By Ivan Ngoboka. Photo: Ivan Ngoboka

Tomorrow, the World will mark the Tuberclosis (T.B) day. The day is used to build public awareness that TB remains an epidemic in much of the world, causing deaths of nearly one-and-a-half million people each year, mostly in developing countries.

In Rwanda, TB mortality rate currently stands at 10 people out of every 100,000 patients, according to the 2013 World Health Organisation report.

About 6,000 TB cases were registered countrywide in 2013. And 2,000 of them are in Kigali alone.

“We noticed that many people abandon the dosage because it’s tiringly long and this exposes them to mortality,” says Dr Michel Gasana, the head of TB division at Rwanda Biomedical Centre

Dr Olivier Manzi, a specialist in infectious diseases at the University Teaching Hospital of Kigali (CHUK), says they are currently using a drug combination that takes about 20 months to cure drug-resistant TB.

“A patient does not only take these drugs for 20 months, but also receives daily injections for the first six months, and this usually presents side effects like hearing impairment, blurred vision and kidney problems,” he says.

“We have had TB patients under treatment running out of patience and escaping from hospital increasing chances of spreading the disease,” says Dr Frederick Fundi Gatare, the medical director of Rutongo Hospital in Rulindo District.

“Because the cure of MDR-TB takes long, some patients become depressed for fear that the disease may never cure after all,” Gatare added.

Gasana says that many health facilities in the country still depend on old fashioned microscopes with low sensitivity to diagnose TB, making it difficult to effectively screen ailments like MDR-TB.

He adds that the country has few radiologists, about five or six, and most of them are concentrated around Kigali, reducing chances of diagnosing the disease through powerful machines like X-ray or C.T scan.

According to the World Health Organisation (WHO), TB is second only to HIV/Aids as the greatest killer worldwide. For instance In 2013, 9 million people fell ill with TB and 1.5 million died from the disease, and over 95% of them (deaths) occur in low-and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44. The statistics add that an estimated 550,000 children became ill with TB and 80,000 HIV-negative children died of TB in the same year. And it is the leading killer of HIV-positive people causing one fourth of all HIV-related deaths.

The report adds that in the same year, an estimated 480,000 people developed multidrug resistant TB (MDR-TB).

“However, the TB death rate dropped 45% between 1990 and 2013. An estimated 37 million lives were saved through TB diagnosis and treatment between 2000 and 2013,” the report notes.

What is TB?

According to WHO, “TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.”

“Shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, or kissing does not spread TB,” says Dr. Cory Couillard, who works in collaboration with WHO’s goals of disease prevention and control.

TB is common amongst individuals with weakened immune systems and HIV/AIDS sufferers. Statistics show that a person living with HIV is about 20 to 30 times more likely to develop active TB, resulting in 25 per cent of HIV-related deaths.

TB is largely driven by factors related to poverty, poor access to healthcare services, and limited awareness and education. Many sufferers of TB live in the poorest and most vulnerable communities such as migrants, miners, prisoners, drug users and sex workers.

The primary causes of DR-TB include inappropriate treatments, incorrect uses of anti-TB drugs and the use of poor-quality medicines.

“We must invest in basic research and research and development for new tools — diagnostics, drugs and vaccines — in order to reach people faster, treat them more quickly and ultimately prevent them from becoming ill with TB,” says Dr Luis Sambo, the WHO regional director for Africa.

Early treatment requires understanding the most common symptoms of TB. Active TB often presents with chest pains, weakness, weight loss, fever, night sweats and a cough with sputum and blood at times.

“A person should see a health care provider anytime they have a cough (especially with sputum) for longer than two weeks. An evaluation is needed in order to make sure that you do not have the actual disease,” Dr. Couillard adds.

TB is a treatable and curable disease. Active, drug-sensitive TB is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support by a qualified health care worker or trained volunteer.

Way forward

Gasana, however, mentions that government in recent years came up with various measures aimed at reducing TB mis-diagnosis; for instance, between 2012 and 2014, about 16 GeneXpert (highly sensitive TB detection) machines were procured and that plans are underway to procure one for every district hospital in the next three years .

