Prescription for Ebola

Paul Farmer charts path toward improving care

Paul Farmer appealed for help in improving health-care delivery in West Africa in a talk at Harvard Medical School. Image: Rick Groleau

When Ebola meets modern medicine, most patients survive.

But the Ebola epidemic in West Africa is raging far from the hospitals in Germany and the United States, where the few people infected with the virus have received prompt diagnosis and aggressive care.

Instead, patients in Liberia, Sierra Leone and Guinea are dying for lack of “staff, stuff, space and systems,” Paul Farmer told the Harvard Medical School community members who gathered to hear him talk about Ebola and global health equity.

Farmer is the Kolokotrones University Professor of Global Health and Social Medicine at Harvard and head of the HMS Department of Global Health and Social Medicine. He is also the co-founder and chief strategist of Partners In Health, whose mission is to bring the benefits of biomedical science to those most in need.

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“Modern medicine and Ebola have never collided before,” he said. “What we are doing now is making them collide.”

Modern medicine means IV solutions and the nurses to deliver them, plus clinics to care for patients and systems to control spread of the infectious disease while winning the trust of the people they serve.

Farmer cast his glance around the Joseph B. Martin Center auditorium, appealing for volunteers to join the cause.

“The unswerving support of the leadership at the medical school and its affiliated hospitals has been and will be critical to turning the Ebola epidemic around,” he said.

On his trips to West Africa, he hears time and time again that the virus was spread by one person caring for another at home.

“Doctors and nurses are at high risk, but so is anyone providing care: children, relatives, neighbors, Good Samaritans,” he said. “The transmission chain of Ebola is caring.”

Hydration and electrolyte replacement are the minimum interventions required to help patients recover. During infection, Ebola patients, much like cholera patients, can lose up to 10 liters a day of fluids. There are not enough health care workers to make up the difference.

“In Liberia, a country of 4 million people, there were fewer than 50 physicians in the country working in health care delivery in the public sector before Ebola. You can imagine what it is now,” Farmer said. “I see 50 physicians on every floor of the Brigham on any given morning.”

Volunteers should be taken care of, too, he said, rather than met with threats of quarantine and stigma when they return.

Ebola’s impact on Liberia’s primary care system has been devastating and complete, he said. “If it was bad before, it’s nothing short of apocalyptic now.”

"Ebola and the Future of Global Health Equity," a talk by Paul Farmer. Image: Rick Groleau

To help “our neighbors,” we need to think about building health systems. But before then, people need to trust the Ebola treatment units where they now fear they will die.

“We need to drop the mortality rate by providing quality health care,” he said.

Farmer buttressed his arguments by citing examples of work done by Partners In Health in Haiti and Rwanda.

In his introduction, Jeffrey S. Flier, HMS dean, said, “Instead of choosing between providing care and building local capacity, Paul finds a way to do both.”

In closing, Farmer reminded his audience of the medical response to people injured in the 2013 Boston Marathon bombings.

Because of staff, stuff, space and systems, he said, no one who made it alive to a Boston hospital died.

“Can we do it in West Africa?” he asked. “Of course we can.”