Western broadsheets are no longer “front paging” Ebola.
Is it because there have been no new cases of Ebola contracted by Westerners in recent weeks? It can't be because the disease is in global remission, because that isn't the case. Ebola is still rampaging through a number of Western African countries. Maybe it’s just a case of “out of sight out of mind myopia” and the malaise of indifference to far-away lands finds expression again.
As we head into the festive season in the affluent West we look forward to family gatherings, indulgence - often excessive, conviviality and largess. Christmas for my local compatriots is a wonderful time of the year. In West Africa it’s an entirely different story.
As the body count mounts in countries like Sierra Leone - 1,768 to date and continuing, Christmas festivity is the last thing on the minds of many. The battle against Ebola continues, mothers lose children, children lose parents, Ebola orphans proliferate and economic recession and starvation sets in.
The health care workers - be they nurses, doctors or volunteers; be they West African, Cubans, Hispanics, Caucasians - in a unified flank wage the battle, along with the American soldiers, who although trained for combat are being deployed to fight an unseen and unforgiving enemy. It will be an incredibly challenging and confronting Christmas for these souls far removed from the joyful festivity of being home for the holidays. Alas, many more will lose their lives in a sacrifice to help those in desperate circumstances.
For our part, our small pro bono group has continued to work on an Ebola building standard for the construction of health care facilities. Some of our pleas for a broader net of ideas and medico technical input have recently been heard. Some seminal comments from a senior official at the Centres for Disease Control were forthcoming and were taken on board. We produced a fourth draft version of the building protocols that may provide some guidance for regulators who intend on developing standards for the construction of these facilities.
There has, however, been a change in emphasis. The standard has been tailored to the likes of Sierra Leone, Liberia and Mali, as this region presents itself as the Ebola epicentre.
We have also come to the realisation that the standard needs to be designed for the construction of health care facility compounds rather than wards or discrete buildings, such are the unique holistic considerations that are germane to the construction of such facilities. Reminiscent of a jigsaw puzzle, where the puzzle is only complete when it can be seen as the sum of all its parts, health care compounds need to have regard to some key elements:
- The need for separate wards for both suspects and carriers
- Security fences
- Separate medical laboratory, administrative, equipment and food facilities that are located within the compound
- Decontamination chambers
- Separated bathrooms
- Toxic waste disposal facilities
- Access for the transporting in and out of the facility personnel and "ebola debris"
One of the biggest challenges relates to the conundrum that is the destruction of highly contagious Ebola debris such as ablutions, toxic grey water and contagious material. The considered view is that the facility needs incinerators that are ideally low in cost, capable of generating very high temperatures and, if possible, mobile. These incinerators need to be on site and preferably multi-purpose. Such is the cultural aversion to cremation and the affinity with traditional burial means of disposing of the deceased, it would be remiss of us to call a multi-purpose incinerator a crematorium. Yet cremation or incineration would be the safest means of containing and eradicating corpse inspired contagion.
Plumbing is another vexed arena. How does one migrate or dispose of toxic grey water expelled by the hosing down of wards? Where does that toxic flow go? We need help and ideas on point and if you the readers have any ideas on point then please comment in the commentary slot.
Initially, our focus was solely on rapid low cost build and implicit was the likelihood that such facilities may not be built to last. A rethink has culminated in the view that the facilities should be sustainable, so that once Ebola is controlled, such facilities could have a longer term application or legacy as regional facilities for other contagious diseases. One of the reasons Ebola has spread so quickly is the crippled and fledgling state of the existing health care infrastructure. Our draft standard has been adapted to allow for the possibility of health care facility perpetuity. If facilities could be built with this utilitarian end game in mind, there may just be a silver lining, some long term good may come from this tragedy.