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Mukesh Kapila, right

A helping hand

26/01/15

Having recently returned from Sierra Leone and Liberia, where he was part of the international effort to fight Ebola, Professor Mukesh Kapila CBE, of the UK’s University of Manchester, has experienced the effect the virus has had on west Africa.

With the EU stepping up its response to the outbreak, it is hoped that the virus will soon be defeated. PEN spoke with Professor Kapila to find out how international health workers are managing.

How much progress is being made in combatting Ebola in west Africa? Are there political or socioeconomic factors to consider as well as medical?

Huge progress has been made. The epidemic is now on a downward curve in all three countries – Guinea, Liberia and Sierra Leone – and while there are no grounds for complacency, the epidemic is coming under control quite quickly.

However, Ebola’s impact goes way beyond the health side. In fact, it’s the socioeconomic impact that is most worrying.

I went to Sierra Leone and Liberia and these countries are in a state of shock. People aren’t allowed to socialise. People can’t hug, shake hands or kiss, restaurants close down early, schools are closed, investment is shut down, airlines are not flying – except for one or two brave European airlines – and so the socioeconomic impact is massive. And because of the psychological impact, it’s going to be prolonged.

On the political side, there are big questions to ask. How did it get so out of control before it could be contained? And what’s happened to all the millions of euros, pounds, dollars that have been spent on these countries post-conflict? Those political factors are about competence, corruption, and institutional systems.

Is the infection rate increasing or decreasing? What about survival rates?

The infection rate is decreasing. The latest figures show that every fortnight, rates are halving and some counties of Liberia in particular are Ebola-free.

However, what is worrying is that there are some new cases which are not connected to existing cases. You can trace one particular case – so one person gets it, another person gets it, a third person gets it, and you can track back to see who was the first person who got it and who they spread it to. That’s called the chain of infection. Unfortunately, there are a few cases arriving which appear not to be connected to a known chain of infection, which means there is continuous transmission of the virus, for example from animals to humans in remote parts. So it’s generally an optimistic picture on infections, but small outbreaks continue to occur.

Huge effort has gone into providing treatment in the Ebola treatment centres, and it has made a difference in that the doctors and nurses who are working there – many of them coming from abroad, including a lot from the National Health Service here and Médecins Sans Frontières and all over Europe – are getting more experience. Ebola is relatively new, and other than high intensive care we don’t really know how to treat victims properly under these circumstances. What’s happened in the last few months is that clinicians – both locals and external people – are getting more experienced at it, with the rehydration and the supportive treatment.

So survival rates are up to around 50-60%, which is a lot better than the 10-20% which has been historically reported.

Are more people seeking help?

Yes. Some of the fear is abating with public education campaigns and general awareness that though Ebola is highly contagious, there have to be certain conditions to catch it, and you’re not infectious when you haven’t got any symptoms.

The stigma, fear, prejudice and ignorance are slowly fading, and people are realising that the earlier you start treatment, the greater the chances of survival. So the mean length between the symptoms starting and admission to one of these new emergency Ebola treatment centres is now falling. Instead of it being a week, it is down to four days.

If there is no cure for Ebola, what treatments are victims being prescribed?

The objective of treatment is to keep the patient alive while the body itself fights the virus, and that means keeping them well hydrated, plenty of fluids, giving them other antibiotics in case of other infections, treating them with anti-malaria drugs in case they have malaria at the same time, giving them vitamins to supplement their body’s immunity and ensuring they’re well fed. This keeps them in optimal condition until the body itself produces antibodies to Ebola and kills it.

What are the main challenges faced by international health and aid workers in west Africa?

The main struggles are to stay alive and healthy themselves. They have to work safely and ensure that they don’t take shortcuts putting on the protective suit. It is very uncomfortable and you can work for a maximum of two hours, so it’s a struggle. Health workers are doing well.

Obviously there are frustrations at the lack of infrastructure. Treatment centres have to be distributed around the country and not just in Freetown or Monrovia or Conakry, because while those are epicentres of the epidemic, real cases are out in the bush and other remote areas. Just the physical aspects of living far away from creature comforts in little hotels or even in the centre itself with basic infrastructure are challenging.

Then there is coping with the trauma of watching people die. Watching one in two die – and earlier on two in three, if not three in four, die – has a psychological trauma on people.

As far as the bureaucracy or the government system is concerned, I don’t think there’s any big problems. I think the authorities in Sierra Leone and Liberia are as good as you can expect in terms of co-operating with international aid efforts. And the EU effort is much appreciated. In Guinea, I’m told that the government machine is not so efficiently organised. The country is not as developed as the others, and of course that’s where the epidemic first arose.

So by and large, international workers were tired and stressed but overall in good morale and have a feeling of actually making a difference, and that’s what keeps people going.

Pan European Networks Ltd