EBOLA has become a household buzz word in the last few weeks, if one can dare to be so presumptuous, based on the amount of media attention this deadly and contagious haemorrhagic disease has attracted since its first reported case in Sierra Leone in May, 2014.
The steadily increasing fatality rate of Ebola continues to compound the complexities of the international response to the disease and the panic and fear of it that has rippled across the countries most affected. It is becoming clear that the needs of pregnant women have to be urgently addressed.
Pregnant women are not only threatened with contracting Ebola and complications related to pregnancy and childbirth, but the devastating impact of Ebola on health systems and health workers mean gains in maternal health (Millennium Development Goals 5) and family planning are being wiped out. Health systems in the countries concerned were steadily improving with significant gains in family planning services pre-Ebola.
The outbreak has spread quickly through four West African countries; Guinea, Liberia, Nigeria and Sierra Leone. The United Nations Population Fund (UNFPA), which is part of the United Nations Mission for Emergency Ebola Response (UNMEER), estimates more than 800,000 women in Guinea, Liberia and Sierra Leone will give birth in the next 12 months.
Of these women, more than 120,000 will die of complications from pregnancy and childbirth if life-saving emergency obstetric care is not made. Fear is a huge factor in women not seeking health facilities for the required antenatal, delivery and post-natal care and related obstetric support. Overwhelmed health systems and under-staffed or closed facilities mean many women will be turned away.
UNFPA further estimates 1.2 million women of childbearing age may lack access to family planning services they require so these countries can expect increased unplanned pregnancies. The dire situation has led the UNFPA executive director Dr Babatunde Osotimehin to call for urgent funding to provide reproductive and maternal health services of women and mothers in Guinea, Liberia and Sierra Leone, presently estimated to cost $US64.5 million ($F125m).
Since its discovery in 1976, this is the deadliest Ebola has ever been. By August 26, of the 2615 reported cases in the four countries, 1,427 people have died according to the World Health Organisation (WHO). Ebola is not new in Sub-Saharan Africa though cases would not normally surpass the 500 mark. Remarkably, there were no cases at all reported between 1979 and 1994.
One of the initial responses by the UNFPA and the government of Sierra Leone was the training of 300 health workers to be contact tracers, a method of tracking people linked to confirmed or probable Ebola cases. By tracing contacts and monitoring their health, health workers can map the movement of the outbreak which ideally would assist in early detection and immediate treatment.
For the United Nations (UN) family as a whole, a directive from the office of the Secretary-General has seen a shift in focus to the response to Ebola albeit the continuation of agencies' current programming and activities with member states.
The outbreak has also been one of the most trying for health workers across the affected countries. Health workers have died in unprecedented numbers. As of August 26, 117 health workers have been infected and 63 have died.
Part of the international community's response to Ebola is a pioneering initiative activated across the UN. For the first time, a system-wide organisational crisis response mechanism was established (UNMEER) and has been guiding the response. However, this was implemented with acknowledgement that Ebola is outpacing the response.
UN Secretary-General Ban Ki-moon told members of the Security Council on September 18: "Despite these wide-ranging efforts, the spread of the disease is outpacing the response. No single government can manage on its own. The United Nations cannot do it alone. This unprecedented situation requires unprecedented steps to save lives and safeguard peace and security."
As observed in previous humanitarian crisis, be it the impact of natural disasters or diseases, the burden of caring for the sick have fallen on women. While there is no difference between vulnerabilities of women and men to contract Ebola, more women have died than men, particularly in Liberia.
Apart from resource mobilisation, the provision of information, education and communication (IEC) materials and on-the-spot technical support like training on case management and advisories on infection control, information dissemination and supplies to health-care providers, UNFPA is providing emergency reproductive health kits (including clean delivery kits) to health facilities, midwives and communities.
The kits contain medical supplies required for safe deliveries and to address possible complications. UNFPA is also procuring medical gloves to facilitate safe deliveries while simultaneously protecting health workers from possible infection; disinfectants, protective health-duty aprons and hand-washing equipment are all part of the UNFPA support.
"This crisis has demonstrated how important it is to respond quickly and collectively," UNFPA Pacific Sub-Regional Office director and representative Dr Laurent Zessler said of the response.
"The intervention provided by various member states has been essential and the private sector which is well-placed to assist have been positive for example a mobile company in Sierra Leone did not hesitate to assist providing mobile telephones and credit to ensure the contact tracing team was able to disseminate information as and when necessary which then ensured some semblance to data collation and how it informed the various responses of the UN."
UNFPA is now implementing innovative approaches such as tent-based outreach and mobile clinics. It is also recruiting several hundred midwives to support maternal health and family planning services. In addition, UNFPA is tackling fears and misinformation and promoting health-seeking behaviour.
For Pacific island nations, the response on the African continent may hold lessons for us, with adaptation of the various approaches being taken, be it for Ebola or devastation post-cyclone or drought.
