By PATRICK HUNTER
At the risk of being accused of flogging a dead horse, I want to go back to the Ebola crisis. I am compelled to return to this subject because of a very illuminating discussion on the CBC Radio’s Sunday Edition this past Sunday. The discussion was with Dr. James Orbinski, a past president of the international aid organization, Medécins Sans Frontière (MSF), also known as Doctors without Borders.
As of October 31, the World Health Organization reports that there have been over 5,000 deaths in the three main countries in West Africa hit by this disease – Liberia, Guinea and Sierra Leone. Liberia alone accounts for about half that total.
One of the reasons for my going back to this subject matter is that there are a couple of very significant points that Dr. Orbinski brings up that makes you wonder where is the political leadership in these situations and where is the concern for the majority of the world population.
The bottom line is this: these crises, more often than not, seem to begin and get out of hand in developing countries. The developed countries seem to jump into action only when their populations appear to be threatened, primarily because of international travel, and the first order of business is to blockade the borders.
You may well ask, why isn’t there an international body, such as the UN, which will take command of the situation that will not only contain the spread of diseases, but will put the necessary infrastructure in place in a rapid deployment way to treat those affected. You may well ask why is it that when these crises occur, there is almost always a call for donations which appears to be the only way to respond?
This is one of the points that Orbinski made: the way the system works is that there is a dependency on the charities and charitable contributions to respond, and that has to change.
The World Health Organization (WHO) which is a UN body identifies itself as providing leadership on global health matters. Orbinski was complimentary of the work of WHO and pointed out that this is an organization whose operating fund is about $4 billion a year, of which $3 billion is by contribution, although all the countries of the UN are required to make a contribution to its operation.
Orbinski notes that the Gates Foundation is a $75 billion organization but it does not have a global health mandate. Nevertheless, the Foundation does make sizeable contributions to the work of WHO. In addition, he points out that the Gates Foundation’s contribution to WHO is three times more than Canada’s contribution.
So, WHO, which should be a primary managing body that would attend to these health crises, have to rely heavily on non-governmental organizations to do some of what they cannot. Hence, you have a situation where these large-scale charitable appeals happen to attend to the crisis.
Most of us know firsthand that the resources to deal with public health in developing countries are strained at best. I remember the days when going to a doctor was a day-long affair for a simple diagnosis and the lineups were long because there were so few doctors.
Orbinski notes that in Malawi where his current organization, Dignitas International, operates, there are between 260 to 300 doctors serving a population of about 15 million.
In Ontario, with roughly the same population, there are about 27,000.
The fact is the tax base for developing countries is much smaller and so, with their limited resources, putting the necessary infrastructure in place to do public health is strained.
Then there is the situation where many of their trained medical professionals seek greener pastures as the developed countries recruit them for their own purposes.
Orbinski says he is optimistic that this crisis presents another learning opportunity on how to establish and support a better infrastructure to manage health crises around the world. There should not be such a massive dependence on charity. There should be greater emphasis on training and prevention. He points to the situation in Nigeria, for example, where the infrastructure which had been set up to deal with other diseases was able to shift to contain the Ebola outbreak before it could get out of hand. That was put in place through WHO.
This is, to say the least, bothersome. These developing countries provide many of the raw materials needed by the developed countries. Yet, when these crises happen, the urgency to close borders seems to be one of the first options considered.
Clearly, through the existence of WHO, there is potential to deliver a better, more organized response to these crises. What they lack is the commitment by member countries that have the wherewithal to provide the necessary supports. This of course does not excuse developing countries from putting in place the necessary infrastructures, as best they can, to avoid these developments.
I wish I were as optimistic as Dr. Orbinski that we, and our political leaders, will learn from this.
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