Category Archives: challenges fighting Ebola

Wish to Do More in Ebola Fight Meets Reality in Liberia

What is like to work at an Ebola Treatment Unit in Liberia?  What type of care does a patient receive?  Here is a link to a New York Times article that answers those questions through a survivor’s success story:  Wish to Do More in Ebola Fight Meets Reality in Liberia

For days, the medical team at the International Medical Corps facility worried that Ms. Sayon would not survive. Credit Daniel Berehulak for The New York Times

“If your child asks you for bread, would any of you give him a stone?” -Matt. 7:9

Corrie Billboard

Ebola is not about numbers.  It is about people.  Numbers help to tell the story of the progression of a terrible disease like Ebola, but behind every number is a person, like Corrie.  Corrie is my neighbour in Yekepa, Liberia.  She is an exceptionally bright 17-year-old with dreams of becoming a doctor as seen in this billboard on the road from Yekepa to Ganta in Nimba County.

It is very difficult for me as an expat, who was to return in mid-August to Liberia, to be forced to sit on the sidelines.  At times, I feel so helpless.  It is so frustrating to see the sloth-like slowness of governments responding to the Ebola epidemic in West Africa, and with such meager aid.  .

Liberia needs your help.  That is the simple message.  But it is not a message to go in one ear and out the other.  It is a message that requires a tangible, helping, and GENEROUS action.

Jesus said, “If your child asks you for bread, would any of you give him a stone?” (Matt. 7:9)   That’s where we are at right now, folks, as Liberia, the second poorest country in the world, is fighting the biggest Goliath of viruses ever seen.  Liberia is asking for help and it is only getting bread crumbs from the international community.  Liberia’s health care system cannot handle Ebola.  There is no contest at all.
You can help Liberia:

1.  Lobby your own country to contribute sizable resources, medical personnel, field hospitals, and logistics.  Nimba County only has one ambulance and yet places like Yekepa are an 8.5 hour drive away.  More Jeep ambulances are needed to get through the mud of the rainy season and the dust and potholes of the dry season. Liberia needs bread loaves not more bread crumb aid.

2.  Donate to MSF (Doctors Without Borders), Samaritan’s Purse, or SIM (Service In Mission).  You can donate online.  In a week you will receive a tax receipt but more importantly, you have helped to save lives.

3.  Tell others about Ebola and Liberia, Sierra Leone, Guinea, Nigeria, Senegal, and the D.R. Congo.  Educate yourself and then educate others.

4.  Most importantly, PRAY.  Pray for Liberia, but also pray for yourselves that you will not be like the Rich Man from the story of Lazarus the beggar.  If you own a car and a house, you are in the top 10% of the world’s richest people.  That carries a huge responsibility on your part, because all that you have is from God, and one day you will have to account to Him about what you used your wealth for.  Did you use it for yourself or for others?

Finally, remember Corrie, my neighbour.  Give her a future and give her beautiful country of Liberia a future too.  Do something.  Listen to Matthew West’s “Do Something” and then do something because has given you this opportunity:

When you bless others, you will be blessed so much more.

Aug. 7, 2014 House Foreign Affairs Subcommittee on Africa and Global Health

Why didn’t the world listen?  On Aug. 7, 2014, Ken Isaacs presented a brutal picture of Ebola in Liberia and in the world if it was not soon contained.  I don’t know why the world did not listen.

Thank you Ken Isaacs for trying and for telling the truth.

Here are some excerpts from Ken Isaacs testimony to the House Subcommittee:

Ebola Experts Warn of an African ‘Apocalypse’

At an emergency hearing Thursday, leaders of the fight against Ebola gave updates on the situation in Africa and the future of the deadly disease’s possible spread.
At an emergency hearing in Washington on Thursday afternoon, major players in the fight against Ebola in West Africa addressed the outbreak that has stolen the lives of more than 900. Leaders from health agencies and humanitarian efforts addressed the need for increased support, as one called the current state of affairs in West Africa “apocalyptic.”

Rep. Christopher Smith, the chairman of the House Foreign Affairs Subcommittee on Africa and Global Health, opened the hearing by urging the speakers to clear the air on a “grave issue” that has “gripped” the mass media for weeks. “We hope to gain a realistic understanding of what we’re up against while avoiding sensationalism,” he told the floor. Here are the takeaways:

The outbreak is getting worse.

