The photo says it all: A very slender, ailing man sits on the floor with his head bent, completely alone in the dark in what used to be an Ebola treatment center in West Africa.
Paul Farmer, MD, PhD, the brilliant physician and humanitarian, flashed the photo on a screen to a rapt Stanford audience last Friday to show the emaciated state of health care systems in West Africa, incapable now of treating the most basic ailments.
Every time someone dies, it's a failure to diagnose and deliver the imperfect tools we have
"The primary determinant of outcomes is the strength of health care systems. And if this is what ETU's (Ebola Treatment Units) look like, there are going to be a lot of fatalities," he told the crowd of some 400 people at Stanford's Graduate School of Business. "We should be saving most of these patients. Every time someone dies, it's a failure to diagnose and deliver the imperfect tools we have."
But this vast inequity in care need not exist, said Farmer, MD, PhD, a Harvard professor. He pointed to examples from his own experience, in which he and the group he co-founded, Partners in Health, helped build robust health systems in Haiti and more recently, Rwanda, saving thousands of lives.
Farmer started working in Haiti while he was a student at Harvard Medical School nearly 30 years ago. In 1998, during the peak of the AIDS epidemic there, he established the HIV Equity Initiative, which relied on community health workers to visit the homes of patients daily to check on their status and ensure that they took their antiretroviral and/or tuberculosis medications. The approach proved remarkably successful, as people rose from their deathbeds to return to normal, functioning lives.
More recently, after the 2010 quake in Haiti, his group helped to build a medical center and teaching hospital in rural Haiti; he showed a photo of the modern, expansive new facility to the Stanford audience, which applauded the work.
"This is what I think of for rural Liberia, rural Sierra Leone," he said. "This is not rocket science. Just think what we could do if we had a lot of help with systems and partners. It just requires sticking with some of these problems for a long time."
Previously: Ebola panel says 1.4 million cases possible, building trust key to containment, Expert panel discusses challenges of controlling Ebola in West Africa, Should we worry? Stanford's global health chief weighs in on Ebola and Biosecurity experts discuss Ebola and related public health concerns and policy implications