“The good news is that unlike before, the World Health Organisation has now approved the use of the GenXpert machine even on children, so cases of mis-detection will greatly reduce.”

He added that they are planning to use a digital network system that can, for instance, help a doctor and laboratory technician share an X-ray report of a particular patient quickly, helping with interpretation and advising where necessary, regardless of distance.

Gasana remarks that the country has also acquired about 50 fluorescence microscopes, which have a 10 per cent higher sensitivity than ordinary ones, and that they are hoping to acquire 200 others over the next two years.

Rwanda has 89.6 per cent of treated TB cases, well above the WHO target of 85 per cent. However, late diagnosis and failure by patients to adhere to dosage instructions remains the biggest challenge.

According to the 2013 World Health Organisation Report, Rwanda ranks third lowest in the region on newly confirmed cases of MDR-TB, with 58 cases, behind Tanzania and Burundi with 42 and 24, respectively.

Kenya and Uganda have the highest cases, standing at 225 and 89, respectively.

Originally published at The New Times Rwanda (health@newtimes.co.rw)

The eye is our window to the brain – and there’s a lot we can tell from it

Irene Gottlob, University of Leicester

The human brain is the most complex arrangement of matter in the known universe. Through our five senses it “digests” vast amounts of information that allows us to see, hear, taste, touch and balance. It commands our muscles, it learns, remembers, hungers, loves and hates.

Understanding how the brain works is a major research challenge; thousands of scientists are studying it in the expectation that through greater understanding we can eventually overcome many tragic diseases and injuries.

What goes wrong during stroke or in dementia? What are the causes and genetics of brain disease, age-related hearing loss, motor neuron disease? What treatments will improve them and will psychological interventions help? Then there are the those who want to explore the brain, to find out how it ticks and how, for example, we see and read.

The eye is the only part of the brain that can be seen directly – this happens when the optician uses an ophthalmoscope and shines a bright light into your eye as part of an eye examination. It shows the innermost layer of the eye (the retina), and the nerve carrying visual messages from the retina to the brain (along the optic nerve) are visible in the back of the eye.

In many neurological diseases, such as multiple sclerosis or stroke, we can see changes in the optic nerve that provide a direct diagnosis. And if pressure in the brain increases, perhaps due to a brain tumour, we can see this as a swelling of the optic nerve. So changes in the back of the eye can be used in the diagnosis of high blood pressure, diabetes, glaucoma, age-related macular degeneration or genetic diseases, such as retinal dystrophies.

An immature retina

A new sophisticated method called optical coherence tomography (OCT) allows the retina to be measured with much more detail. We can see all ten retinal layers and scan them in a few seconds at almost microscopic resolution. OCT has greatly enhanced diagnosis and treatment of retinal and optic nerve diseases in adult patients. For example in glaucoma, loss of nerve fibres can be detected, and assist diagnosis and detection of progression.

Until recently it was not possible to examine children with OCT because they could not stay still for long enough. However, hand-held scanners are much more suitable for children. But there is little knowledge about what constitutes a “normal” retina in a child and of course things are also changing as children grow and develop.

At the University of Leicester Ulverscroft Eye Unit researchers are investigating normal and abnormal development of the retina and optic nerve as an aid to future diagnosis. They found that the retina is immature at birth. For example, the photoreceptors, the sensors in the retina which detect light, are very small at birth, but slowly grow and elongate by about 30 times, until the age of six.

Scientists can also follow the development and formation of the fovea (this is the central region of sharpest vision, made up of closely packed cones) and this shows that retinal and optic nerve development is not completed before young adulthood.

Abnormal photoreceptors

In several eye diseases the normal development of the fovea is slowed or halted. The photoreceptors remain small and the inner retinal layers do not migrate properly. This is called foveal hypoplasia. Disrupted development can occur in genetic diseases, for example in albinism, or in very early born premature babies.

In these children vision is reduced. Often they cannot hold their eye still and develop constant involuntary to-and-fro movements of the eyes, called nystagmus. In retinal dystrophies, the lining of the retinal layers is disturbed. Abnormal foveal development and retinal changes can be diagnosed very early with OCT. Early diagnosis can direct further exams and genetic investigations and help to avoid unnecessary examinations under anaesthesia.