It’s already an unprecedented outbreak, CDC Director Dr. Tom Frieden says, and the number of infected and killed by Ebola will likely soon outnumber all other Ebola outbreaks in the past 32 years combined. According to the CDC, there have already been more than 1,700 suspected and confirmed cases of Ebola in West Africa, and more than 900 deaths—numbers that Frieden later called “too foggy” to be definitive. Ken Isaacs, the vice president of Program and Government Relations for Samaritan’s Purse, painted an even bleaker picture. According to the World Health Organization, West Africa has counted 1,711 diagnoses and 932 deaths, already, which could represent only a small fraction of the true number. “We believe that these numbers represent just 25 to 50 percent of what is happening,” said Isaacs.

The atmosphere in West Africa is “apocalyptic.”

In a six-hour meeting with the president of Liberia last week, Isaacs said workers from Samaritan’s Purse and SIM watched as the “somber” officials explained the gravity of the situation in their countries, where hundreds lie dead in the streets. “It has an atmosphere of apocalypse,” Isaacs said of the Liberia Ministry of Health’s status updates. “Bodies lying in the street…gangs threatening to burn down hospitals. I believe this disease has the potential to be a national security risk for many nations. Our response has been a failure.” Isaacs says that the epidemic is inciting panic worldwide that, in his opinion, may soon be warranted. “We have to fight it now here or we’re going to have to fight it somewhere else.”

The international response has been disastrous.

Isaacs, head of the humanitarian agency for which Brantly worked, vehemently condemned the international community for a response that he considers both delayed and insufficient. “The disease is uncontained and out of control. The international response has been a failure,” he said. With three of the poorest nations in the world affected, West Africa is extremely ill-prepared for the disaster—a fact, Isaacs argued, that necessitates a stronger response. “The ministries of health in these countries do not have the capacity to handle this. If a mechanism is not found, the world will be effectively relegating the containment of this disease to three of the poorest nations in the world,” he said, adding later: “Is the world willing to let the public health of the world be in their hands?”

Doctors in the Ebola-infected countries are in desperate need of supplies.

Dr. Frank Glover, a missionary with SIM who also testified at the hearing, expressed frustration at the affected countries’ lack of personal protective gear (PPG), which he says is increasing the spread of infections significantly. Glover says the doctors and nurses in these areas, particularly Liberia, are “terrified” to enter the hospitals because of a lack of proper gloves, goggles, and gowns that are needed to protect them. “The No. 1 cause of infections in Liberia is lack of protective gear. It’s unconscionable that we’re asking them to take care of people without gloves. If we’re putting people on the line, we owe it to them to give them a fighting chance.”

The quarantined towns are in desperate need of other vital support systems.

Rep. Karen Bass, a standing member on Smith’s subcommittee who spoke with Liberian President Ellen Johnson Sirleaf, says the quarantined areas in West Africa are in desperate need of basic supplies like food and water. “Health care is a human right. We must ensure these countries have what they need to fight for it,” she said. Both Isaacs and Glover also expressed concern over the lack of education in West Africa about both the symptoms and proper response that should be taken in the wake of an infection. “A poster on the wall saying ‘Ebola kills’ isn’t going to do it,” said Isaacs. “They need education.” Grover cited the 14-year civil war in Liberia, which left millions illiterate, as one of the main roadblocks in educating the country.

The disease could spread to other countries.

Isaacs, whose warnings to Congress about the urgency for a better response prompted Thursday’s meeting, says he is gravely concerned about the future. After first observing the outbreak in April, he’s watched the disease spread furiously across West Africa with little to no effective international support. “I think we are going to see death tolls in numbers that we can’t imagine,” said Isaacs. “If we do not fight and contain this disease, we will be fighting this and containing this in multiple countries across the world. The cat is, most likely, already out of the bag.”

Source:  Ebola Experts Warn of an African ‘Apocalypse’

Selected Field Notes from Liberia Situation Report 118 Sept. 10, 2014

A new ETU will soon be accepting patients in Bong County.  Save the Children found 40 vulnerable children living in a school in Margibi County whose parents had died and who were rejected by their community.  More ambulances are needed in Nimba County.

