In the last 10 days, Uganda has been hit by a new Ebola outbreak. There is no approved vaccine for this particular virus strain. The current health crisis in Uganda is a stark reminder of the ongoing Ebola threat across the African continent.
Perhaps lessons can be learned on how to deal with the situation in Uganda from the account of a British obstetrician who was a doctor on the front lines of a spreading Ebola epidemic in Sierra Leone in 2014 and struggling to save the lives of pregnant women mothers and their babies.
Globally, a woman dies every two minutes from a pregnancy-related complication. Sierra Leone is the country with the highest mortality rate among pregnant women in the world. This is the country where we find the author – Benjamin Black Belly Woman: Birth, Blood and Ebola, The Untold Storyat the beginning of his fascinating story.
In May 2014, Ebola, one of the deadliest known human infectious diseases, entered Sierra Leone from neighboring Guinea. When Black arrived in July 2014, he found himself at the epicenter of a deadly and ever-growing Ebola outbreak.
There are quite a number of books on Ebola, whether from a purely scientific perspective on phenomena such as zoonotic transmission, or as a kind of disease thriller. Black’s book is not like that. It’s a much more personal narrative, similar to Paul Farmer’s Fever, Feuds and Diamonds: Ebola and the Devastations of History. The late Paul Farmer was a physician and medical anthropologist who founded Partners in Health, an organization that has for many years fought outbreaks of infectious diseases in developing countries, from tuberculosis in Peru to AIDS in Rwanda to Ebola in West Africa.
When Black arrived in the capital, Freetown, in 2014, “Western Sierra Leone was ground zero of the epidemic, and Upper West Africa was pretty much the worst place on earth to be seriously ill or injured.” This, of course, also applies to pregnant women Women in emergencies that require immediate intervention. Black reports on the lack of basic medical supplies and an implied failure to have properly invested in basic health infrastructure and supportive care in Sierra Leone. The author reminds us that the causes of such neglect are multifactorial – political, socioeconomic, cultural – and therefore not easy to solve. Black also cites ongoing issues preventing optimal maternal care, as well as Ebola, as well as a fundamental distrust of both the healthcare system and Western medicine.
Medical ethicists often describe the very difficult decisions that must be made regarding triage in times of crisis, as well as the moral dilemmas involved in situations where resources are severely constrained. Such ethical thought experiments, while illustrative, can be quite far from reality. Black makes this clear by showing what the real world of West Africa was like in 2014, when crisis mode was a constant and the choices healthcare providers faced were extraordinarily difficult.
Specifically, Black was tasked with caring for pregnant women presenting in the hospital with a variety of prenatal crises stemming from infections, diabetes and eclampsia while Ebola struck.
As Black points out, the twin crises – one temporary in nature, the other a permanent phenomenon in many developing countries – invariably test our conscience, ethics and clinical judgment.
Black is an obstetrician and gynecologist based in London and is currently a consultant for international charities. He teaches medical teams around the world how to improve reproductive health care for the most vulnerable subpopulations in the most challenging environments. As a working member of MSF, Black is uniquely qualified to tell a detailed, sobering story of what it was like to be on the ground as multiple crises unfolded. The author writes about balancing fears of contracting Ebola with a desire to treat patients who walk through hospital doors with a variety of obstetric emergencies. He doesn’t sugarcoat the situation. While there are mothers he saves from dire conditions like eclampsia, he also sees many die, including their fetuses and babies. At the same time, it offers a somber reminder of the horrors of Ebola. He even loses a fellow doctor to the disease.
While the book’s focus is on midwifery and the 2014-15 Ebola epidemic in West Africa, it also flashes regularly to deal with the Covid-19 pandemic as experienced in London, as well as other more everyday situations that doctors like Black face in a wealthy nation like the UK.
Black puts a human and deeply human face on the medical profession, working in teams where problem-solving is often only possible on the side. Some things you can’t prepare for. There is little time to peruse manuals and peer-reviewed literature. or providing resources to adequately prepare or plan for alternative scenarios.
In this context, Black’s narrative goes beyond telling his experiences. He wants to help find a way forward and provide proper guidance to organizations like Doctors Without Borders. Ultimately, the overarching goal is to reduce global disparities in maternal health and help prepare for future epidemics.