The ongoing Ebola epidemic in Africa is “unprecedented” due to its high mortality rate (up to 90%), geographic spread (at least 5 countries have reported cases of the disease, which has spread to urban areas as well), and difficulty enforcing quarantines that would reduce the spread. As with many outbreaks, the factors involved are complex and wide-ranging.
We can address the issues contributing to the outbreak by capturing them in a Cause Map, or visual root cause analysis. This intuitive method ties impacted goals to cause-and-effect relationships, allowing development of solutions to all aspects of an issue.
First we begin with the impacts to the goals. The outbreak began in Guinea at some point in early 2014, but was reported to the World Health Organization (WHO) on March 23, 2014. The outbreak is still ongoing and has impacted Guinea the most, but has also spread to neighboring countries. The strain involved is the Zaire Ebola virus, which is spread by bodily fluids.
At the date of publication, the virus has killed at least 101 out of 157 infected in Guinea alone. The infections and deaths, as well as the spread of the disease, can be considered impacts to the public safety goal. This is the first outbreak to have impacted urban Guinea, though there have been dozens of outbreaks in Africa over the past 40 years.
“Why” questions are used to determine the cause-and-effect relationships that resulted in the impacted goals. Death typically results from bleeding or shock, which occurs due to infection with the virus and insufficient treatment. Infection results from the initial transmission (caused by eating raw infected meat), and the spread of the disease. The spread in this case has resulted from the unusual migratory pattern, both because of the easy and frequent travel between countries but also due to an as-yet-unknown factor. Normal outbreaks involve a much smaller geographic area.) Victims are contagious for a long time, meaning the disease is easily spread, and it has been difficult to enforce quarantine, because of mistrust of local authorities and foreign aid workers. According to Stéphane Hugonnet of WHO, “The mortality rate is extremely important. Nine out of ten patients will die. If we look at this from the population’s perspective, why would you go to a hospital if you have almost zero chance of getting out of it.” However, with effective care, there is a chance of surviving Ebola.
However, providing that care is another challenge. There is no cure for Ebola, possibly because financial incentives to develop a cure for a rare disease that primarily strikes poor African villages isn’t there. Care essentially involves keeping a person alive long enough for their body to be able to fight back, difficult in a country that has 0.1 physicians for every 1,000 people fighting a disease that rapidly replicates and – through an unknown mechanism – disables the immune system.
So what’s being done to end this outbreak? Medical teams from Doctors without Borders (or Médecins Sans Frontières) and WHO have been dispatched to the area. These medical teams may include anthropologists, to better address local concerns regarding the disease. WHO has also recommended limiting personal contact and a on raw bush meat. Meanwhile, researchers are working on a vaccine to prevent transmission of Ebola. It is hoped that these steps together will end this outbreak – and prevent future outbreaks as well.
To view the Outline, Cause Map and Solutions, please click “Download PDF” above.