Here are selected excerpts from highlights of Liberia Ebola SitRep 118 Sept 10 2014

Bong County
• The new ETU has been officially turned over to the County Authority and County Health
Team. It is awaiting admission of patients
Lofa County
• Total number of patients in Foya Case management center (FCMC)- 32
Montserrado  County (including Monrovia)
• 1828 (98%) of the 1859 contacts under follow up were seen by 4 contact tracing teams.
• Of the 1859 contacts being followed, 2 became symptomatic today.
• Of the 1859 contacts being followed, 87 completed 21 days today.
• Of the 22 deaths reported 9 were from ETUs and 13 from the communities.
• Total admission at Redemption Holding Unit – 28.
• Red Cross made available 12 contact tracers to be used in our current tracing structure. They will be assigned in New Kru Town, where there are more than 300 contacts as of today.
• Health promotion section completed verification of gCHVs to be trained by UNICEF on Friday of this week
• 30 volunteers from SEARCH, a local NGO, were trained in contact tracing
Margibi County
• 147 contacts completed 21 days of follow-up
Save the Children discovered (15) families in the Mamba-Kaba and Kakata Districts with a total of 40 vulnerable children whose parents have died from Ebola.
• Affected children, rejected by the Community in Dolo Town, are living in a school building
Nimba County
• Africare donated $100. USD worth of scratch cards to CHT to strength communication and 20 gallons of gas as monthly support to each of the District Health Teams for Surveillance/Case tracing and specimen collection
• The Surveillance/case tracing and psychosocial teams reunited one Ebola survivor with her family and community people in Cooper Village
Issues & Constraints
• PPEs nearing stock-out in the County
The one ambulance for the transport of confirmed cases to the ETUs in Monrovia is inadequate
CAN ANYBODY DONATE 3 AMBULANCES FOR NIMBA COUNTY?

More Ebola patients than room at Ebola Clinics in Liberia

Here is a Wall Street Journal article:

Deadly Disappointment Awaits at Ebola Clinics Due to Lack of Space

Sick Patients Are Turned Away; At Least 1,515 Hospital Beds Needed in Liberia, Sierra Leone and Guinea

By Drew Hinshaw in Monrovia, Liberia, and Betsy McKay in Atlanta

Sept. 7, 2014 8:55 p.m. ET

Workers wearing protective gear stand inside the contaminated area at a hospital run by Doctors Without Borders in Monrovia, Liberia, on Sunday. Agence France-Presse/Getty Images

Milton Mulbon arrived in a taxi at the gates of an Ebola clinic in Liberia’s capital, Monrovia, with his 24-year-old daughter, Patience, bleeding in the back seat. Guards turned them away.

“They’re telling me no space?” he protested, the taxi parked nearby. “She’s lying down in there almost at the point of death!”

Taxis, ambulances, and even men pushing their sick in wheelbarrows are crisscrossing Monrovia, looking for an open bed in West Africa’s overbooked Ebola clinics, health-care workers say. Sometimes they get in, through persistence and good timing. Mostly they don’t.

Liberia, Sierra Leone, and Guinea—the three nations bearing the brunt of the outbreak—need at least 1,515 hospital beds for the more than 20,000 people who could be infected before the outbreak can be curtailed, according to World Health Organization estimates. At present, there are only a few hundred beds. International support has been slow to come and is just beginning to address this specific problem, with the U.S. promising 1,000 additional beds in a new aid package.

The shortage is so dire that ambulances have picked up people raging with the symptoms of Ebola, driven them around for hours, then dropped them back at home, medical workers say.

The odds of surviving Ebola at home, without intravenous hydration, are slim. Along the way, the sick often infect their families. That is creating ever more Ebola patients arriving at the gates of overcrowded clinics.

Some, like Mr. Mulbon, collect a bag of sanitary products and painkillers. His daughter, the mother of two boys, died within hours of receiving it. “She was helpless,” Mr. Mulbon said.

Health workers complain they can’t throw down mattresses fast enough. Some organizations, including Doctors Without Borders, are asking Europe and the U.S. to send disaster relief—even military personnel—to help West Africa get ahead of an Ebola epidemic that has been under way since December.

“Many months into an Ebola outbreak, we’re in the position of turning away patients who look like they have Ebola,” said Henry Grey, a Doctors Without Borders emergency coordinator. “That’s an indication of the direct failure of the international community.”

Ebola patients at the hospital. Agence France-Presse/Getty Images

A few foreign governments are beginning to respond. On Friday, the European Union said it would pledge €140 million ($181.3 million) to the three hardest-hit countries, €97.5 million of it going directly to their national budgets.

“The situation is going from bad to worse,” said Kristalina Georgieva, the EU commissioner for international cooperation, humanitarian aid and crisis response.

