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Ebola: It’s not over

Ebola may have receded from the headlines, but the challenges and threat of the disease persist. The epidemic, which has killed more than 10,700 people in West Africa, exposed glaring weaknesses in the local health-care systems, including the critical shortage of workers, poor infrastructure, lack of agreement about best practices and poor coordination among caregivers, Stanford global health expert Michele Barry, MD, told a crowd of health writers Friday.

These are among the problems that still have to be tackled to limit vulnerability to Ebola - and other diseases - in West African communities, said Barry, director of Stanford's Center for Innovation in Global Health.

There is no consistent, united leadership on how to care for Ebola patients... That's not an effective way for a workforce to tackle a major epidemic.Though the number of reported Ebola cases has fallen to 40, the epidemic "is really not almost over - we need to keep pushing that line," Barry said. She spoke to some 60 medical at the Association of Health Care Journalists conference, which was co-hosted by Stanford Medicine.

She noted that Africa carries 25 percent of the global disease burden, yet it has only 3 percent of the world's health workers. In Liberia, for instance, there are just 117 doctors for a population of 4.3 million. The country's only trained internist, a colleague of hers, died of Ebola in the course of treating an infected patient.

"Some of us have been campaigning for a long time about this (extreme shortage of health care workers)," Barry said. "We need to take responsibility for workforce, not just within our borders."

When the epidemic struck, she said many well-meaning, outside organizations rushed in to help fill the health care gap, but there was a tremendous lack of coordination, as well as some competition, among these groups. They didn't even agree on some basic principles of care, such as whether patients should be rehydrated by intravenous lines or orally.

"To this day, there is no consistent, united leadership on how to care for Ebola patients. No one is really in charge," she said. "That's not an effective way for a workforce to tackle a major epidemic."

She argued for the creation of a Global Health Workforce Reserve, a cadre of trained nurses and doctors who could be called upon to help during crises like Ebola. She has floated the idea with World Bank officials, who are supportive and are working on developing a way to fund the reserve, she said.

At the same time, West African countries need assistance rebuilding their fragile health care systems to manage not just Ebola but the many other noncommunicable diseases that afflict them today and that have largely been ignored during this crisis, she said.

Previously: The Ebola crisis: an ethical balancing actExperience from the trenches in the first Ebola outbreakDr. Paul Farmer: We should be saving Ebola patients and Should we worry? Stanford’s global health chief weighs in on Ebola

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