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Friday, August 22, 2014

Dr. Paul Farmer on African Ebola Outbreak: Growing Inequality in Global Healthcare at Root of Crisis

Mentre il bilancio delle vittime dallo scoppio di Ebola bell'Africa occidentale si avvicina a 1400, due missionari americani che hanno ricevuto farmaci sperimentali e top-notch sanitario sono stati rilasciati dall'ospedale. Passiamo l'ora con il co-fondatore di Partners in Health, Dr. Paul Farmer, per discutere di cosa si può fare per fermare l'epidemia e la necessità di rafforzare le capacità di assistenza sanitaria locale, non solo una risposta di emergenza. "L'epidemia di Ebola, che è la più grande nella storia, che noi conosciamo, è semplicemente un riflesso della crisi della salute pubblica in Africa, ed è per la mancanza di personale, materiale e sistemi che potrebbero proteggere le popolazioni, in particolare quelli che vivono in condizioni di povertà, da epidemie come questa o da altre minacce per la salute pubblica", dice Farmer, che ha dedicato la sua vita a migliorare la salute dei più poveri e più vulnerabili tra le persone del mondo. E' docente presso la Harvard Medical School e attualmente è consigliere speciale delle Nazioni Unite sulla medicina di comunità. Ha scritto diversi libri tra cui "Infezioni e disuguaglianze: Piaghe Moderna"

As the death toll from the West African Ebola outbreak nears 1,400, two American missionaries who received experimental drugs and top-notch healthcare have been released from the hospital. We spend the hour with Partners in Health co-founder Dr. Paul Farmer discussing what can be done to stop the epidemic and the need to build local healthcare capacity, not just an emergency response. "The Ebola outbreak, which is the largest in history that we know about, is merely a reflection of the public health crisis in Africa, and it’s about the lack of staff, stuff and systems that could protect populations, particularly those living in poverty, from outbreaks like this or other public health threats," says Farmer, who has devoted his life to improving the health of the world’s poorest and most vulnerable people. He is a professor at Harvard Medical School and currently serves as the special adviser to the United Nations on community-based medicine. He has written several books including, "Infections and Inequalities: The Modern Plagues."

TRANSCRIPT

This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: We turn now to the Ebola outbreak in West Africa that has killed nearly 1,400 people across Liberia, Sierra Leone, Guinea and Nigeria. The World Health Organization estimates another 2,473 have been infected, but the tally is widely believed to be higher. The WHO has warned that countries hit by the outbreak are starting to suffer shortages of fuel, food and basic supplies after airlines and shipping companies suspended services to the region.

AMY GOODMAN: Senegal has just shut its border with Guinea. South Africa has banned noncitizens traveling from Guinea, Liberia and Sierra Leone. The hardest-hit nation has been Liberia, where at least 576 people have died. On Wednesday, police opened fire on protesters in the West Point neighborhood of Liberia’s capital city, Monrovia, after they quarantined residents without any notice in an effort to stop the spread of Ebola. A 15-year-old boy was shot in the leg. Residents said the protest was sparked by the police’s heavy-handed presence in the quarantine area. This is local resident Isaac Momolu.

ISAAC MOMOLU: We expect the government to come out with awareness. That’s what we expected. By 4:00 am this morning they deployed police, armed forces, immigration, whatever, beating people, and that’s not the way. My personal opinion, it’s very, very bad. It’s very, very bad. But as you can see, as you can see, the area is a business area. Nobody is selling now. You can’t even cross. If you try to make way and come to your own area, they will stop you from coming to your place.

JUAN GONZÁLEZ: The Ebola outbreak has also generated an international debate over the use of experimental drugs to treat the disease. Three weeks ago, the first two doses of an experimental serum known as ZMapp went to two American missionaries, Dr. Kent Brantly and Nancy Writebol, who had contracted the disease in Liberia and returned to the United States for treatment. Both were released from the Emory University Hospital this week. On Thursday, Emory’s Dr. Bruce Ribner confirmed the aid workers no longer pose a health risk to the public.

DR. BRUCE RIBNER: Today, I’m pleased to announce that Dr. Brantly is being discharged from the hospital. After a rigorous course of treatment and thorough testing, we have determined, in conjunction with the Centers for Disease Control and state health departments, that Dr. Brantly has recovered from the Ebola virus infection and that he can return to his family, to his community and to his life without public health concerns.

