money meant to save the lives of the dying.

The Superstitous Ebola Fear

As the Ebola epidemic was advancing on Guinea’s capital Conakry in April 2014 a powerful rumour started to spread among the people living on the outskirts. Onions and coffee, so the saying went, could protect against the disease. Within hours, onions were completely sold out at the stalls of the city’s main market. Of course, the rumour was false. Despite the health authorities’ immediate efforts to discredit the rumour on social media and through radio, it spread rapidly, becoming one of many examples of misinformation.

False information took many forms during the epidemic. Some people did not believe in Ebola at all. Others believed it existed but had wrong ideas about how and why it was spreading.

“Even until now, part of the population still doesn’t believe in the existence of Ebola,” says Sakoba Keita, the national coordinator of the Guinean health ministry’s response team. “They believe it was invented by the authorities.” Other strategies to combat the virus, such as spraying houses to disinfect them, were sometimes perceived as doing exactly the opposite. Keita says many people believed that the spray, which was laced with chlorine for disinfection, also contained the Ebola virus. They believed “that the spray was a propagation factor”, Keita says. Similar rumours soon spread about the thermometers used to measure body temperatures. The health staff who took away the sick and gathered dead bodies had to work quickly, with little time to communicate what they were doing, or why. Often, their actions clashed with communities’ religious beliefs and traditions. Relatives were not allowed to touch the deceased and go through traditional funeral rites. This gave rise to conspiracy theories. Keita explains that many people began to strongly oppose the Guinean government’s strategy to manage corpses. “They thought we collected organs from the bodies for sale,” he says. Some people saw the disease as a plague sent by God only on atheists, so they came to treat the exercise as a religious purification ritual rather than a hygiene measure. Stressing the need for better communication, Keita adds that his response teams persuaded religious and community leaders to speak to the population “so they understand the ins and outs of the disease”.

At the height of the epidemic, when hundreds of people died every day, panic spread. In radio broadcasts and stories spread by word of mouth, Ebola was portrayed as an inescapable, apocalyptic threat. Jérôme Mouton, head of the Médecins Sans Frontières response team in Guinea, says Ebola was used as a source of horror in literature and movies across West Africa “The first messages that were broadcast portrayed Ebola as a disease that kills almost every time and one that has no cure,” he says. “With such messages, to obtain a rational and thoughtful response from the population was obviously not easy. Instead of appeasing, rescue teams, in some situations, reinforced fear.”

Misinformation was also spreading over the internet. From the onset of the crisis, health authorities tried to use social networks such as Twitter and Facebook to distribute information on Ebola and gather hints on where their response teams might be needed next. But although social networks reach many people, it soon became clear they were not always an appropriate forum in which to discuss complex issues. Information about Ebola’s spread and prevention got muddled, warped and hyped. Social media users spread half-truths and rumours in an environment already gripped by a general panic, propagating misinformation quickly. This was exacerbated by the lack of reliable conventional media channels to broadcast reliable information.

 In fact, in the rush for sensational news, some traditional media outlets repeated ridiculous rumours that Ebola was a ‘Zombie disease’ sent by God to punish atheists. One of the things that people clung to was witchcraft. Supernatural forces are still a reality in the minds of many African societies, even those with advanced education and social development. In West Africa, many people responded to mystical explanations of the disease by seeking out traditional healing, despite government efforts to discourage such practices. And sometimes, the witchcraft remedies would appear to work, potentially reinforcing such beliefs. The idea that Ebola was a supernatural evil also meant that those who got infected often doubted their ability to recover. SaaSabasse Tèmèsadouno, a health worker at Guéckédou hospital in Guinea, was infected with Ebola whilst caring for other victims. As a medical assistant, Tèmèsadouno had some basic knowledge about the virus. But he still doubted his own ability to recover due to persistent rumours that Ebola was caused by witchcraft.  “After I got infected many people kept saying I had no chance of surviving because there was no cure for Ebola,”

Some news channels blatantly harnessed misconceptions to further their own goals, for example by playing on existing political and ethnic rivalries in the country, says Charles Vieira Sanches, the senior programme manager for West Africa’s branch of Article 19, an NGO working to defend freedom of speech. For instance, in Guinea the leader of the opposition party claimed that the ruling party were selectively spreading Ebola to the forested regions of the nation. Sanches and his team initiated a number of awareness campaigns on social networks, and tried to limit the political damage and social unrest this rumour and others like it were doing.

It was not until the height of the epidemic, around July 2014, that response teams realised how the social constraints generated by misinformation prevented them from stopping the epidemic. “We therefore had to take these parameters into consideration,” adds Keita.

To address rumours, health authorities called in social anthropologists for advice, and used information relays such as radio and newspapers, artists, and religious and community leaders.

One essential part of the strategy, according to MSF’s Jérôme Mouton, was to make treatment centres and what goes on inside them more transparent to the general population. From the start, health workers had experienced problems related to these centres. Since Ebola patients need to be strictly isolated and will, for a time, only come in contact with people in strange-looking protection coats, the experience of being taken away to a centre is traumatising both for patients and their relatives. Mouton said that this “isolation aspect” of the disease fed the rumours. “When people do not know what's going on, they imagine all sorts of terrible things,” he says. “For instance, there were rumours that the centres were used for organ trafficking. No one, under such circumstances, would want to be treated in our centres.” MSF became more transparent “When we inaugurated new centres, we’d ask the population to visit them and understand what they were all about,” Mouton explains. “Once people are convinced of the value for their communities to temporarily suspend certain traditions in the interest of public health, communication with the population becomes much easier,” he says.

