More than two weeks ago, I had the rare opportunity and privilege of testifying on the Ebola outbreak before the US House of Representatives Subcommittee on Africa, Global Health, Global Human Rights and International Organizations. I co-testified with Dr. Kent Brantly, arguably the best worldwide known face in the current battle to end the Ebola outbreak as the first American to contract Ebola in Liberia. At the Congressional testimony, Dr. Brantly had a simple message: The fight against Ebola is eminently winnable with concerted efforts. I come to this event with the same simple message to Africans in the Diaspora: We can win the fight against Ebola with your participation and that of other stakeholders. However, time is of the essence.

Current Ebola Outbreak

In United States, the biggest news is the first known Ebola case in the country. A Liberian visiting his family in Dallas, Texas came down with Ebola and is now in serious but stable condition in a Texas hospital according to the Centers for Diseases Control and Prevention (CDC). This individual reportedly had up to 100 contacts that must be followed up for the average 21 day incubation period to ensure that none of the potentially exposed persons develop an active disease. With a robust healthcare system, strong government at local, state and federal levels, informed citizenry and assertive press and civil society, it is likely that this single case and any other case/s subsequently will be contained in United States. This is a far cry from Guinea, Liberia and Sierra Leone, current epicenters of the 2014 Ebola outbreak with severely challenged health systems. It is however remarkable that what reportedly started as a primary infection in a Guinean traditional healer in December 2013, according to the WHO and the CDC, is now the biggest news in the United States.

In West Africa, as of September 30, 2014, the WHO reports that more than 6,500 individuals have Ebola and more than 3,000 have died.  Case fatality rates hovering around 47% since my Congressional testimony two weeks ago are now approximately 70 percent. A recent study published by the New England Journal of Medicine suggest that Guinea, Liberia and Sierra Leone may soon experience thousands of news cases and thousands of deaths EACH WEEK if the following containment efforts are not urgently implemented: A) effective contact tracing; B) efficient case isolation; C) better quality of clinical care: D) robust community engagement, and; E) rapid, qualitative and quantitative international response.

Guinea, Liberia and Sierra Leone face tremendous odds since none can currently implement any of the aforementioned urgently needed containment efforts. Nigeria appears to have contained the only known imported case of Ebola. Senegal, another country under close watch by the WHO, also appear to ward off multiple newer cases.

However, no country in West Africa can mount a long term containment effort. No other country in Africa to the best of my knowledge can deploy a sustained response against Ebola for multiple reasons.

First, as I and my colleagues noted in my edited Book, Healthcare Services in Africa: Overcoming Challenges, Improving Outcomes, healthcare systems in Africa face tremendous challenges in management, surveillance and containment, infrastructure, regulatory framework, financing, logistics, human resources, quality of care, outreach and community participation.

Second, despite economic growth in the last decade and predictions of rosy future, African countries continue to grapple with wide ranging economic problems, including high rates of abject poverty and income inequalities. Large segments of Africans are unable to access quality and affordable health and social services. The two dominant economic powerhouses in Africa-Nigeria and South Africa-have some of the most significant income inequalities in the world according to both the World Bank and the Africa Development Bank.

Third, weak governance and poorly managed national institutions in many African countries create crises of confidence with the populace leading to devastating setbacks in information, education and communication (IEC) campaigns against rapidly, spreading health risks. Reports of disbelieving public in severely affected countries during the early stages of the 2014 Ebola outbreak is extremely unfortunate.

Fourth, deploying technical, skilled workforce resident in many Africa countries to address emerging challenges remains a work in progress. Professional bodies in Africa often have adversarial relationships with ruling governments, especially in the health and legal field. These disagreements usually revolve on salary and other pay issues for public sector workers, regulation of private practice, contribution to public policy and professional independence. The Government of Nigeria recently sacked 16,000 resident doctors for continuing an ongoing industrial action despite the deadly challenge of an Ebola outbreak in the country. Continental initiatives to assemble and deploy technical expertise remain at a premium. We should applaud the African Union Commission for its reported plan to deploy a small contingent of an Ebola continental response team. However, more should be done. This is perhaps where the Africa Capacity Building Foundation can play a decisive role.  

