The Lancet publish a statement from researchers working in Sierra Leone calling for improvements to health care resources, disease surveillance and diagnostic technologies to tackle the ongoing Ebola crisis in West Africa.

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“Even if a patient wanted to be tested for Ebola,” write the researchers, “few (if any) laboratories in the region have the capacity to safely test a biosafety level 4 pathogen.”

The authors say that the true extent of the outbreak is very difficult to determine as most people with fever-causing illnesses in Sierra Leone are self-diagnosed and treated at home using over-the-counter medications.

Not only is there a lack of professional diagnoses of suspected Ebola cases, but the authors write that there is little incentive for patients to seek professional diagnosis. This is partly because a patient and their family may be stigmatized if diagnosed with Ebola. Also, laboratory testing is expensive and unlikely to change the course of treatment.

“Even if a patient wanted to be tested for Ebola,” write the researchers, “few (if any) laboratories in the region have the capacity to safely test a biosafety level 4 pathogen.”

Although the authors believe that the disease surveillance systems in the region are inadequate, they suggest that mobile phones – “ubiquitous in West Africa” – could be deployed to routinely collect surveillance data.

Another significant issue described by the researchers is a shortage of medical personnel and access to health care facilities:

The relatively few physicians, nurses, and health care providers attending to these underserved populations often have poor access to basic personal protective equipment, and might therefore be understandably unwilling to provide direct care for patients suspected to have Ebola. There is an urgent need to provide reliable and constant access to personal protective equipment in health care centers across the region.”

The researchers point out that the city of Bo, in which they are located, has less than 15 physicians for a population of more than 150,000 people. The number of physicians per person is similarly low, they note, in neighboring nations Guinea and Liberia.

The few physicians and nurses in these regions are also reportedly reluctant to provide direct care to patients with suspected Ebola on account of poor access to basic protective equipment.

Finally, the authors also urge that communication with the population needs to be improved for developing and implementing public health responses to outbreaks.

As evidence of how miscommunications arise, they point to inefficient bans on travel and sales of bushmeat that – in the way they were communicated – raised anxiety and “fueled rumors that led to counter-productive behaviors.”

In other news, the World Health Organization (WHO) has announced that it will establish a regional control center in Guinea to coordinate response to the outbreak.

This follows a summit of ministers from the Democratic Republic of the Congo, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Senegal, Sierra Leone and Uganda, as well as health experts and Ebola survivors.

“It’s time for concrete action to put an end to the suffering and deaths caused by Ebola virus disease and prevent its further spread,” said Dr. Luis Gomes Sambo, WHO regional director for Africa.

WHO reports that there have been 759 Ebola cases in Guinea, Sierra Leone and Liberia as of June 30th, including 467 deaths.