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In which John discusses long-term solutions to long-term problems, "acute on chronic" emergencies, post-ebola healthcare in Sierra Leone, and other thoughts stemming from this story about Ophelia Dahl and Partners in Health:

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And more about Sierra Leone and its health challenges from the World Health Organization: UNAIDS and the BBC:

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Good morning, Hank, it's Tuesday, 

In your video last week you mentioned this New Yorker profile of Partners in Health co-founder Ophelia, and ever since reading it, I've been thinking about Ebola. Remember Ebola? An outbreak of the virus in 2014 killed over 10,000 people and to quote some 2014 headlines: "Ebola was a global health crisis," "A pandemic," and above all "An emergency." 

And I think in general, humans are quite good at responding to emergencies. We rally together in the immediate wake of disasters, we raise money, we lobby our governments- but we really struggle when it comes to long-term solutions to long-term problems. 

Back in 2014, the worlds responded to the Ebola emergency with big healthcare investments in the nations affected by the outbreak: Guinea, Sierra Leone, and Liberia. And then, to quote The New Yorker article "As soon as Ebola appeared to be stabilized, the money evaporated." The influx of aid in 2014, did help end the Ebola crisis, but it did very little to address the long-term crisis.

When the outbreak began, Sierra Leone - a nation of over seven million people - had fewer than 200 doctors. And over 5% of them died of Ebola in 2014. For context, my home state of Indiana - which has a slightly smaller population than Sierra Leone - has over 16,000 practicing physicians. Short-term aid did not fix that problem. Sierra Leone still has far too few health workers who are paid far too little. And facilities are hugely inadequate, more than half of the public hospitals in Sierra Leone lack running water and drugs and other supplies are often out of stock. And all of that has real catastrophic consequences. 9% of kids born in Sierra Leone will die before they're five. 

I want to say here that I'm totally unconvinced by the argument that these problems are not our problems or that the inadequacies of Sierra Leone's health care system should be fixed entirely within Sierra Leone. I just think that ignores so much complexity and also so much history. The history of slavery and colonialism, but also much more recently; Sierra Leone was forced for decades to spend less than five dollars per person per year on health care by misguided global loan regulations. And we also can't ignore how deeply interconnected and interdependent we are as a species. Like when inadequate stocks of drugs and lack of healthcare facilities means that people's tuberculosis treatment gets interrupted. The multi drug-resistant tuberculosis that spreads is not only a problem for Sierra Leone. As Ophelia Dahl put it: "Ebola was acute on chronic." That's what they call it when someone has smokers lung and then suddenly something precipitous happens like pneumonia. 

As long as the world fails to meet basic health care needs, we will continue to experience "acute on chronic" emergencies. In fact, in Sierra Leone in 2014, twice as many people died of tuberculosis as died of Ebola. And almost all of those TB deaths were preventable. But training and paying more health care workers, improving facilities, spending money on ongoing restocking of drugs - all of these require long-term investments.

These are changes we chart over years and decades, not over days and weeks, but we can see changes like life expectancy in Sierra Leone is low but it's rising. the health care system is woefully underfunded but it is nonetheless better than 10 or 20 or 50 years ago. 

Now, none of this is to say that we should stop responding to emergencies. Like, let's definitely stay good at that, or even try to get better at it. To me this is not an either/or proposition, it's a both/and proposition. Let's both try to respond to emergencies and try to focus more attention and resources on long-term problems and the long-term solutions they demand. 

There's a link below to that article about Ophelia Dahl and Partners in Health, it really is fascinating. By the way, for those who don't know, Nerdfighteria has donated more than a million dollars in total over the last several years to Partners in Health. 

I think it's helpful to understand how far that money has gone... but also how far we still have to go. Frankly, it's infuriating to think about the hospitals that have had to close since the Ebola money dried up; and the lives that have ended as a result. I guess we can only hope that these outrages - and all outrages spark empathy and commitment... instead of fear and resignation. 

Hank, I'll see you on Friday.