Ebola & the Caribbean: Prevention Key

PAHO/WHO representative Dr Gerry Eijkemans (Photo: Petre Williams-Raynor)
PAHO/WHO representative Dr Gerry Eijkemans (Photo: Petre Williams-Raynor)

The mere thought of the Ebola virus pushes most, if not all of us, into a near panic — perhaps more so those of us from small economies already labouring under the weight of very pressing concerns.

Not the least of these concerns is climate change and its impacts, including on the water sector due to, among other things, increased extreme weather events, such as droughts, and rising sea levels.

The reality is such, therefore, that there are those who would dearly love to be able to close our borders, blanketing us, at least in theory, from the dreaded Ebola that snatches the lives of many in a matter of only a few days.

However, realistically, this is not an option open to us. Among other things, we can’t afford it; trade and travel are part of a reality of today’s Caribbean and, through industries like tourism and agriculture, brings billions to our shores.

So what are we left with in the hustle to guard against Ebola getting a foothold in our region?

Dr. Gerry Eijkemans, the Pan American Health Organisation/World Health Organisation (PAHO/WHO) representative in the Bahamas and the Turks and Caicos Islands says: ‘basic public health tools and principles’.

PAHO/WHO, she said, is now working with ministries of health across the region to boost readiness for the arrival of Ebola, which has an up to 70 per cent mortality rate.

“As long as we have an epidemic in West Africa, it is unavoidable that every now and again a case will get out of West Africa and come to Europe, North America, the Caribbean, Latin America. That is unavoidable,” she said.

“So what needs to happen is that the airports need to be aware that if somebody comes in that is already ill, then immediately that person has to be taken to the designated area where that person will be treated,” Eijkemans added.

She was speaking with this blogger on the sidelines of the high level session of water and environment ministers at the Caribbean Water and Wastewater Association Conference in the Bahamas on Thursday.

“Now most of the time, that will not be the case. The person will come in [and] still be healthy; there is an incubation period of three weeks. So the person can be infected, travel and be alive and still have no symptoms,” she said further.

So what’s PAHO/WHO’s advice to country stakeholders?

  • There needs to be enough information among the population about where to go in the event of illness. “You go to the clinic, the hospital that has been assigned to receive Ebola patients in the first instance”.
  • Staff at all health facilities need to be well trained so that where somebody comes in with a fever, they are asked whether they recently travelled to West Africa and/or been in touch with anyone who has Ebola.
  • Staff at health facilities need to be equipped with personal protective gear. “If you need more, we (PAHO/WHO) have a warehouse in Panama and we should be able to get some more. Of course, we will try to keep countries that have suspected cases supplied.”
  • Collect blood samples from those with symptoms of Ebola, once admitted into care. “The health workers should know how to do that and how not to do that. Then it has to go off to CDC (Centre for Disease Control) or to the Public Health Agency in Canada. They are the only two centres in the entire region that can test for Ebola.”
  • Treat the person in care as though he/she had the disease while awaiting the test results.
  • Trace contacts and monitor. “Everyone who has been in touch with the person needs to be monitored. You monitor them for three weeks. They have to know what to do and if you think they cannot do it for whatever reason, you have to provide the help so that people can do that.”
A section of the beautiful Negril Coastline to which hundreds of tourist flock each year. Closed borders in response to Ebola is not an option open to Caribbean countries like Jamaica, which are hugely dependent on tourism dollars. (Photo: Emma Lewis)
A section of the beautiful Negril Coastline to which hundreds of tourist flock each year. Closed borders in response to Ebola is not an option open to Caribbean countries like Jamaica, which are hugely dependent on tourism dollars. (Photo: Emma Lewis)

The objective of the procedures and adhering to them strictly, Eijkemans said, is prevention, which is vital for the Caribbean — given the enormous expense associated with treating Ebola.

“I don’t have the exact amount of money, but it is expensive even in terms of the amount of personal protective equipment that needs to be used. Plus, you need to have an isolation room; you cannot use that room for anything else so there is even the opportunity cost. Particularly in small islands where you have one hospital and if you need to use an entire wing or a section of the hospital to do that, you take away from other healthcare activities that are going on. So it is a direct cost, but there are also indirect costs,” she explained.

Given this reality, prevention is key.

“We have to ensure that we don’t get to a point where there are thousands of people infected. If you have that, it means that we failed at the primary prevention level and that is where we need to focus on,” she advised.

“That is why we have to focus on — instead of trying to prepare our hospitals to receive more and more people and building bigger and bigger hospitals — prevention,” Eijkemans added.

The doctor also emphasised the importance of agencies and countries working collaboratively to stem the spread of the deadly virus, which has ravaged West Africa.

“The economic effects of (restricting trade and travel) are huge and it will really affect our collective capacity to help West Africa to control the epidemic. That is where our efforts need to be now, not on building walls; we have past that. And you need to work with the basic public health tools and principles in order to protect our populations,” she said.

What is more, Eijkemans said indications so far were that more than any other factor — survival appeared to be determined by where and how one is treated.

“So particularly very poor countries with challenged health systems and services simply do not have the resources to take care of all the patients. It is, of course, water; water is an element always’, water is life. But it is also how many nurses do you have, how many doctors do you have to watch the patient,” she posited.

“That is the main factor that determines if you are going to live or not. For now, the drugs are still too experimental. We still don’t know if they are working and also they are still very scarce,” Eijkemans added.


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