Canadian Women’s Health Network (cwhn.ca) by Carol Amaratunga 1 October 2014

Forty-five years ago, as a student, I had the incomparable privilege of being accepted as a volunteer with Operation Crossroads Africa. In the summer of 1969 I was sent to the remote village of Bendaja, Liberia to help build a rural health clinic.

I have a vivid, startling memory from that summer of the Apollo 11 moon landing on July 20, 1969, an event that is no doubt seared into the minds of those of us who are a bit older. As Neil Armstrong said, it was “a giant leap for mankind.” Seated around an open fire on that dark and cloudy evening, my Crossroads team and the villagers of Bendaja glanced up to the heavens as we listened to the Apollo mission being broadcast by the Voice of America. When the broadcast ended, one of village elders turned to me and said, “It is just an American trick.” For my part however, I was both awe-struck and devastated. How could we spend millions of dollars to send men to the moon while down here, in the villages of Africa, people were sick, destitute and hungry?

You may wonder what this story has to do with women’s health. Bear with me for my memoire has everything to do with women’s health, humanitarianism, and the current Ebola crisis in Africa. The real question is:  what can we do to help?

It was the rainy season and the women, children and families of Bendaja Village were essentially cut off from the rest of the world. The laterite roads were awash with a blood-red mud slurry and were impassable. There were no stores, no Loblaws or President’s Choice. It was a lucky hunter who could provision his family with wild meat. The night of the moon landing, the villagers brought us some of their valued hunt. It was a feast they shared with selfless generosity.

Recognized as the “worst Ebola epidemic in history,” without a major global effort and an immediate infusion of human and material resources, African countries may lose the battle.

Today the Ebola outbreak is out of control in a number of West African countries. In Liberia, Guinea, and Sierra Leone specifically, the epidemic is rapidly escalating and outstripping national health capacity. It is spreading through direct contact with infected persons and sometimes through the consumption of Ebola-infected wild meat. Such meat remains a necessary staple for people living in remote and rural areas. Bats are believed to be the vector for Ebola, and given that they often infect wild game such as monkeys, wild meat can sometimes be a deadly source of food.

The acute surveillance programs of international and national public service agencies such as the World Health Organization, the US Centers for Disease Control and Prevention, the Canadian Public Health Agency, all acknowledge that Ebola poses a critical and serious threat. NGOs, such as Doctors Without Borders, are critical of the inadequate response on the part of the so-called “developed world.” Recognized as the “worst Ebola epidemic in history,” without a major global effort and an immediate infusion of human and material resources, African countries may lose the battle. The NGOs are making a Herculean effort, but without significant and ongoing international donor support, many aid agencies, like their African counterparts, are stretched beyond the limit.

In Canada, editorials assert there may be lessons from SARS that can be applied to the Ebola outbreak. What we learned from our team’s SARS research at the University of Ottawa was that it was essentially public health education that helped us to defeat SARS (See Caring for Nurses in Public Health Emergencies). The message was first proselytized by Florence Nightingale in the 1850s, when she admonished the British generals in the Crimea to get their horses out of the drinking water. Yes, it was old- fashioned public health and public education that had made a difference in defeating SARS. And thanks to Florence Nightingale, hand washing and social distancing are cornerstones of public health today. But SARS, in my view, is not necessarily a helpful model for Ebola. The health infrastructure and socio-economic context of Toronto and Vancouver are vastly different from the conditions facing an Ebola patient trying to survive in the slums of Monrovia or Conakry.

HIV & AIDS may yield better lessons for Ebola than SARS as Africa served as the testing ground for combatting HIV & AIDS. As we learned from AIDS, progress can be made when the design and delivery of public health education and interventions are tailored to specific needs, demographics, and local infrastructure. And while Canadian and US public health and pharmaceutical interests are developing one or more potentially efficacious Ebola vaccines, supplies of experimental vaccines to date are severely limited. It will take considerable time to produce the required quantities of Ebola vaccine for health-care workers and the general public. In the meantime, African hospitals and rural health-care centres need immediate support and a vast infusion of resources.

It is my personal view that West African university departments, i.e., Nursing, Medicine, Home Science and Agricultural Extension, have been an underutilized resource. In some countries, universities and colleges are currently closed due to Ebola but their faculties and students could be more mobilized. These local centres of knowledge are trusted. They are also experienced and best equipped to reach out to rural populations. Popular education such as radio farm forums are also trusted media sources and could serve as key players in promoting and delivering Ebola education, public health and prevention campaigns.

As of mid September 2014, more than 2,400 have died. It is estimated that there are already more than 1,000 orphans (UNICEF Rapid Assessment: Ebola Outbreak Impact on Children in Liberia). We can predict with confidence that based on past performance, the Ebola crisis will continue to threaten civil society, food security, good governance, law and order. As is typical in natural and human-made disasters, we will also see higher rates of drug abuse, more domestic violence against women and girls, ongoing school closures, hunger and artificial famine caused by food hoarding, and rabid inflation. Sadly, the Ebola crisis today is contributing to the increased geographical isolation and social quarantine of Africa, not only through the cancellation of commercial flights but also as a result of increased stigma and discrimination. In short, the Ebola epidemic and its burden on local infrastructure will bring about short, medium and long-term suffering to these affected nations and their populations.