AMY GOODMAN: Today we spend the hour with a doctor who has devoted his life to improving the health of the world’s poorest and most vulnerable people. He’s traveled the world, not only treating impoverished patients, but also challenging entire healthcare systems. His name is Dr. Paul Farmer. He’s an infectious disease doctor as well as a medical anthropologist. Twenty-five years ago, he helped found the charity Partners in Health, an international nonprofit organization that provides direct healthcare services to those who are sick and living in poverty. Farmer co-founded the group in 1987 to deliver healthcare to people in Haiti. It now works in—across the world, including Rwanda, Malawi, Lesotho and Mexico, as well as Siberia. Dr. Paul Farmer is a professor at Harvard Medical School and chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston. From 2009 to ’12, Dr. Farmer served as the U.N. deputy special envoy for Haiti working under former President Bill Clinton. He currently serves as the special adviser to the United Nations on community-based medicine and is also on the board of the Clinton Health Access Initiative. Dr. Paul Farmer is the author of a number of books, including Infections and Inequalities: The Modern Plagues and, most recently, In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez. Paul Farmer recently returned from Rwanda and Sierra Leone.

We welcome you back to Democracy Now!

DR. PAUL FARMER: It’s great to be here. Thank you both.

AMY GOODMAN: Talk about what we should understand about this outbreak of Ebola, Paul.

DR. PAUL FARMER: Well, I think the most important thing to understand is that this is a reflection of long-standing and growing inequalities of access to basic systems of healthcare delivery, and that includes the staff, the stuff and, again, these systems. And that’s what—that’s how we link public health and clinical medicine, is to understand that we’re delivering care in the context of protecting the health of the population. And so, if you go down to each of these epidemics—that are, of course, one epidemic—and you ask the question, "Well, do they have the staff, stuff and systems that they need to respond?" the answer is no. And then, what will stop the epidemic, which it will be stopped, is an emergency-type response. But then again, how are we building local capacity to do that so these epidemics don’t spread—as they would never spread in the United States, by the way?

JUAN GONZÁLEZ: And the astounding fatality rates that we keep hearing about, is that more, in your sense, in your view, a result of the disease itself or the weaknesses of the healthcare systems that confront them?

DR. PAUL FARMER: Well, you know, I think the more important hypothesis is that it’s the latter, right? Because—and it would be great to talk to our colleagues at Emory, the infectious disease colleagues who treated patients. It’s not that they had an experimental medication; it’s that they had supportive care. And supportive care, in medical terms, doesn’t mean having someone hold your hand. It means, if you’re bleeding, you get blood products. If you’re hypotensive, or your blood pressure is low, you get IV solutions, right? That’s not what’s happening in these Ebola centers. You know, it’s really quarantine without a lot of the care, right, because supportive care requires sometimes an ICU.

AMY GOODMAN: That was very interesting that you just said that Ebola couldn’t be—there couldn’t be an outbreak in the United States.

DR. PAUL FARMER: Well, there could be, but it would be stopped quickly, because patients would be isolated, not in quarantine facilities without medical care, but in places like Emory or the place where I work in Boston, at the Brigham and Women’s Hospital. And even in Haiti or in Rwanda, you know, we’ve prepared, along with the authorities, isolation rooms that are not to shut people away, but to take care of them while protecting the rest of the staff, if they have an infectious illness, an airborne illness, say.

So, you know, back to Juan’s question, why would there be such massive variation in case fatality rate? And to me, that always says, because there has not been an overlap between the epidemic, Ebola epidemic, and modern medicine. We’re talking about Medieval-level health systems and a modern plague that’s going to spread. And when we can overlap modern medical systems and modern public health systems, then we can see what the case fatality really would be. I mean, just to be provocative, what if it’s 10 percent instead of 90 percent? What if it’s 5 percent, with proper medical care? And I’m saying even without a specific therapy for that disease, which we’re all waiting for and hopeful about some of the new agents.

JUAN GONZÁLEZ: Well, last week, when we had some guests on discussing this issue, there was somewhat of a debate over this whole issue of the quarantine. Laurie Garrett, who won a Pulitzer Prize for her coverage of one—of an initial Ebola outbreak, supported the necessity for even forced quarantines because of the reality of the weak systems. However, Lawrence Gostin, who is the faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University—he’s a specialist in geoquarantines—he warned against the use of a cordon sanitaire, a large quarantine. This is what he said.

LAWRENCE GOSTIN: People who are in the quarantine area are very frightened, and I think deservedly so. And they’re frightened not only because they are in a hot spot, a hot zone of Ebola, but also with roads blocked. Food is expensive and getting scarce. There are no medical supplies. And basic needs, psychosocial and medical needs, are not being met. And so, this is a really inhumane way of trying to do that. We never should have come to this. ...

