Aid Organizations Working in Ebola Regions

Last night, Ian Mackay posted this very disturbing logistics/supply chain chart, showing that some personal protective equipment stock in countries battling Ebola are at “zero” – and have been for a while. Articles from the and New York Times bleakly illustrate just how bad the situation has become.

Donation box. Note: Cats are not needed at this time.

Donation box. Note: Cats are not needed at this time.

Because, contrary to popular opinion, humans don’t always suck, people seeing these posts immediately started asking what they can do to help and began brainstorming ways to crowd-fund supplies. However, as Twitter user Macrophagic so succinctly put it, the best thing to do right now is use established supply lines.1

In support of both people’s inclination to give, and to have that giving filter through established supply lines, here is a list of trustworthy organizations2 that, as of Sunday, August 17, are still operating in Sierra Leone, Guinea, and Liberia. I’ll update this list as I come across more information, or as people enter/leave the affected region(s). Feel free to add your suggestions in comments.

Please check to see if your workplace does matching donations for charity.

The CDC Foundation
The CDC Foundation is an independent, nonprofit organization that connects individuals and the private sector with CDC’s expertise and distribution channels. The Fund’s Global Disaster Relief Response Fund is only activated during extreme emergencies, and has been activated for the Ebola crisis. They are providing personal protective equipment, communications equipment, emergency operations equipment, and funds for public health campaigns. The CDC Foundation received a rating of 96.07 from Charity Navigator. Donations are accepted worldwide.

The International Federation of Red Cross and Red Crescent Societies
IFRC is the world’s largest humanitarian network. Their donation page currently has a Syria crisis appeal, but if you select “donate,” the second option is for their Ebola campaign. You can also make a donation to your specific Red Cross or Red Cresent; here is the link to the American Red Cross website; that donation is tax-deductible. (I would recommend donating directly to the IFRC website, as that is guaranteed for Ebola efforts.) The American Red Cross receives an 85.25 rating from Charity Navigator.

Direct Relief
Direct Relief is coordinating with doctors on the ground in Sierra Leone and Liberia to provide personal protective equipment and other supplies, which are being sourced directly from manufacturers. You can direct your donation to their Ebola efforts; they accept international donations. Charity Navigator gives Direct Funds a pretty amazing 99.71 rating.

AmeriCares
AmeriCares is organizing air shipments to hospitals in Liberia that have no necessary personal protective equipment, including gloves, gowns, and masks. They are accepting contributions for future shipments. AmeriCares receives a rating of 92.89 from Charity Navigator. Donations are tax-deductible.

Medecins Sans Frontieres/Doctors Without Borders
MSF has been pushed to its limits in the outbreak region, and vocal about it. What they need right now, however, is not more supplies, but more people. Their current fundraising campaign for Ebola is listed as fulfilled, and they are requesting that donations be made to their general fund for a more flexible response. MSF anticipates being in the West African region for at least six more months, so it’s entirely likely that they will re-open fundraising for that region. That said, given the extended timeline, it’s plausible general funds will be used. However, they are working in multiple regions of the world, so there is no guarantee that donations to the general fund will be used in West Africa. MSF/Doctors Without Borders receives a 92.03 rating from Charity Navigator. Donations are tax-deductible.

  1. For more information on why this is the case, read Harvard professor Calestous Juma’s excellent Al Jazeera op-ed on how the lack of infrastructure in the affected region and how this affects all public health. []
  2. Trustworthy as defined by me, based on research, name recognition, and Charity Navigator if possible. Vague, I know, but I wanted to get an international-as-possible list up as quickly as I could. []

No, American Doctors, You Don’t Need Tyvek In Case of Ebola

One of the more interesting aspects of the constant media coverage of the latest Ebola outbreak has been watching how developed nations like the United States, Britain, and Canada assume that the entire world is Just Like Them. The Seattle Times had a charming example of this yesterday, with American doctors questioning the CDC guidelines for how to care for an Ebola patient in America. An example of the ignorance on display comes from Tulsa, Oklahoma emergency physician Justin Fairless, who says that health care workers in West African nations

are wearing the highest level of protection, but the CDC recommendation lets us go down to the lowest level of protection.

