The Ebola outbreak, which is the largest in history that we know about, is merely a reflection of the public health crisis in Africa, and it's about the lack of staff, stuff and systems that could protect populations, particularly those living in poverty, from outbreaks like this or other public health threats.Paul Farmer is one of the world's most respected medical anthropologists and physicians. If you missed this in-depth interview with him on Democracy Now, and cannot view the video, here's a link to the transcript.
Dr. Farmer and his colleagues in the U.S. and abroad have pioneered novel, community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings in the U.S. and other countries. Their work is documented in the Bulletin of the World Health Organization, The Lancet, the New England Journal of Medicine, Clinical Infectious Diseases, and Social Science and Medicine.Farmer, along with other medical anthropologists and epidemiologists does not minimize the seriousness of Ebola, but he talks clearly about what needs to be done, cuts through the fearmongering around this current crisis, and discusses how we need to approach public health as a global system.
Dr. Farmer also has written extensively on health and human rights, about the role of social inequalities in the distribution and outcome of infectious diseases, and about global health. His most recent book, Reimagining Global Health, co-edited with three colleagues, presents a distillation of several historical and ethnographic perspectives of contemporary global health problems. Other titles include To Repair the World: Paul Farmer Speaks to the Next Generation, a collection of short speeches, Partner to the Poor: A Paul Farmer Reader, Pathologies of Power, Infections and Inequalities, The Uses of Haiti, and AIDS and Accusation. In addition, Dr. Farmer is co-editor of Women, Poverty and AIDS, The Global Impact of Drug-Resistant Tuberculosis, and Global Health in Times of Violence.- Advertisement -
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From the interview transcript:
AMY GOODMAN: Talk about what we should understand about this outbreak of Ebola, Paul.In an October 3 address at Stanford, Farmer stated, We should be saving majority of Ebola patients.
DR. PAUL FARMER: Well, I think the most important thing to understand is that this is a reflection of long-standing and growing inequalities of access to basic systems of healthcare delivery, and that includes the staff, the stuff and, again, these systems. And that's what--that's how we link public health and clinical medicine, is to understand that we're delivering care in the context of protecting the health of the population. And so, if you go down to each of these epidemics--that are, of course, one epidemic--and you ask the question, "Well, do they have the staff, stuff and systems that they need to respond?" the answer is no. And then, what will stop the epidemic, which it will be stopped, is an emergency-type response. But then again, how are we building local capacity to do that so these epidemics don't spread--as they would never spread in the United States, by the way?
JUAN GONZÁLEZ: And the astounding fatality rates that we keep hearing about, is that more, in your sense, in your view, a result of the disease itself or the weaknesses of the healthcare systems that confront them?- Advertisement -
DR. PAUL FARMER: Well, you know, I think the more important hypothesis is that it's the latter, right? Because--and it would be great to talk to our colleagues at Emory, the infectious disease colleagues who treated patients. It's not that they had an experimental medication; it's that they had supportive care. And supportive care, in medical terms, doesn't mean having someone hold your hand. It means, if you're bleeding, you get blood products. If you're hypotensive, or your blood pressure is low, you get IV solutions, right? That's not what's happening in these Ebola centers. You know, it's really quarantine without a lot of the care, right, because supportive care requires sometimes an ICU.
AMY GOODMAN: That was very interesting that you just said that Ebola couldn't be--there couldn't be an outbreak in the United States.
DR. PAUL FARMER: Well, there could be, but it would be stopped quickly, because patients would be isolated, not in quarantine facilities without medical care, but in places like Emory or the place where I work in Boston, at the Brigham and Women's Hospital. And even in Haiti or in Rwanda, you know, we've prepared, along with the authorities, isolation rooms that are not to shut people away, but to take care of them while protecting the rest of the staff, if they have an infectious illness, an airborne illness, say.
So, you know, back to Juan's question, why would there be such massive variation in case fatality rate? And to me, that always says, because there has not been an overlap between the epidemic, Ebola epidemic, and modern medicine. We're talking about Medieval-level health systems and a modern plague that's going to spread. And when we can overlap modern medical systems and modern public health systems, then we can see what the case fatality really would be. I mean, just to be provocative, what if it's 10 percent instead of 90 percent? What if it's 5 percent, with proper medical care? And I'm saying even without a specific therapy for that disease, which we're all waiting for and hopeful about some of the new agents.
"Almost no [care] delivery has occurred around Ebola," said Farmer, MD, PhD, who recently returned from Liberia, where his Partners in Health organization is working to combat the epidemic. "There is not a lot of T [treatment] and not a lot of C [care] in Ebola care units. If you don't have the resources, you're not going to have the staff, the space, the stuff you need. I think the least we could do is have a safety net for everybody," he told the 400 people who gathered to hear him speak. His presentation was moved to the Graduate School of Business to accommodate the crowd.His conclusions:
He said patients are not receiving even the most basic of care, such as fluids and electrolyte replacement for shock, a common symptom of the disease."A lot of the problem is related to treatable issues. We should be saving the majority of patients," he said.
"Stopping it is going to require a lot of staff and materials. Just the sheer amount of personal protective equipment is enormous, not to speak of diagnostics, equipment and so on. And there will need to be massive renovation and creation of new spaces, because this is a difficult disease to manage. So it's a big problem. I think it's going to be around for a long time."
He said those most at risk for the disease are caregivers because they are most likely to be exposed to patients' blood and body fluids.