RUNNING HEAD: Ebola- Global Disparity 1

Health Impact Framework Research Paper

Ebola

Delaware Technical Community College

Nur 310- Global Health

Lindsay OHara

December 2, 2017
RUNNING HEAD: Ebola- Global Disparity 2

Abstract
The Ebola virus has been in existence since 1976. The most current outbreak in West

Africa in 2014, was largest and deadliest outbreak yet. The world was quite unprepared for the

outbreak and the global response was lacking. Ebola virus mimics many other illnesses with

symptoms such as fever, diarrhea and vomiting. Most people who have contracted the virus die

from complications of dehydration and eventually hemorrhaging. The lack of clean water, food,

and medical supplies are a catalyst for transmission. Traditional burial practices further the

spread of the infection. Currently, there is no proven vaccine to help cure the virus, but

supportive therapies such as IV hydration and proper isolation techniques are used to help

combat the virus. Education is most important weapon to help fight this virus. Educating local

citizens on proper recognition signs and symptoms, ways to prevent transmission, and improving

traditional burial practices can inhibit transmission. An increase of in clean medical supplies and

medical staff can help current volunteers and local hospitals improve the prognosis of patients.

Globally, there needs to be collaborative effort to combat this deadly virus.

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Introduction

It wasnt very long ago that the Ebola virus reached the United States of America. In

2014, the U.S. had it very first case of the Ebola virus, and it caused quite a panic across the

country. Until the events in 2014, Ebola was considered a third world disease. The United States

was completely unprepared for the outbreak, which imposed rash decisions and unnecessary

laws. Unknown to the United States, the Ebola virus has been ravaging Africa since 1976.

As we now know, diseases know no boundaries or borders and do not discriminate.

Disease can affect anyone at any time, which is why it extremely important to be prepared for

any disease at any given time.

Ebola was originally discovered in 1976 in Democratic Republic of Congo, along the

Ebola river. The virus originated from the filiovirus. There are five identified Ebola virus

species, four of which are known to cause disease in humans: Ebola virus (Zaire ebolavirus);

Sudan virus (Sudan ebolavirus); Ta Forest virus (Ta Forest ebolavirus, formerly Cte dIvoire

ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston

ebolavirus), has caused disease in nonhuman primates, but not in humans (Center for Disease

Control, 2017). The Zaire Ebola virus, being the most recent outbreak in West Africa in 2014.

Transmission of the Ebola virus is zoonotic and the culprit being fruit bats. Fruit bats

contaminate other animals in the wild. Transmission to humans may have occurred through

direct contact with tissue or bodily fluids from an infected animal (Fauci, 2014). The disease is

also spread like many other viruses, blood or bodily fluids, or direct contact with someone who is

currently infected with the disease.

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Many people do not realize they have contracted the Ebola disease, because some of the

signs and symptoms mimic the flu. Fever, myalgia, fatigue, and weakness can be associated with

any number of illnesses and diseases. Some of the more serious signs and symptoms, such as

diarrhea, vomiting and unexplained hemorrhage can be fatal without proper treatment

immediately.

The original outbreak of Ebola was in 1976. This disease was spread by close contact in

hospitals, including the sharing of contaminated needles. From 1976- 2001, there were sporadic

outbreaks, mostly due to the consumption of tainted animals. In 2001, it was discovered that

mourners of people who succumbed to Ebola were contracting the disease. The most recent

outbreak in West Africa 2014-2016 is the deadliest yet. According to the Center for Disease

Control, there were 28, 616 reported cases, and 11,310 were fatalities.

