This document provides an overview of the Ebola outbreak in West Africa, including key facts and events. It discusses some of the social factors that impacted the spread of Ebola, such as traditional funeral practices and gender roles. It also examines the health care systems in West Africa and lessons that can be learned from past Ebola outbreaks in Uganda and Nigeria. International aid efforts are outlined, such as those from Doctors Without Borders, the Chinese PLA medical team, and the US sending military personnel to set up treatment centers.

1. Triangle Smart Talk_Ebola
Bolun Li
Master of Science in Global Health &
International Development Policy
Certificate
Duke University, Nov.23, 2014

2. Table of Contents
 Some facts about Ebola
 Key events in the spread of Ebola
 Understanding Ebola from a social perspective
 How do people feel about Ebola in West Africa
 Health care systems in West Africa
 Gender and Ebola
 Tradition: Funerals
 International lessons and efforts in fighting Ebola
 Uganda & Nigeria
 International aid

3. Some facts about Ebola

4. Reported Cases/Deaths
Country Cases Deaths Last update
Liberia 7,069 2,964 15 November 2014
Sierra Leone 6,073 1,571 16 November 2014
Guinea 1,971 1,192 16 November 2014
Nigeria 20 8 outbreak ended 20 October 2014
Mali 7 6 20 November 2014
United States 4 1 16 November 2014
Senegal 1 0 outbreak ended 17 October 2014
Spain 1 0 16 November 2014
Total 15,146 5,742 as of 16 November 2014

5. Where did the outbreak took place

6. Widespread transmission: Guinea, Sierra Leone, Liberia Local transmissions - no
deaths: Texas, Spain
Initial cases - deaths: Texas, Mali Initial cases - no deaths: New York
Medically evacuated cases - deaths: Spain, Germany, Nebraska
Medically evacuated cases - no deaths: Georgia, Maryland, United Kingdom, France,
Norway, Switzerland
Previously had cases, now Ebola-free: Senegal, Nigeria

10. Key events in the spread of Ebola

11. DEC. 28, 2013
Emile, a 2-year-old boy in Guinean village of Meliandou, dies of a mysterious
sickness, becoming West Africa’s first Ebola victim.
EARLY 2014
Amid a multitude of deadly diseases, Ebola spreads without being noticed.
MARCH 23, 2014
The World Health Organization publishes notification of a “rapidly evolving” Ebola
outbreak in Guinea involving 49 patients and 29 deaths. Suspected cases in Sierra
Leone and Liberia are being investigated.
MARCH 30, 2014
The WHO reports that two Liberians tested positive for the Ebola virus after
traveling to Guinea, including a 35-year-old woman who died March 21.
MAY 10, 2014
Dozens of mourners attend the funeral of a traditional healer who contracted
Ebola while treating patients. The funeral, in Koindu, Sierra Leone, helps the virus
spread and may be linked to 365 Ebola deaths, local health authorities say.

12. MAY 25, 2014
Sierra Leone health authorities confirm their first Ebola case, a young woman
admitted to a government hospital in Kenema after a miscarriage.
JULY 20, 2014
Liberian American Patrick Sawyer ignores the advice of medical officials and
flies from Monrovia to Lagos, spreading Ebola to Nigeria. He dies five days
later, and the virus goes on to sicken 19 and kill eight, the WHO says.
AUG. 2, 2014
Dr. Kent Brantly, a 33-year-old American who contracted Ebola while working
in Liberia, is taken to Emory University Hospital in Atlanta. He becomes the
first patient with Ebola to be treated on U.S. soil.
A 21-year-old man who was being monitored by health authorities in Guinea
flees to Dakar in neighboring Senegal, becoming that country’s first and only
Ebola case. He is released from a hospital Sept. 19.
SEPT. 15, 2014
A 2011 photograph shows Thomas Eric Duncan, who died of Ebola in Dallas
on Oct. 8, at a wedding in Ghana.

13. SEPT. 16, 2014
President Obama says he is sending up to 3,000 military personnel to West
Africa, where they will set up 17 treatment centers and train healthcare
providers.
SEPT. 18, 2014
The U.N. Security Council declares the Ebola crisis in West Africa a threat to
international peace and security.
SEPT. 19, 2014
Duncan boards a plane in Monrovia, Liberia, to visit family in Dallas.
SEPT. 19, 2014
Sierra Leone begins a nationwide lockdown to identify and count cases of
Ebola. The country’s residents are required to stay home for three days while
healthcare workers and volunteers go door to door searching for Ebola
victims and distributing information about the virus.
SEPT. 30, 2014
Tests performed by the CDC and a Texas laboratory confirm that Duncan has
Ebola, the first case diagnosed on U.S. soil.
The WHO announces that Ebola outbreaks in Senegal and Nigeria are under
control.

