admin
Laurie Garrett Correspondent
What follows is a modest proposal. It endeavours to solve three crucial problems all at once: US-Cuba relations; the post-Ebola human resources deficits in physicians for Guinea, Sierra Leone, and Liberia; and the scarcity of skilled nurses in those same countries.When the Ebola virus of the recent outbreak first surfaced, undetected in the village of Meliandou, Guinea, in December 2013, its spread across those countries was in part facilitated by the desperate state of health-care systems in the three poor, post-civil war nations. These countries never did have enough skilled health workers; Ebola has claimed the lives of devastating numbers in their ranks; and slowing the epidemic prompted the nations to lean heavily on the generosity of the Cuban government, which sent physicians to West Africa’s rescue. In many cases, the Cubans toiled inside facilities financed by US taxpayers, and poignantly the US Department of Defence swore willingness to treat infected Cubans should it be necessary – in the Army-built treatment unit outside Monrovia, Liberia.
Tragically, the Ebola epidemic has claimed the lives of more than 10 percent of the health-care workforces in the three countries, killing some of the nations’ most highly skilled physicians and nurses. Such losses would be terrible in any place in the world, but are devastating where the infrastructure and human resources were as dismally stressed as they were before the epidemic. The loss of physicians is especially horrible, as their training and expertise are the result of enormous investments by the nations and the physicians’ personal education and sacrifice over more than a dozen years, post-secondary school. Liberia had 51 doctors in 2013; it has 46 today.
As the chart released by the Liberian Ministry of Health at the end of April 2015 displays, 378 health workers contracted Ebola, which killed more than half of them. The greatest concentrations of loss were in the counties of Bong and Bomi, hit hard in the early days of the epidemic, and in the capital city of Monrovia, located in Montserrado County.
The government of Guinea has never released precise numbers regarding infections and deaths among its physicians. In late March, three more doctors became infected, at which time the government acknowledged that over 50 doctors had contracted Ebola since December 2013, with a 66 percent death toll, or presumably 33, leaving the nation with 1 142 doctors.
In April, the US Agency for International Development (USAID) announced the creation of a $126 million fund for the reconstruction of health systems in the three countries, which is a small step toward garnering the $8 billion that Presidents Ernest Bai Koroma of Sierra Leone, Alpha Condé of Guinea, and Ellen Johnson Sirleaf of Liberia say their nations need for full recovery. By late December 2014, many countries and private organisations had pledged support for the fight against Ebola, promising $4,3 billion – what Save the Children estimates is considerably more than the combined, normal annual governmental expenditures on health care for the three countries.
But the commitments were never fully realised – some estimates put actual disbursement at merely 40 percent.
The Cuban Connection
In 2014, the government of Cuba sent 165 health-care workers to the Ebola epidemic, where the men (they were all male) provided dangerous front-line medical care.
While many countries provided technical assistance, logistics, and training, the Cuban government sent more physicians to provide direct health care than did any other nation. Members of the Cuban medical corps are back in their island nation now, greeted as heroes in a country that has put health diplomacy at the centre of its foreign policy.
A centrepiece of the Cuban health diplomacy effort is the Latin American Medical School (ELAM), located about a two hours’ drive from Havana in Santiago.
Since 2005 the school has graduated 23,000 physicians and now trains 10,000 at any given time. I visited the sprawling campus, its classes, and its laboratories in 2010 and met with students from the United States and Haiti. ELAM isn’t ever going to rival Johns Hopkins’s or Harvard’s medical school for training in advanced tertiary clinical care and research, but that’s not its point.
I have discussed with Cuban authorities the possibility of sending a large number of nurses from Guinea, Sierra Leone, and Liberia to ELAM for physician training. All three African countries have schools of nursing, offering the possibility that they could train replacements for the nurses locally.
And nurses start with a skill set that allows them to reach physician licensing much more rapidly than typical 18-year-old medical students.
With physicians in Cuba who have had experience working in the three African nations, there may be a core group prepared to facilitate training and cultural acquisition of language and other skills necessary to matriculate in ELAM.
The Cubans are interested. But they want to get the Americans on board.
The American Connection
Cuban officials I spoke with were reluctant to provide details regarding the costs of training African physicians, out of concern that any public statements during diplomatic negotiations with US President Barack Obama’s administration might be misconstrued.
While ELAM is designed to handle foreign students, most are from Latin America and obtain sponsorship to cover their travel, housing, and other expenses from either their home governments or private organizations, such as churches and political parties.
Such sponsorship cannot be expected from impoverished Liberia, Sierra Leone, or Guinea.
A joint US-Cuban physician-training effort would not only solve the human resources crisis in the Ebola-hit nations, but would further open the doors of diplomatic co-operation between Washington, and Havana. – Foreign Policy Magazine
Through funding from USAID and perhaps private sources — from the likes of, say, the Bill & Melinda Gates Foundation — the costs of travel, housing, and education for African nurses, as well as subsidies for educating their nursing replacements inside the West African countries, could allow rapid deployment of 200 or more nurses to ELAM.
Within three to four years the African nations would see their physician ranks swell, thanks to the United States and Cuba. The potential outcome of this partnership could be that for a fraction of the cost of constructing a medical school in West Africa, and far more rapidly than such a school could every produce skilled physicians, the US-Cuba connection could transform a large number of nurses into doctors ready to staff clinics by 2018 or 2019.
There are few other means imaginable for speedy creation of a significant physician pool for the beleaguered nations.
Training in wealthy countries is not only far more costly, but poses serious crises of conscience for newly minted doctors who are tempted to remain in Europe or North America, sending remittances home rather than returning to their desperately poor countries to practice medicine in poorly resourced clinics. It is inconceivable that medical schools can be constructed inside the region on a meaningful time scale.
And neighbouring nations, such as Ghana, Nigeria, and Senegal, are hard-pressed to train sufficient physicians in their medical schools to fill their own enormous human resources gaps.
Combining the money, logistics, and talent of the United States, Cuba, Sierra Leone, Guinea, and Liberia to rapidly train a team of new doctors for the West African nations offers the most cost-effective, swift, and appropriate means to solve the health systems crisis faced in the Ebola-hit countries. – Foreign Policy Magazine
Online Reporter