The eye is the only part of the body where nervous tissue and vessels can directly be seen. This allows direct view of changes caused by disease. The direct view of the retina and optic nerve make the eye extremely well suitable for research, for example to observe maturation of nervous disease and changes in neurological disease.

This article was originally published on The Conversation.
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Kidneys are amazing for all they do, be sure to look after yours

By Christine Carson, Harry Perkins Institute of Medical Research and Aron Chakera, University of Western Australia

Tucked away just below your ribcage near your spine are two bean-shaped organs known as the kidneys. And when they’re quietly getting on with their job, it’s easy to forget they’re there and how important they are. But their absence, or even less-than-optimal performance can have dire consequences.

Kidneys are a feature-packed, highly efficient filtration and waste elimination system as well as the source of some essential hormones and vitamins. When all is said and done, the “factory-fitted” system for all they do beats alternatives for efficiency and convenience. They’re compact, built-in, self-contained, portable and low maintenance.

About 1,500 litres of blood pass through the kidneys each day, through a series of highly-regulated pumps and channels. Essential nutrients and water are reabsorbed and the waste products created by our cells are removed in volumes ranging from as little as 500 millilitres to as much as ten litres, in the form of urine.

Together with the bladder, which acts as a mechanism to batch this output, kidneys are the ultimate personal waste disposal system, requiring little maintenance. In fact, you could say the greatest inconvenience they pose is the need to occasionally quickly locate “conveniences”.

When things go wrong

Although the list of conditions causing kidney disease is long, dietary and other lifestyle issu

Health Check: why do some people feel the cold more than others?

By Duncan Mitchell, University of Western Australia; Andrea Fuller, University of the Witwatersrand, and Shane Maloney, University of Western Australia

When HMS Beagle docked at the southern tip of Tierra del Fuego, Charles Darwin remarked on the capacity of the locals to deal with cold:

A woman, who was suckling a recently born child, came one day alongside the vessel and remained there out of mere curiosity, whilst the sleet fell and thawed on her naked bosom, and on the skin of her naked baby.

Japanese pearl divers dive for long periods in cold water without the comfort of wetsuits, whereas many of us whimper as the waters of the relatively warm Pacific or Indian Oceans reach our midriff.

Why is there such variation in our reaction to cold?

The perception of cold begins when nerves in the skin send impulses to the brain about skin temperature. These impulses respond not only to the temperature of the skin, but also to the rate of change in skin temperature.

So we feel much colder jumping into cold water, when skin temperature drops rapidly, than after we have stayed there for a while, when our skin temperature is low but constant.

The burst of nerve impulses generated by falling skin temperature provides early warning of an event likely to cause body core temperature (the temperature of the internal organs) to fall. If unchecked, a fall in body core temperature can result in lethal hypothermia.

In healthy people, physiological systems prevent hypothermia from occurring. Impulses from the skin arrive at the hypothalamus, a brain area responsible for controlling the internal environment of the body, which generates instructions in the nervous system that prevent a drop in body core temperature.

Nervous impulses sent to muscles generate extra metabolic heat through shivering. Blood vessels that would otherwise transport warm blood from the internal organs to the cold skin, where the blood would lose heat, constrict, constraining most blood, and its heat, to the internal organs.

Impulses arriving at the cerebral cortex, the part of the brain where reasoning occurs, generate information about how cold we feel. These combine with impulses arriving from the limbic system, responsible for our emotional state, to determine how miserably cold we feel. These feelings motivate us to perform certain behaviours, such as curling up or putting on more clothes, and to complain.

Feeling cold is not the same as being cold. Jumping into a cool swimming pool feels cold, but it can cause body core temperature to rise because of the warm blood retained in the core. Body temperature can stay elevated for up to an hour.

Many of us also have felt cold at the beginning of a fever, when the body core temperature starts to rise. During a fever, the nerve circuits that control body temperature are reset to a higher level, so the body responds as if it is cold until its temperature stabilises around that higher level.

While fever indicates a problem, is there anything wrong with feeling excessively cold rather than actually being cold?

Some of us have the misfortune to suffer from Raynaud’s phenomenon, a condition in which the blood flow is too low to keep the fingers and toes warm.

