Upon her return from 6 weeks in west Africa working with Partners In Health on the Liberia Ebola response, Farrah Kashfipour reflects on the challenges of responding to an epidemic in a resource-limited setting.
The Ebola epidemic continues to ravage west Africa, killing about half of the people who contract the virus. Those lucky enough to recover face the stigma of having been infected and the subsequent challenge of reintegration into their devastated communities. Many children are left orphans.
In Liberia the number of new cases has fallen in many areas, including cities, while hotspots continue to develop in rural communities. Contrast that with the situation in Sierra Leone where the number of new infections increased rapidly over the past few weeks but may have leveled off more recently.
While in Liberia, I had the privilege of being part of a team- Partners In Health, Last Mile Health and the Ministry of Health county health teams, that hosted 2-day training sessions throughout a rural county in Liberia. In spite of the difficult conditions, poor roads, lack of cellphone or internet connectivity, and the constant heat and humidity, the trainees showed up every morning, optimistic and enthusiastic as they practiced following the protocols for safely getting into and out of their personal protective equipment.
During breaks from the training I asked them about the local health care system. One participant mentioned that the first responders to the latest confirmed case of Ebola were a county health team just a few hours away. I was confused as to how the team was notified about the case seeing as there are no cell towers, no access to email, and it takes much too long to get there and back by motorcycle or car. He told me, “You see that spot near the tree. There’s cell service there. We know where to go to receive calls or texts.” As he continued to tell me about another rooftop that boasted ample reception, I was left wondering how, with so few resources, this system has remained functional, and how much energy must have been put in by the various local health workers in these rural villages over the past several months.
The number of new infections has been falling, and international aid agencies have certainly accelerated their efforts in this regard, but the vast majority of work done to combat this epidemic has fallen to local health teams, working tirelessly with scant resources and less than their share of the credit. In global health, we often cite rural, resource-poor or resourced-limited settings to emphasize the challenges of reaching populations in villages far away from cities and hospitals. What we sometimes fail to appreciate is how front line health workers in these settings devise creative solutions to deliver healthcare services to their communities despite the many difficulties they face. With all the talk of foreign intervention and vaccines in the developed world, we should not forget to acknowledge the sacrifice by those on the front lines, working in extremely difficult conditions, at great personal risk. Their efforts should not go unnoticed.