Show Notes: Chatu Yapa - Ebola vs COVID-19

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Show Summary:

Dr Chatu Yapa joined Doctors Without Borders, or MSF, in 2012. As a trained epidemiologist, she’s completed placements in Iraq, the Philippines, Lebanon, and South Sudan, and she’s currently involved in Australia’s response to the COVID-19 pandemic — which echoes her time in Liberia, at the height of West Africa’s Ebola outbreak.

Show Notes:

  • [0:35] What’s it like working in the middle of an Ebola outbreak?
  • [1:43] What’s the difference between handling an Ebola outbreak and handling COVID-19?
  • [5:38] When it comes to a pandemic, what are some of the factors that determine whether you have an Australia or New Zealand experience versus an Italy experience?
  • [8:23] Community engagement and its role in addressing public health
  • [10:33] The diverse backgrounds of Doctors Without Borders staff
  • [13:18] What have you learned from this particular pandemic?

Links:

  • MSF - Doctors Without Borders (link)

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Transcript:

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Jimmy
Dr. Chatu Yapa joined Doctors Without Borders or MSF in 2012. She’s completed placements in Iraq, the Philippines, Lebanon and South Sudan. As a trained epidemiologist she’s currently involved in Australia’s response to the COVID-19 pandemic, which echoes her time in Liberia at the height of West Africa’s Ebola outbreak. We’re talking today about what she learned from Ebola and how it relates to Coronavirus chatter. Thanks for jumping on.

Chatu
Thanks for having me, Jimmy.

Jimmy
So you worked in the middle of an Ebola outbreak? What was the experience like?

Chatu
Yeah, that’s right. So I was in Liberia, in Monrovia, in 2014, towards the tail-end of when things were, you know, calming down a little bit, and the Ebola epidemic of West Africa and that was, you know, it was I don’t know if you remember, but it was a very scary time for the world. You know, it was a time when people were seeing images of people dressed up in yellow, you know, duck suits in these hazmat suits and working in Ebola treatment centres, with people who were very scared at the time. And you know, I think the whole world was scared. There’s a lot of fear and panic about what was going to happen. Borders were closing and flights were being restricted. And it was a scary time for a lot of people. And there was, you know, similarities with what we’re seeing now, in some ways.

Jimmy
Yeah. And what is the difference? Because Ebola didn’t spread around the world. We didn’t have lockdowns in all the developed countries. Was that a success of containment? Or was that something to do with the nature of the virus itself?

Chatu
Yeah, it’s probably the latter like you say. So one of the biggest differences between Ebola and what we’re seeing now with the current Coronavirus pandemic is the way it’s transmitted. So, for Ebola, the transmission is usually by contact with infected people. So usually through their bodily fluids like sweat or you know vomit or faeces or, and so you have to be in quite close contact to someone who’s infected, whereas with Coronavirus, or you know, viruses that are spread through droplet transmission, you can even be in the same room as someone and you know, within about two metres of them to catch the virus. So, the Coronavirus is much more easily spread and transmitted and that’s a significant difference. Another difference is also, I suppose, where the viruses originated. So, you know, Ebola has been in the African continent, predominantly it was first discovered in the Democratic Republic of Congo. And when we saw it in West Africa was the first time that it had jumped across the continent ever. And and it you know, it has a history of being contained quite well. In the past and in the West Africa epidemic, it was the first time we saw it even expand out to three countries, whereas with the Coronavirus, you know, it set it out in China, it was spread quite rapidly and because of international travel and free borders, it spread as rapidly as as we saw, you know, within three months it had reached more than 100 countries around the world. So, the nature of the virus and the nature in which it’s bred really allowed it to become a pandemic.

Jimmy
And something else that I’ve heard a few times is that ebola as a virus is almost too successful. You contract ebola and then you dead pretty quickly and it almost constrains its ability to spread to other people. Is that correct? Is that accurate?