Feeling excessively cold during pregnancy, when the foetus acts as a small furnace, may be a symptom of low thyroid hormone activity, needing hormone supplementation.

But some healthy people can feel colder than do others in the same environment. Women often report that they feel colder than men in the same environment. This is probably because they have a lower skin temperature, a consequence of more subcutaneous fat and the hormone oestrogen.

Some of us may inherit feeling excessively cold. A study of twins found that the prevalence of the feeling of cold hands and feet is highly heritable, implying a genetic basis for exaggerated temperature perception.

Some of us also may feel cold simply because of how others close to us look, a phenomenon called “cold contagion”. In one study, healthy volunteers felt colder if they were shown videos of actors pretending to be cold than if the actors pretended to be warm. The temperature of the volunteers’ hands dropped as the blood vessels to their hands constricted, even though they were not in a cold environment.

Most of us who are healthy but claim to feel excessively cold, however, have only ourselves to blame. Unlike Darwin’s Fuegians, we have habituated ourselves to feeling comfortably warm. In the developed world we rarely expose ourselves to cold, letting expensive clothing protect us from outdoor cold and letting power companies warm our living and working spaces.

Allowing power companies to do the work that our metabolism used to do when we experienced cold may actually contribute to obesity. We’d probably all be much better off if we spent more time being cold.

This article was originally published on The Conversation.
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Happy 50th anniversary to cisplatin, the drug that changed cancer treatment

By Nial Wheate, University of Sydney and Michael Apps, University of Sydney

This year marks the 50th anniversary of cisplatin’s accidental discovery as an anti-cancer drug. Despite its horrible side effects, and the ability of cancers to become resistant to it, the drug remains as relevant now as it was when it first reached the market.

And the good news is that the drug can, and is, being made better. New formulations are being designed to make it more effective and less toxic.

The history of cisplatin

The history of cisplatin starts not in 1965, but in 1844, when it was first created by Italian chemist Michele Peyrone. For a long time it was known as Peyrone’s chloride. But the really important event was its accidental discovery as a cancer treatment by Barnett Rosenberg, a biophysical chemist.

At the time, Rosenberg was trying to study the effect electric fields had on bacterial growth. During his experiments, he found bacteria grew 300 times their normal size, a very unusual result, when he used platinum electrodes to generate the electric fields. It took a while to figure out what was going on, but in the end he discovered the platinum electrodes were corroding in the test solution, producing cisplatin.

Rosenberg published his remarkable findings in the journal Nature and followed this up three years later with another paper showing cisplatin could cure tumours in mice.

Cisplatin has been used as a treatment for cancer since its approval by the US Food and Drug Administration in 1978. And while five other platinum drugs based on the structure of cisplatin have been developed since, it has never been replaced.

Platinum drugs are now used in 40% of all chemotherapy treatments. This has completely changed how some cancers are treated. For instance, before cisplatin’s discovery the cure rate of testicular cancer was just 10%, but when combined with early detection the cure rate is now approaching 100%.

The good and the bad

Cisplatin has to be given as an intravenous injection because it’s not effective when delivered orally. Once in the veins, it moves from the blood stream into cancer cells where it bonds with water to form a more reactive form of the drug.

In this form, the drug can stop DNA from replicating and from acting as a blueprint for making proteins. This causes cancer cells to recognise something is wrong and initiate a type of cell suicide called apoptosis.

But cisplatin is not without its problems. Its suite of horrible side effects includes severe nausea and vomiting. These two side effects are, in fact, so bad that the drug’s development was almost stopped when it was first tested on people. It was only the invention of effective anti-nausea drugs that led to cisplatin’s approval by drug authorities.

Cisplatin also makes patients anaemic and susceptible to infections. It destroys their kidneys too, although giving the patient lots of water before and after treatment has been found to be effective in reducing this.

Worse still, because these side effects are so severe, they limit the dose of the drug that can be given to patients. Many cancers end up getting treated with less than optimal doses as a result, which leads to tumours rapidly developing resistance to further treatment. This is a particular problem in the treatment of ovarian cancer because it develops resistance faster than other types of cancer.

