Health Inequity in Ebola-affected Countries Maria van Veelen, Keele University

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Thank you for visiting Frankfurt, your journey and visit will include: An airlift from Sierra Leone on a private medically-

specialised plane A greeting at Frankfurt airport by multiple emergency

services: fire service, police service, medics and security You will be provided a private dedicated staff of a total of 26

doctors, 57 nurses and 5 support workers to provide day-to-day care

Your doctors only work 4 hour shifts and nurses only work 3 hour shifts

A private intensive care unit (ICU) room with four other beds surrounding your room taken away from other patients

16 days of care in ICU and 24 further days in private hospital room

Total Cost of your trip: Over one million euros for

hospitalisation alone11

(4)

(5)

(6)

Thank you for staying in Liberia! Please expect to share during your visit here in the ETU: You will share on average 3 expatriate doctors, 8 expatriate

nurses and 24 local nurses with 50 other patients7

Your medical staff will work shifts of 6 to 12 hours or

longer7,8,9

You will most likely be placed in a 40 to 60 bed ETU with

your bed located in an open corridor with or without walls

separating beds7,9

The closest laboratory may be located 100 miles away (3-4

hour drive) and you could wait from 5 hours up to 7 days for your EBOV RNA result. Your blood sample is often

transported on a motorbike motorbike7,9

Total cost of your visit: Estimated between $1685 to $6627

United States dollars (USD), depending on whether you

survive or die10

Thank you for visiting New York City, your journey and visit will include: 500 staff members of DOHMH for patient and

community monitoring and education outreach with a

total cost of over four million USD12

You will be cared for by 106 healthcare personnel

including 38 clinical staff, 42 laboratory staff and 22

environmental management staff12

You will stay in a private negative-pressure ventilation

room updated to include an anteroom and point-of-care

laboratory testing13

Your private intensive care unit prepared for EBOV

patients by Bellevue hospital was estimated to cost three to four million USD by the New York City Health and

Hospitals Corporation Corporation13

Countries with Former Widespread Transmission and Current, Established Control Measures16 Country Total Cases Laboratory-Confirmed Cases Total Deaths (Suspected, Probable, and Confirmed) --------------------------------------------------------------------------------------------------------------------

Guinea 3814 3358 2544 Sierra Leone 14124 8706 3956 Liberia 10678 3163 4810 Total 28616 15227 11310

35%

in Guinea

50%

in Sierra Leone

62%

In Liberia

Estimated Increase in Malaria-

attributable Mortality15

00.61.21.82.4

33.64.24.85.4

66.67.27.88.4

Healthcare Worker Deaths vs. General Population𝟏𝟒

Pe

rc

en

t D

ea

ths

Guinea Sierra Leone Liberia

Shortage of Health Personnel2

Unstable Health

Infrastructures

Uneven Distribution

Poor Working Conditions

High Rates of Attrition

Prior to the West African Ebola outbreak, there was already a deficient number of healthcare personnel working in unstable health infrastructures with high rates of staff turnover, an unequal distribution of staff and resources and

poor working conditions2.

After the 2002-2003 outbreak of severe acute respiratory syndrome (SARS), the United Nations created a goal to bring together countries under the International Health Regulations to prevent further outbreaks, yet many of the countries involved have still not met their commitment

3.

This can be seen as a major health injustice prior to the West African Ebola crisis as preparations for such an epidemic were meant to be in place.