Chatu
Yeah, well, I think probably not too. So I think Ebola virus probably is the opposite. It’s not it’s not very successful as a virus in its ability to transmit so because it dies off in its host in about 70% of the time, it’s actually not a very good transmitter if you if you if you consider it just as a from from its virus form, whereas the Coronavirus You know, this this this particular strain of the Coronavirus that we’re seeing now is a very effective virus because it can spread from person to person quite quickly through droplet transmission. And also it has you know, it has a potential to infect, even before people start showing symptoms. So, and that’s the particularly worrying thing about Coronavirus compared to Ebola whereas an Ebola you know, you really can’t infect another person until you start showing symptoms. So what that means in terms of containment is that we can, we can put control measures in quite quickly in the case of Ebola because as soon as someone starts showing symptoms, if we isolate that person, and and and do effective contact tracing, figure out who they come into contact with, we can effectively stop the chains of transmission. Whereas with Coronavirus because they might people might have been in contact with someone, even before they started showing symptoms. We don’t know exactly who they might have infected within their within their group of peers, colleagues, you know, family, and that’s why it’s been particularly hard to contain.

Jimmy
Right, right. And even within this particular pandemic, there’s been a huge difference and outcomes it seems between countries, which you would think well, I would have thought that would have quite similar experiences. So what are some of the factors in a broad sense that that determine whether you have an Australia experience or a New Zealand experience versus say, an Italy experience?

Chatu
Right? Um, you know, I think I think what we’re seeing with this virus is that it really it doesn’t show any regard for what we have, you know, traditionally thought was rich and poor and, and high income, low income countries and, you know, the virus does it, it sees through all of that, right, and it’s able to bring out, you know, bring to the bring to light, whatever in inequalities inequities we have in in health systems. And so I think what we’re seeing in the responses, you know, some of it is luck and timing. So, for example, in Australia, New Zealand case, we were lucky enough to have been some of the later countries to have seen what was happening in other countries like China and Italy and Iran, to you know, to be prepared, but also I think, what, what we have in Australian and New Zealand a very strong public health systems and so so that’s one aspect of it, but there are many others and I think you know, things like politics, you know, how leadership and governance and political systems have responded have been a huge factor. Community behaviours and and how the local communities have responded you know, how seriously they how much trust they’re placed in their governments, how they listen to the advice that’s been given? How they take that advice as well, are really interesting and important factors. So, you know, it’s it’s a multifaceted complex response that is necessary and some countries have got it right with the way they’ve done the messaging with the way they’ve had very clear instructions and and really taking the whole country along with them. And a case in point is probably the leadership of Justin Trudeau and and and what’s been happening in New Zealand and other countries haven’t done so well on that aspect. And you know, and this is that this is this is what we see time and time again and in many of the countries that I’ve worked in with the you know, with MSF and and even with the Ebola epidemic is you really need to involve communities in this response and you can’t do it without everyone. On board, you know, and there’s all these slogans about we’re all in this together. And and it’s really true, you know? Yes, you have some exemplary examples of leadership and governance and politics. But really this has needed a community response and everyone to be a part of, of knowing what their role is in the outbreak control and then playing that role.

Jimmy
It’s very much a collective action, isn’t it?

Chatu
Absolutely.

Jimmy
So going back to Ebola for a second, you know, talking about community when you’re working for MSF, and these developing countries on something like an Ebola outbreak? Is part of the job dealing with the community trying to get them on board, explaining what’s important, explaining what to do? Or is that does that fall to someone else?