The future of cisplatin

But there’s good news on this front. Over the last two decades, many researchers, including my research team, have been developing new formulations of cisplatin in an effort to reduce its side effects. The best way to do this is through the use of nanoparticles to better target cisplatin to cancer cells. Better targeting cancer drugs is important so they don’t attack non-cancerous tissue.

One such nanoparticle formulation being commercially developed is Lipoplatin. This formulation encloses cisplatin in a shell called a liposome, which is similar in structure to the walls of human cells. As a result, it floats in the bloodstream for longer and gets trapped selectively in tumours but not normal tissue.

And it doesn’t stop there. Novel nanoparticle formulations of cisplatin using exotic materials are also being developed, although these are much further away from being ready for human testing. To date, cisplatin has been attached to carbon nanotubes, gold nanoparticles and even spaghetti ball-like polymers called dendrimers.

My team has also attached cisplatin to the outside of nanoparticles made of rust. Because rust contains iron, we could control the movement of the nanoparticles with magnets, ensuring the drug only goes to the sites in the body where it’s needed.

This drug has revolutionised the treatment of many types of cancer, especially testicular, and remains as critically important now as when it was first discovered. So happy 50th anniversary to cisplatin and good luck to all those working to make it better.

This article was originally published on The Conversation.
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By Dr. JOSEPH KAMUGISHA

Today hypertension is one of the commonest chronic illnesses in our society. However, it should be noted that a proper life style and normal feeding routine can regulate it’s aggressiveness to an appreciable limit.

Normal blood pressure is very important for the well being of an individual. Low blood pressure is nearly as dangerous as high blood pressure but it is the latter that afflicts people in far greater numbers than the former.

The condition of high blood pressure is also known as hypertension. Diet has been recognised as a key factor in combating hypertension. There is a varied opinion upon what food to eat for high blood pressure.

Limiting salt and sodium intake is one thing a hypertension patient must always do. Three other minerals have been found to assist in controlling blood pressure. These are Calcium, Magnesium and Potassium.

Potassium and calcium play an important role in regulating high blood pressure. Foods like bananas, beans and potatoes are all rich sources of potassium.

One must however avoid boiling potassium rich food, as potassium leaches out into the water during cooking. As for calcium, an average adult needs at least 1000 mg of calcium daily. This is why taking ripe bananas is very much advisable and better for potassium than cooked bananas.

However, herbal supplements may well be avoided, as they may increase blood pressure. Generally speaking, a diet that emphasizes fruits and vegetables, whole grains and low fat dairy products appears effective in taking points off a blood pressure monitor reducing your blood pressure measurements.

In particular, shedding off weight, cutting down on sodium, boosting potassium intake and limiting alcohol are all proven ways to lower your blood pressure. Therefore it is advisable to take a balanced diet, get a blood pressure tester, keep an eye on your blood pressure readings, maintain blood pressure charts and exercise regularly.

Precaution is the best blood pressure medication.

Also important to note is that fruits have been found to be good for high blood pressure control. Grape seed extracts have been found to control blood pressure.

We all want to stay fit throughout our lives but many a time the wish is not granted. And when one finds that one is suffering from high blood pressure, it could come as a shock because not many who are apparently healthy even think that they could be suffering from any disease at all.

High blood pressure is condition that can be a result of a number of factors. Smoking, high stress, physical inactivity, and excessive alcohol consumption are a few of them. Besides these factors, our daily diet plays a vital role not only in contributing to high blood pressure but also in affecting the overall health.

It is always advisable for a patient of high blood pressure to reduce the intake of foods rich in sodium and salt, as they are found to be a major contributing factor to high blood pressure. No doubt that with the reduction of the quantity of salt in your daily diet you can lower sodium content to some extent but the best way to avoid sodium is to have a diet of whole foods such as fresh fruits, vegetables, and whole grains. In addition to the above, even with the lowering down of the consumption of canned and frozen foods you can limit the intake of sodium.

The quantity of water should be increased to eight glasses per day. This would make your diet healthy. Start having grilled lean meats rather than fried variety of foods. A reduction in the consumption of white flour and sugar also helps.

