CONSIDER A FATHER from rural Liberia who shows symptoms of Ebola. There are no health clinics in or near his village, so he and his family make the 10-hour trip to Liberia’s capital, Monrovia, using public transportation, potentially infecting others at every stage of their journey.
They arrive at the city’s public hospital, which is overflowing with patients because the facility is understaffed and underresourced. Staff members don’t have sufficient training or the tools to treat Ebola’s symptoms, the space to isolate infected patients, or the appropriate equipment to protect themselves from danger. They can’t cope with the sheer number of patients—those with the virus or with other illnesses—and the father likely dies.
What if, instead, the father is seen by a community health worker in his village? She notes his fever, vomiting, and diarrhea and knows he needs fluids immediately. The nurse who supervises her concurs, and they begin treatment. In the meantime, the nurse sends word for an ambulance from the nearby clinic to retrieve him, and she tells the family to limit their contact with others and to watch for similar symptoms in themselves for three weeks.
The local clinic is fully staffed and resourced. Doctors and nurses in full protective gear meet the ambulance, take the father to a hospital bed that is placed at some distance from others, and continue administering fluids. Because his community health worker spotted his symptoms early, and because high-quality care is close by, the father likely lives.
EBOLA HAS FLOURISHED because of the first scenario. The countries most affected by the virus are among the poorest in the world and, as we’ve seen, lack the public health infrastructure to cope with the outbreak. But strengthening it is what will change the path and progression of Ebola—or any disease.
“Many people are coming to help us deal with Ebola, and that is fine,” Liberia’s President Ellen Johnson Sirleaf told a group of Partners In Health doctors during their visit to the country in September. “But they will disappear. The real issue is our health- care system.”
How can we effectively partner with Liberia to bolster those systems? Obviously the first step is to support and supplement existing efforts to care for the sick. Many individuals, organizations, and governments have committed resources to this. But a longer-term effort must focus on partnering with the government to build a decentralized health-care network that links communities to clinics to hospitals.
A strong system starts at the community level, by recruiting, training, and paying villagers to serve as professional health workers. With supervision and supplies, they can treat the bulk of health issues people in their villages face by administering vaccines, dispensing malaria medicine or deworming tablets, and providing neonatal care. Instead of patients traveling long distances to receive care, these health workers bring care to them.
For cases outside their expertise, local health centers and hospitals must be close by—and staffed with trained professionals who have access to medical equipment and supplies. Where those conditions don’t exist, we must create them.
For example, Martha Tubman Memorial Hospital, in the rural village of Zwedru, could be treating patients but is virtually empty for lack of “staff and stuff.” Partners In Health is working with local partner Last Mile Health and the Ministry of Health to recruit and train clinicians, logisticians, and procurement experts to ensure that patients who come to the hospital are seen by a clinician who has the tools he or she needs to deliver care.
Before the Ebola outbreak, Liberia had only 50 doctors working in public-health facilities serving a population of 4.3 million, according to its Ministry of Health. Meeting this doctor shortage—and shortages of all health-care workers—may mean establishing more medical and nursing schools, or residencies and fellowships, to help train the next generations of clinicians.
None of this is easy. This level of accompaniment requires a long view—and long-term investment. And it requires partnering with the government, so the work is integrated with the country’s public sector. But ensuring poor people don’t die from diseases that are treatable in wealthy countries demands a better response—one that is just and equitable.
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