Paul Farmer: We should be saving majority of Ebola patients

A slender, weakened Ebola patient sits alone, head in his hands, on the floor of a darkened room in an abandoned treatment center in West Africa.

That is the unfortunate portrait of Ebola care in the region today — an emaciated system completely incapable of containing the rapidly spreading virus, renowned physician and humanitarian Paul Farmer told a Stanford audience Oct. 3, referring to a photo projected on a screen behind him.

“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.

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.

He said the West Africa epidemic is unfortunately symptomatic of stark global inequities in health care — an issue he and his group have so ably addressed in Haiti and Rwanda.

This is not rocket science. Just think what we could do if we had a lot of help with systems and partners. 

In Rwanda, for instance, which has seen the world’s steepest decline in mortality in recent decades because of government and private investments in health, he said his group transformed an abandoned district hospital, with a few cots in darkened rooms, to a white-washed, flower-draped health clinic that provides quality care.

Similarly, in Haiti, after the only nursing school was reduced to rubble in the 2010 earthquake, his team built a medical center and teaching hospital — an expansive, modern complex in a rural area of the country, he said to applause from the audience.

“This is what I think of for rural Liberia, rural Sierra Leone,” said Farmer, who is also a professor of global health and social medicine at Harvard. “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.”

No end yet

At the current, rapid rate of spread, Farmer said he does not expect the epidemic to end anytime soon.

“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.

“Most care-giving takes place at home. Who gives care? Your mom. The others at risk are nurses, nurses’ aides, ambulance drivers, even Good Samaritans, like the Liberian man [the first infected person in the United States] who was trying to help a neighbor who was pregnant. So it is a caregiver’s disease,” Farmer said.

He championed the role of community health workers in fighting the disease, a model he effectively applied in Haiti during the peak of the AIDS epidemic there. Though his HIV Equity Initiative, he pioneered the use of community caregivers, known as compagnateurs, who visited their HIV-positive neighbors daily, monitored their health and ensured they were taking their antiretroviral and/or tuberculosis medication. Thousands benefited from the approach, with the “poster child” for success being a man named Joseph; Farmer showed photos of Joseph transformed from a skeleton to a robust young man with a child on his hip.