For Michele Barry, director of Stanford’s Center for Innovation in Global Health, the unprecedented Ebola outbreak in West Africa is a personal concern as well as a professional one. Two Liberian colleagues who helped train Stanford medical residents have died treating the disease, prompting her to join a fundraising effort that so far has raised more than $30,000 for badly needed protective medical supplies.
We talked to Barry about the disease.
Q. In the five months since the Ebola outbreak began to make headlines, what has surprised you most?
A. I am surprised by how long it’s lasting—and how many people are infected. I think this goes back to just a very fragmented health infrastructure in the West African countries affected, a lack of personal preventive equipment on the ground and the inability to quickly educate a population that is not health literate.
One also could speculate that this outbreak is more prolonged because we are doing a better job of keeping people alive, which is good thing, but then there is a prolonged potential for exposure of a healthcare provider to a highly viremic patient.
Q. A recent Harvard School of Health survey indicates 40 percent of Americans fear a major outbreak here. Is that fear warranted?
I think Ebola easily could be transported here by airplane by an infected patient. The Nigeria outbreak is a result of air transport of an infected individual. But I think we have the facilities to support such patients safely. We have personal protective equipment, easily mobilized mechanisms for decontamination and isolation. I think there is no reason to be worried about it spreading in the U.S.
Q. Yet many Americans are more worked up by Ebola than previous deadly epidemics like SARS or H1N1, which spread more easily. Why does Ebola elicit such fear?
I think it’s the “bloody death.” I think it’s the very fast death. And I think it’s been heightened by social media and traditional media. I think it’s also been popularized by movies such as Outbreak and Contagion and Richard Preston’s book The Hot Zone.
The hard facts are that about 1,500 patients have died from this Ebola outbreak — many more thousands die annually from influenza, a far more contagious disease.
Q. What does scare you about this outbreak?
What scares me is the absolute decimation of a very small group of health care workers in that part of the world. Africa has 25 percent of the world’s disease burden but only 4 percent of the health care workforce. We are actually seeing the kill-off of a small group of health care workers in that part of the world. It’s going to take them years to replenish that.
Q. The death toll has been particularly high in Liberia, where the School of Medicine sends residents through the Johnson & Johnson Global Health Scholars Program. Why?
Having worked in the main teaching hospital there, I can tell you that they lack preventive protective equipment. It’s often difficult to find gloves. The emergency room is quite chaotic. It’s easily seen how one could be contaminated with the virus.
And also they have a very small health care workforce. It’s easy to make mistakes when people are stretched that thin. Liberia has lost some 5 percent of its health care workforce.
I am particularly saddened because two of my colleagues died there—the chief of medicine, Sam Brisbane, and the deputy chief, Abraham Borbor, physicians I know, who taught our residents.
Q. Will Stanford residents continue to go to Liberia?
We were supposed to send someone in September and we won’t be sending them. The level of physician that I send to J&J sites are ones in training. I am not sending them into a chaotic setting.
Q. The Liberian government has responded by sealing off slums. What do you think of that?
I am disappointed in some of the government’s decisions to militarize a mandatory quarantine. A better way to set up mass quarantine is to educate patients and to offer incentives such as food and temporary housing. Choosing a slum to situate the quarantine setting also provoked anger.
The U.S. has 18 quarantine stations across many states and has federal authority to quarantine people with certain infectious diseases, including Ebola if needed. The last mass mandatory quarantine that I can remember is Cuba’s mass quarantine for HIV, but they changed that after being criticized for abrogating personal civil rights to one with food and housing incentives and used the setting for education.
Q. What are the broader lessons of the crisis?
I think it’s a wake-up call that we as a planet need to recognize that diseases need to be combated wherever they are in these times of globalization. We need a better mechanism for strengthening health infrastructure in a better coordinated way in the developing world. Perhaps a centralized WHO Global Health Reserve Corps of physicians and nurses ready to be mobilized during catastrophic events should be considered.
INTERVIEW HAS BEEN EDITED AND CONDENSED
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