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As Healthcare Workers Struggle Against Ebola, Other Problems Also Demand Their Attention

In November 2013, John Fankhauser, former medical director and chief medical officer at Ventura County Medical Center and Santa Paula Hospital in Ventura, California, moved to Liberia to help the country build a better healthcare system by serving as deputy medical director at the 45-bed ELWA Hospital.

"We were hosting the country's first family medicine residency program," Fankhauser said via remote video at a 4 November AAAS event. "We were developing curricula, putting together training lectures, and recruiting specialty faculty. And then Ebola hit."

"...I am convinced that this is an opportunity for health professionals around the globe to step up, accept risk, and do something important for the world that we live in."

John Fankhauser
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Sia Dean and Charles Dean (left) and John Fankhauser (right) via remote video | AAAS

Now doctors in West Africa are in crisis mode as they struggle to save lives on the front lines of the Ebola epidemic while protecting themselves from the virus. Healthcare workers have been disproportionately affected by Ebola, yet they are faced with stopping the spread of the virus, preventing secondary public health problems, and rebuilding the region's public health infrastructure, experts said at the "Ebola Forum: A Conversation about the Ebola Outbreak in West Africa." The event included representatives of the Liberian diaspora and the departments of Defense, Homeland Security, and State as well as current and former AAAS Science and Technology Policy Fellows. It was organized by the Fellows' Global Health Affinity Group, led by Linda Mobula and Anjali Shastri, who are currently Fellows at the U.S. Agency for International Development and in the State Department, respectively. 

"The need now in Liberia is immense," Fankhauser said. "It's beyond what you can imagine. But I am convinced that this is an opportunity for health professionals around the globe to step up, accept risk, and do something important for the world that we live in."

The risks to healthcare workers fighting the Ebola epidemic are real. Since the event, Fankhauser has returned to the United States for quarantine due to Ebola exposure. This summer, Fankhauser and Mobula provided medical care to American healthcare workers infected with Ebola. Fankhauser has also escorted Ebola-infected doctors from ELWA Hospital to the airport so they could return to the United States for treatment. Five doctors and 52 nurses have died of Ebola in Sierra Leone, said Sia Dean, a nurse volunteering there.

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Linda Mobula (left) and Anjali Shastri | AAAS/Kat Zambon

The Centers for Disease Control and Prevention has reported more than 14,000 cases of Ebola, as well as 5,100 deaths in West Africa, including more than 400 cases among healthcare workers, Mobula said. While working with healthcare professionals at an Ebola case management center in Liberia this summer, "I witnessed the dedication and sacrifice of Liberian staff working on the front lines," she said. "They deserve our support and our utmost respect as they continue to fight this horrific epidemic."

Ebola's Secondary Costs

The public health problems plaguing West Africa before Ebola, including malnutrition, malaria, and teen pregnancy, did not disappear when the virus emerged. With most medical professionals in West Africa focused intently on stopping the spread of Ebola, Sia Dean worried that other regional health concerns will slip through the cracks. "We believe the numbers from this secondary crisis will eclipse the Ebola death toll," she said.

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Lisa Cooper | AAAS/Kat Zambon

Increasing the numbers of volunteer healthcare professionals on the ground in West Africa can help prevent the spread of Ebola as well as a secondary health crisis while starting to rebuild the public health infrastructure in West Africa, said Lisa Cooper, who is a professor of medicine at Johns Hopkins University School of Medicine and a Liberian expatriate.

"We know that people are dying of malaria as well as other conditions that are completely treatable because of the poor healthcare infrastructure," said Cooper. "So while a lot of the efforts are focused on the current outbreak, I think part of it is actually trying to lay a foundation for the infrastructure so that something like this doesn't recur in the near future."

An International Call to Service

Volunteers from the West African diaspora are uniquely qualified to help with the Ebola epidemic, said Charles Dean, also with US Diversified Power Company. "You need people that already know the culture, that people can trust, to talk to them," he said.