Now, the CDC has repeatedly said that caring for patients in African nations is quite different than caring for patients in America, Canada, other developed nations, but apparently Dr. Fairless and others need a pictorial show-and-tell to understand that not everyone lives and works in a state-of-the-art world.

But first, a bit of description to set the stage for the pictures you are about to see. (Note: There are no sick or dead bodies in the following photographs.) This is from a Pulitzer Center on Crisis Reporting report on maternal/fetal care in Guinea, published in February of 2014, before the international community was aware of the Ebola outbreak:

“The biggest problems at Donka are no electricity, no water, no equipment, no sanitation and very high rates of infection,” said Bintu Cisse, adjunct midwife supervisor, who has worked at Donka National Hospital for 20 years … External support provides some operational assistance, but Donka lacks basic facilities due to the inefficiency of Guinea’s under-performing infrastructure … Inside the maternity ward operating room, Cisse pointed out that the equipment did not work and doctors used suspended basins of water and a mixture of chlorine to sanitize. The main light sources were open windows—outside garbage was burning.

Cisse is describing the largest medical center in Guniea, Donka Hospital, which is also the university teaching hospital for the country.

This is what their isolation unit looks like:

Donka Hospital Isolation Tents. Cellou Binani/AFP/Getty Images.

Donka Hospital Isolation Tents. Cellou Binani/AFP/Getty Images.

Those are tents. Here’s what those tents look like on the inside:
DonkaIsolationWard-Open

When patients are inside, they are lined up on cots, one after another. There is nothing separating the patients from anyone, or anything. There is no airflow system–isolation wards in regions where Ebola is active tend to work by setting up large barriers to prevent people from getting close enough to worry about contagion; this could be large plastic sheeting, it could be fences that indicate the line at which people should not pass.

This is what an isolation unit looks like at your average, developed world, fully-equipped hospital:

Isolation room at Wellington Hospital, New Zealand.

Isolation room at Wellington Hospital, New Zealand.

So, as you can see, Dr. Fairless, and others, things are just a little bit different in countries where the GDP is more than USD 6 billion a year.

A MSF worker suits up to care for Ebola patients.

A MSF worker suits up to care for Ebola patients.

The major difference in treatment, aside from already-discussed issues, is who is in isolation. More specifically, in places like Guinea, Liberia, and Sierra Leone, while patients are isolated from other people in order to curtail infection, the health care workers are the ones “in isolation”–they’re the ones who are kitted up in bunny suits, in full Tyvek, layers of gloves, and the whole nine yards. Because: see above. The effort here is to keep the HCW in a protective environment to limit transmission to the worker, because it’s impossible to keep the patients inside a protective environment, due to the economy, the lack of infrastructure, the lack of ability because there’s no technology, there’s no power.

Isolation units in America and other developed countries, on the other hand, function to keep the patient inside isolation; patients are isolated from others to curtail infection, and that includes being “in isolation”: that is, the protective bubble that bunny suits and Tyvek create for HCWs in Guinea, etc, is extended around the patient in the form of negative air pressure rooms and glass walls.

In that sort of environment, the basics of gloves, gown, and mask are more than sufficient to care for a patient with Ebola–or any other highly infective agent. Which is why that’s what the CDC recommendations are; because technology and care levels are different, and the basic approach to isolating and isolation can change.

It’s also worth remembering that bunny suits and Tyvek weren’t always around when people were fighting Ebola. Here’s what Peter Piot was wearing in 1976, when Ebola was first recognized:

Peter Piot wearing protective gear in Yambuku, 1976.

Peter Piot wearing protective gear in Yambuku, 1976.

That’s how the outbreak was stopped in 1976. In conditions that in many ways were worse than in the pictures shown above.

