Ebola III - The 2014 Outbreak

The 2014 outbreak in West Africa is the largest Ebola outbreak and the first one in West Africa. It is concentrated in Guinea, Sierra Leone, and Liberia, though there have been cases elsewhere including some in Europe and the United States. It has been going on for many months but only recently started getting media attention. Many infectious disease, public health, and other experts suggest that this is a critical point in the spread of the outbreak; without adequate resources to contain Ebola, it may become a worldwide epidemic or pandemic.

Understanding the disease requires understanding the culture, history, and people of West Africa. I know little about this, but it is really important. The behavior of the disease depends intimately on the sociocultural context where it exists. For example, burial customs in West Africa often involve touching, kissing, or bathing the deceased. Much of the early spread of Ebola happened at funerals with the death of an infected person. Furthermore, ongoing risk and spread occur when family members or patients lie about their disease or symptoms because they worry they will not get a funeral. Without proper education, the virus will continue to spread even as it kills its host. But this simple point - education - is a challenge if the people of West Africa don't believe authorities.

Suspicion of medical personnel and facilities also contributes to the problem. There have been instances of health care workers and hospitals being attacked because of a scared public that doesn't understand Ebola. The delivery of health care is impeded if patients refuse to seek care when they have symptoms. These countries are poor; they can't even handle those who do present for care. Fear of the disease may limit the treatment rendered; many patients are underresuscitated because of a fear to place an IV. Lack of protective health equipment for providers means that many providers have contracted and succumbed to the disease. There are so many barriers preventing effective control of this outbreak. In order to successfully contain the disease, we need to address not just the medical aspect, but also the social milieu in which it resides.

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