Staff, stuff, systems and space. Those are the four things Paul Farmer said are necessary in order to combat infectious pathogens in healthcare deficient areas.
On Tuesday, Farmer, a physician, anthropologist, chief strategist and cofounder of Partners in Health, gave a lecture entitled, “Taking up the Challenge of Poverty: Why Accompaniment Matters” that tackled the complexities of the Ebola outbreak and accompaniment, which consists of long-term health care provision on the community-based level.
“Every single one of the documented Ebola outbreaks since 1976 have the same story,” Farmer said. “They are all due to poor infection control. Even the most recent outbreak, the story is the same. They simply don’t have the staff, the stuff, the space or the systems to stop the epidemic.”
Farmer said the Ebola epidemic is primarily focused in Liberia, Sierra Leon and Guinea. According to Farmer, Ebola is a type of zoonosis pathogen, meaning it is an animal pathogen that ends up in humans. He said these pathogens, which can adapt to multiple hosts, often lead to death.
“Why these three countries and no others? All the neighboring countries were effected — but not a lot. Why? These countries were uniquely vulnerable because of the extraordinarily weak health systems that collapsed not only because of wars, but because of extractive institutes that did not feel the need to reinvest in health and education,” he said. “The real story is one of continued extraction, colonial rule, and then, after independence, continued extraction and eventual civil war.”
In order to contain Ebola, Farmer said the worldwide response has largely been segregation, which is inefficient.
“This ‘control-only’ paradigm is the one that we only advance officially, as the world, to stop Ebola. The focus was on isolation, containment, quarantine and segregating those who fall ill,” he said. “If you’re putting people put into a holding room with no proper food and water … of course they are going to perish.”
According to Farmer, those infected with Ebola often do not seek medical attention, as they know that the hospital will be largely understaffed and unable to provide effective treatment. Therefore, Farmer said, family members often end up taking care of the sick.
“It’s a concentric cycle of caregiving without proper accompaniment. It’s not caregiving in improper fashion — it’s that these people need accompaniment to care for the sick and help bury the dead,” he said. “This is a big problem. A ‘disease-control’ only paradigm that did not have caregiving in the middle of it was the main reason that Ebola stayed at home … it’s because people knew they would end up in horrible places [like understaffed medical centers].”
“The healthcare deficiencies in these countries has led to understaffed and decaying hospitals that are unable to serve patients,” Farmer said. “That is why accompaniment matters.”
It is necessary that the healthcare systems in these countries be improved and strengthened, Farmer said.
“Accompaniment is not just about being a nice person; it’s about having expert mercy linked to pragmatic solidarity. This is a technical matter, but it is not enough to have a technocracy,” he said. “We need to have compassionate, merciful and just healthcare systems, and that is part of accompaniment.”
Farmer also said emergency responses to epidemics never lead to health system strengthening, training, capacity building or research, which are critical to ensuring that an epidemic does not occur again.
“Surely there has to be progress, and we have to get better about thinking of health system strengthening,” Farmer said. “These matters are regarded as not urgent enough [during epidemics]. But, nothing is more important then building a health system that prevents people from falling ill or dying in the first place.”