On Thursday, the U.S. Agency for International Development said it would build 10 Ebola treatment centers with 100 beds each, part of a nearly $100 million aid package to the three nations. USAID Administrator Raj Shah said the agency is moving to fund and deliver beds and several hundred critical-care personnel “as quickly as possible.”

The challenge isn’t just delivering beds. It is training staff, said Jeremy Konyndyk, director of USAID’s Office of U.S. Foreign Disaster Assistance, which is coordinating the U.S. government’s response.

“We could get a bunch of tents and beds in here in no time,” said Mr. Konyndyk. “The hard part is who staffs those beds.”

It takes between 200 and 250 health workers to treat 80 Ebola patients, according to the World Health Organization. USAID and the U.S. Centers for Disease Control and Prevention are both looking to recruit and train health workers to take care of Ebola patients. The CDC program will begin in late September.

The trouble is finding doctors and nurses willing to treat a deadly disease—with no vaccine or formally approved treatment. In addition, the training is challenging, because they have to learn to care for patients while wearing cumbersome protective gear and meticulously guarding their safety.

Meanwhile, USAID is giving sick people who can’t find a free bed a home treatment kit. It includes bleach and disposable gloves, Mr. Konyndyk said.

An estimated 3,685 people have been sickened by the latest outbreak, WHO says. About half have died.

But those numbers represent a small portion of the true toll, the organization says. Because most Ebola victims are suffering at home, their deaths or recoveries aren’t noted in any official tally. Now, as clinics open, some of those who have been fighting the virus at home are beginning to show up.

A WHO clinic opened late last month in what had previously been a dental office. It was meant for 30 patients. But on a recent Tuesday, it was overbooked, with several patients sprawled out on the concrete floor, including children. The hospital’s director was reviewing a list of patients in the car on her way to brief Liberia’s Health Ministry.

Dr. Anne Deborah Omoruto Atai counted 44 patients. It was an improvement from a week prior when they had more than 70 people in the clinic with patients dying on the ground, she said.

“It’s difficult to give them adequate care when they’re lying on the floor,” she added. “We just leave it to natural selection.”

Across town, workers at the Doctors Without Borders clinic were assembling a 400-bed tent hospital in the mud and rain. The field clinic they already have, with 125 beds, uses 350 head-to-toe body suits, 25,000 liters of water and 2,500 gallons of bleach—every day.

Taxis pull up here so frequently that both Doctors Without Borders and the CDC worry the taxis themselves have become conveyors of the virus. The disease spreads through bodily fluids and if a healthy person were to put his hands into the sweat left by previous passenger, it could spread—and in a way that would be impossible to trace.

“We’re hearing stories of people taking four taxis across town,” said Caitlin Ryan, communications officer for Doctors Without Borders.

Outside the clinic, two taxis pulled up at the same time. Once again, there wasn’t any room for the sick. So a shouting match ensued.

“We are all Liberians,” screamed a man who had brought a sick girl in his cab.

“They think we don’t want to help,” said Randy Tomanne, one of the guards. “Their child is ill. There’s no other way you’d feel.”

Later, a third taxi arrived. The driver said he had been paid $10 to take a family with a 6-year-old girl lying across their laps to a clinic. He had no idea it was an Ebola clinic.

“He just said the hospital,” said the driver, Ibrahim Somir, while a man in a head-to-toe plastic suit sprayed down his taxi in bleach.

Before leaving to try his luck elsewhere, the girl’s uncle shrugged off the risk he’d put the taxi driver in: “What else should we do?”

MOHSW Situation Report comments help to understand what the war on Ebola is like

Bong Highlights
• Community still apprehensive of the contact tracing teams due to denial
• Limited manpower to contain the outbreak
• Lack of risk allowance for Ebola Emergency teams
• Lack of treatment center
• Health workers at the two (2) Hospitals have not returned to work
• Increased community deaths
• Twenty-three contacts were not reached due to resistance from community
• Limited logistics (vehicles)
• Limited rain gears for teams
BomiHighlights
• Bomi County burial team today buried one Ebola confirmed case from the Nyanla community in
Tubmanburg.
• The Deputy Chief of the Armed Forces of Liberia along with US embassy military staff visited the BCHT today and assured health workers that all is well, amidst rumors of gun fire in Bomi which
turn out false
• The two confirmed cases in Tubmanburg are still awaiting transfer to ELWA ETU/Monrovia
Grand Cape Mount Highlights
• Contact tracing team has not been trained
• No funding for gCHVs to follow up on contacts
• Staffs in need of case management training
• Inadequate supplies and material including rain gears

Best article I’ve read so far on reasons why Ebola has gotten out of control

Seven reasons why this Ebola epidemic spun out of control

If you’d asked public-health experts a year ago whether an Ebola outbreak could turn into an epidemic spread across borders, they probably would have confidently told you that there was no way: the virus isn’t transmitted very easily, and people usually get so sick and die so quickly, it has little opportunity to infect a new host.

