Band-Aids Won’t Fix Ebola: Long-term solutions in resource-poor settings will require innovative technologies and strategies
Editor’s note: This post was co-written by Dr. James Bernstein, Huma Malik and Ariel Trilling, all of whom are with Eniware. It was updated after Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, died Wednesday morning.
With the death on Wednesday of the first Ebola patient diagnosed on U.S. soil, the extent to which the global effort to contain the virus has failed is tragically apparent. Every day, pledges of more money and medical aid to the affected countries are announced, but devastating accounts of the reality indicate that the Band-Aids being piled on cannot staunch the bleeding from the wound that Ebola has ripped through the fabric of these health systems, not to mention the region’s food security and economic stability.
It is obvious now that there is still a long road ahead before this outbreak is contained, but it is not too early to consider how the experience should shape global health agendas going forward.
Unlike some infectious diseases, there is as yet no “magic bullet” to be used against Ebola – no treatment or cure or straightforward preventive intervention that can be fundraised for, purchased and then shipped over to the communities in need. But Ebola can be contained, and it appears that proper supportive care can reduce its mortality rate. To do so requires a modern, functional health system that can reliably provide a basic standard of care to its citizens, even in emergency conditions. It requires the capacity to carry out diagnostics and infection control measures, to effectively communicate public health messages and to provide basic supportive care such as IV fluid replacement.
It is clear that progress made by the deployment of magic bullets to combat specific diseases has not permeated across other parts of health systems in poor countries. Life-saving therapies for HIV and TB are made available, but many more people suffer from conditions that require health infrastructure beyond a pill. The Ebola outbreak highlights the need to strengthen the ability to provide fundamental care, but this need has been evident for some time: take the 800 women who die every day of preventable causes while giving birth, or the millions who suffer from untreated non-communicable disease. Although these realities may not inspire the same sense of urgency and fear as Ebola, they cause more death and disability even though they are largely preventable.
The seeming intractability of extreme poverty and resource limitations is no excuse for denying a good portion of the world the same basic standards of care that we consider to be routine in wealthy nations.
How should we structure comprehensive and resilient health care in places with limited access to electricity, water and trained physicians? This is no doubt a challenge, but one worth pursuing. A recent commission of global health and economics experts convened by the Lancet concluded that investment in health system strengthening in low- and middle-income countries reaped impressive economic returns and greatly reduced mortality. Efforts to provide and strengthen the fundamentals – starting with training health workers and building facilities with appropriate, functional equipment – allow countries to grow economically in the long run and mean they are better prepared to deal with unexpected crises.
The development of innovative technologies and strategies to prioritize affordability and resource conservation in addition to high-quality care will be key in this effort. One such strategy that has had great success rejects the traditional hierarchy of academic medicine to optimize existing human resources.
For example, in Uganda, the Makerere University College of Health Sciences has begun training nurses and other health workers to perform simple surgical procedures to address the severe shortage of certified surgeons.
And on the technology front, companies are introducing devices that allow hospitals and clinics to continue essential functions even when seemingly essential resources are scarce, such as oxygen monitoring and anesthesia delivery. Our company, Eniware, LLC (Note: The authors are on the Eniware team) has developed a device to affordably sterilize surgical instruments and supplies without heat, electricity or water.
No health system can provide a high level of care if undergoing a necessary procedure at a clinic or hospital puts a patient at a high risk of developing an infection. The current standard for dealing with the lack of sterilization in many low-resource settings is the use of disposable, one-time-use instruments, equipment or supplies that must constantly be restocked, and the hazardous waste safely disposed of. This is a Band-Aid, not a long-term, sustainable solution. And as Ebola has demonstrated, it is particularly untenable in a crisis situation.
Hopefully, this tragedy will be a wake-up call to the rest of the world. In times of a true crisis, an immediate influx of money and medical assistance cannot solve problems caused by persistent structural fragility of health systems. Instead of piling on the Band-Aids, it is time to start healing the wounds.