Author: Willie Ngumi, September 15 2014 - It’s not the first time I’ve heard of Ebola. Every time the epidemic has raised its ugly head, it has been a fairly safe distance from me. And like any other human being, I figured it was "their problem". Even on this occasion it didn’t raise any flags for me personally until it touched Nigeria, and when I had to book a flight to Ghana. Faced with the reality of air travel to West Africa, I began to Google everything about Ebola. Suddenly, it was an issue for me. I have a wife and three young children, as do so many people living in the affected countries.
- It is a virus disease (Ebola Virus Disease EVD) with no cure in sight yet. So most of the time, medic response is to manage symptoms and reduce further infections where possible, considering the very high mortality rate of up to 90%.
- It is spread through contact with body fluids. While there may be a little debate about how effective sweat and saliva are in carrying the virus, some sources indicate that these aren’t deal breakers, compared to other body fluids. I don’t know about you, but this rings a familiar bell (i.e., Human Immunodeficiency Virus (HIV).
- It is received through open wounds, broken skin, and mucus membranes, and this rings the same bell in number two above, as HIV infections usually take place through body fluids via broken skin, and mucus membranes such as eyes balls.
Contact with the body fluids of an infected person could come about in many ways. In the current outbreak cultural practices like embalming the deceased has been sighted as a likely multiplier of infections. The source is still suspected to be from wild/game meat and a little animal called the fruit bat. There could be many other behaviour practices that aid the spread, but like all difficult problems it is wise to start with the known.
As I write this I’m seated in Ghana, as a mHealth Technical Expert, and I can’t help but feel that mHealth could be a key pivot point to reduce of the rapid spread of Ebola. While I am fully aware that mHealth is not the be-all-and-end-all, nor the Midas touch that turns everything into gold, the following points, maybe repetitious for those in mHealth circles, are important to highlight:
- Prevalence/penetration of mobile service. As I write this, statistics indicate that mobile phone access should have reached more than half the world’s population and has by far outnumbered older communication technologies like radio, TV, print media, and the smoke signal. With 7 billion mobile connections and 3.6 billion unique mobile subscribers, there is no contest. Without a doubt, the ability to immediately and specifically target a national population with information is through a mobile phone.
- Infrastructure challenges. Most of the affected villages and areas tend to be out of reach of key infrastructure, like good roads to get the sick to hospitals as soon as possible. These facilities are understaffed and under resourced. The fully protective barrier method (moon suit), is most likely not available at district and village level, which means that health workers are constantly at risk of exposure.
- Cost. Many pilots that have been conducted, but not much evidence is being presented to Governments on the cost effectiveness of mHealth. Compared to traditional information dissemination methods in the health sector (flyers, door-to-door campaigns and public address at health facilities) mobile messaging presents a per unit low cost method of communicating, with a higher ascertainable reach as well.
Ebola has a very uncanny resemblance to HIV, due to the fact that it is a virus and spread in pretty much the same way. Unlike HIV, which has a Post Exposure Prophylaxis (PEP), Ebola has no known effective treatment or cure. Ebola goes one step further than HIV, with a shorter incubation period and a very abrupt transition from the full blown to mortality timeline. Notably though, current information being shared relates to behaviour change. Villages are being educated and encouraged to cease risky cultural practices that increase exposure, and some efforts have even included distribution of chlorine and education on hygiene.
So why mHealth for Ebola? Time is short and this particular West African outbreak has seen high rates of infection. Therefore, in additional to the physical efforts being undertaken, an "information battle" needs to be waged against the disease. The key enemy in this case is the lack of information on how Ebola is spreading, and where information is available, reach is not verifiable. It is definitely time to digest and distil the most important and hopefully effective behaviour change messaging around Ebola. Then, the countries affected can adapt these messages for cultural, contextual and language uniqueness. The more people informed about how to avoid Ebola infection, the more likely that they will share/spread accurate information, and take the right precautions in the event that they suspect possible exposure.
The time it takes to mobilize a team with the correct tools and aids to reach one village is much longer than the time it takes for national outreach via mobile technology. National outreach can emit key messages on what Ebola is, how it spreads, how it is acquired as well as various barrier methods to prevent spread or exposure. This may just turn the tide down, long enough for most governments to have effective mechanisms of identifying, diagnosing and managing Ebola patients. Time for action!
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Source of Ebola facts – the World Health Organization (WHO)