Chatu
A community engagement involvement is one of the key pillars of any response. And it’s certainly a huge aspect for MSF response, and I think we’ve learned over time that, that that is a huge has to be a huge aspect of outbreak response and control. And without it, we failed in the past. You know, and we saw that even in the evolution of the Ebola epidemic in 2014. Early on, and in the epidemic, though, there was a bit of mistrust around what, you know, what international actors in particular were doing in these countries? You know, people thought that white people were coming in to harvest organs and, you know, taking their blood and, you know, and and, and what they saw in these Ebola treatment centres were their loved ones going in for isolation and treatment, but not returning because the mortality rate was so high, and that message wasn’t communicated adequately to the community. And so then we had, you know, everyone, all actors had to do a big kind of change in their tactics and a bit of really back to, to really go back to grassroots level and get community leaders and people in And so we changed the whole design of Ebola treatment centres, for example, to make it much more transparent. You know, there weren’t big concrete walls around the treatment centres they were open and see through, you know, just with just our orange kind of barricades around, we allowed, we kind of designed the treatment centre so that visitors could even come in, you know, with with clear boundaries and infection prevention control mechanisms in place, but, you know, we made it more accessible to the community so they could see exactly what was going on inside. And you know, there wasn’t anything that they weren’t happy with. So community engagement is a huge aspect of what we have to do.

Jimmy
And is that part of is there a special section of MSF that deals with that sort of thing? Because as you talk about that, that involves so many different disciplines, right? It’s kind of psychology, counselling, design, interior design, whatever. Does MSF have a range of disciplines within it, or is it a medical organisation that is kind of doing double duty on all of these other skills and aspects?

Chatu
Yeah, um, no. So I think I’m probably contrary to popular belief. MSF for Doctors Without Borders isn’t just made up of doctors and nurses, you know that we have a whole range of different profiles and roles within the organisation. And really, I think Ebola was a great example of how much other disciplines were hugely important and one of the biggest ones was logistics and construction and you know, how we design these buildings, like you say, but also equally important. We’re anthropologists and and, yeah, you know, sociologists and, and they were some of the first people to actually even go to West Africa to understand the, the social dynamics of the community we were working in. So you know, that was a that was a hugely important part of that of that response. So Yeah, so you know, every outbreak every health emergency is different and MSF will deploy different kinds of people and roles depending on what’s needed. But in saying that community engagement is up to everyone, so you know, in the way MSF works, it’s very different obviously to, you know, as a non government organisation working on the field, we’re working directly with communities and people and so every time we go out and we do a job, we’re in contact with the community. So, you know, community engagement is an interaction between us and the people that we’re that we’re working for and serving. So, you know, that is an everyday thing. It’s up to everyone to, to do well, but in saying that, you know, there were specifically people there to understand specific aspects, such as anthropology and sociology and logistics people to kind of figure out how we could, how we could design our treatment centres in a way that was safe, you know, firstly safe for staff and patients, but also engaging and open to the community.

Jimmy
There’s a real surprise there that anthropologists are part of Doctors Without Borders, right? There’s this interesting expansion of actually what that organisation does. Yeah. And you trained as an epidemiologist. And through MSF, as we’ve talked about, you have a tonne of on the ground experience. But is there anything that you have learned from this particular pandemic? Has it been surprising or unusual in any way? Or is this really a textbook case of how you’d actually expect a pandemic to play out?

Chatu
Just personally, what surprised me about this pandemic is how much it has crippled nations and how much you know, it’s really put health at the forefront of everything we do. I mean often in public health we talk about, you know, helping, helping so important and public health is one of those forgotten disciplines in medicine where, you know, a lot of people don’t know what we do unless it’s something like this, you know, where with that public health action, you see the kinds of disease and morbidity and mortality that we’re seeing right now with Coronavirus. So I think what’s and and, you know, as going through public health training, you know, we often plan for worst case scenarios and we plan we have these pandemic preparedness exercises. But I don’t think that anybody could have thought about the kinds of things that are happening in the world right now. You know, just the flow on effects one thing leading to another to another, you just can’t I mean, I certainly couldn’t have imagined what’s, what’s happening with, with the kinds of risks restrictions, borders closed, you know, huge lines of code. To use outside welfare centres, just hundreds of thousands of people dying, and the millions being affected, it almost seems like a movie script sometimes. So I think that’s surprising. And then and then probably what else is surprising is that, you know, given where we are in 2020, with all the technology that we have, and all the latest gadgets and gizmos that we have, what’s still working from a public health perspective and containing this outbreak are really time tested age old public health methods off off quarantining, isolation, contact tracing, and effective communication and messaging, you know, these are things that would have been Yeah, that could have been done and in with the Spanish epidemic, you know, the Spanish flu epidemic sorry, in the 1920s. So yeah, that’s it’s been interesting from that perspective, as well.

