Gino Strada, one of the doctors on the frontline of fighting Ebola in Sierra Leone,is opening a 100-bed hospital in four weeks. He has the supplies that he needs, the gloves and gowns. But there's one worry that keeps Strada, the founder of the non-profit group Emergency, up at night: he thinks he might not be able to find the health workers to actually staff the hospital.
"The personnel is a critical factor," says Strada, a surgeon who is used to operating in the middle of more traditional battlefields, such as Afghanistan and Sudan. "To be able to provide each patient with a minimum of five to six hours of medical attention means you have to work on a rotation basis, so you need 100 nurses, and 10 to 15 doctors."
He is trying to recruit among the Cubans, the British, and the Italians. But it hasn't been easy, and with the hospital opening in about a month, he's not sure he'll find all the people he requires.
Strada's problem is the one many aid groups working in West Africa right now are facing: when asked what they'd say is the single most important resource needed to stop this epidemic, they all pointed to people.
You can buy equipment and supplies, but if you don't have people to use them, they're useless. You can build clinics, but if you don't have people to staff them, they'll sit empty. You can design an Ebola treatment or vaccine, but if you don't have people to hand them out, they can't save anyone. If this Ebola epidemic is going to be stopped, experts say more people need to join the fight. But as it gets worse, recruiting health workers is becoming an increasingly difficult task.
"In the last six months, a fair number of doctors have been infected and killed by the Ebola virus," says Dr. Daniel Bausch, associate professor at the Tulane University School of Public Health. "Obviously if you're one who hasn't been infected with Ebola, how enthusiastic are you about doing that work if you see colleagues getting sick and dying? So you go to West Africa, and you say, 'Raise your hand if you want to work in an Ebola treatment unit.' You don't see many hands in the air."
People are critical to fighting the Ebola outbreak — and they're in short supply
Today, the World Bank Group singled out the personnel factor in an announcement of an additional $100 million in funding for Ebola. The money will be used "to speed up deployment of foreign health workers" to the three worst-affected countries in West Africa. They estimate that about 5,000 international medical, training and support personnel are needed as soon as possible.
"The world's response to the Ebola crisis has increased significantly in recent weeks, but we still have a huge gap in getting enough trained health workers to the areas with the highest infection rates," says World Bank Group President Jim Yong Kim. "We must urgently find ways to break any barriers to the deployment of more health workers."
The World Health Organization has also said it needs a 20-fold increase in health personnel (20,000 national staff and 1,000 internationals) to meet the demand on the ground.
"Based on calculations of where the outbreak might be developing, it is estimated that 56 treatment centers are needed in the three most affected countries," explained Dr. Ian Norton, who is helping run the WHO's recruiting effort. "Of those, there are 15 up and running already, and there are 22 that will be ready to run by the end of November and for which teams have been identified."
But, he added: "The concern is for the 19 centers that do not yet have teams to run them."
Doctors Without Borders spokesperson Tim Shenk says they have 270 international staff and more than 3,000 local staff in West Africa right now, but that they're overwhelmed with work, and the group is having trouble finding qualified workers to fill the spots.
"The requirements for working in an Ebola outbreak are so high," Shenk says. For this reason, MSF hasn't put out its usual open call for volunteers, and instead has run very targeted recruitment effort to find staff.
Ebola experts in high demand
It's this shortage of Ebola experts that has left Lina Moses, a Tulane University epidemiologist who has been working in Sierra Leone, in high demand. "I'm constantly getting job offers because I have four and a half months of experience with Ebola," she says. "That's more than most people in the world have with Ebola."
She estimates that she now gets about three to four offers per week related to Ebola. Before this year, she says, "I have never had an offer or any inquiry as to whether or not I would be interested in working on Ebola — ever."
But she's worried that the rising panic and stigma about Ebola in America — including mandatory quarantines of returning health workers — are going to dissuade experts from going over.
"You have people volunteering their time to go over for the response, taking vacation time to do this, and they have to come home and be quarantined for 21 days even though they don't show symptoms," she says. "I think it's insulting. It's fear-mongering."
State quarantines may discourage volunteers from going over
She's referring to the fact that states are increasingly implementing quarantines for returning health workers.
Some states, such as New Jersey, are requiring that health workers who had risky exposure to Ebola quarantine themselves in their homes on return to America for 21 days, the incubation period for Ebola.
Maine has stationed a police car outside of Doctors Without Borders nurse Kaci Hickox's house, to ensure that she doesn't break the three-week order.
The Obama administration and public-health experts say that the requirement is overkill, and that daily temperature monitoring is enough, since Ebola is only contagious only when a person is already symptomatic.
In a White House press conference yesterday — featuring health workers such as the American Ebola survivor Dr. Kent Brantly — President Barack Obama said that every effort needed to be made to respect health workers and not to discourage them from going to West Africa to right Ebola there, which will keep Americans safe here.
"We need to call them what they are, which is American heroes," the president said. "Each of you studied medicine because you wanted to save lives. The world needs you more than ever."
Brantly echoed Obama's plea: "More medical professionals are desperately needed."
Local staff shortages, as workers walk off the job
Beyond attracting international staff, Moses says she is most concerned about how to support and recruit local staff for the Ebola response effort, who right now are also in short supply or have walked off the job.
Ebola outbreaks don't typically happen in West Africa, and that meant doctors and nurses weren't prepared for what treatment would entail. Even after they learned about Ebola, they didn't have the resources (gloves, gowns, masks and personnel) to stay safe. Some have refused to work because the stress and danger of caring for people in a drastically under-resourced setting became overwhelming.
"You need the local staff to effectively communicate to communities," says Moses. "Even though Sierra Leone and Liberia are English-speaking countries, most people in these countries — particularly in rural areas — don't speak those official languages, they speak the various tribal languages."
But she's not surprised that local workers are striking or walking away: 270 health workers have already died treating Ebola patients there and 520 have contracted the disease.
"We're not ensuring the safety and adequate training of local people," Moses says. "We are not protecting them. When I go back to Sierra Leone… I know that my organization will make sure, if something happens to me, that they will do everything possible to take care of me. None of the local health care workers have that same experience."
She adds: "This is why people are not showing up for work. Until we start focusing on them, there's no way this outbreak is going to get under control. It doesn't matter if we develop a vaccine. Who is going to deliver the vaccine?"