Socioeconomic Factors
The geographical location of most of the Ebola outbreaks is Sub-Sarahan Africa. Sub-

saharan Africa is definitely an under developed area with poverty stricken countries. The Ebola

outbreak of 2014 was mostly contained to Sierra Leone, Liberia, and Guinea. All three countries

rank in the bottom third where economy is concerned. First, poverty drives people to expand

their range of activities to stay alive, plunging deeper into the forest to expand the geographic as

well as species range of hunted game and to find wood to make charcoal and deeper into mines

to extract minerals, enhancing their risk of exposure to Ebola virus and other zoonotic pathogens

in these remote corners (Bausch & Schwarz, 2014). Poverty is causing the citizens of these

countries to fight tooth and nail for the basics necessities to survive, increasing the risk for

exposure.
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Food is essential for survival. Unfortunately, due to poverty stricken conditions in these

countries, food is scarce. Citizens are going further into the forest to find sources of food. Fruit

bats are contaminating other animals by bites or animal consumption, thus infecting the animal.

Bush meat is a common source of food for these desolate countries.

A likely source of mostly of outbreak in the unsanitary burial rituals. In West African

culture, it is a tradition to cleanse the corpse before burial. One urgent priority is to change

long-standing funeral practices that involve close contact with highly infectious corpses. In

Guinea, for example, 60% of cases have been linked to traditional burials (Chan, 2014).

Sierra Leone, Liberia, and Guinea have been war torn for years, and government

infrastructure is severely fractured. Health care facilities are lacking in clean supplies. Then, the

situation is compounded when the unlucky infected person presents to an impoverished and

neglected healthcare facility where a supply of gloves, clean needles, and disinfectants is not a

given, leaving patients and healthcare workers alike vulnerable to nosocomial transmission

(Bausch & Schwarz, 2014).

Changing the Context

In order to change the West African peoples choices, they first need the basic necessities

to help aid in their decisions. Clean water is absolutely essential for proper sanitation and

preparation of food. The lack of clean water can help further spread contamination. With a clean

water source, proper sterile techniques can be used for cleaning already scarce medical

equipment. Clean water can also aid in the traditional burial cleanse and proper disposal of that

water.
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An increase in food supplies would decrease the need to hunt for food, and the possibility

of consuming an animal that is infected with the disease. The World Food Program, with its

unparalleled logistic capabilities, is addressing daily material needs in the quarantine zones

(Chan, 2014). With the aid from the global community, the need to consume bush meat can be

reduced drastically.

Lasting Preventions
At the time of the outbreak, there was no vaccine to help prevent further infection. There

are vaccinations under development and are currently being laboratory tested. The virulence of

the disease is so strong, it is necessary to take time for proper testing. Although, there was an

experimental antibody therapy, ZMapp, that was used on 2 patients that were evacuated from

Liberia to the United States for treatment. The Food and Drug Administration allowed the

vaccine to be used under the compassionate use exemption policy. Formal clinical trials were

conducted in 2015, and the results were inconclusive. The laudable and rapid decline in eligible

new cases of EVD was a factor that no trial design could anticipate, and it affected our ability to

reach definitive conclusions. Despite the concerted efforts of many dedicated researchers

domestically and internationally who participated in this and other trials, the outbreak appears to

have ended with no incontrovertible evidence that any single treatment intervention, or

combination of interventions, was unequivocally superior to the types of supportive medical care

typically provided (The Prevail Writing group, 2016).

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Clinical Interventions

In order to contain the disease, proper identification and isolation is necessary. Public

health measures such as early isolation and infection control are critical (Fauci, 2014). One of

the reason many patients werent seeking medical attention because of the isolation from their

families. Whats most distressing is the fact that patients with Ebola face a solitary death,

without their loved ones, surrounded by people wearing space suitsThis is why people are so

scared, and why they dont come to the hospitals (Vogel, 2014). Proper isolation with proper

protective equipment could allow patient and their families to be together while being treated.

The current treatment of the Ebola virus is supportive therapy. Once clinical diagnosed,

its imperative to begin IV hydration. The virus causes major dehydration through diarrhea and

vomiting. As a result, severely ill patients are frequently dehydrated and need intravenous fluids

or oral rehydration with solutions that contain electrolytes. Such interventions can help sustain

some patients and allow them to recover, but in many cases, patients progress toward multi-

organ failure, shock, and death (Hampton, 2014).