The doctors and other health care workers in that Seattle Times piece should be ashamed of themselves, demanding bunny suits and Tyvek and full protective gear when not only is it unnecessary, it’s a waste of money. But more than that, and even more than the myopic view of the world that appears to assume everywhere is just like their tidy and neat and well-staffed and well-maintained medical center, it illustrates the continued “me me me” reaction people in the developed world have around Ebola.

…after all, you don’t hear anyone suggesting that full isolation suites be sent to Guinea, or Sierra Leone, or Liberia, so that those countries can revert to the simpler CDC recommendations, do you?

Paternalism, Procedure, Precedent: The Ethics of Using Unproven Therapies in an Ebola Outbreak

The WHO medical ethics panel convened Monday to discuss the ethics of using experimental treatments for Ebola in West African nations affected by the disease. I am relieved to note that this morning they released their unanimous recommendation: “it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention.” WHOsOnFirstThere are, of course, the common caveats about ethical criteria guiding the interventions, but ultimately the recommendation has saved me from a tortured “WHO’s on first”-style commentary.1 I’m sure we all appreciate that.

But just because the WHO recommendation follows what I’ve been arguing for the last 10-odd days doesn’t mean that the argument is actually over. In fact, as far as I can tell, it’s just getting worse, where worse should be interpreted to mean “even more people coming out of the woodwork to argue about ethics when they don’t have any familiarity with ethics.” Granted, Twitter is full of sample bias, but still. It is for this reason that I think it’s still important to post this statement on the ethics of providing unproven interventions that my husband (a real life bioethicist) and I worked on last week. We were side-tracked by needing to actually verify the science behind ZMapp, as well as the additional hands-throwing-up of hearing that ZMapp was provided for a Spanish priest after various US public officials stated there was none left to give.2 I hope that having this information out there–on why yes, it is ethical to provide unproven interventions in pandemic situations–is useful for answering the questions people who don’t have much background in ethics may have, as well as getting into the cultural zeitgeist for discussions not only about future pandemic situations but also discussions about disparate treatment of people from the Developed vs Developing World.3 [Cross-posted at The Broken Spoke.]


Paternalism, Procedure, Precedent
The Ethics of Using Unproven Therapies in an Ebola Outbreak

A “secret serum.” A vaccine. A cure. A miracle. With the announcement of the use of ZMapp to treat two Americans sick with the Ebola virus with apparently no ill effect, the hum and buzz on social media, commentary websites, and even the 24/7 news cycle, has become one of “should the serum be given to Africa? Will it?” The question has dominated for more than a week, and become something that the World Health Organization feels it needs to address by convening a panel of medical ethics experts to offer an analysis of what should be done.

And the general question about untested cures/vaccines in the event of a disease pandemic is an important one; there are already guidelines for what kind of treatments can and will be made available during a flu pandemic, and it seems quite sensible that a guideline be developed for all potential pandemic pathogens. However, it isn’t a question that is relevant in the current context, because we are already past that.

While people may be stating “should the serum be made available?” that’s not the question being asked.
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  1. For other commentary on the committee composition, see Udo Schuklenk’s short, sweet, and to the point commentary; you can also read his reaction to their statement here. []
  2. After it was confirmed that the Spanish priest received ZMapp, ]
  3. Again, to clarify: This was finished on Saturday afternoon. Obviously, in that time frame, we have learned that a third Westerner was given ZMapp, it was released to two West African doctors, and WHO’s medical ethicspanel convened and–pleasantly–reached the same conclusion we did. This is merely a more detailed argument for the release of unproven interventions. []

Wielding a Red Pen: Correcting a Fear-mongering Ebola Piece with Facts

If you catch me on Twitter, or read the fantastic Red Ink, you might have seen my corrections and edits to the first page of a genuinely awful, fear-mongering piece on Ebola that was inexplicably published by Pacific Standard.1 You might have also realized why:

  1. I was forbidden from grading in red ink when I TA’d (“did you dip that in red ink?”);
  2. I was consistently voted most likely to become a doctor or teacher in those elementary school “most likely” contests.

