The current outbreak of Ebola Virus Disease (EVD) in West Africa is one of the great public health challenges of the still-young twenty-first century. In a few short months, Ebola has infected more than fifteen thousand people and claimed over fifty-five hundred lives, with the vast majority of fatalities in just three countries — Liberia, Sierra Leone, and Guinea.
Despite the toll Ebola has already taken and the broader threat it poses to populations everywhere, the global healthcare community has been painfully slow to respond. As of mid-November, remained one of only a handful of foreign humanitarian relief organizations treating Ebola patients in the region.
To be sure, operating an Ebola Treatment Unit (ETU) safely and effectively in rural West Africa is no easy task. Any organization taking on the challenge must be experienced in working in remote, difficult conditions. An arduous four-hour journey is required to reach our seventy-bed ETU located on the grounds of a former leprosy colony in Bong County, Liberia, a hundred and twenty miles north of Monrovia. We opened a similar-sized ETU in neighboring Margibi County at the end of November and expect to have a pair of fifty-bed ETUs operational in Sierra Leone by year's end.
Maintaining an ETU of that size requires three critical components: people, supplies, and money. While the majority of our staff are local Liberian nationals, it is a constant challenge to keep a sufficient and steady flow of skilled international medical and technical personnel willing to give up a two-month chunk of their lives to work in a potentially dangerous environment, then risk being ostracized — or even quarantined — upon returning home. To treat Ebola patients effectively, each ETU requires a staff of around two hundred and seventy. At present about 90 percent of the staff are Liberian nationals. We follow a medical staffing ratio of three expatriate and four local physicians, along with eight expatriate and twenty-four local nurses for every fifty patients. Additional staff are required to provide water, sanitation, hygiene, nutrition, and other needs. Ambulance crews pick up suspected cases to isolate them as quickly as possible, then return those who test negative for the virus or who have been successfully treated to their homes. Trained crews also disinfect, protect, and bury the remains of those who succumb to the disease.
Because they consume large quantities of essential materiel needed to keep them operating in a safe environment, ETUs also present a huge logistics challenge. Basic needs range from disinfectant and medicines to personal protective equipment and water. To ensure the safety of our staff, we currently require an average of two disposable personal protective equipment (PPEs) per patient per day, or about eight hundred and forty per week.
In addition to skilled personnel and sufficient equipment, fighting Ebola requires one more crucial ingredient: money. The monthly cost of operating a single hundred-bed ETU in West Africa runs about $1.1 million. In addition, there are plans under discussion for a network of Community Care Centers — essentially, triage stations located in small population centers where those suspected of being infected with Ebola can be taken from their homes quickly for testing and initial care while they await test results. Those who test positive for the virus would be transferred to an ETU for full treatment, while others would return home, where family members can nurse them back to health. Assuming that there are twenty-seven regional ETUs, along with a hundred and twenty community care centers, we anticipate it will require about $1.6 billion over the next six months to contain the outbreak. We also need to consider the secondary impact of the outbreak — the added costs of food, security, and loss of economic activity — which are estimated at $500 million, plus another $600 million to rebuild decimated healthcare systems and maintain an adequate disease surveillance system in the affected countries.
As unsettling as these costs are, the fight against Ebola is about much more than the number of cases, deaths, and dollars. Behind each case is a wrenching human drama, behind each death a family tragedy. Take the story of Elijah, a fourteen-year-old-boy living with relatives who worked in a pharmacy that treated patients infected with the virus. Within twenty-four hours, he watched his aunt, uncle, and cousin all die from Ebola. By the time he was picked up by an International Medical Corps ambulance and brought to the ETU, he was weak, exhibiting symptoms of the disease, and had lost the will to carry on. Fortunately, a member of the medical team managed to make an emotional connection with him, and he started to call her "Auntie." Before long, he began to eat and take his medications, while the staff brought him a radio to stave off his loneliness. Within a week he was on the road to recovery and eventually was discharged.
While Elijah survived, it doesn't change the fact that the most recent outbreak of EVD has claimed the lives of seven out of every ten people infected by the virus. Indeed, despite IMC's unusually high success rate, Ebola all too often overwhelms our best efforts. Still, our teams in West Africa are confident the outbreak will be contained in the coming months, so long as the global public health community follows up with the resources needed to fight the disease. Even then, however, it will not be an easy fight.
Rebecca Milner is vice president of institutional advancement at International Medical Corps.