A patient with hypertension should visit the doctor regularly because that would keep your condition well monitored. This would help you a great deal in keeping your high blood pressure within acceptable limits and below danger levels.

As already mentioned, it is a fact that there is no cure for high blood pressure, but one can still keep it under control with the help of proper diet, medication and exercise.

Also important to note is that hypertension has some genetic predisposition, this is why it is common in some families than others.

health@newtimes.co.rw

 

Dr Google can improve older people's health – if we bridge the technology gap

By David Tuffley, Griffith University and Amy Antonio, University of Southern Queensland

With more health information going online every day, it has never been easier to proactively manage our health. The problem is, the people who would benefit the most seem to be using it the least.

Older adults typically have a greater need for health-related information but their health literacy – their capacity to obtain, process and understand health information to make appropriate health decisions – is the lowest among all age groups.

Research shows that only about 3% of the elderly know how to access health-related information. And of those older adults who seek health information online, few are careful to evaluate its credibility. This points to the need for interventions to assist older adults’ use of computers and the internet.

There are clear benefits, both at a personal and social level, to teaching the elderly how to access health information and to use the internet generally. Efforts have been made to address this skills gap, but with limited success.

What works?

Sometimes the best solutions to behavioural problems are those that graft naturally onto people’s instinctive behaviours. The European Union has done just that with the Grandparents and Grandchildren program that puts old and young together so that the old might learn from the young.

This approach is working, probably because it taps into the natural instinct we have to connect with our blood relatives. School and college-age people are spending time with their grandparents for the purpose of learning how to use technology.

Beyond the family benefits, there is the potential for great savings to be made on health-care costs, keeping people in their own homes and out of hospital; a win-win situation.

Several health literacy programs are being trialled that involve helping the elderly to use the internet to find and appraise web-based cancer information. The participants in these programs reported getting better at doing this.

Follow-up studies show that once having learnt, the participants continued to use the internet to search for health-related information.

Benefits of digital literacy

Google heads recently announced they will improve the validity of health-related searches by creating a database of commonly searched medical conditions that have been fact-checked by doctors. When consumers search for these conditions, these pre-vetted facts will appear at the top of the search results. It is hoped that this will get people the right information faster.

Once the elderly know how, they can proactively manage their health by accessing a wealth of information on many topics. A person with type 2 diabetes, for instance, could learn how to live on a low-glycaemic index diet, thus reducing the need for medication and lowering their risk of heart attack. They could also make use of the many health and fitness apps now available. SmartWatch technology is taking the whole business to a higher level of sophistication.

Important for healthy ageing is keeping the social bonds of family and friends strong and maintaining a sense of social connection. Not an easy thing to do in today’s world with friends and family living far and wide for employment. Skype, email and social media can go a long way to making people feel connected with those they love.

With an ocean of knowledge just a few key-strokes away, there is plenty of scope for people to explore their interests. No matter how specialised they might be, you can find a community of interest to get involved with. It is well-known that keeping one’s mind active helps to delay cognitive decline and the on-set of dementia.

Many elderly people have lived interesting lives. They have things to say, but no-one on hand who is prepared to listen. These folks might want to record their experiences for posterity by writing their richly-textured biographies. Who knows what gems of wisdom might be contained in such accounts?

Next steps

It takes a village to raise a child, as the old saying goes, but we might also add that it is a two-way street – it takes a community to look after the elderly. We need to put in some time and effort into finding better ways to do this.

One of the best things we can do for the older members of our community is to give them the means to better look after themselves by teaching them how to use the technology that the rest of us take for granted. An Australian pilot study to adapt the Grandparents and Grandchildren would be a good start.

It is true that not everyone in this age group will want to learn. Some will be content to let it pass them by. But others will see the possibilities and eagerly embrace the potential for improvements to both quality and quantity of life.

This article was originally published on The Conversation.
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Six lessons from the initial failed international response to Ebola

By Catherine Gegout, University of Nottingham

The Ebola virus has killed more than 9,000 people – about 2,000 in Guinea, 3,000 in Sierra Leone and 4,000 in Liberia. The outbreak started in Guinea in December 2013, but the Ebola crisis really started in April 2014 when it began to spread.