“Fear is an important part of all problems we had to face while dealing with the Ebola epidemic,” says Mouton, adding that the panic caused by the epidemic explains why even the most outlandish Ebola rumours were so easily believed. “Fear has never helped people to think in a sensible manner. When we are scared, we no longer act rationally.” http://www.scidev.net/global/disease/feature/ebola-rumours-misinformation-west-africa.html

Ebola: The American Army Aid Ineffective

Only 28 Ebola patients have been treated at the 11 treatment units built last year in Liberia by the U.S. military. Nine of the centers have never seen a single patient. 

Despite millions of dollars spent and nearly 3,000 U.S. troops deployed in the effort, it all came too late, the paper reported. Deploying the military cost $360 million, according to the report, not including the construction, staffing and operating expenses at the treatment centers it built.

“But even before the first treatment center built by the American military opened there, the number of Ebola cases in Liberia had fallen drastically, casting doubt on the American strategy of building facilities that took months to complete.”

Of the 11 centers the U.S. military built, all but one opened after Dec. 22. By then, Ebola cases had already fallen to the point that Liberian and foreign officials were discussing the closing of treatment units built by other organizations that were no longer needed, the paper reported.

“I knew that most of the ETUs that were being built may not receive a single patient,” Dr. Francis Kateh, who helped lead the response of the Liberian government, which decided with the Americans where to build the 11 centers, said “But at the same time, you couldn’t put a stop to that process,” he added. “The train was coming full force.”

Ebola - the African Response

Africa’s efforts to tackle the Ebola crisis have been largely overlooked even though Africans have taken the lead in providing frontline staff and shown themselves “better placed to fight infectious diseases in their continent than outsiders”, according to the African Union(AU).

Dr Olawale Maiyegun, director of social affairs at the AU commission, said that despite the fact that Africans had proved both willing and able to deal with Ebola, the focus had been on the work of international agencies and those with the greatest media clout. “Unfortunately, Africans do not have the international voice of CNN, BBC and France 24, therefore much of our work is overlooked in the western media,” he said. “Most of the assistance provided by the international community is in the areas of finance and infrastructure. In the most critical human resources for health, Africans – including the affected countries – have had to take the lead.”

The AU deployed more than 835 African health workers to Liberia, Sierra Leone and Guinea at the peak of the epidemic. “The success of African health workers – including the heroic health workers of Liberia, Sierra Leone and Guinea – shows one thing: African health workers are better placed to fight infectious diseases in their continent than outsiders,” he said. Maiyegun said the AU’s response had been guided by the philosophy that it should not dictate how the the affected countries should run their fight against Ebola. “We put volunteers at the disposal of the governments of the affected countries,” he said. “They told us what to do and we have performed creditably.” He added: “The people of the affected countries must be given credit for doing a good job. With so many actors in the field, it’s important that it’s not just those with the loudest voices who are credited in the press for bringing Ebola under control.”

The Fight Against Disease

The world focused on Ebola but what about malaria and measles? Sierra Leone had some of the highest rates of death from tuberculosis, malaria and measles in the world, according to the World Health Organization (WHO). The medical charity Medicins Sans Frontieres says the Ebola outbreak has affected the attitudes of people towards modern healthcare.

A study published in the journal, Science, earlier this month warns that measles could cause as many deaths as Ebola after vaccinations were disrupted.

"We project that after six to 18 months of disruptions, a large connected cluster of children unvaccinated for measles will accumulate across Guinea, Liberia and Sierra Leone," the study says. It finds that the number of children susceptible to measles in the three countries is expected to double, resulting in between 2,000 and 16,000 additional deaths.

Nearly 500 health workers - most of them local - have died as a result of Ebola

How to stop Ebola

Not a single American victim has died of Ebola; the majority of Europeans infected have survived; a Cuban survivor is already back here at work. Across West Africa, 70 per cent of those afflicted die. And that figure applies only to the sick who receive care at treatment centres: More than 90 per cent of those who stay home perish. What accounts for the extreme variation in death rates? Firstly, it is not that foreign aid workers are shipped home and receive experimental treatments.

What kills most Ebola patients is a massive loss of the body's vital fluids - up to 10 litres of day - along with proteins and electrolytes, primarily through vomiting and diarrhoea. We often hear there's no treatment for Ebola or other hemorrhagic viruses. That's not true. Survivors all received was excellent supportive care, most of it from nurses. In medical parlance, the term "supportive care" does not mean hand-holding but the replacement of fluids and electrolytes; treatment of secondary infections (bacteria escaping from the gut, say, or malaria); and, in some cases, renal dialysis and assisted ventilation.

Three weeks ago, a baby named Jariatu was found by a burial team, barely alive, in a house full of dead family members. She was taken to Port Loko, where nurses and doctors were unable to locate a vein for an IV; the baby was dying, too unresponsive to drink. So they did what they would do in Boston or London: They inserted an infusion needle into the bone marrow of her tibia. It was three days before Jariatu was conscious enough to show any interest in taking anything by mouth. She's expected to survive.

What was always needed to improve survival in West Africa is the capacity to safely deliver excellent supportive care. It's hard to deliver supportive care there, due to the obvious lack of staff and stuff and space, and it's dangerous.

