Dr Margaret Mungherera is President of the World Medical Association and a member of HIFA. She gave an 11-minute interview about the Ebola crisis to New Zealand national Radio on Friday 1st August. The audio is freely available here. Dr Mungherera has kindly agreed for us to transcribe the interview (below). We have also translated the interview into French: version française. In it, she highlights the importance of reliable health information and education for health workers and citizens, in addition to material support such as supply of personal protective equipment:
World Medical Association head on Ebola epidemic
Interviewer: The World Medical Association says doctors lives are at risk because of poor medical practices. Dr Margaret Mungherera, the President of WMA, says doctors and health workers need more help.
Dr. Mungherera: “They need to have had the training first of all, so we need to make sure that the training itself has the equipped them with knowledge about haemorrhagic fever and how to manage them. But I think the training first of all has to have done that. Now the other thing of course is that they need to have information, they need to be made aware when there’s a threat but they also need to be able to have the capacity to be able to protect themselves by practising infection control procedures, which are universal. Now, unfortunately these are quite a challenge in many places because we do have health workers in places in particular that don’t have water, they might not have the antiseptics, they might have the gloves and all the other things that are necessary, masks etc. So to be able to protect themselves, the normal infection control measures need to be in place to protect them. Now, if there is a case or a suspected case then of course they need to be able to identify that, and that means that there needs to be a case definition that needs to be made available to them to be able to identify the risks and they need support in terms of management of suspected cases. What we usually want to see is isolation centres put up for suspected cases. They need to have investigations available to confirm that these are cases, and of course if they are suspected or confirmed they need protective gear Here are some of the things mentioned. But there needs to be a protocol on how to proceed, when one suspects that this might be an Ebola or another haemorrhagic disease.
Interviewer: So there’s a lot that’s required, what’s happening in reality? Do doctors have at the very least protective equipment to protect themselves?
Dr. Mungherera: With health facilities in many of the African countries the health systems are weak in terms of resources that are needed to be able to manage epidemics like these. They don’t have the emergency preparedness that is required. The health workers, many of them are junior health workers being that many of the senior health workers are not really there to support the junior health workers and there’s the whole problem of retention. So you do have this happening and as a result many of them are not able to cope with these epidemics and need support from government departments, WHO and all the other organisations that are able to come in.
Interviewer: In fact we have heard of health workers, senior doctors who have died, is that partly because they simply haven’t got what they require?
Dr. Mungherera: Yes, they don’t have what they require, they don’t have the support, they don’t have the training and I think affected countries where the systems are already very weak and they’re countries where there are very few health workers and especially senior, qualified health workers, but they all these juniors that have just come out of medical school, out of training institutions and then are left to struggle on their own without any support. The whole of Africa has a human resource crisis where a lot of the doctors are junior doctors just coming out of medical school and then they’re the ones who are heading the teams and support the rest of the teams and I think it’s quite difficult for them. Now they also need the information and I think the governments need to help but have delayed response in countries that have been affected, but another result that they’re at the frontline and they’re the ones that have been affected the most not only in terms of getting the infection, all the fear, the scare and that is de-motivating them further. So I think they are the ones most affected, yes.
Interviewer: If governments do not step up Margaret and act quickly to bring in better conditions, to bring in isolation centres, to bring in protective gear what are going to be the consequences because this is already spreading so quickly?
Dr. Mungherera: First of all already there is massive loss of life. I mean if you have more than 670 people who have died from this problem in one country, that’s already massive. So there’s massive loss of life, then of course the scare, people keep away from the health facilities and as a result even though they have other infections and diseases, accessing much less than they would normally so that again causes problems. Women who would have delivered in the health facility now deliver at home, people keep away from the health facilities due to beliefs about the causes of this problem, we have our cultural beliefs that have come in as well were people approaching people saying that this is some sort of curse etc. So they keep away from the health facilities. But also it means that the health workers themselves will flee away from these facilities so that again is further another problem and on top of that these are places that have been affected by conflict so they already have the problems that have come out of conflict and various problems etc. And then again this is another insult to injury so it further weakens the system and it makes access to health facilities for the community even more difficult.
Interviewer: The WHO has announced $100 million as a response plan. What will the WMA be looking for from this amount of money? A considerable amount of money but what do the priorities need to be?
Dr. Mungherera: I think the priorities need to be measures: first of all awareness, public awareness, the communities need to be made aware, of course the anxieties have to be allayed, information has to be given and all the myths and misconceptions dealt with so a lot of public awareness is important, especially working with the media, but also there is a need for training, massive training of health workers, I hope that will happen, but also the protective gear, fitting up the isolation centres but also providing the basics, fluids, basic sundries and supplies and drugs that are needed. We don’t have the treatment for this haemorrhagic fever, but just to make sure the other issues that come up are to be managed. But I hope that is what is going to happen with the priorities: the protective gear, the isolation centres, the training – because it’s one thing putting up the isolation units but you’ve got to train and I think that’s what we’re hearing from the doctors who are reporting to us and the junior doctor networks especially, the junior doctors they need their support, the support supervision for what’s necessary. I hope that can be the sort of priorities they could look at, consider with that sort of funding.
Interviewer: Do you believe that this Ebola outbreak Margaret has been taken seriously enough internationally? Or there a concern that the rest of the world will go well thats Africa’s problem we’ll be fine.
Dr. Mungherera: You know what’s happening is I think that was the main response to it and I think that has caused a bit of a problem because we now hear cases all the over the west of Africa and we are beginning to hear cases that are suspected. We had a case that came up today in Uganda about a case where somebody who died of what appears might be Ebola. But you know he’s had no contact with anyone else so you know all of these ideas come in. But then of course you know people are mobile, with their mobility in the African continent, so definitely governments come in but they come in so late and they don’t put their own domestic resources they look for funding, but you can’t fund something that other people have to deal with, and I think that should not happen, I think governments need to be more clear about committing more resources to management of these epidemics especially emergency funding, the training that needs to be done and the public awareness. But I think to come in late with all the mobility and all these borders are so porous, people just walk through and many of these borders are between countries and so it’s very difficult to contain. But also the anxieties, the apprehension that it does in an already de-motivated health workforce and stretched already, it helps to further the stress and it gets further weakened. So I think governments need to take these epidemics more seriously and act more quickly. But also the international community also need to come in, its already done a lot but you know we need a bit more in terms of committing resources early in the epidemic and not as late as it has been, it’s been massive loss of life. Communities are really being affected, even just mentally, you can see the type of social issues problems that come up as a result of these sort of epidemics.