I have just returned from Liberia with a group of physicians and health activists. We are heading back in a few days. The country is in the midst of the largest ever epidemic of Ebola haemorrhagic fever. It’s an acute and brutal affliction. Ebola is a zoonosis – it leaps from animal hosts to humans – which is caused by a filovirus (a thread-like virus that causes internal and external bleeding). It was first described in 1976 in rural Congo, not far from the Ebola River, as an acute-onset syndrome characterised by complaints of weakness, followed by fever and abdominal pain. Patients became dehydrated as a consequence of fever, vomiting and diarrhoea. Many became delirious and started to haemorrhage from the mouth, nose, vagina, at sites where intravenous lines had been placed, even from the eyes.
The Ebola virus is terrifying because it infects most of those who care for the afflicted and kills most of those who fall ill: at least, that’s the received wisdom. But it isn’t clear that the received wisdom is right. It’s true that many of those who have died were medical professionals. The 1976 epidemic, for example, started in a mission hospital where Belgian nuns worked as nurses alongside Congolese colleagues. But even then it was known that the virus could be transmitted as the result of a failure to follow the rules of modern infection control: the nurses reused needles and did not wear gloves, gowns or masks, which were all in short supply. Nor did the nurses, still less their patients, receive what in Brussels, Boston or Paris would count as modern medical care.
Farmer, P., 2014. Diary. London Review of Books [Online] vol. 36 no. 20 pp. 38-39. Available from http://www.lrb.co.uk/v36/n20/paul-farmer/diary [Accessed 30 October 2014].