Nevertheless, though they're afraid of Ebola, as any sane person should be, thousands of medical professionals, most of them African, show up for work every day (a lack of electricity makes it hard to make a similar claim about night shifts, which is another cause of high mortality). Could there be a relationship between poor-quality care and people's reluctance to seek it in hot and raggedy Ebola units, where patients are interned until death or until blood tests show no circulating virus?

The quality of care in this part of West Africa - not simply for Ebola but for more common ailments and injuries - must be improved. It means cooler units - even fans would help - and personal protective gear made for tropical conditions. It means improved nutrition and a lot more support for the public health delivery system. Since hospitals with poor infection control have always amplified Ebola's spread, the two tasks - stopping transmission and improving care - are the means by which the world's largest outbreak will be halted and proper health systems built.

http://www.stuff.co.nz/world/africa/65166983/secret-to-ridding-west-africa-of-ebola-is-no-secret-at-all

IMF Austerity Helped Fuel Ebola Crisis

In a report published online last week in The Lancet Global Health the four researchers, professors from three British universities, accuse the International Monetary Fund (IMF) through its strict lending policies of contributing to the Ebola crisis. "A major reason why the Ebola outbreak spread so rapidly was the weakness of healthcare systems in the region, and it would be unfortunate if underlying causes were overlooked," said lead author Alexander Kentikelenis. "Policies advocated by the IMF have contributed to under-funded, insufficiently staffed, and poorly prepared health systems in the countries with Ebola outbreaks."

Kentikelenis and co-authors explain that IMF's economic reform programs forced reduced government spending, IMF may put caps on funds for government wages, including healthcare professionals, and it pushes for decentralization of healthcare systems, which "can make it difficult to mobilize coordinated, central responses to disease outbreaks. All these effects are cumulative, contributing to the lack of preparedness of health systems to cope with infectious disease outbreaks and other emergencies," they write.

Other observers have also made a connection between such economic policies and the deadly outbreak. Emira Woods, a Liberian director at ThoughtWorks, a technology firm committed to social and economic justice, in an interview with Common Dreams explained "A crisis of the proportion we've seen since the beginning of the Ebola catastrophe shows this model has failed." While years of war played a role in weakening public systems, it is the "war against people, driven by international financial institutions" that is largely responsible for decimating the public health care system, eroding wages and conditions for health care workers, and fueling the crisis sweeping West Africa today, said Woods.

Even the World Health Organization, which is tasked by the United Nations with directing international responses to epidemics, acknowledges the detrimental impact these policies have had on public health systems. "In health, [structural adjustment programs] affect both the supply of health services (by insisting on cuts in health spending) and the demand for health services (by reducing household income, thus leaving people with less money for health)," states the organization. "Studies have shown that SAPs policies have slowed down improvements in, or worsened, the health status of people in countries implementing them. The results reported include worse nutritional status of children, increased incidence of infectious diseases, and higher infant and maternal mortality rates. Depressing peoples' access to healthcare greatly increases their susceptibility to all diseases and pathologies.

The important thing to remember is that the destruction of the healthcare systems in these countries has not been accidental; it has been deliberate. This epidemic was as much a man-made disaster as a natural one. Austerity kills. Capitalism kills 

Is West Africa's Challenge Ebola Or Malaria?

West Africa’s fight to contain Ebola has hampered the campaign against malaria, a preventable and treatable disease that is claiming many thousands more lives than the dreaded virus.
In Gueckedou, near the village where Ebola first started killing people in Guinea’s tropical southern forests a year ago, doctors say they have had to stop pricking fingers to do blood tests for malaria.

Guinea’s drop in reported malaria cases this year by as much as 40 percent is not good news, said Dr. Bernard Nahlen, deputy director of the U.S. President’s Malaria Initiative. He said the decrease is likely because people are too scared to go to health facilities and are not getting treated for malaria.
“It would be a major failure on the part of everybody involved to have a lot of people die from malaria in the midst of the Ebola epidemic,” he said in a telephone interview. “I would be surprised if there were not an increase in unnecessary malaria deaths in the midst of all this, and a lot of those will be young children.”

Figures are always estimates in Guinea, where half the 12 million people have no access to health centers and die uncounted.
Some 15,000 Guineans died from malaria last year, 14,000 of them children under five, according to Nets for Life Africa, a New York-based charity dedicated to providing insecticide-treated mosquito nets to put over beds. In comparison, about 1,600 people in Guinea have died from Ebola, according to statistics from the World Health Organization.

Malaria is the leading cause of death in children under five in Guinea and, after AIDS, the leading cause of adult deaths, according to Nets for Life.

read whole article here

Ebola: Big Pharma "Indifferent To Collateral Damage"

Margaret Chan, director of the World Health Organization, nailed it when she blasted the pharmaceutical industry's failure to develop an Ebola vaccine. "A profit-driven industry does not invest in products for markets that cannot pay," Chan said at a press conference last month.

Since it first surfaced in the Democratic Republic of the Congo (DRC) in 1976, there have been 22 outbreaks, all of them in western and central Africa. Incidentally, viruses like Ebola and HIV first jumped from animals to humans in the DRC during a period of rapid deforestation at the hands of rapacious multinational timber and mining companies. Habitat loss pushed chimpanzees and bats into closer contact with humans and, eventually, became vectors for HIV and Ebola, respectively. From the perspective of free market capitalists, ecological devastation and disease epidemics are simply collateral damage with no impact on the bottom line.

