Africa might be ‘rising’, yet, some (West-) African stakeholders perhaps waited too long for an international – read: a WHO led – response to the Ebola outbreak. Also, some of the actions they did take were perhaps not the right ones.

For example, the closing of borders (by some neighbouring countries) might very well contribute to the spread of Ebola, in my opinion, as more poverty inevitably further jeopardizes hygiene. Instead, neighbouring countries could install medical staff on the ground, in border areas, to inform about the risks of Ebola Virus Disease (EVD) and make a rapid health assessment based on specific questionnaires addressing symptoms of EVD.

Most observers agree the lack of sensitization was a key factor in the spread of the disease. At the beginning of the outbreak in Guinea,  traditional healers stated that they could cure the disease. The death of some of them proved them – quickly – wrong, but the damage had been done. Also socio-anthropologists were not much (or at least not enough) involved in the prevention strategy, the consequence was a misinterpretation of EVD which, for many ordinary people, now is a “disease created by the West to kill Africans”.

The lack of awareness about the looming threat of EVD led neighbouring countries to neglect some of the usual strategies of prevention, for too long. In my opinion, when there are Ebola cases around the corner, every possible way to inform populations should be used to provide good information about prevention, such as flyers, the use of social media popular in the region like Facebook ( check out for example the open Facebook group ‘West African Alliance Against Fever Ebola’), religious celebrations, town criers, … but also more traditional media such as radio and TV. My own experience with the Facebook group to spread info about prevention measures, “West African Alliance Against Fever Ebola”, taught me that this is a very cost effective strategy, because one just needs an internet connection, yet, it allows a rapid scale up of information. There’s one big drawback though: in sub-Saharan Africa 80% of the population can’t read or speak French or English. So it’s just one of the tools that should be used, together with others (see for example this recent Letter in the Lancet with some other suggestions)  .

Another factor, well known by now, is that EVD kills a lot of healthcare workers. Indeed, many, if not all, healthcare workers (HCW) are working in fear, because of the lack of Personal Protective Equipment (PPE), gowns, gloves, and because particularly in this West African Epidemic many atypical cases are being diagnosed and are viremic, so they have contributed (and continue to contribute to) to the spread of the disease in the community.  In many parts of West Africa, not just in Liberia,   HCW hence went on strike because the government didn’t properly equip them. Health systems are crumbling – with the consequences one can expect also for other diseases, as has been reported in recent weeks and months. But can you blame these health care workers?

But there are also encouraging role models. In Central Africa, because of their past experience with EVD and other hemorrhagic fevers, a few years ago a doctoral school was launched in Franceville, Gabon. The school focuses on epidemiology and laboratory aspects of hemorrhagic fever, particularly EVD. The name of the school is “Ecole Doctorale Regionale d’afrique Centrale  en Infectiologie Tropicale ( see here ) and the school collaborates with the WHO reference center of emerging Infectious Diseases,  Centre international de recherches médicales de Franceville (CIRMF). Since 2012 this school forms specialists in infectious diseases who could be useful for the EVD outbreak and others. This is surely a model to follow elsewhere. It has also been reported that experienced Ugandan medical teams have been dispatched to the West-African region. This is the kind of thing we would like to happen on a larger scale.

I think African countries must team up and align their resources for greater impact: human resources, logistics, … to fight against Ebola. Even if some measures have been taken by African institutions and stakeholders, African people hope for far more effort by the African Union (AU), the West African Health Organization (WAHO), the  Economic Community of West African states (ECOWAS) (see for example the recent suggestion for a ECOWAS special envoy, or the case for African leaders to take the lead on an effort for a Framework Convention of Global Health) , …. Put bluntly, people are in expectation of real actions on the ground and not just ‘high level’ meetings in hotels of countries not (yet?) affected by the outbreak. They also demand better governance of public resources, because this could explain – at least partly – the hesitation of many international organizations to contribute financially, as the latter are not sure that the money will be used to fight the EVD epidemic. Well, we know there are other reasons too for the belated international response. But lack of trust in domestic governance has been a key factor in the spread of this epidemic, and perhaps international actors feel likewise ?

Yet, I request more international solidarity and also less international paranoia – for example, the restriction of Occidental flights in west African countries seems not the best way to protect Western populations (even if we know there are also commercial reasons for this).  Many European countries seem to have forgotten the vast number of Africans who are trying to reach Europe by the sea…

Obviously, international solidarity is needed to roll back EVD in West-Africa and in the world, but let’s also see what we, Africans, can do ourselves. If we believe Africa is indeed rising, let’s show the world.

The World Young Doctors’ Organization (WYDO) was founded on 24 June 2011. It provides a forum for young doctors to share their ideas, concerns and experiences. The organization already counts members from 28 countries, according to its website. After last year’s inaugural World Young Doctors’ Day (WYDD),  with the theme ‘Internet, Social Media and Medicine’, this year’s event focused on the working conditions of young doctors. The meeting took again place on 24 June. Many events were planned by WYDO such as an online awareness raising campaign, a young doctors’ café, the launch of a WYDO global working group on working conditions,  seminars, workshops, … you name it.

On 24 June, medics from Benin, Mali, Guinea,  Ivory Coast, Chad, Congo Brazzaville, Cameroon all  joined in Dakar, Senegal,  for a young doctors’ café focusing on the topic of this year. Most of us agreed that the pyramidal administrative organization of the health system positively affects working conditions of young doctors in our countries (although we acknowledged there are drawbacks to this as well). Negative points, we felt, are the absence of a real policy of medical education of young doctors based on the HR needs in our countries, non-employment of skilled young doctors, the organization of the private sector, the lack of diagnostic tools to confirm clinical diagnosis, the lack of health insurance for young doctors, the absence of electricity in the majority of rural areas, the absence of continued medical education, … You get the idea. More negative aspects than positive ones were mentioned.

This situation is troubling for Universal Health Coverage (UHC) because most global health observers would agree the medical workforce is key for the scale up of UHC in SSA. The last thing you need is a continuing medical brain drain to developed countries, if we are to scale up UHC in our countries. Unfortunately, the consensus was that bad working conditions of young doctors in SSA are still a key threat for the scale-up of UHC and our health systems in general, even if in some – especially middle income – countries you already see the beginning of a reversal. No need to repeat here that Africa still carries 24% of the world’s burden of diseases with only 3% of world health workers as compared to the US ( with 37 % of the world’ health workers for 10% of the world’s disease burden). Some solutions were proposed by the participants of the young doctors’ café.

–          First: each SSA country should clearly define a medical education policy based on its real needs.

–          Second: working conditions need to be improved, especially in rural areas, by ensuring accessibility of electricity, telephone & internet connection.

–          Third: continued medical education of young doctors needs to be organized and technical equipment of the health system improved.

It was great to discuss these issues with peers from other countries. But maybe we should come up with a different acronym – WYDO.  We don’t want people to think we’re a bunch of medical weirdoes !