The president of the World Bank on Friday praised a New York doctor who became that city’s first Ebola victim, saying the doctor’s decision to volunteer in West Africa was “exactly what is needed to stop this epidemic.”
“Dr. Spencer is a hero,” Dr. Jim Kim, who’s headed the World Bank for the past two years, said, referring to Craig Spencer, a 33-year-old physician who returned to the United States last week from Guinea, where he’d been treating Ebola victims on behalf of the global medical charity Doctors Without Borders.
Praise for a medical volunteer from the president of a global financial institution may seem like an odd way to begin a breakfast with a group of reporters in Washington. But Kim is an unusual World Bank president, the only leader of that institution not to be a career banker or financier. Instead, Kim is an epidemiologist by trade, a noted researcher of infectious diseases who earned renown for developing ways of treating multidrug resistant tuberculosis in the slums of Peru, and who once worked for the World Health Organization, the U.N.’s global health agency. Better health care, he argues, is the path to economic growth. In low to middle income countries, he says, 25 percent of economic growth can be attributed to better health outcomes.
Kim has been at the forefront of pushing the global response to the Ebola epidemic, persuading the slow moving World Bank system to approve $400 million to jump start the medical response in Liberia, Guinea and Sierra Leone in a mere nine days when it became clear that other potential donors were not moving fast enough. Of that, $117 million has been dispersed, he said.
He’s in frequent contact with Dr. Margaret Chan, the secretary general of the WHO, and spoke with her at 6:15 a.m. Friday to learn both the results of a meeting Thursday in Geneva on ways to speed development of an Ebola vaccine and to discuss what is one of his greatest concerns: that there simply aren’t enough healthcare workers willing to go to West Africa to do the work needed to stop the epidemic.
“We need to have health workers,” Kim said. He said he was grateful to the United States and Great Britain for their “tremendous work” building clinics and labs but he added that his greatest concern was the lack of people to tend to the needs of the thousands of people who’ve fallen ill in West Africa.
“My biggest concern is we’ll build facilities but won’t have enough people,” he said.
How many people? That’s not a figure he knows. But as an example of the enormous staffing needs an epidemic the size of the current one presents he cited the experience of Nigeria, which was declared Ebola free this week after its response to about 20 cases -- the result of one man flying to Lagos from Monrovia after he’d become sick. That country responded to those relative handful of illnesses with 200 doctors, 600 other health care workers and 19,000 home visits to find anyone who might have had contact with an ill person, Kim said.
“You can imagine what would have been required if there were 100 or 1,000 cases,” he said. Let alone the nearly 10,000 cases that have been recorded in Liberia, Guinea and Sierra Leon so far in this epidemic.
It’s hard to imagine where that kind of medical force would come from. He praised Cuba’s contribution -- 256 doctors and nurses -- but it seems a drop in the bucket when talking about not just the thousands needed to staff a first round, but the thousands more needed to relieve the first thousands. No one can work Ebola wards for months on end without a break.
How to pay those medical workers is another of the concerns Kim and Chan discussed in her early morning call, Kim said, and that’s an area the World Bank is trying to resolve, perhaps through electronic funds transfers, so that payments come on time.
As for risk to health care workers, that’s a given. More health care workers have been stricken with Ebola during this epidemic -- more than 420 by WHO’s most recent count -- than the number of people who fell ill in the previous largest Ebola outbreak. At least 239 of those workers have died, by WHO’s most recent count.
But Ebola need not be a death sentence, even though the current mortality rate is thought to be 70 percent, Kim said. Indeed, the news of the last few victims in the United States -- the nurses Amber Vinson and Nina Pham, the NBC free-lance Ashoka Mukpo, all of whom have been declared Ebola-free now -- is evidence of that.
Kim called Ebola “a very interesting virus.” “It doesn’t adapt to a modern world,” he said, one where medical centers are able to provide round the clock hydration and monitoring, especially of potassium levels in the blood. “We have the tools,” he said. “Any modern medical system can handle this.”
Thomas Duncan, the Liberian man who died at Dallas’ Presbyterian Hospital, is an exception. By the time his disease was recognized, he was too sick to be saved. “We learned a lot from Dallas,” he said, in particular the value of suspecting the worst when someone who’s been in West Africa reports symptoms. “In Dallas, there just wasn’t the heightened level of suspicion,” he said. “Duncan died because we were late.”
But even in Liberia, people can survive Ebola, though the effort is Herculean. He recalled the case of a Liberian doctor who survived -- by drinking 12 liters of water daily, more than three gallons, and forcing himself to eat, by holding his nose. Imagine if the capacity could be developed to monitor electrolytes and provide intravenous hydration and tube feeding.
That was another of Kim’s messages as he met with reporters for a breakfast sponsored by the Christian Science Monitor -- not to be cowed into hopelessness. “We have to get beyond the nihilistic thought that nothing can be done,” he said. If all ill people can expect is isolation with no hope of treatment and little hope of survival, then they will go elsewhere, spreading the disease with them.
That’s why Dr. Spencer is a hero, Kim reminded. “Dr. Spencer understood this epidemic,” Kim said, that the only way to stop it is to treat it.
He recalled the oaths physicians take. “Our job is to go out and treat people who are sick,” he said.
As for Spencer -- “I would not be surprised if he goes back,” Kim said.