A number of commentators have speculated that, had Ebola landed on US shores sooner, a vaccine would already be available. Big Pharma executives, driven by fear of contagion, would have invested in vaccine research even if it wouldn't be profitable. After a handful of domestic Ebola cases, we now see a rush to start human trials of a vaccine that was created 10 years ago, tested successfully on monkeys, then shelved for lack of a profitable market.
Clinical trials are finally on the fast track not simply owning to fear. The industry's decision to move forward was a response to intense public pressure, and, notably, financial sponsorship of clinical trials courtesy of the National Institutes of Health and other government agencies. Now that Ebola has crossed the Atlantic, Big Pharma surely sees dollar signs; in the event of an epidemic, 316 million petrified Americans will promptly roll up their sleeves. It's a great deal for Big Pharma - government foots the bill for clinical trials, and Big Pharma pockets the profits.

In short, the lack of an Ebola vaccine - and the wildfire spread of the virus - are a direct result of private-sector control over vaccine development and the absence of public health infrastructure that could have contained the outbreak.
Western Africa, like much of the developing world, has little by way of public services to compensate for the looting of its forests and mountains by multinational corporations. Those same corporations, along with Big Pharma, are indifferent to the public health catastrophe (aka "collateral damage") now unfolding.

Ebola makes for a tragic case study in the perils of profit-driven medicine, but there are other more ordinary diseases that Big Pharma has chosen to write off. For example, I have an uncommon, stubborn gastrointestinal infection that requires several rounds of a drug called Yodoxin to cure. After one course of Yodoxin, my little friends are still in residence, and I require additional rounds to permanently evict them. Alas, the drug has been discontinued for unspecified "business reasons." That leaves thousands of us to make do with less effective medications and/or cope with lifelong nausea, abdominal pain and fatigue.
The FDA explains: "FDA can't require a firm to keep making a drug it wants to discontinue. Sometimes these older drugs are discontinued by companies in favor of newer, more profitable drugs . . . FDA works to . . . mitigate drug shortages; however, there are a number of factors that can cause or contribute to drug shortages that are outside of the control of FDA." 

What's outside of the FDA's control is the same things that's outside of all of our control: capitalism.
There is no vaccine for Ebola because our economic system vests virtually all decision making in the private sector. We do so knowing that for-profit companies exist to maximize profits. It doesn't matter if they're selling medicine, gasoline, soda pop or credit default swaps - the corporations that make these products do so for one and the same reason.

Big Pharma's greed isn't some kind of aberration; it's an inherent feature of free-market capitalism: A capitalist system, by design, puts profits over people. The handful of sectors that remain under government control, such as water, highways and public schools, anticipate and deliver services that meet the public's needs (or, at least, used to). Not just wealthy people's needs or white people's needs or able-bodied people's needs but, assuming the government has not been crippled by austerity measures, everybody's needs.

On the other hand, sectors controlled by the free market serve only certain people (i.e. those who can pay) and only under certain circumstances. If market research projects insufficient demand for a product or service to meet corporate profit goals, that product or service doesn't come to be, regardless of the fact that it's vital for the health of people or the environment.

Capitalism is inimical to human health and well-being because it rolls like this: If you fit into the right market demographic and can afford to pay, you get the goods. If not, tough luck. Tough luck for you, tough luck for your community, tough luck for the planet.

from here

Problems never end

Half a million people in three West African nations rocked by Ebola are going hungry and that number could double by March if food supplies do not improve, two UN agencies warned. In Guinea, 230,000 people are estimated to be facing sever food shortages because of the impact of Ebola. By March 2015, the number is expected to rise to more than 470,000. Nearly 300,000 Liberians are expected to face severe food problems by March, up from 170,000 today.

In Guinea, Liberia and Sierra Leone, the countries at the heart of the worst recorded outbreak of Ebola, workers have been staying away from markets and fields for fear of spreading the virus that has killed more than 6,800 people since March. This fear has caused labour shortages on farms for planting and weeding and cut household incomes, compounding an economic slowdown in these three countries. Border closures and quarantines are disrupting supply chains, hindering market access and exacerbating shortages, raising fears that one million people from a combined population of 20 million could be going hungry by March.

"The outbreak has revealed the vulnerability of current food production systems and value chains in the worst Ebola-affected countries," Bukar Tijani, the Food and Agriculture Organisation's (FAO) representative for Africa said in a statement. The FAO said more food needs to be imported into these countries which are facing a financial crunch because exports have dropped and recommended cash transfers or vouchers for affected people to buy food and help stimulate markets.

Denise Brown, a relief coordinator for the World Food Programme, said the situation regarding food supplies could get worse before improvements are seen from international efforts.

http://www.scientificamerican.com/article/1-million-people-could-be-hungry-by-march-due-to-ebola/

Ebola need not be a death sentence

Ebola patients are suffering the double whammy of poor quality care and lack of research

Basic medical interventions such as giving Ebola patients rehydration salts and fluids from bigger bags could cut the death toll in west Africa in the absence of a proven cure, experts in tropical diseases write in the Lancet. Doctors say it is “therapeutic nihilism” to assume there is no treatment for Ebola just because there are no drugs. It is likely, they say, that many patients die because of dehydration. Improving the basic care that Ebola patients are receiving will have an effect on people’s willingness to leave their homes and go into a treatment centre, which will in turn help to slow the spread of the disease, the paper argues.

