Tag Archives: health

Putting Ebola in Perspective (along with other preventable causes of death in West Africa)

This is just a quick post on the spread of Ebola… Can’t really not do something on this when you teach health and development…..

The spread of Ebola

As of 7th November 2014 there have been 13268 confirmed cases of Ebola and almost 5000 deaths from Ebola, spread across Sierra Leone, Guinea, and Liberia, with 1/2 people contracting the dieseas dying from it. This web site outlines the current cases and deaths from Ebola in West Africa and beyond…..

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html

Projections

A report from September  (Estimating the Future Number of Cases in the Ebola Epidemic—Liberia and Sierra Leone, 2014–2015) estimated that wthout additional interventions or changes in community behavior, by January 20, 2015, there will be a total of approximately 550,000 Ebola cases in Liberia and Sierra Leone or 1.4 million if corrections for underreporting are made. The report also noted that halting the epidemic requires that approximately 70% of Ebola cases need to be cared for either in Ebola Treatment Units or in a community setting in which there is a reduced risk of disease transmission and safe burials are provided.

What are the symptoms of Ebola?

In a nutshell, victims bleed to death.

AKA Ebola hemorrhagic fever, symptoms typically start between two days and three weeks after contracting the virus as a fever, sore throat, muscle pain, and headaches. Then, vomiting, diarrhea and rash usually follow, along with decreased function of the liver and kidneys. At this time some people begin to bleed both internally and externally.The disease has a high risk of death, killing on average 50 percent of those who contract it, often due to low blood pressure from fluid loss, and typically six to sixteen days after symptoms appear.

Ebola lives on in the deceased for at least three days…..and this is when Ebola is at its most contagious. All it takes is one tiny speck of any of the various body fluids associated with death to enter your body, and you’re infected.

Why is Ebola spreading so rapidly?

Here I focus on Sierra-Leone

(1) The first case….

The first confirmed Ebola case was in Sierra Leone was in May (2014), when a woman was admitted to a government hospital in Sierra Leone. The authorities traced her back to a well known healer in the region, who many people visited both from SL and from accross the border in Guinea, where Ebola had already been confirmed. This healer (for obvious reasons) contracted Ebola herself, and died, and this was seen as a seminal event in Ebola’s spread, with 365 deaths being traced back to her well-attended funeral.

The virus, being highly contageous, spread rapdily after that, with doctors and nurses being common casualties, dampening the ability of the country to delay the further spread of the disease.

(source – http://www.who.int/csr/disease/ebola/ebola-6-months/sierra-leone/en/)

(2) Traditional burial practices in West Africa?

One THEORY of the spread of Ebola is that traditional burial practices, which involve morners touching the deceased, lead to the rapid spread of the disease.

However, the main evidence from this comes from Anthropoligsts who have observed death ceremonies in Uganda, which is firmly in East Africa (see this article) http://www.thedailybeast.com/articles/2014/08/13/kissing-the-corpses-in-ebola-country.html

As one anthropologist describes a UGANDAN burial ceremony…..

In the Ugandan ceremonies the sister of the deceased’s father is responsible for bathing, cleaning, and dressing the body in a “favourite outfit.” This task  is “too emotionally painful” for the immediate family. In the event that no aunt exists, a female elder in the community takes this role on. The next step, the mourning, is where the real ceremony takes place. “Funerals are major cultural events that can last for days, depending on the status of the deceased person.” As the women “wail” and the men “dance,” the community takes time to “demonstrate care and respect for the dead.”  When the ceremony is coming to a close, a common bowl is used for ritual hand-washing, and a final touch or kiss on the face of the corpse (which is known as a “a love touch”) is bestowed on the dead. When the ceremony has concluded, the body is buried on land that directly adjoins the deceased’s house because “the family wants the spirit to be happy and not feel forgotten. These burial rituals and funerals are a critical way for the community to safely transfer the deceased into the afterlife. Prohibiting families from performing such rites is not only viewed as an affront to the deceased, but as actually putting the family in danger. “In the event of an improper burial, the deceased person’s spirit (tibo) will cause harm and illness to the family,”

(3) Mistrust of health workers

Terry O-Sullivan, who spent three years volunteering in Sierra-Leone reports that….