In order to properly treat patients, it is essential to have clean medical supplies. During

the 2014 outbreak, some of the locations were remote and medical supplies are often scarce, if

not available. An increased effort to supply these areas was initiated. The WHO is mapping the

outbreak to pinpoint areas of transmission and the location of facilities and supplies to ensure

that assistance is coordinated and rapidly and rationally distributed. Personal protective

equipment is being dispatched on a nearly daily basis (Chan, 2014).

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Counseling and Education

Proper counseling and education are necessary to help prevent and aid in another

outbreak. One of the most important intervention is positive identification of the Ebola virus. The

Ebola virus symptoms mimic other diseases that already run rampant in these countries. First,

Guinea, Sierra Leone, and Liberia are resource-poor countries already coping with major health

challenges, such as malaria and other endemic diseases, some of which may be confused with

EVD (Fauci, 2014). Proper identification and thorough travel history can aid in timely

identification of the disease.

It is very difficult to change anyones tradition, especially being from a different country.

It is a delicate balance to try to implement new burial practices while trying to adhere to their

traditions. Proper education on ways to include tradition with proper disposal of biohazardous

materials is vital.

The most important intervention is education on how the Ebola virus is transmitted. In

West Africa, there was a fear of anyone in an authoritative capacity, including health care

workers. Fear causes people who have had contact with infected persons to escape from the

surveillance system, relatives to hide symptomatic family members or take them to traditional

healers, and patients to flee treatment centers (Chan, 2014). Trust must be established with all

patients and their families in order to properly educate on transmission possibilities.

Nurses have unique role in the prevention and research for the Ebola virus. Nurses may

be the first person the patient sees, whether it be in a hospital or a makeshift clinic. Taking an

accurate and thorough history can lead to accurate isolation and quick treatment. One of the

biggest problems was the slow reaction of the global community. Recognition that the response
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to the West African Ebola epidemic was unacceptably slow and disorganized has prompted

efforts to establish a robust mechanism for planned preparedness for future pandemic disasters

(National Academics of Science, 2016). Nurses can participate in preparedness drills and make

sure they are well informed of the most current PPE needed and treatments available.

Conclusion
Even though the Ebola threat has significantly decreased since the 2014 outbreak, it is

important to diligently educate on the proper techniques to avoid contact and transmission.

Health care infrastructure in these lower developed countries are slowly coming together and

trust is being established with local citizens to ensure traditional customs are being observed

while integrating proper infection control. Scientists are hard at work to come up with a

vaccination to help cure the virus. Funding and research needs to continue in order to help keep

this virus in submission. Curing and containing the Ebola virus is truly a global effort.
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References
Bausch, D.S. (2014). Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets

Economy. PLoS Negl Trop Dis, 8,7. Doi: 10.1371/journal.pntd.0003056

Chan, M. (2014). Ebola Virus Disease in West Africa- No Early End to the Outbreak. New

England Journal of Medicine, 371, 1183-1185. doi:10.1056/NEJMp1409859

Center for Disease Control and Prevention. (2017) Ebola Virus Disease. Retrieved from

http://www.cdc.gov/ebola

Fauci, A. (2014). Ebola-Underscoring the Global Disparities in Health Care Resources. New

England Journal of Medicine, 371, 1084-1086. doi: 10.156/NEJMp1409494

Hampton, T. (2014). Largest Ever Outbreak of Ebola Virus Disease Thrusts Experimental

Therapies, Vaccines into the Spotlight. Journal of American Medicine Association, 312,

987-989. doi: 10.1001/jama.2014.11170

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2016 Nov 30. 4, Current and Future Research Opportunities. Retrieved from:

https://www.ncbi.nlm.nih.gov/books/NBK401931/
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The PREVAIL II Writing Group, for the Multi-National PREVAIL II Study Team. (2016) A

Randomized, Controlled Trial of ZMapp for Ebola Virus Infection. New England Journal

of Medicine, 375, 1448-1456. doi: 10.1056/NEJMoa1604330

Vogel, L. (2014). Ebola Epidemic: Outpacing response: MSF. Canadian Medical Association

Journal, pp. doi: 10.1503/cmaj.109-4890