Analyse af Lise Rosendal Østergaard, Københavns Universitet
Ebola-virussen spreder sig hurtigere end de vestafrikanske lande kan reagere. Ifølge FNs sundhedsorganisation WHO er flere end 1.700 blevet smittet og 932 er allerede døde. Det er det hidtil værste udbrud af sygdommen.
The Ebola virus causes fear far beyond the affected countries due to its combination of death, infection rates and taboos. A fear that is fueled by the concern that the disease might be spread through routes of globalization: air travel, transit visits and evacuations.
When all the experts, however, believe that this is highly unlikely to happen they refer to the robustness of the health system’s in the global North.
A robustness, which is painfully lacking in Guinea, Liberia, Sierra Leone and Nigeria.
After several years of working within health systems in West Africa, I would like to point the often overlooked role that trust plays in a well-functioning public health system.
Firstly, there is a lack of trust between health workers and authorities in many West African countries. Many health workers perceive the government to be unwilling to provide them with decent working conditions – how to practice bio-medicine in an environment of technological and material deprivation? – or to protect them from occupational hazards.
Health workers have been the professional group which has suffered the highest mortality rates during the outbreak of Ebola. Also under normal circumstances health workers are exposed to all kinds of infections during work. And they see little of the state when it comes to preventing or recompensing them for these risks.
For example, the compensation health workers in Burkina Faso receive if they have been exposed to HIV infection is as low as DKK 80. This creates frustration among the health workers and strikes, sit-in and conflicts occur frequently.
For example, as the first case of Ebola hit Lagos the the public health workers in Nigeria were on strike. This lack of trust in the public health authorities inhibits a rapid and coordinated response.
Secondly, people often distrust the public health-care sector. Health clinics are often overcrowded, understaffed, and without the necessary diagnostic equipment to produce health.
Typically people will have had mixed past experiences with the public health system and the providers and therefore they will be skeptical when the system suddenly demands that they cooperate by surrendering family members of that same system.
Especially as long as the system cannot offer any treatment. The only way to stop the chain of Ebola infection is quarantine of the infected victim. In a situation where the health system can only offer the prospect of dying behind a closed door far away from family, people are reluctant to seek health care system.
The question is how to strengthen trust in the public health-care sector? One option is to build on the experiences of another infectious disease that has ravaged Africa: HIV/AIDS.
From 30 years of the AIDS epidemic, we have learned that disease is not just a matter between the authorities and the patient. The affected populations and their families must be involved in prevention, contact tracing and information activities. Cultural traditions must be respected. Communication must be adapted to the target group and changes in practice must be carried out in dialogue with representatives from the local community.
Ebola is a disease that makes the health system’s weakness visible to the naked eye. Other diseases, on the other side, remain in-visible to us.
During 2013, it is estimated that in Guinea, Liberia, Sierra Leone and Nigeria 41 791 women died in childbirth according to a comprehensive study of levels and trends in maternal mortality published in May 2014 by the Lancet.
A large proportion of these deaths could have been avoided with a better functioning health system.
The point is not to talk the Ebola epidemic down by comparing the number of deaths. Rather, it is an invitation to Danida and other donors to invest in strengthening health systems in Africa.
Robust health systems with decent working conditions for health workers, which is based on the needs of the population. It can help prevent much human suffering in the countries concerned.
Lise Rosendal Østergaard er Ph.D.-studerende ved Institut for International Sundhed, Immunologi og Mikrobiologi og Institut for Antropologi ved Københavns Universitet.
