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.
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