14. OCT. 6, 2014
Teresa Romero Ramos tests positive for Ebola in Spain, becoming the first person
known to have contracted the virus outside West Africa in the current outbreak. The
nursing assistant had treated two infected missionaries.
OCT. 20, 2014
The WHO declares Nigeria to be free of Ebola.
OCT. 17, 2014
The WHO declares Senegal to be free of Ebola.
OCT. 23, 2014
Dr. Craig Allen Spencer enters isolation at Bellevue Hospital in New York City and is
diagnosed with Ebola. He had recently worked with Doctors Without Borders in
Guinea.

15. Understanding Ebola from a social
perspective

16. How do people feel about Ebola
in West Africa

17. In a school building used to quarantine Ebola patients in Monrovia,
Liberia, Umu Fambulle stands over her infected husband after he
fell

18. A three-day lockdown in Freetown,
capital of Sierra Leone
As in Sierra Leone, the virus marched into the capital city, Freetown, where it
took advantage of overcrowded living conditions
and fluid population movements to grow in explosive numbers.

19. Heroes Forever
Mbalu Fonnie
Alex Moigboi
Dr. Sheik Humarr Khan
Alice Kovoma
Mohamed Fullah
"I'm afraid for my life, because I cherish my life. And if you
are afraid then you must take the maximum precautions,
stay vigilant and stay on your guard." Dr.Khan

20. Health care systems in West Africa

21. Understanding the System
(source:Lyttelton Braima, Sierra Leone)
PHU (primary health unit/peripheral health unit): lowest tier of health service
delivery in rural areas:
1. Maternal and Child Health Post (MCHP): ideally should service 500 – 5,000
people in villages within a 3-mile radius
2. Community health post (CHP) should service about 5,000 – 10,000 people
in villages within 5-mile radius
3. Community Health Center (CHC) should service about 10,000 – 30,000
people in villages within 5 – 10-mile radius
MCHP and CHP are at village level
CHC at chiefdom headquarters
District hospitals are the main referral centers for the village and chiefdom level facilities.
District Hospitals are Located in District Headquarter towns.
● In big towns and cities, target local council wards or divide the city/town into zones to ease operation (management and
coordination).
● Private and faith based health clinics/health centers in big towns/cities.

22. Gender and Ebola
• Cultural roles of women in Africa
caregivers
nurses
cross-border traders
who prepare for burial
traditional birth attendants
• Female health workers receive less
protection than male workers

23. Casualties & gender
Source: Wolfe, 2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Liberia Guinea Sierra Leone
Male
Female

24. Tradition: Funerals
• Kenema, Serra Leone (mid-May) one traditional healer’s
funeral
 Mourners came from other nearby towns, to honour her
memory by participating in the traditional funeral and burial
ceremony.
 14 women were infected
 365 Ebola deaths linked to this funeral
 The funeral's role as origin of Ebola in Serra Leone is
confirmed by M.I.T. and Harvard who sequenced the virus
found in 78 patients
• In Guinea, 60% of all cases had been linked to traditional
burial practices.

25. International lessons and efforts in fighting
Ebola

26. Lessons from Uganda
• Gulu outbreak in 2000
 425 contracted Ebola
 more than half died
• Early warning system
 Village health teams: year-round monitoring
 Health massages broadcast on over 200 radio stations
• Rapid diagnostic testing center in Luwero district
• Emergency-operations center

27. Lessons from Nigeria
Measures
 Nigerian teams managed to trace everybody who had
contact with those who later developed the disease.
 A centralised emergency operations centre
 A first-class virology laboratory affiliated to the Lagos
University
 Quickly disbursed government funds
 TV broadcasts
Lessons
 Rapid case identification and forceful interventions can
stop transmission.”
 Persistence, rigorous enforcement of quarantine and
disinfection of premises contribute to a success story for
Nigeria

28. International aid
• http://www.theguardian.com/global-development/
datablog/ng-interactive/
2014/oct/28/-sp-ebola-funding

29. MSF(Doctors without Borders)

30. Medical team, PLA(解放军医疗队)

31. US sending 3,000 military
personnel to West Africa

32. UN Chief Board Meeting on
Nov.21 after Mali outbreak

33. Thank you very much!
谢谢！