You can’t have a health crisis turn into a human rights crisis. You have to provide food. You have to provide medical care. You have to provide psychosocial support. And you need to provide secure, but also safe and sterile, isolation equipment, with personal protection equipment. And that’s what a smart sanitaire is.

JUAN GONZÁLEZ: I’m wondering your response.

DR. PAUL FARMER: Well, I don’t think that they’re disagreeing, Laurie Garrett and—who actually took the picture on the cover of Infections and Inequalities, it’s Ebola outbreak—and Larry Gostin, because you can’t have a smart—you know, he used the term cordon sanitaire—you can’t have a smart quarantine without real care for the people being quarantined. And that’s what—you know, it seems to me the patients, the American patients who went to Emory, they were being quarantined, right? But they were also receiving care. And that requires, again, staff, stuff and systems. You can’t be compassionate without expertise, and you can’t have expertise without the supplies that you need to do a good job. So I do not see those two positions as really in contest. A human rights position should also include the right to healthcare, the right to compassion, the right to psychosocial support, just as a public health response has to be aware of how an illness is transmitted and how to protect the public. And this tension, which is very profound, as you note, is worsened by the fact that there is no good medical system in Liberia or Sierra Leone or Guinea. And we have to build one.

AMY GOODMAN: We’re talking to Dr. Paul Farmer. We’ll come back to this discussion after break. The music that we’re about to hear is called "Ebola [in] Town." It’s a Liberian song written earlier this year to raise awareness about Ebola.

[break]

AMY GOODMAN: "Ebola in Town" by the Liberian musicians Shadow, D-12 and their friend Kuzzy, written earlier this year to raise awareness about the disease. This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Juan González. Our guest for the hour is Dr. Paul Farmer, an infectious disease doctor, medical anthropologist, founder of Partners in Health, professor at Harvard Medical School, written many books on the issue of infections, disease and inequality. Before we move on, if you could just lay out for us, Dr. Farmer, what Ebola is.

DR. PAUL FARMER: Well, Ebola is a—Ebola virus disease is a hemorrhagic fever caused by a kind of virus called a filovirus. And Marburg is another one of those. And it’s spread through close contact, in the sense of blood, mucous membranes. So, you know, when I heard someone say—unfortunately, an official say—that Ebola had gone airborne, I knew that wasn’t right. But what happens is, the symptoms include vomiting, diarrhea. It looks a lot—it can look like malaria. And this is one of the problems, is that you have to diagnose it, because we have readily available—or, we should have readily available therapies for malaria. And now with all this fear around Ebola, people aren’t going to receive care for that potentially fatal illness. So there’s all kinds of complexities.

JUAN GONZÁLEZ: But how does an outbreak begin in a human population?

DR. PAUL FARMER: It’s a zoonosis, so an outbreak begins when—and again, you know, say that the reservoir might be bats, OK, or in a bushmeat, all right? The animal population and the human population are competing for resources, right, and as these cities and towns grow and as—and so, it jumps—these illnesses jump to humans, and then they have to jump to other humans, again, through close contact and like preparing someone for burial or nursing someone, right? Because if you think about, again, someone who’s vomiting or has diarrhea, and if you’ve helped nurse that person, in the sense of doctors nurse people, but your mother, your sister nurses you, you’re going to be exposed to infected secretions, right? So, the way to prevent that is sometimes called "barrier nursing," right? That means you’re wearing personal protective equipment, and, you know, probably an apron, mask, gloves would do. But again, if someone’s vomiting, you know, you can get it in your eye, or you get tired of following strict precautions because you’re working long hours. So, again, staff, systems, stuff—you need the stuff to protect the healthcare workers and to take care of the patients, and the staff to relieve one another so they can follow this strict infection-control process.

JUAN GONZÁLEZ: And then also proper precautions for disposing of the protective gear that you’ve been using.

DR. PAUL FARMER: Exactly, you know, and that’s the systems issue, right? So, it’s not that all places in Africa don’t have good healthcare systems. Rwanda has built back from an even more gruesome situation than the wars in Sierra Leone and Liberia, and they’ve been trying to focus on the systems issues, right? How do we link community health workers to clinics, to hospitals, for people who are sick? And we’ve been very proud to be part of that work as Partners in Health.

JUAN GONZÁLEZ: But then, in a crisis like this—let’s take Liberia, for example, where in Monrovia, the five hospitals in the capital for a while were shut down, which has been through a civil war, been through all of this internal strife—how do you, in the midst of an epidemic like this, rebuild—

DR. PAUL FARMER: Yeah.

JUAN GONZÁLEZ: —a system that can cope with it?