“It is often stated that there are no proven therapies for Ebola virus disease but that potential treatments, including blood products, immune therapies, and antiviral drugs, are being evaluated. This view is inaccurate,” say Dr Ian Roberts of the London School of Hygiene and Tropical Medicine and Dr Anders Perner, intensive care specialist at the University of Copenhagen.

Ebola virus disease, they say, is “a febrile illness with severe gastrointestinal symptoms. Nausea, vomiting, and diarrhoea cause profound water and electrolyte depletion [the loss of salts that the body needs, such as sodium, potassium and calcium] leading to circulatory collapse and death.”

Some simple interventions could save lives. Intravenous fluids, for instance, are not given as standard in west Africa, Roberts said. Low levels of sodium in the blood, which can cause brain swelling, leading to coma and death, could be treated with salt injections. There are also proven treatments that can help patients overcome pain, agitation and secondary bacterial infections, as well as malaria.

There are not enough nurses to care for patients overnight, so fluid bags do not get replaced when they are finished. Staff are also under heat stress during the day, from wearing personal protective equipment in a hot climate. The simple solution, he said, is to supply treatment centres with five-litre bags in place of one-litre bags. The paper argues that a series of pragmatic clinical trials in the current epidemic should be launched to establish the best ways of managing patients, bringing down death rates and safeguarding health workers at the same time.

“In earlier outbreaks, the death rate was about 90% and, in this outbreak, it started out at about 70% and it’s come down but it could come right down again and we could see this largely fatal disease became a largely survivable disease. That is eminently possible,” Roberts said. “A stronger policy focus on providing effective care for patients with Ebola virus disease is not only a humanitarian imperative, but could also help to bring the epidemic under control. Patients cared for in Ebola treatment centres are less likely to infect other people than those cared for in the community. However, Ebola treatment centres must be more than a setting for quarantine. Patients will be reluctant to attend treatment centres unless the care they receive from them is superior to the care provided by family members.”

Aid, Ebola and the White Saviour Industrial Complex

Have we learned nothing? Thirty years ago, the Band-Aid video showed pop stars with 1980s hair raising funds for “Africa”. But it wasn’t for Africa, even though the resulting record featured a guitar in the shape of a continent. It was Ethiopia, and the resulting “documentary” began with BBC clips of starving people lined up for food in a camp, with the usual flies swarming, hollowed eyes, and white doctors being interviewed regarding their plight. The songs, the recordings, the video – all identified all of Africa with these images of helplessness, sounding the call of the “white savior industrial complex” for a new generation. Despite the feel-good super sales of the song, controversy continues around the question of whether the effort did more material harm than good.

Fast forward to today: The just-released remix of the principal song of the 1984 Band-Aid concerts — “Do They Know It’s Christmas?” — plays to the same sentiments with many of the same stars (and some new ones, like One Direction) — and has all of the same problems. Again, have we really learned nothing? The video opens with what was known in the 1990s as “aid pornography” (a term and debate which unfortunately has dropped from the radar screen) – shots of dying people – shots that these stars would never allow of themselves. Then we see them filing into the studio one-by-one in the requisite shades, every move (but looking good, not in the throes of death) captured by paparazzi, then emotionally singing, then holding each other, giggling and smiling after they have done their good deed.

Yes, funds are needed to fight Ebola; yes, people are suffering; yes, it can be good to “do good”. But it is never good to show others’ suffering without their consent, especially when showing them stripped of dignity. And as many of the CIHA Blog’s posts and those of others insist, over and over again, what we need is to target the neoliberal austerity policies that have led to the breakdown of health systems in West Africa as well as other areas of the world (including many parts of the U.S.) Representing Africans – yet again – as helpless and without dignity while representing ourselves as knowledgeable problem-solvers (who give up nothing in our attempts to do good) IS part of the problem and NOT part of the solution. We Westerners really should have learned something by now.

by Cecelia Lynch, Professor of Political Science and Director of the Institute for International, Global and Regional Studies at the University of California, Irvine.

from here with links

The environment and ebola

It is clear that the spread of Ebola in West Africa is directly linked to the region's deep poverty: Out of 187 countries on the United Nations' Human Development Index, Liberia, Guinea and Sierra Leone rank 175th, 179th and 183rd, respectively. But, while it is easy to recognize the links between poverty and the spread of the virus, there has been little focus on the root causes of the region's impoverishment itself. West Africa is in the running for the region with the highest deforestation rate in the world. Some researchers have drawn clear links between the outbreak of the disease and the resource exploitation that plagues the region. “Those who are knowledgeable about the relation between the increasing human contact with wildlife, some of which have been noted as carriers of the Ebola virus, attribute that to the increasing deforestation in the region. Deforestation in West Africa is continuing in an alarming way. Most of the forest cover in the entire upper Guinean forest ecosystem has been lost. Liberia is the only country in the region that retains a significant cover of rainforest. So, it is understandable that scientists are pointing out that there may be a link between declining forest cover, increasing human contact with wildlife and the Ebola outbreak.”

Across West Africa we are seeing lots of agribusinesses coming into the region. It's not new, but it is now being taken to a very severe scale, and they are decimating the last remaining plots of forest. So there is increasing loss of habitat for bats, for chimpanzees - and as a result, increasing contact with human communities. That's where our leadership needs to look at the Ebola crisis as a wake-up call: to begin to think, "Well, if diminishing forests and ecosystems are a problem, if increasing human-wildlife contact is a problem, than we need to take additional steps to avoid the situation getting worse."