Sorry about that. Well, at least the second one; handwriting has never been my strong suit. Due to said possibly challenging handwriting, I figured I would go ahead and expand on my comments here.2
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  1. Per policy, I won’t drive traffic to horrible pieces. You can find it on your own relatively easily. []
  2. Okay, most of this is taken from a Facebook rant the other day that accompanied a snapshot of the edits I did. I’m not sure if this counts as self-plagiarism or self-citing. []

The Flaw in “Where Did it Come From?!” Ebola Panic Narratives

I am an aficionado, if you will, of the mystery plague novel. I can probably place the blame for that somewhere between my father and the science fiction he raised me on, and Michael Crichton’s The Andromeda Strain.1 And of course, one of the key aspects of the mystery plague novel is the driving question of “where did it come from?” The thinking typically goes that if we know the plague origin, we can cure it, and a panicked rush to discover both origin and cure drives many (if not most) stories in the genre.

So it’s not too surprising to see the mystery plague origin pop up in the West Africa Ebola outbreak coverage. There seems to be a lot of concern about it’s unknown origins, how did the virus get from Central Africa to West Africa, and assertions that this must mean mutation of some sort.2

A quickly pulled together map showing the combined ranges of fruit bats mentioned in Hayman DTS, Yu M, et al., save straw-colored bats, along with the current Ebola outbreaks in West African countries.

A quickly pulled together map showing the combined ranges of fruit bats mentioned in Hayman DTS, Yu M, et al., save straw-colored bats, along with the current Ebola outbreaks in West African countries.

All of which, of course, is of limited accuracy to flat-out wrong. In fact, you don’t even need to know what you’re looking for to find this information; I was looking for an outbreak map when I came across this Emerging Infectious Diseases letter from 2012: Ebola Virus Antibodies in Fruit Bats, Ghana, West Africa. The authors of the letter found a relatively high proportion of EBOV-seropositive bats in a small sample size of mixed bat species across Africa.

Africa. Not Central Africa. Not West or South or Noth. Just Africa. Which is a big continent, but bats? They have wings. And while the EBOV-seropositive bats were largely not straw-colored fruit bats, which often migrate as far as 1550 miles/2500 kilometers, they did have a significant range.

It didn’t take terribly long for Ian Mackay3 to find a newer issue of EID reporting on testing Sierra Leone patient serum samples and finding a range of viral hemorrhagic diseases, including Ebola. Shortly after, he found a paper discussing EBOV antibodies in fruit bats in Bangladesh.

It isn’t a surprise that fruit bats are implicated in this current outbreak of Ebola, since they’ve long been considered a possible reservoir for the disease, and may also be the host. Nor is it terribly surprising that the bats have this large of a range, or even that as human settlement encroaches into the forest, there will be more spillover events. The bats, the humans moving into new habitat, the zoonotic virus spillovers; these are all part of the story of Ebola. It’s a story we’ve been piecing together for 38 years, because science is never so fast as it is in the books and movies, and it’s a story where the origin probably won’t inform the cure.

The mystery plague origin is one that appeals, and it’s easy to write. It plays into books and movies, people know the expected narration, and there’s a thrill to it; “is this the one?” as speculation for people who don’t really have to worry about if “this is the one.” It also ignores science and evidence, and turns real life tragedy into an adrenaline-based fictional story for reading before bed, erasing the victims, from that first family who died in December 2013, to those who died just a few minutes ago.

  1. I was always bitter about the differences between book and movie, moreso than just about any other adaptation. []
  2. I’m not linking because I refuse to drive traffic to bad science. It’s not hard to find the stories, if you know where to look. []
  3. He’s the real deal. If you really want to understand viruses, find a virologist to throw questions at. I recommend Dr. Mackay, but I’m biased–he answers my questions, after all. []