The Ebola outbreak, which public health officials privately fret could turn into a global pandemic, carries with it a quiet riddle: while West Africa ineptly focuses on prevention, virtually no one has focused on care.
Or to put it mathematically, the fatality rate from Ebola, historically near 90%, sits closer to 50% during this outbreak (4,366 cases, 2,218 deaths), despite the fact that the facilities in Liberia, Sierra Leone and other countries affected remain appalling. What would the true rate be if victims were treated under western standards? And the larger ramifications if Ebola was no longer viewed as an automatic death sentence?
“There’s never been a connection between Ebola and first-rate medical care,” says Paul Farmer, the renowned co-founder of Partners in Health, before pointing out that none of the health care workers flown back to the U.S. for treatment have died. Could the answer to the outbreak lie in the care regiment for those afflicted?
We’ll soon find out. Farmer landed in Liberia this morning, at the center of a coalition quietly formed to specifically – and quickly – test that thesis. In the next few weeks, the Farmer group will open a top-notch treatment facility in one of Liberia’s most rural provinces, along with strategies designed to maximize its effectiveness.
“This has been coming together for years,” Farmer tells Forbes, a few hours before departing on the trip. “The Ebola crisis pushed it over the edge.”
The impetus for this coalition began with a meeting two weeks ago, convened by Farmer’s co-founder at Partners in Health, Jim Kim, who is now president of the World Bank. Attendees included Director-General Margaret Chan of the World Health Organization, Tom Frieden, Director of the Centers for Disease Control and Francis Collins, Director of the National Institute for Health. Dismayed by the global response – Kim told the group that the outbreak already ranks among the worst health crises in world history -- Kim tabbed Farmer as the World Bank’s special Ebola advisor and also enlisted another attendee at the meeting, Raj Panjabi, who runs Last Mile Health in Liberia. (Full disclosure: Panjabi was mentored at last year’s Forbes 400 Summit on Philanthropy and I now chair the advisory board for Last Mile Health, which hires, trains and manages front-line health care workers in remote villages.)
George Soros’ Open Society Foundations quickly provided $4 million to fund this project. “The coalition got us a proposal the next day, they answered all our questions the day after, and we got them the funds they needed before the week was out,” says Chris Stone, the organization’s president. The project was appealing to Soros’ team because it features a local group familiar with the turf, an entrepreneurial mentality and the ability to scale.
Scalability is key because if this test facility in Liberia’s Grand Gedeh County works short-term, it provides the long-term blueprint to curb the outbreak. Rather than quarantine healthy people with the sick or sometimes watch suspicious -- and highly-contagious – patients break out even after being committed, Farmer and Panjabi plan to create a top-notch, results-driven care facility that the afflicted want to go to. The sick will seek help, and get helped. “It’s a very natural, about-damn-time progression,” says Farmer.
And instead of massive, centralized centers – creating treks that can take days, with the sick infecting caring family members who bring them (“a damned if you do, damned if you don’t dilemma,” says Farmer) – localized treatment will stem, in theory, Ebola’s explosive spread.
Such decentralization has another benefit: creating a national medical structure in a country that, after Liberia’s cripping civil war, only had 51 doctors left to treat a diffused population of 4 million. Says Panjabi: “One of the best ways to fight Ebola is to ramp up the health care system that should have been there in the first place.”
If Farmer’s crew can show results, it would be left to folks like the World Bank’s Kim, USAID chief Raj Shah, who has also expressed his support, and President Obama, who has taken tentative steps to help, to move quickly to implement this decentralized system throughout West Africa.
How soon will we know? The Grand Gedeh facility will up in a matter of weeks. And Farmer and Panjabi will be in Liberia until Sunday, looking for early clues. They’ll be back next week, to give a report on their progress at the Clinton Global Initiative summit in New York.