“Palm oil companies like Golden Veroleum and Sime Darby grow the palm, and then process and export crude palm oil. But this is not for the Liberian market; it is not intended to contribute to the food needs of the country. This is intended to sell to Europe and to other parts of the world to be turned into biofuels. But this is land that we need to grow food. Rather than doing that, we are devoting all of this land to grow oil palm and other commodities for the West. This applies to all the raw materials we have.” explains Silas Siakor, director of Sustainable Development Institute/Friends of the Earth Liberia.

The full interview is available here.

The effects is more than a disease

Nearly half of all Liberians who were employed when the Ebola outbreak began are no longer working, a survey by the World Bank hasfound. It said many workers have been told to stay at home or have lost their jobs, while markets have been forced to shut. Those living areas of Liberia that have not been hit by Ebola "are suffering the economic side effects of this terrible disease".

Ebola outbreak was expected to cost the region about $3-4bn (£1.9-2.5bn). The World Bank said its survey found that 70% of respondents said they do not have enough money to afford food.

Ebola had ravaged the tourist industry across Africa. A survey showed that travel bookings were down by as much as 70%, even for destinations far away from the affected areas.

Irrational Ebola Theories

The Liberian Council of Churches has blamed Ebola on homosexuality. It’s tragic enough that 10,000 people have contracted Ebola in the region, and that half of them have died. Now, according to a report in Reuters, gay people are literally afraid to walk the streets after religious leaders have blamed the plague on them and newspapers have splashed their photos on the front page.

"Since church ministers declared Ebola was a plague sent by God to punish sodomy in Liberia, the violence toward gays has escalated. They're even asking for the death penalty. We're living in fear," LGBT activist Leroy Ponpon told Reuters over the phone from Monrovia. 

The Liberian Council of Churches released a statement saying "God is angry with Liberia, and that Ebola is a plague."  It went on:

 “Liberians have to pray and seek God's forgiveness over the corruption and immoral acts (such as homosexualism, etc.) that continue to penetrate our society. As Christians, we must repent and seek God's forgiveness.”

"Voluntary sodomy" is a crime in Liberia and can lead to a year in jail.

President Ellen Sirleaf called for a three-day period of fasting and prayer back in August, “to seek God’s face to have mercy on us and forgive our sins and heal our land.” Notably, Sirleaf’s call blamed witchcraft, rather than homosexuality, for the spread of the disease.

Oh, those backward Liberians. Oh, those backward Christians. Oh, those backward homophobes. But didn’t Ronald Reagan say that the AIDS epidemic took place because “illicit sex is against the Ten Commandments”?

In early August, Oklahoma conservative Christian radio host Rick Miles appeared to echo the anti-gay Liberian clergymen, pinning the advent of the epidemic on things loathed by American right-wing.

 "This Ebola epidemic can become a global pandemic, and that’s another name for plague," he said. "It may be the great attitude adjustment that I believe is coming. Ebola could solve America’s problems with atheism, homosexuality, sexual promiscuity, pornography and abortion."

Rational explanations for epidemics such as poor basic health-care and lack of medical dethrones their God from the position of Controller-in-Chief. And if God isn’t the one calling the shots in the universe, why bother with religion? So, better a vengeful God, who punishes a nation because some in it are having sex, than no God at all.

After Ebola, then what?

Crises, no matter how urgent they are, eventually fade. Too often, when the crisis disappears, so too do the armies of aid workers and buckets of money deployed by the developed world to address them. That has been the history of developmental assistance in Africa, where shameful economic and health conditions have festered for decades, relieved now and then by a panic response to an emergency that catches the developed world's eye.

 Africa's long-term health crisis can only be met with sustained efforts. Organizations such as Doctors Without Borders have been calling for such assistance for decades.

A large number of chronic diseases and other health conditions beset sub-Saharan Africa, causing much higher death tolls than Ebola. Death rates from parasitic diseases (often a reflection of poor water sanitary conditions), infant and maternal injuries, and malnutrition are all an order of magnitude or higher than Ebola. Cultural practices, poor transport and communications infrastructure, and poverty all contribute to the intractable nature of health problems on the continent.  But global indifference has played its part.

HIV took nearly 122 lives per 100,000 population in Africa in 2012, according to the World Health Organization. In the United States, the figure was 2.6 (in 2010).

Malaria is an endemic killer in Africa, accounting for 62 deaths per 100,000 population. Malaria kills one African child every 30 seconds.

Polio, now eradicated from many parts of the world, is still endemic in Nigeria and outbreaks also occur in other African countries. Once contracted, it is incurable and can cause permanent paralysis.

Other common diseases include:

elephantiasis, which causes an accumulation of fluid, usually in a limb,

leprosy, which causes disfiguring skin sores and nerve damage,

helminthiasis, an infestation of parasitic worms in the intestines, and

trachoma, a bacterial eye infection which can lead to blindness.

Half of Africans do not have access to essential drugs. With the provision of the right drugs to treat respiratory infections, diarrheal diseases and malaria, around 10 million lives could be saved by 2015.

