Friday, April 08, 2005

Marburg in Angola

Ever since reading The Coming Plague, medical journalist Laurie Garret's phenomenal discourse on the sorry state of the world's health-care systems with regard to the proliferation of virulent virus- and bacteria-borne diseases, I have been interested in all things epidemiological.

Now Marburg virus, a haemorrhagic-fever virus in the same family as Ebola, has emerged in Angola, with devastating effect. This is the latest report from the World Heath Organization:


As of 7 April, 205 cases of Marburg haemorrhagic fever have been reported in Angola. Of these, 180 have died. Zaire Province has reported its first 6 cases, bringing the number of affected provinces to seven, all concentrated in the north-western part of the country.


Mobile surveillance teams in Uige were forced to suspend operations yesterday when vehicles were attacked and damaged by local residents. As the situation has not improved, no surveillance teams were operational today in this province, which remains the epicentre of the outbreak.


WHO staff in Uige were notified today of several fatalities but teams were unable to investigate the cause of death or collect the bodies for safe burial. Discussions have been held with provincial authorities to find urgent solutions.


The dramatic symptoms of Marburg haemorrhagic fever and its frequent fatality are resulting in a high level of fear, which is further aggravated by a lack of public understanding of the disease. Moreover, because the disease has no cure, hospitalization is not associated with a favourable outcome, and confidence in the medical care system has been eroded.


WHO is familiar with such reactions, which have been seen during previous outbreaks of the closely related Ebola haemorrhagic fever. Two medical anthropologists are already in Uige and will be joined shortly by experts in social mobilization from Angola, the Democratic Republic of Congo, and Mozambique. Public compliance with control measures is not expected to improve in the absence of intense campaigns to educate the public about the disease.


In African countries, the single most important factor in controlling viral haemorrhagic fevers is the engagement of affected communities as partners in control. To achieve this engagement, local belief systems about the causes of disease and traditional rituals for mourning the dead must be respected. When the public understands and accepts a few simple messages – avoid contact with blood and other fluids when caring for the ill, don’t touch bodies of the deceased – transmission within the community can be stopped and the outbreak brought under control.


International appeal


Specialized international staff and equipment have been deployed rapidly and measures are beginning to have an impact. Control of the outbreak will require intensified and sustained technical support from multidisciplinary teams, and additional materials and supplies. Provision of adequate personal protective equipment is a particularly urgent need. Increased field coordination of technical, operational and logistic support is likewise needed.


Today, WHO has launched an appeal, through the United Nations, for funding to support the emergency response to this outbreak. WHO needs US$ 2.4 million to support the Ministry of Health, Angola to intensify ongoing operations in the field.
To reduce the risk of transmission in the community, priority activities include intensive social mobilization and health education in the towns and villages of Uige Province. To reduce the risk of transmission in health care facilities, priorities include the provision of personal protective equipment for front-line staff and essential supplies for infection control, including disinfectants. Additional activities that urgently need to be strengthened include the early detection and isolation of cases and the tracing and follow up of contacts.


My reactions:

1) 180 of 205 is a very high death rate, even for Marburg.

2) Locals fear hospitals because they see family, friends, and community members go there with headaches and leave as corpses. Therefore, they want nothing to do with modern medicine and the associated WHO/international surveillance teams whose caravans they attack. This is a stark case of ignorance claiming lives.

3) WHO needs $2.4 million to support its Angolan field operations, while battling the virus is as much about battling the people to educate them as it is about not touching bodily fluids or corpses. Which raises the question: While Marburg and Ebola are rare, wouldn't it be worth WHO/international-community resources to educate villagers about the viruses before they break out? Maybe that education takes place. I don't know. But I doubt it. It's a resource problem, I'm sure. Hence the $2.4 million request.

(I can't fail to mention the directly related problem of educating legions of third-world peoples all over the world about drinking clean water and other sanitation techniques. And for that matter, finding, making available, or giving them clean water.)

4) Clearly, this is a fairly thin branch of a large tree that represents many, many problems in Africa (esp. sub-Saharan Africa), but it is indicative of the larger problem: The combination of corrupt or (physically and morally) absent national governments (Angola's civil war has left nothing but carnage, fear, and distrust), warring factions and their ruthless warlords, economic despair, and poverty poses the most daunting challenge the Western world has on its plate. And I suggest it is obligated to take on this challenge. Yet, the continuing devastation in Darfur and the Congo, as just two vivid examples, rarely find airtime on Western TVs or ink in Western papers.

The only reason we hear about Marburg is because it's the stuff of made-for-TV movies (think "bleeding from all orifices").

Everything else is too messy.

2 Comments:

Blogger ajmac said...

Sobering.

On the topic of providing clean water, this organization is one of many doing great work, and plans to commence its African operations in Kenya later this year.

http://www.healingwatersintl.org/flash.html

3:18 PM  
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