Then came 2014, the year that is rewriting  the Ebola rulebook. More people have died from the virus in the last nine months than the total number of deaths since the first recorded outbreak in 1976. The virus has also popped up in enough countries — first Guinea, then Liberia, Sierra Leone, Nigeria, and now Senegal — that the cases add up to the world’s first Ebola epidemic.

 

eboal chart

How did Ebola spiral so badly out of control?

There are a few obvious features that have made this outbreak different and more violent: the virus hit unprepared countries in West Africa that had no previous experience with Ebola, and it quickly moved to densely populated urban hot spots (as opposed to isolated, rural areas where the virus typically popped up in Central and East Africa).

But there are other more subtle factors that are helping Ebola survive today for the first ever Ebola epidemic. They hold lessons for public health responses of the future on how to better contain such a deadly disease.

1) Public-health campaigns started too late and didn’t reach enough people

In Uganda, as soon as an Ebola case is identified, public health officials overwhelm all streams of media with messages about how to stay safe. People won’t leave their houses out of fear of infection, and they immediately report suspected cases to surveillance officials. It’s one of the reasons Uganda has successfully stamped out four Ebola outbreaks, even ones that have turned up in urban areas.

Dr. Anthony Mbonye, Uganda’s director of health services, said this aggressive public-health awareness campaigning didn’t start soon enough in the current West African outbreak. “They responded too slowly to make the community aware of the disease,” he told Vox.

Ishmeal Alfred Charles, who has been working on the Ebola front-line in Freetown, Sierra Leone, said there was little awareness about Ebola until late July, about four months after the first suspected cases emerged in the country.

charles

Ishmeal Alfred Charles washing his hands in Freetown, Sierra Leone. (Photo courtesy of Charles.)

“It only got serious when we lost Dr. Sheik Umar Khan,” he said of the prominent local Ebola physician whose July 29 death made international headlines. “That’s when the political wheels (started turning) and the government started putting resources together to help.”

Charles also noticed that, in the initial periods of the outbreak, most of the public-health messaging about Ebola was concentrated on mainstream media, including TV and radio, so it was mainly reaching the middle- and upper-classes of the country.

“Not a lot of people have access. We’re talking about people who are living in very poor communities so they basically have little or no Internet or TV or to radio.”

For this reason, by the summer, Charles — who works as a program manager with the Catholic aid agency Caritas — took to the streets to spread the word. “We get people out into small communities to talk to people (about Ebola),” he said. “We gave megaphones to our community volunteers and told them to go public places, to markets, to houses.” Of course, the message came too late and Ebola has now reached almost every district in Sierra Leone.

2) The countries affected by Ebola have some of the world’s lowest literacy rates

Health campaigning and raising health literacy is not easy in places where people can’t read. As you can see in the map below, the countries that are now most affected by Ebola  — Guinea, Liberia, and Sierra Leone, circled in green — are also the ones with the lowest literacy rates in the world.

literarcy

Adult literacy by country. (Map courtesy of Uncesco.)

3) There’s a strong Ebola rumor mill

The low levels of literacy, poor access to health information, and delayed public-health campaigning only fueled the Ebola rumor mill. There’s no proven treatment for Ebola but lies about supposed cures have spread fast. One persistent myth has been that hot water and salt can stop Ebola. Others suggest faith healing or hot chocolate, coffee and raw onions will stamp out the virus. Homeopathy has also emerged as a supposed Ebola crusher.

In the US, the the FDA has warned consumers to watch out for Ebola quackery, while African public health officials are getting creative to debunk the lies. The electro-beat song ‘Ebola in Town‘ was created to set the record straight about how to avoid the illness. “Ebola, Ebola in town. Don’t touch your friend! No kissing, no eating something. It’s dangerous!”

In Lagos, Nigeria, the local government resorted to hiring a “rumor manager” to help wage a war on the misinformation that is swirling about. “The rumors themselves can actually cause a lot of damage,” Lagos state Commissioner for Health Jide Idris told reporters. And he has reason to be worried. If this disease starts to take off in Lagos – Africa’s largest city, population 22 million – some say this could “instantly transform this situation into a worldwide crisis.”

