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Paul Farmer: Diary - a Discussion By a Doctor Working on Ebola in West Africa

Health & Wellness  (tags: Ebola, West Africa, US, Europe, dehydration, fluid resuscitation, electrolyte replacement, blood products )

- 1675 days ago -
A third of all Ebola cases ever documented were registered in September 2014. But the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola's rapid spread and fatality rates.


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Evelyn B (63)
Sunday October 19, 2014, 1:16 pm
This is a very long presentation, but shares important considerations that should be shared to reduce hysteria around the subject of Ebola.

For example, Dr Farmer writes:
But the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus. The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90 per cent, should survive.

David C (75)
Sunday October 19, 2014, 1:29 pm
...the world could use more people like Paul Farmer......

. (0)
Sunday October 19, 2014, 2:38 pm
" Fear is useless. " (I.Asimov) & Hysteria certainly is even less useful than fear. But it does seem to afflict many, esp. in what used to be called "Home of the Brave".
WP: By 29 September 2014, 7,192 suspected cases and 3,286 deaths had been reported, however the World Health Organization has said that these numbers may be vastly underestimated. The WHO reports that more than 216 healthcare workers are among the dead, partly due to the lack of equipment and long hours.
2014-09-29: 7,192 suspected cases and 3,286 deaths
2014-10-10: 8,376 suspected cases and 4,024 deaths..reported
2014-10-14: 9,216 suspected cases and 4,555
2014-10-12: the CDC confirmed..the first known case..contracted in the USA.
2014-10-15: 17 cases of Ebola treated outside of Africa, four of whom have died

.. it'll peak. When and at what numbers, this is here the question.

John B (185)
Sunday October 19, 2014, 7:30 pm
Thanks Evelyn for the great post and link to Mr. Farmer's diary page. Extremely informative piece and he lays out a very reasonable path to combat this outbreak. Now if we can just get the UN, WHO and world leaders to respond. Read and noted..

Rose Becke (141)
Sunday October 19, 2014, 9:49 pm
Great info

Darren W (218)
Monday October 20, 2014, 1:40 am
I may be a bit naive here, but an element of entry level diagnosis together with preventative measures, earlier on, would I think have nipped this in the bud. Ebola is not something completely new, so they should have reacted better, and the world shouldn't have simply, casually assumed that because this originated in Africa that there was no possibility of it spreading. Here's where the richest developed nations need to take an attitude and perception shift, with regards to their less well off developing nations. WE'RE ALL PEOPLE AFTER ALL.

Jonathan Harper (0)
Monday October 20, 2014, 2:06 am

Evelyn B (63)
Monday October 20, 2014, 6:11 am
Darren - that's "hindsight is 20:20 vision"! The reality is that across much of Africa, investment in health services has been inadequate, basic equipment desperately lacking, shortage of trained health staff especially in rural areas - for reasons not unrealted to the challenge of getting basic and secondary education services out into rural areas ....

To be fair, one can understand poor rural families who've invested in one or two children achieving secondary education and more (and yes, even when it is free, there's considerable investment, because the families forego the income their child could have been bringing in, whether in cash or by their work on family land) wanting their educated child to take a job with status and reasonable income, rather than return to the village and work for peanuts ...

"Ebola has always been there" - true - but not continuously active. Suddenly, in the space of a month, more cases were seen than IN DOCUMENTED HISTORY before THAT TIME. That would throw out the supply lines in ANY part of the world - but in more developed countries, mechanisms are in place to replace stocks rapidly ... not the case in poorer countries.

Preventive measures for Ebola are not simple - and won't be until there is a proven vaccine or profilactic medicine that can be distributed. We don't have adequate preventive measures in the West, either. And the drugs control systems (rightly) require careful verification before new treatments may be released for general use. I'm sure that labs around the world are currently working flat out on the question now ... but the rarity of Ebola before this summer meant it was lower on research priorities: AIDS, bird 'flu, malaria etc were seen as of higher priority. And until this outbreak, we wouldn't have questionned such priority ratings.

What does one do? Quarantine all travellers for 3 weeks on arrival? (Where? Who pays? Maybe with today's technology, many travellers could "telecommunte" from their place of isolation... but not all.) If governments had applied such systems at the beginning of the outbreak, there would have been huge screams from those affected, their families, etc ... Even now, it isn't evident how one should control travel - to tight a control, and more illegal travel would occur, reducing possibilities of tracking and diagnosing early.

Not a simple challenge, at all!

Past Member (0)
Monday October 20, 2014, 8:25 am

Kay M (46)
Monday October 20, 2014, 1:12 pm
Good Afternoon and thank you for the article --it was along one - but well worth reading and get educated on the subject of EBOLA - all these poor people that are being led to fear by the REPUBLICAN SHIT STEERING DO NOTHING CONGRESS - I feel sorry for them- READ UP AND GET EDUCATED because you can not treat what you do not understand- I am afraid that on Nov 4th - the american public are going to put these same idiot republican in charge of both HOUSE and SENATE and oh boy what a mistake that will be---- GOD HELPS ALL -what a mistake that will be------ Sincerely Kay M.
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