Dr. Paul Farmer: 'Redoubling Our Efforts'

On March 10, which seems like years ago to many of us, we learned that one of our employees working in Sierra Leone had fallen ill with Ebola Virus Disease (EVD). This has been a hard few days for many of us, but most of all for our colleague and family.

Cases of EVD among health care workers result from the transfer of the virus from patient to provider during care. Partners In Health is collaborating with the Centers for Disease Control’s superb local team, along with the World Health Organization and Sierra Leonean authorities, to thoroughly investigate protocols, policies, procedures, and safety around the incident leading to the positive Ebola diagnosis of our PIH colleague, and the potential exposures of subsequent caregiving contacts. Since we are working in more than 23 facilities, all of them public, across two nations, you can imagine the tens of thousands of patient-provider contact hours we have logged over the past few months.

After the 2010 earthquake in Haiti, which took the lives of so many of our colleagues and friends and family, but which led to a redoubling of our efforts with Zanmi Lasante and the Haitian Ministry of Health, many of us were given to saying, “Partners In Health is not a disaster relief organization.” But, in truth, the everyday health conditions faced by the poor across much of West Africa are nothing if not a disaster. Redoubling our efforts in Sierra Leone and Liberia, while supporting the Guinean effort as we are able, should be the next step for PIH and its partners. That will require a great deal of humility—How might we have moved faster? How might we provide better clinical care so that our case fatality rates are lower? How might we do so more safely, so that there are no more occupational exposures, for either expatriates or national staff? How can we learn from our mistakes? How can we make sure that the end result of our efforts is to strengthen local and national institutions so that they can do their work more effectively, and with the staff, stuff, space, and systems they need?—as well as determination and persistence.

Our greatest concern right now is our colleague who is sick. We know that this first responder is receiving the highest standard of care in the world, and from close friends and supporters of PIH. We also know from the patients who’ve been treated elsewhere in the United States and Europe—again, the places where EVD has truly collided with modern medicine—that this is not an acute disease but a stormy one usually lasting a month or more, and with many ups and downs along the way. So I am in close contact with our clinician’s family (who request confidentiality, but are grateful for moral support and prayers; we can pass on messages from colleagues and supporters) and with the physicians leading a large team of expert caregivers. We also stand in solidarity with our Sierra Leonean colleagues and patients, and will continue to do so. We pray for the continued wellbeing of those counted as “contacts” but who are not sick. I’m sure you can imagine the anxiety associated with the long wait, in unfamiliar places, and hope you will join us in supporting them and in protecting their confidentiality.

I know I speak on behalf of the leadership of Partners In Health and staff across the world in arguing that the best way to honor their service, and that of the many others who have gone before them, is to redouble our efforts to build enduring institutions within Liberia and Sierra Leone and with our national partners there. We have to do more, not less, and better, and remind ourselves that freedom from want includes freedom from the catastrophic impact that serious illness has for so many people in the world, as it sometimes does for those who reach out to strangers to offer help.

Dr. Paul Farmer is a co-founder and chief strategist of Partners In Health.