Sub-Saharan Africa averages 1.15 health workers for every 1,000 of its citzens. A severe shortage of nurses and midwives means that over two-thirds of women in Africa have no contact with health personnel following childbirth. Therefore, Africa accounts for more than half of the world's maternal and child deaths. 

For every Liberian doctor working in Liberia,  two work abroad.

From here 

Beyond Ebola

The current focus on ebola should not let the impact of malaria (as well as other illnesses) and the campaign to develop a vaccine for malaria be forgotten about. While endeavouring to contain the present ebola epidemic,  Liberia's Foreign Minister Augustine Kpehe Ngafuan explains"As we and our many international partners struggle to douse the wildfire caused by Ebola, we have been left with inadequate resources, time and personnel to attend to other routine illnesses like malaria, typhoid fever and measles, thereby causing many more tangential deaths," he said. 

Malaria is associated with high mortality and morbidity especially among children under five and pregnant women.  Around 90 per cent of estimated deaths from malaria occur in sub-Saharan Africa and 77 per cent of these are in children under the age of five.

Data from the phase III vaccine trial programme shows hope that a malaria vaccine is just a step away.

Plant-based therapies have held the ace in the treatment of malaria from chloroquine obtained from the Quinine bark also called Cinchona tree to the artemisin from the Chinese salad plant, Artemisia annua. Unfortunately, the malaria parasite, Plasmodium falciparum, has begun to develop resistance to the WHO-endorsed treatment ACT, made from Artemisia annua.

  Nigerian researchers have discovered and validated local plants that treat malaria like World Health Organisation (WHO)-endorsed drugs such as Artemisinin-based Combination Therapies (ACTs), amodiaquine, mefloquine and sulphadoxine/pyrimethamine. A recent study published in Malaria Journal has identified medicinal plants such as Momordica charantia (bitter melon), Momordica balsamina (balsam apple), Ageratum conyzoides (goat weed), and Diospyros monbuttensis (Yoruba ebony or walking stick ebony) to be very efficacious in the treatment of drug resistant malaria. The results of the study showed sensitivity of 100 Plasmodium falciparum (malaria parasite) isolates to chloroquine, quinine, amodiaquine, mefloquine, sulphadoxine/pyrimethamine, artemisinin, Momordica charantia, Diospyros monbuttensis and Morinda lucida. The researchers concluded: "Natural products isolated from plants used in traditional medicine, which have potent anti-plasmodial action in vitro, represent potential sources of new anti-malarial drugs." 

Ebola - a food crisis, too

The Ebola epidemic is not just a mounting health crisis but also a growing economic problem.

Asked whether the food shortages will also reach countries outside West Africa, Dr Fan, director-general of the International Food Policy Research Institute, explained Ebola is triggering a food crisis through a series of interrelated factors, including farmer deaths, labour shortages, rising transportation costs, and rising food prices.

“Within these countries, where undernourishment has long been a problem, the food crisis may persist for decades,” Dr.Fan warned.

And because Sierra Leone, Guinea, and Liberia are all net food-importing countries, the Ebola-triggered food crisis is unlikely to spread to other countries in the region or beyond, Dr. Fan added.

“In addition, the costs of staple foods including rice and cassava are rising precipitously in the affected areas as crops are abandoned and as labor shortages grow,” the statement added. As the harvest season is beginning, labour shortages are putting the food security of tens of thousands of people at risk in particularly affected areas.

Food that would be imported from these areas is not making its way to other regions, either.

“So, as we weigh the dangers of this dreaded disease, we must not forget the very real threats it poses to food security,” the  International Food Policy Research Institute warned. “The global community must come together to ensure that there are safety nets to protect not only those infected with the disease, but also those whose access to food is severely affected,” IFPRI added.

These safety nets, which could be in the form of cash or in-kind transfers, should be accompanied with nutrition and health interventions. “This is important, because investing in the nutrition and health of vulnerable populations could lower the mortality rate of diseases like Ebola, as nutritional status and infection are intricately linked.” Dr. Fan said

Schools in Sierra Leone have closed, shutting down critical feeding programmes for children. And restrictions on the consumption of bush meat, the suspected source of Ebola, have eliminated a traditional source of protein and nutrition from local diets.

Recent efforts by the World Food Programme (WFP) to provide food assistance to around 1.3 million people in these three countries indicate an idea of the scope of the current crisis. The Food and Agriculture Organisation (FAO) is also providing food assistance to nearly 90,000 farming households to abate the food security crisis.

Questions Re US Response To Ebola Outbreak In Liberia

On September 16, President Obama announced a multimillion-dollar U.S. response to the spreading contagion. Obama's announcement comes on the heels of growing international impatience with what critics have called the U.S. government's "infuriatingly" slow response to the outbreak.
Assistance efforts have already stoked controversy, with a noticeable privilege of care being afforded to foreign healthcare workers over Africans.

After two infected American missionaries were administered Zmapp, a life-saving experimental drug, controversy exploded when reports emerged that Doctors Without Borders had previously decided not to administer it to the Sierra Leonean doctor Sheik Umar Khan, who succumbed to Ebola after helping to lead the country's fight against the disease. The World Health Organization similarly refused to evacuate the prominent Sierra Leonean doctor Olivet Buck, who later died of the disease as well.