We must admire the stunning courage and commitment of local health-care workers. Almost 150 front line workers have succumbed to Ebola, including several doctors, most recently Sierra Leonean physician Dr. Olivet Buck. However, there is another shining light in the Ebola story. National and international non-governmental organizations or NGOs are making an important difference. One international NGO of note in West Africa is IBIS from Denmark. Read the heart-rending blog of Anne Catherine, a Canadian IBIS staff member who, until recently, was stationed in Monrovia, Liberia. Last week, Anne Catherine and her co-workers were evacuated to Ghana for safety reasons and from there they will continue to work to mitigate the epidemic.

From Anne Catherine’s experience in Liberia we hear, in real time, the horrendous impact of Ebola on women, children and families. We know from front-line workers and from UNICEF briefing reports that the majority of health-care facilities are not operating, schools and universities are closed, quarantines are being enforced, and sporadic violence, civil unrest and demonstrations are taking place with greater frequency and severity. UNICEF has also confirmed that 75 per cent of those infected with Ebola are women—mothers and girls. What is particularly tragic is the fact that 20 per cent of all fatalities are children. The disproportionate rate of female infection is understandable given women’s gender roles as family caregivers, health-care professionals and as paraprofessionals. Culturally assigned gender roles require women and girls to tend to the sick and dying, bathe and ready the deceased for burial, clean homes and hospitals.

At the moment however, the Ebola-affected nations of Africa are very much on their own. They are figuratively and effectively quarantined from the rest of the world.

As mentioned above, given that Ebola is transmitted through direct personal contact, caregivers of all kinds are at great risk. We learned from the gender-based analyses of natural and human-made disasters (e.g., the Asian Tsunami, the New Orleans flood, the Haiti earthquake, and HIV &AIDS), that women and girls are more vulnerable and disproportionately affected because of their gender roles. There are many reasons for this, but as already mentioned, most have to do with women’s and girls’ social, domestic and employment roles. We also know from our past work on HIV & AIDS with the Commonwealth Secretariat that “education and treatment approaches that do not take into account gender, cultural, or social disparities do not use resources efficiently or effectively and fail to improve long-term population health outcomes.”(See Gender Mainstreaming in HIV/AIDS: Taking a Multisectoral Approach). Gender considerations are urgently required to address the Ebola outbreak. A gendered approach needs to be “mainstreamed” into all interventions—health, education, and economics—to ensure that women and girls, men and boys are treated equally and equitably.

UNICEF’s 2014 Generation 2030/AFRICA – Child Demographics in Africa report presents a worrisome forecast:  Africa’s population is anticipated to double in the next 35 years to 2 billion people—and almost 1 billion of those will be children and babies. Unless Ebola education and prevention programs can be developed and delivered by African states themselves, the long-term effects of Ebola will have a serious impact on the well-being of future generations. Given the historical mistrust that sometimes accompanies foreign aid interventions, it is essential that African nations be supported to develop their own health-care capacity and human resources.

At the moment however, the Ebola-affected nations of Africa are very much on their own. They are figuratively and effectively quarantined from the rest of the world. If the worst case scenario forecasts are realized—with as many as 20,000+ predicted fatalities, these affected West African states will no doubt descend into even greater desperation and suffering.

Because the Ebola crisis is raging, it is the time for extraordinary measures by ordinary people—not only in Africa but around the world. A dollar from every person in Canada would contribute more than $35,427,524 towards public health delivery systems. Our contributions would provide urgently needed resources in support of family caregivers, teachers, schools, public education and health-care delivery. On the critical list we need to invest directly in field hospitals, health-care professionals, laboratory and testing infrastructure, and the delivery of training and public health education, especially for rural and remote areas. Assistance will also be required to develop vaccine delivery systems to people living in remote communities.

As Canadians, we pride ourselves on helping others in time of crisis. We can reach deep into our pockets. We also need to emphatically inform our country’s leadership that both human and material resources to combat Ebola are needed—now!

In closing, a Lancet journal editorial recently referenced the UNICEF Generation 2030 report for Africa. The authors concluded quite rightly:  “The time has come to acknowledge our shared responsibility to the future of Africa and to take the policy decisions needed for all of Africa’s children, present and future, to finally realize all of their rights and potential.”

Post Script

In 1969, when I returned to Canada from my Crossroads experience in Liberia, I told my grandmother about my experience in Liberia listening to the Apollo moon landing. And remarkably, just like the Liberian village elder, my grandmother looked at me quizzically and in all seriousness said:  “It was just an American trick.”

And so Dear Reader, I conclude my guest editorial with the phrase:  “We are all out of Africa” and we share a common humanity. Surely, if we could land a man on the moon 45 years ago, we can find the political commitment and the financial resources to help our fellow human beings to defeat Ebola!  Let us work together and make this effort another giant leap for mankind!

For more information

The Ebola Situation in Liberia, blog by Anne Catherine Bajard, August 2014

UNICEF’s 2014 Generation 2030/AFRICA – Child Demographics in Africa. August 2014

UNICEF Rapid Assessment:  Ebola Outbreak Impact on Children in Liberia, September 2014

Carol Amaratunga is a Women’s Health researcher, writer and activist. In former lives, she served as the Executive Director of the Atlantic Centre of Excellence for Women’s Health (Dalhousie University) 1996 – 2003. In 2003 she was awarded the Ontario Women’s Health Council (OWHC) Chair in Women’s Health Research, University of Ottawa. In 2008, Carol was recruited as the inaugural Dean, Applied Research, Justice Institute of British Columbia. Carol recently retired from academic life and now resides in Victoria, BC where she has re-invented herself as a social scribe and journalist.