The initial international response was deemed “totally inadequate” by British MPs. Since then efforts have improved, but here are six lessons that can be learned from the problematic initial response – from the problems highlighted by the MPs – and especially pertinent to those states that have the capacity to react to epidemics.

1. Trust NGOs and build WHO expertise

Médecins Sans Frontières (MSF) alerted governments as early as April 2014 about the Ebola problem, but it was not until August that year that the World Health Organisation declared Ebola a public health emergency. MSF was right about the scale of the problem. A witness at the House of Commons, Fergus Drake, who is Director of Global Programmes at Save the Children, said: “MSF have been the real heroes, in terms of people on the ground and the scale of their response.”

The four-month absence of reaction by the WHO had terrible consequences for the areas affected by the Ebola virus, in a large part because governments which had aid programmes that could be used for epidemics chose to follow the advice of the WHO.

If the international community had reacted straight away, the outbreak could have been contained. States should rely on the expertise of doctors on the ground, or make sure that the WHO has a similar level of expertise if that is the advice they want to follow. And the WHO should not replicate the work conducted by NGOs.

2. Improve health facilities

The international community should address the fact that medical facilities were insufficient in Sierra Leone, Liberia and Guinea. At the outset of the outbreak, there were only 40 doctors for a total of 4m people in Liberia, 120 doctors for 6m people in Sierra Leone, and 1,200 for 12m people in Guinea. Senegal and Nigeria, which reacted as soon as people were diagnosed with Ebola, have a more developed infrastructure of medical services, and local doctors were able to respond to the Ebola outbreak. In Nigeria, experience working to eradicate polio particularly helped.

However, in general, more doctors are desperately needed in the following states, which have fewer than 100 doctors for 1m people: Guinea, Ghana, Congo, Mali, Cameroon, Timor Leste, Guinea-Bissau, Zambia, Zimbabwe, Benin, Senegal, Togo, Papua New Guinea, Rwanda, Eritrea, Lesotho, Central African Republic, Burkina Faso, Mozambique, Chad, Somalia, Burundi, Equatorial Guinea, Ethiopia, Haiti, Sierra Leone, Malawi, Niger, Liberia, and Tanzania.

To put this into context: the United Kingdom and the United States respectively have 2,800 and 2,400 doctors for 1m people.

3. Plan logistical responses

The UK had no detailed contingency plan for a sudden medical emergency. According the parliamentary report, when the Ebola crisis was in full swing the UK could only send 55 health professionals to stricken countries, whereas Cuba committed 165 at various grades to work in the UK-funded treatment centres.

The British government relied on Save the Children to run Ebola facilities, but this NGO had never done this before, and the first facility was only set up in November 2014.

Funding – for example for aid – is one thing but expertise that can be deployed by international actors and especially local actors in emergencies is also important. The Department for International Development and other funding organisations could focus their aid on education and health facilities. China, for instance, opened a hospital in Sierra Leone in 2012 and in Liberia in 2011 and 2014.

4. Follow scientific advice

The United Kingdom, the United States and France revoked the licences of planes with direct flight paths to the regions where people were ill with Ebola, despite the absence of scientific justification for doing so. This made it harder for NGOs and doctors to access the region.

The Ebola crisis led to unnecessary panic in the United States, but it is the responsibility of governments to look at the science and reassure rather than add to it.

5. Recognise states that contribute

And shame those who do not contribute enough. Until now, the UK and the US have been the most involved in committing funds to fight the Ebola virus. However, taking into consideration the population of each state, the British donated twice as much as the Americans. The states lagging behind have been Germany, France, Canada and especially Italy. Ebola is a threat to all people in the world: every donor, and not only former colonising states, should be engaged in fighting the virus.

6. Pharma should cover range of vaccines

One of the reasons why there was no vaccine for Ebola was that it concerned few people in remote areas in African states. Margaret Chan, Director-General of the WHO, said that Ebola vaccine was never developed “because it only affected poor African countries”.

Ebola was not the priority of governments and pharmaceutical companies. Research on Ebola has been conducted in North America, Europe, China and Africa. However, more research is needed, and vaccines against viruses such as Ebola or Marburg should be commercialised, and made available cheaply.

This article was originally published on The Conversation.
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