The Pentagon provoked its own controversy when it announced plans to deploy a $22 million, 25-bed U.S. military field hospital—reportedly for foreign health workers only.
One particular component of the latest assistance package promises to be controversial as well: namely, the deployment of 3,000 U.S. troops to Liberia, where the U.S. Africa Command (AFRICOM) will establish a joint command operations base to serve as a logistics and training center for medical responders. see earlier post here

Few would oppose a robust U.S. response to the Ebola crisis, but the militarized nature of the White House plan comes in the context of a broader U.S.-led militarization of the region. The soldiers in Liberia, after all, will not be the only American troops on the African continent. In the six years of AFRICOM's existence, the U.S. military has steadily and quietly been building its presence on the continent through drone bases and partnerships with local militaries.

The U.S. operation in Liberia warrants many questions. Will military contractors be used in the construction of facilities and execution of programs? Will the U.S.-built treatment centers be temporary or permanent? Will the treatment centers double as research labs? What is the timeline for exiting the country? And perhaps most significantly for the long term, will the Liberian operation base serve as a staging ground for non-Ebola related military operations?
The use of the U.S. military in this operation should raise red flags for the American public as well. After all, if the military truly is the governmental institution best equipped to handle this outbreak, it speaks worlds about the neglect of civilian programs at home as well as abroad.

whole article here

Who Gains From 3,000 US Troops In Ebola Affected African Regions?

Demilitarising Epidemic Diseases In Africa

President Obama has responded to the Ebola crisis in Africa by sending 3,000 military personnel to the affected region. The real beneficiary of this militarised messianism is, in fact, the military-industrial complex back in the US.

The international system has long become inured to the relentless hiccup of African insecurity malaise. Major clichés and few strong allegories conjure up the spasms of this ongoing malaise to the point of oversimplifying the field of African security. A cascade of crises encapsulated by patterns of sociopolitical ‘fragility’, ‘failure’, and ‘vulnerabilities’ has been plying the continent’s security environment with regards to the HIV/AIDS pandemic, the Ebola outbreak in West and Central Africa, as well as the hydra of terrorism and bout of violent conflicts. To be sure, the continent as a surrogate ideological battleground between Western democracies and a soviet-centric security dilemma has been put to rest. Noticeably today, a post 9-11 terror-centric security messianism has been perking up on Washington’s foreign policy chariot wheels in Africa. This security messianism is characterized by an insulated minimalist engagement riding on a missionary rhetorical commitment to African security.

Not surprisingly, the continent is broadly painted under a missionary diplomatic utopia that promises to terminate the ills of Africa. Putting aside some headier geopolitical matters, President Bush in July 2005, with an evangelical tone, made the confession that the U.S. ‘seek[s] progress in Africa because conscience demands it.’ Binding tightly moral imperatives with security concerns, Bush exited the White House cementing his signature legacy as the AIDS president. He left behind a strong savoury trademark of his long-standing gig to defeating the tides of malaria and AIDS on the continent. By the time he left the world stage, President Bush had increased aid to the continent by more than 640 percent. In humanitarian aid, the continent was the beneficiary of more than $5 billion a year. The $46 billion President’s Emergency Plan for AIDS Relief (PEPFAR) was instrumental for at least 2 million people who received antiretroviral drugs.

To be sure, the fine apostles of HIV/AIDS policy wonk have been battling out support for access to drugs and treatment for AIDS patients. As a result of this global battle, expensive treatment and drugs for AIDS had garnered public resources and attention as well. Ironically, expensive drugs and treatment have been raining down on environments without proper hospitals, qualified medical doctors, and poorly equipped clinics. While antiretroviral drugs are available to patients, the resources to training health workers and building schools of medicine have been drying up. Tellingly, American Ebola victims from the West and Central have to be flown home to Grady Memorial Hospital in Atlanta for treatment. Though the much-hyped PEPFAR project christened President Bush as the healer- in- chief on African shores, the everlasting romance between militarized health foreign policy and security is hard to disconnect. As a shining jewel on President Bush’s chest, PEPFAR stands out as a corporate bonanza for US pharmaceutical corporations to harvest safe vouchers from financial manna. Oil corporations such as Mobil Oil and Chevron own a share of some HIV-medicine patents and medication. Not only had US foreign policy aid to HIV made vast profit for US firms, but it softly tied up HIV/AIDS’ industrial headquarters to oil corporations and the creation of the unified command for Africa to oversee security and conduct military operations as necessary.

Of course, the hotly touted Obama’s West African foreign policy pledged a major US military-led surge to stop the Ebola virus as a global health and national security threat. Far from throwing a monkey wrench on military expansion, such a foreign policy vision has not divorced from a militarized version of epidemic diseases. On September 16, 2014, President Obama made public his decision to establish a joint military command headquarters in Liberia by quickly dispatching 3,000 US troops to Monrovia and Senegal. The Ebola outbreak crafted its own response to the military footprint on the continent. The Obama administration pledged $ 1.26 billion to fighting against Ebola that has already claimed more than 2,800 lives in West Africa. The crisis has spurred the opportunity to hew a close look at some nichified source of security fixes in order to reinforce the post-9-11 security quandaries.

President Obama’s quick policy stand is not unprecedented. The root of the militarization of Washington foreign policy goes back to 1947 with the Cold War. The National Security Act of 1947 amends the US armed forces as intrinsically embedded with national security policy in peacetime. To be sure, demilitarizing epidemic diseases in West Africa will divert resources to building roads that lead to good hospitals and schools of medicine to train public health personnel for the continent.

  by Narcisse Jean Alcide Nana from here