There are also psychological reasons why it would be beneficial for health professionals from the diaspora to volunteer in West Africa. "I think where the value lies in bringing health professionals who are in the diaspora, who are from those countries, back home is that it's a morale booster to the people who are at home to see some of their own coming back," Cooper said.

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Nicolette Louissaint | AAAS/Kat Zambon

Volunteer healthcare workers need to be prepared to stay in Liberia for months, not weeks. Fankhauser encouraged volunteers to consider serving for at least three months while Sia Dean suggested a six-month minimum. Also, teams of volunteers are preferable to individuals, said Nicolette Louissaint, a AAAS Science and Technology Policy Fellow serving on the Ebola Coordination Unit at the State Department.

"One of the things that USAID identified very early on is that it doesn't benefit us to have individuals who go to respond as healthcare workers," Louissaint said. "We need teams. We need people who are part of an NGO community who are getting trained. We need them to be foreign medical teams who are being dispatched."

Rebuilding hospital services in West Africa after Ebola will require strong healthcare leaders, Fankhauser said. "We need people who can come and serve among their Liberian colleagues, taking care of patients, taking night call, being available to do surgery and deliveries, and essentially being in the trenches with the Liberians that we work alongside," he said.

U.S. Government Agencies Respond to the Outbreak

Speakers from the departments of Defense, Homeland Security, and State described the different roles that their agencies are playing when it comes to slowing the spread of the Ebola epidemic.

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Aaron Firoved | AAAS/Kat Zambon

"The single most important thing that we can do to prevent a more serious outbreak here in the U.S. is making sure that we get what is a raging epidemic right now in West Africa under control," said Aaron Firoved, senior biodefense advisor in the Department of Homeland Security Office of Health Affairs, restating President Obama's 15 October comments on Ebola. "That is both something important to do from a humanitarian perspective but it's also important from a homeland security perspective," said Firoved, a former AAAS Science and Technology Policy Fellow.

In West Africa, the U.S. Defense Department built a 25-bed, state-of-the-art hospital specifically for healthcare workers, to be staffed by the U.S. Public Health Service for the next six months, said Stic Harris, chief of the Alert and Response Operations team in the Division of Integrated Biosurveillance at the Armed Forces Health Surveillance Center. The Defense Department has also supplied mobile testing labs and a dozen Ebola treatment units.

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Stic Harris | AAAS/Kat Zambon

"The Department of Defense was involved long before President Obama called for troops to go to Liberia," said Harris, a former AAAS Science and Technology Policy Fellow. "While sending military troops to deal with a microbiological enemy may seem odd, there are few better at logistics than the U.S. military."

Additionally, the Defense Department has created and trained a 30-person medical support team to provide short-notice assistance to civilian medical providers in the United States as needed. At the same time, the Department of Homeland Security is striving to keep Ebola out of the United States by screening travelers at airports. Passenger screenings at airports not only prevent sick travelers from boarding flights to the United States, but they also discourage ill passengers from traveling more generally, said Firoved.

Meanwhile, the State Department is working to coordinate the various U.S. and international government agencies involved in the fight against Ebola, including the departments of Defense, Health and Human Services, and Homeland Security, as well as U.S. Agency for International Development and the National Security Council.

AAAS

"The State Department Ebola Coordination Unit has the role of leading on our international outreach and engagement," Louissaint said. "That requires that we work very closely with USAID and others to make sure that we have a sense of what is happening on the ground, what the needs are, and that we can target our request to the international communities in that regard."

While more practiced at dealing with natural disasters, the international community has minimal experience responding to a public health crisis like Ebola, Louissaint said. "Things are very dynamic on the ground. They change, sometimes moment to moment. So getting the international community to really understand what the needs are and how they can train and deploy has been something that we've worked on pretty hard. But I think that we are starting to see a turning of the tide."

[Photo credit for associated teaser image: Flickr/European Commission DG ECHO]