Monday, December 15, 2014

Slow Learners Pay The Price

GENEVA (Reuters) - The failure of Sierra Leone's strategy for fighting Ebola may be down to a missing ingredient: a big shock that could change people's behaviour and finally prevent further infection.
Bruce Aylward, the head of Ebola response at the World Health Organisation, said Sierra Leone was well placed to contain the disease -- its worst outbreak on record -- with infrastructure, organisation and aid. The problem is that its people have yet to be shocked out of behaviour that is helping the disease to spread, still keeping infected loved ones close and touching the bodies of the dead. "Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die ... before those behaviours start to change," Aylward told Reuters.The WHO's death toll from outbreak has climbed to 6,583 but the actual figure is likely to be far higher due to under-reporting of cases. The flare-up in Sierra Leone's capital Freetown and the country's more heavily populated western areas resemble the massive infections suffered in August by Liberia's capital Monrovia. "In Monrovia you had bodies on the streets, you had a riot, you had someone shot - awareness went through the roof in a very, very short time as a result," said Aylward.             "You don’t want to see that kind of thing drive public awareness but it has an impact very, very fast. People changed behaviours in Monrovia - bang! Like that." Mali also learned through a shock. Just as it seemed nobody had been infected by its first Ebola patient in October, another cluster of deaths sprang up the following month. Aylward said he told Malian officials that the only way to stop the outbreak was to trace anyone who may be at risk. "That’s when the contact tracing... took a jump from around 60-70 percent completion to 98 percent," he said.Denial and ignorance are part of the problem but a weak healthcare system and logistics also play a part. Officials in Kono - where an explosion of infections was discovered this week - said the eastern district of 350,000 inhabitants had only one ambulance and no Ebola treatment centre."The forest area of these three countries has got some really special and concerning practices, where they share meals with the corpse, where they sleep with the corpse," he said.Some areas of eastern Sierra Leone that were hit hardest early in the epidemic -- around the towns of Kenema and Kailahun -- have seen a massive reduction in case numbers as people change behaviour. "The areas that are now doing badly are the areas that were affected last. They are still on the learning curve."

Amazing to hear the UN official in charge of the entire WHO response wistfully longing for the more resposible parties to shoot few stupid people to get their attention, but there it is, and in print.

And short of that or massive die-offs, currently in progress, about the only thing likely to wake them up.

And as noted by commentor geoffb, the lesson fades from view overnight:
ABUJA Nigeria (Leadership) -The declaration of Nigeria as an Ebola-free country by the World Health Organisation (WHO) in October has prompted many Nigerians to discontinue the practice of maintaining a good level of hygiene as a measure of containing the Ebola Virus Disease.
From schools to banks and other public places, the strict measures of screening for signs of the disease put in place while the outbreak lasted between July and October, have fizzled out in most places. Most Nigerians are now living a care-free life because, according to them, Nigeria has been certified Ebola-free by the WHO, which means there is no cause for alarm.

Hopefully Ebola got the same memo, or the remedial course is going to be a bitch there.


Alexander said...

And then it will be the WHO's fault, because obviously there weren't free of Ebola so why did you tell them they were!

The next terrifying step will be word that Ebola has hopped a flight to Istanbul or Cairo, or made it's way to an Indian Ocean port... and everyone here will keep saying, "Meh, still in the land of perpetual clusterfucks - nothing to worry about here."

Anonymous said...

"share meals with the corpse, where they sleep with the corpse"



Rob Crawford said...

Sounds like a self-inflicted problem. Why should we do anything beyond protect ourselves?

Aesop said...

Let's ask Dallas how that works out in the age of jet air travel.

"Protecting ourselves" against that is the one thing we've explicitly taken off the table.

The dice on that gamble will not come up 7s for us perpetually, yet that is the official plan.

Anonymous said...

Think of it as evolution in action.

geoffb said...

"Bruce Aylward, the head of Ebola response at the World Health Organisation, said Sierra Leone was well placed to contain the disease -- its worst outbreak on record -- with infrastructure, organisation and aid"This piece has photos of the infrastructure in Freetown and it is not too impressive.

In other news Sen. Schumer has upped his demand from $20 million to $50 million to reimburse New York for its Ebola related expenses.

Aesop said...

Thanks Geoff.
Missile launched.

Anonymous said...