Fifth, the overwhelmingly predominant human-to-human transmission of Ebola poses significant challenge to African countries.  Overcrowded and shabby health facilities, overworked and poorly paid health workers, poor waste disposal mechanisms, limited access to portable water and basic sanitation services, peripatetic electricity supply and underwhelming laboratory services indicate a gargantuan struggle to maintain basic Ebola containment efforts in the continent. In particular, since no vaccine or “cure” currently exists according to the WHO, very few African health centers have the technical capacity and space to maintain the robust round-the-clock supportive clinical care critical to survival for thousands of individuals stricken with Ebola.

Role Of Africans In The Diaspora

Africa will benefit from an international public-private partnership to rebuild health systems in the continent. I also noted that Africans in the Diaspora represent an important stakeholder in this process. Additional, I suggested that getting a scaled up response from the African Diaspora may represent one of the toughest jobs for any individual or organization.

I have written extensively with Melvin Foote and other colleagues on Africa-Africa Diaspora partnerships, including incredible opportunities and severe constraints. We had noted the incredible opportunity since the African Union adopted Africans in the Diaspora as the “sixth region” of the organization. We had also underscored the need for Africans in the Diaspora to be better organized, better focused technically and operational engaged on specific issues in specific geographical areas of the continent to achieve economies of scale. This is not a forum to rehash these issues. 

However, Africans in the Diaspora can play a decisive role in the Ebola response in Africa by taking advantage of five ongoing opportunities. Africans in the Diaspora can take advantage of the Obama Administration response to the Ebola Outbreak in West Africa. Africans in the Diaspora can partner with key U.S. agencies engaged in the response, including the State Department and the USAID, the Department of Defense, the CDC, the FDA and other agencies. President Obama is promising to send up to 3,000 US technical personnel to Guinea, Liberia and Sierra Leone.

US Congress efforts to contain global Ebola outbreak represent an additional opportunity. Africa Diaspora communities and professional organizations through their Senators and Congressmen can assist the Congress pass relevant legislation.

Africans in the Diaspora can partner with the African Union and other continental institutions. The African Union Africa Diaspora Health Initiative which I served as the pioneer Executive Chairman is a distinct possibility. The Africa Development Bank and the United Nations Economic Commission are additional partners. The Africa Capacity Building Foundation is another potential partner. The regional economic communities are also critical partners.
 
Africans in the Diaspora can lead new efforts to develop and implement a new public-private partnership to rebuild health systems in the continent. African Diaspora communities and professional groups in every industrialized nation, including the United States can help bring together bilateral agencies, international organizations, global philanthropies, organized private sector, the academia/scientific/research institutions, professional organizations and the civil society. This new partnership will not be business as usual.

It will bring a fresh thinking and perspective on how to rebuild health systems in Africa anchored on access to portable water, basic sanitation, best scientific practices, affordable access to quality care and robust community participation. The long cherished dream of a Global Health Architecture advanced by Western democracies to deal with current, new and emerging health threats.

Finally, African Diaspora communities and professional organizations should organize better and mobilize more effectively to supplement ongoing efforts. Guinea, Liberia and Sierra Leone communities and professional organizations should mobilize resources and put volunteer boots on the ground in respective countries. The U.S. National Medical Association should activate its Africa Diaspora Health program which I helped design as a Senior Visiting Fellow. Other organizations such as the National Dental Association, the National Black Nurses Association and other similar organizations should be actively engaged on the ground in Africa. I am to add that it would be counterproductive either in the highest policy circles or in legislative processes for Africa Diaspora communities and organizations to be requesting additional resources from Western governments without proven engagement on the ground in affected areas in Africa.

Conclusion

Africans in the Diaspora have a fundamental role to play in a coordinated response to the Ebola outbreak in West Africa and in preventing a global epidemic. This role requires better organization and mobilization of inherent capacities within Africa Diaspora communities. It also requires partnership with existing structures and platforms dedicated to the Ebola. Finally, Africans in the Diaspora should play a leading role in a new international partnership committed to rebuilding health systems throughout Africa.

By Dr. Chinua Akukwe
National Academy Fellow and Chair, Africa Working Group,
National Academy of Public Administration, Washington, DC.
Email: cakukwe@att.net; cakukwe@gwu.edu