“People have no idea how infectious diseases work. They see people go into the hospital sick and come out dead—or never come out at all,” he says. “They think if they can avoid the hospital they can survive.” This mistrust of the medical world seems to be validated when a family is prohibited from honouring the dead, participating in the funeral, or even seeing the body.”

This is backed up by a report from the BBC World Service (28/10/14) focussing on the ‘dead body management team’ in Sierra Leonne’s capital Freetown – The report described how, with Ebola still on the increase, although the message about the risks associated with the disease is getting through, there is enoromous resistance in rural or semi-rural villages when the disposal team arrives to remove a dead body for cremation. The reason for the resistance is that it is traditional for relatives to bury the body, typically with a lot of physical contact being involved.

The report followed the disposal team into one village, where a 65 year old woman had recently died. Their job was to get the morners ‘on side’, disinfect literally everything in the hut containing the body, bag the body up (in 2 body bags) and remove it, spraying everything on root. In the process the team is thoroughly suited, with gloves taped on. Apparently the most dangerous part of the process is the removal of the suit afterwards, the staff have to be sprayed with chlorine as every layer of protective clothing is removed.

(4)  The literacy rate in SL is only around 35%, which hampers the ability of authorities to explain how Ebola is spread and how to prevent its spread, athough I imagine this isn’t so important given the widespread prevalance of the radio as a means of communication in SL.

(5)  Lack of money and medical resources in SL. In the article above O’Sullivan appears to be suggesting that it would be necessary to have health workers in every village to win the trust of villagers and supervise funerals so that they can be conducted safely, without risk of spreading the disease. Until that happens, he seems to think it’s unlikely that its spread will be stopped.

 

Putting Ebola in perspective….

Looking at current figures, there are 14 things which kill more people per year than Ebola (including road traffic accidents) – Using WHO data from 2011 To illustrate…..

Deaths %
1. Malaria 13,262 17.77
2. Influenza & Pneumonia 10,761 14.42
3. Diarrhoeal diseases 8,673 11.62
4. Tuberculosis 7,143 9.57
5. Low Birth Weight 3,654 4.90
6. HIV/AIDS 2,775 3.72
7. Birth Trauma 2,748 3.68
8. Maternal Conditions 2,191 2.94
9. Stroke 2,143 2.87
10. Measles 2,047 2.74
11. Coronary Heart Disease 1,788 2.40
12. Meningitis 1,712 2.29
13. Road Traffic Accidents 1,311 1.76
14. Malnutrition 1,176 1.58

15. Ebola (so far in 2014) 1130

NB I don’t want to underplay the threat of Ebola – I’m aware of the unfair comparison and the doubling every 20 days or so. If current projections come true and there are 500 000 or more confirmed cases in SL and the death rate is one in two, then Ebola will top the death league tables for 2015 by a long way. It is, however, important to note that in the table above these deaths are occurring every single year – so cumulatively deaths from preventable causes is a massive problem in SL even without Ebola.

If people really want to prevent West African children dying from preventable diseases then ending poverty in SL is the most important long term goal. Just turning up in chemical suits for a few months and then turning our backs isn’t going to help that much. It will, however make us feel a lot better about ourselves.

Ebola and the globalised culture of fear….

One interesting line of analysis about Ebola is the extent to which media attention reflects predominent narratives in the West….

Ebola sits well with parellel narratives in the ‘globalised culture of fear’ – Ebola’s basically another threat from abroad – just like the immigrants and terrorists – All of our problems come from outside, and the Ebola story reinforces this ignorance, especially when, in its original incarnation, it does actually come from the Heart of Darkness, which is pretty much the same as the all-the-same countries in West Africa.