4) Sierra Leone, Liberia, and Guinea are some of the poorest countries in Africa with fragile health systems

Before the Ebola outbreak, the three countries hardest hit this year had very weak health systems and little money to spend on health care. Less than $100 is invested per person per year on health in most of West Africa and these countries record some of the worst maternal and child mortality rates on the planet.

ebola

So resources were already extremely constrained when Ebola hit.

Daniel Bausch, associate professor at the Tulane University School of Public Health and Tropical Medicine, who is working with the WHO and MSF on the outbreak put it this way: “If you’re in a hospital in Sierra Leone or Guinea, it might not be unusual to say, ‘I need gloves to examine this patient,’ and have someone tell you, ‘We don’t have gloves in the hospital today,’ or ‘We’re out of clean needles,’ – all the sorts of things you need to protect against Ebola.”

He’d walk into the hospital in the morning and find patients on the floor in pools of vomit, blood, and stool.

In these situations, local health-care workers — the ones most impacted by the disease — start to get scared and walk off the job. And the situation worsens. In Liberia, nurses have gone on strike because of Ebola. When Bausch was in Sierra Leone in July, he and other doctors were left scrambling during a nurse strike, too. “There were 55 people in the Ebola ward,” he said, “and myself and one other doctor.”

He’d walk into the hospital in the morning and find patients on the floor in pools of vomit, blood, and stool. They had fallen out of their beds during the night, and they were delirious. “What should happen is that a nursing staff or sanitation officer would come and decontaminate the area,” he said. “But when you don’t have that support, obviously it gets more dangerous.” So the disease spread.

5) These countries have spotty disease surveillance networks

These countries also had spotty disease surveillance networks. “We’re dealing with countries with very poor health systems to start with,” said Estrella Lasry, the tropical medicines adviser for MSF. “That goes from setting up surveillance systems through setting up networks of community health workers.”

ebola

An MSF medical worker feeds an Ebola child victim at an MSF facility in Kailahun, Sierra Leone. (Photo by Carl de Souza/AFP.)

By contrast, places that have been able to fight off the virus in the past — like Uganda — have robust disease surveillance systems, said Lasry. That means that suspect cases can be tested and reported on quickly, and that information can spread through the surveillance network in the country as fast as possible so that prevention measures and public-health campaigns are implemented right away.

While there’s no way to completely prevent another outbreak from happening, she said, “We can prevent spread by putting the appropriate measures in place so we can identify Ebola and stopping transmission as quickly as possible.”

 

6) The international community responded painfully slowly

“Ebola is a very preventable disease,” said Lawrence Gostin, a health law professor at Georgetown University. “We’ve had over 20 previous outbreaks and we managed to contain all of them.”

But this time, the international response just wasn’t there. “There was no mobilization,” Gostin said. “The World Health Organization didn’t call a public health emergency until August — five months after the first international spread.”

Part of the reason for the slow response can be attributed to cuts at the WHO that have left the agency understaffed and under-resourced.

But Gostin said this epidemic has also revealed how poorly designed and unready our global systems seem to be for epidemics. In an article published today in the Lancet, he offered this wake-up call for future outbreaks:

“How could this Ebola outbreak have been averted and what could states and the international community do to prevent the next epidemic? The answer is not untested drugs, mass quarantines, or even humanitarian relief. If the real reasons the outbreak turned into a tragedy of these proportions are human resource shortages and fragile health systems, the solution is to fix these inherent structural deficiencies.”

7) The countries most affected — and our world — is increasingly interconnected.

The most worrying vector of spread in any epidemic or pandemic is the traveler. And in this outbreak, the three worst-hit countries shared very porous borders, where the disease could easily hop across in people moving around for work or to go to the market.

But Dr. Bausch said this West African outbreak should also serve as a reminder that we live in an increasingly interconnected planet.

“Even from the most remote areas of our world, people are getting more and more connected,” he said, “sometimes nationally, sometimes internationally.”

This is the new normal, he said, and it should rewrite how public health officials think about Ebola going forward.

“The various different features of this outbreak —where we have an outbreak cutting across international boundaries, involving urban areas — we can think of this as the new norm and we have to be concerned this can happen every time because of the connectivity of places.”

http://www.vox.com/2014/9/4/6103039/Seven-reasons-why-this-ebola-virus-outbreak-epidemic-out-of-control