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Opinion: Healthcare apartheid is unacceptable – there can be no 'them and us'

Solutions do not come easy, but Ebola transmission can be stopped.

Breda Gahan

BEFORE HIV TREATMENT was available in Sierra Leone and Liberia, everyone infected died of Aids.

The situation improved considerably when Aids drugs became available through donors, including Irish Aid. But the Ebola outbreak has resulted in HIV patients not receiving medications due to closed health clinics as well as people refusing to attend available clinics due to the risk of exposure to Ebola.

Over 300 health workers have died in Liberia, Sierra Leone and Guinea, the worst affected countries in this Ebola outbreak. Imagine if the nurses in the Mater or St Vincent’s Hospital were afraid to go into work to treat people with a dangerous infectious disease due to a lack of proper protective equipment?

Of course, the situation in West Africa has been complicated, not least by the fact that civil wars in Liberia and Sierra Leone only ended in the mid-1990s. The wars destroyed economies and hundreds of thousands of people were killed.

There was a flight of educated and skilled personnel including health staff to safer locations. Many have not returned to their home country.

Just 51 doctors in the entire country

Following country collapse, the health systems in Liberia and Sierra Leone had only begun to function when the Ebola virus took hold, tragically displaying their frailty and weakness. Our teams there have been telling us that Ebola is “negatively impacting on every aspect of life in Sierra Leone”.

Health and education systems are the backbone of any country – everything else is secondary. These systems work best where there is supportive leadership and sustained investment.

In Ireland, there are more than 16,000 doctors for our population of 4.6 million people.

Liberia has a similar population size but only 51 doctors in the entire country. Sierra Leone has less than 140 doctors to reach their whole population of 6 million. The need for doctors and nurses in both countries has never been greater than now, in the midst of the biggest Ebola outbreak the world has ever seen.

People in Sierra Leone and Liberia suffer when there is poor health care. Often, it is the poorest who lose their lives first. People will sell their last asset to try and get medicine for a sick parent or child.

Solutions do not come easy, but Ebola transmission can be stopped.

Education reduces fear

Prevention through education can be life-saving. It makes a difference, and we see that daily. People now understand that Ebola is more threatening than HIV, but education has reduced fear among the population and has reduced life-threatening practises, especially with handling the bodies of the dead.

Healthcare medical apartheid is as unacceptable in 2014 as apartheid was ‘back in the day’ in South Africa. There can be no ‘them and us’.

Some African countries – like Uganda – that have Ebola containment experience are already helping in West Africa. This important cooperation is now – somewhat belatedly – being resourced and expanded with professional expertise from wealthier countries in Europe, the Middle East, Australia and USA.

This week the World Health Organisation issued its latest data: 5,459 Ebola fatalities in West Africa out of 15,351 cases. Too many lives have been lost already.

Concern’s teams in Liberia and Sierra Leone are supporting Ebola prevention with water and sanitation, provision of protective equipment, infection prevention and control training, emergency education and health care for routine illnesses.

Health system strengthening is a long process, with health workers on the frontline and among the people in the communities that they serve. It requires adequate and sustained investment.

Concern Worldwide, the UN and African governments cannot stop the spread of Ebola alone but our chances are greater when we work together, as committed and coordinated partners in this battle.

Peter Piot, the first Executive Director of UNAIDS and one of the scientists who first identified the Ebola virus almost 40 years ago, only this week sounded a note of cautious optimism when he said the current Ebola outbreak may get worse before it gets better but “thanks to now massive efforts at all levels” he hoped to see cases and fatalities decreasing next year.

As with the battle we are now winning against HIV because it eventually secured the resources and expertise it needed, sustained commitment is key.

Ebola cannot be allowed to ‘win’.

Breda Gahan is Global HIV and Aids Adviser with Concern Worldwide.

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Breda Gahan

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