Ebola also fits well with the Modernisation Theory narrative that ‘backward Africans’ cultural practices lead to them dying off… The predominant focus in the media seems to be on silly Africans with their backward burial rituals, all touching each other and monkeys and bats and given each other Ebola, rather than focussing on the lack of money and facilities which are essential to dampening the spread of the disease and preventing the other 14 preventable causes of death which currently kill more people every year than Ebola’s killed so far this year.

Of course what the media should be focussing on are the year on year causes of death in SL and other poor countries – and the day to day causes of health problems in general – poverty, lack of clean water and poor sanitation, and of course the good ole’ unfair trade rules which keep poor countries poor. This however is a lot more difficult for an ignorant and generally uncaring audience to understand.

 

Chelsea footballers – paid more than Liberia’s National Health Budget

I just knocked this up quickly to coincide with some tweets on the #TodayinLiberia – I just recently taught health as part of an A level module, so thought I’d share some quick ‘harrowing comparisons’. 

Liberia’s total health expenditure in 2009 was $53 per capita (source – WHO)

If you multiply this by the population (almost 4 million) you get a figure of $212 million dollars a year

It’s interesting to compare this to the Premiership wage bills (2007/08 figures)

Chelsea – £172m on salaries or $273 million dollars!

£121m spent by Manchester United,

£101m by Arsenal

£90m by Liverpool.

The total for the whole premiership was around £1.2 billion or $1.9 billion

OK – there will be some error here due to odd year comparisons – but not too great a difference!

 

Coffee really is bad for your health (and safety)

Two nice articles illustrating the madness of health and safety… both concerning coffee….

In Bournemouth, a bus driver ordered passengers off a bus after a woman spilled some coffee. One woman spilt a third of her cup of coffee while getting on the bus, and then a further ten people were told they couldn’t get on because specialist cleaners were needed to clear up the ‘dangerous liquid’. The bus was pulled to one side and a replacement vehicle ordered, leaving the ten passengers to wait in the rain.

Secondly, according to and item I found in The Week, “health and safety officials in Warwickshire have banned hot drinks at a mothers’ coffee morning. ‘Coffee and play’ sessions at the Children’s Centre in Stratford-upon-Avon have been renamed ‘baby play’ and parents now catch up over a (plastic) cup of squash or water. The council said its ‘hot drinks policy’ was to minimise the risk of scalding children. ”

These two cases together are a wonderful illustration of the far reaching effects of  ‘individualisation’ and ‘litigation culture’ working together to result in collective lunacy – Both cases involve local councils who are no doubt very aware of the potential of being sued for any ‘preventable accidents’ on their property – a situation which can only happen when the populace at large are highly individualised – feeling little sense of obligation to wider society, while feeling they have the right (in this goaded by claims lawyers) to cream as much out of society as they can when the opportunity arises.

Going a little deeper – I’d blame neoliberalism for this – a political economy that allows individuals the freedom to exploit and enrich themselves at the expense of others – this is the kind of logic that has lead to the emergence of ‘Fortress Cities’ – in which the rich defend themselves in gated communities and SUVs against the increasing numbers of urban poor.

I think its appropriate to view the above two cases as local councils adopting a ‘fortress city’ mentality – setting up rules that protect themselves against any selfish individual who might try to make money out of them by holding them responsible and suing them for those unfortunate accidents (slipping/ scalding) that are, in reality, just an unfortunate and it has to be said extremely rare part of modern life.

Although, the optimist in me sees an opportunity for collective action in this – On reflection I’m wondering if the first case isn’t part of a surreptitious ‘work to rule’ campaign on the part of a unionised bus driver, whose just had a pay freeze? – Maybe this raises the possibility of using health and safety as part of a campaign against public sector cuts….

So in the interests of health and safety I think all unionised teachers should cease doing all of the following – Any curricular activities involving physical activities, especially school trips; any teaching that involves teaching to tests, in fact we should drop all testing and examinations altogether, this causes way to much stress to our delicate children; and all marking and preparation outside of class – associated with numerous health problems such as RSI, eye strain, back pain and stress in general.

In fact, perhaps we could go further, in the interests of health and safety, maybe we should just stop doing anything, and just….. sit there, over coffee of course.