Jimmy
And you’re now working on the New South Wales Coronavirus response and in Australia, how would you compare your experiences, say in Liberia, with Ebola with these experiences right now, are you doing similar things day to day? Or is it a really different - is it playing out in a very different way?

Chatu
It’'s two very different health systems, two very different countries. So, you know, working in Sydney in a very high income, highly resourced government compared to, you know, working in Monrovia with an NGO with with very few resources. So I think the resource constraint is one of the biggest differences. But in terms of what I’m doing, you know, following the epidemiology, looking at who’s getting affected and the kind of the kind of work that I’m doing is pretty similar in a very different context. But the the principles of epidemiology and public health apply - so similar in that front. Yeah.

Jimmy
And did you get any government level pushback in Africa? Was there any trouble dealing with as you talked about community? Some community pushback or suspicion was the same thing coming from the government level as well?

Chatu
Um, I mean, you know, in generally at that time, in particular, with Ebola, it was the government was very happy to have MSF there. You know, it was a time when, particularly early on in the outbreak where there was very little international response, you know, people were very scared to go to Ebola, to those kind of affected countries in West Africa. And so, you know, the government was receiving MSF with open arms. So, you know, the, there wasn’t any pushback. And generally, you know, we go to places where the government is asking for assistance. So, ya no, at that particular time, there wasn’t any pushback at all.

Jimmy
So far, the big outbreaks have been almost all, as far as I’m aware in developed countries. And I get the sense that it’s a matter of time before that spreads. Do you have a sense of how Doctors Without Borders would be preparing right now for an outbreak in the developing world?

Chatu
Yeah, yeah. So we MSF is working in more than 70 countries around the world helping these in in mostly in our regular projects that we’ve been running, you know, for for months or years. And we’re working with local governments and with our local project teams to make sure that, that where we’re working, we’re prepared for COVID. And so every single project of ours is affected by COVID in some way, whether we’re directly responding to COVID in terms of preparedness and, and planning, or we’re actually putting together a COVID response. And so some of the things that we’re doing are kind of working on improving infection prevention and control in hospital facilities. We’re working with vulnerable communities and asylum seekers refugees, to make sure that they’re taken care of. We are working and we’re working. Now actually, this is quite different to to where what we’ve done in the past, because we are without borders. We’re also working, you know, in high income countries. And for example, we’ve just, we, we work, we’re working in France. We’re working in Spain and Italy. We’ve just opened up a programme in Canada in the US. And so it’s not just low and middle income countries that, you know, that that we’re working in. It’s also with the vulnerable communities in high income countries. And yeah, so you know, our efforts are being scaled up. But, of course, that has to be balanced with the resources that we have available as well.

Jimmy
It is quite nice to have that existing presence to sort of pivot into treating a new threat, isn’t it?

Chatu
Absolutely. Yeah. I mean, we that as you say, yeah. We have been working in more than 70 countries for a long time. Now, you know, we’ve been around for about 50 years. And we, we are known in many of these countries, and we are able to access populations quite easily. So yes, it’s a good position to be in at a time like this.

Jimmy
Thanks for jumping on that was Dr. Chatu Yapa talking with us about what she’s learned from working with Doctors without Borders on the Ebola and Coronavirus outbreaks. You can find the audio on show notes for this episode at minaalradio.com/chatu.