DR. PAUL FARMER: Yeah. Well, I would say that we know it’s not impossible, because it’s been done after war and strife before, right? And I mentioned the example of Rwanda, which remains a poor country, which is only 20 years out from, you know, the genocide. If you have more resources, you can build the systems more quickly. But again, it needs to focus on building local capacity. So, in Liberia, that would be Liberians. In Sierra Leone, that would be Sierra Leoneans; in Rwanda, Rwandans; in Haiti, Haitians. And a lot of this emergency response approach doesn’t do that, right? It’s not the function of an emergency response to build local capacity, but it needs to be done. It might not be the job of the emergency responders, but it’s got to be someone’s job. So how do you do that in the midst of strife? You invest in—you invest resources—you know, money. And there is money that could be invested more wisely in healthcare. Some of it’s foreign aid money, and some of it is local tax money. And then you invest in human capital, right? You train doctors, nurses, community health workers—in probably the other order, by the way, community health workers, nurses, doctors, because you don’t need an infectious disease doctor to treat Ebola. You don’t need an infectious disease doctor to treat AIDS. We’d like to contribute, of course, and have our contribution to make, but it’s really the system that has to be rebuilt. And that’s possible in even the most strife-torn region once the strife lets up.

AMY GOODMAN: So the politics of who gets medicine and who doesn’t—as two American doctors treated with an experimental serum were pronounced cured, two medical ethics experts wrote Thursday in The Lancet medical journal, quote, "Fair selection of participants is essential." Ezekiel Emanuel of the University of Pennsylvania and Annette Rid of King’s College London added, quote, "Especially in a dire emergency such as this one, well-off and well-connected patients should not be further privileged." Talk about what is available, what ZMapp is, where it comes from, this drug. Supposedly, the first person who was supposed to get it was the top doctor in Liberia, Médecins Sans Frontières—

DR. PAUL FARMER: Dr. Khan.

AMY GOODMAN: Dr. Khan. They debated through the night whether to give it to him, afraid that it could kill him. This was the story written up in The New York Times. Fearing that, in the end, they didn’t. He died. Those drugs went to the two white American missionaries in Liberia, couldn’t be given here, because the FDA hasn’t approved it. And then they were sent to Emory, and they did survive. Also given to a Spanish priest, who did die. And now they say that the drug is out. What’s the company that makes it? Are other companies doing it? What causes a company not to invest in a Ebola vaccine?

DR. PAUL FARMER: Well, I mean, just to say very clearly, I’m thrilled that those two Americans received proper care. Right? And proper care requires, if you’re critically ill and you are having hemorrhage—it’s called hemorrhagic fever for a reason—you need supportive care that’s real, not fake supportive care. And so, the more people who can get it, the happier I am. And I’m very happy that they got back and received care. So I just want to get that out of the way, because people have asked me, not so much in Rwanda, but since I’ve been back here a couple days, you know, "What do you think about people getting airlifted to Emory?" I’m saying, great, you know, no problem there.

The ethical positions that can’t take this broad view of economic disparities, but only, you know, come in to comment on specific instances, I know it has its place. But it would be far better, I think, to say, OK, here are the impact of health disparities in general, right, pre-Ebola epidemic, right. That is, you’ve got some people living in Medieval conditions still in the 21st century and some people living in the 21st century. And how do we move more people from here to here? Like, you don’t have to have—you know, treble your GDP to start building a health system. Health systems help grow your economy, investing in health and education. So, to me, that’s the big picture—rich world, poor world—rather than a narrow view of an incident, although I think we should be commenting on them.

Now, about the companies that are making various—because you mentioned vaccine. These are not vaccines. You know, we’re talking about a serum and some new—a new class of drugs, you know, that interfere with RNA, RNA interference drugs. And from what I understand, it’s actually a number of companies, right? But the thing that’s important for us to know is a lot of that is supported by the National Institutes of Health—public tax dollars. That’s how a lot of therapy for AIDS—that’s how therapy for AIDS was developed. And so, we all have a say, I think, and the world has a say—because I regard the NIH as the jewel in our crown as a nation, right? We have a say in how we build out an equity platform to make sure that those discoveries reach those in greatest need in the global sense. And I believe, actually, that the survival of our two American missionary workers could spur this forward, right? Because it’s not that they shouldn’t have received care; it’s that others should also receive it.

AMY GOODMAN: Well, The Onion, the satirical newspaper, recently published an article headlined "Experts [Say]: Ebola Vaccine At Least 50 White People Away."

DR. PAUL FARMER: I saw it. I saw it. Actually, I saw it in Rwanda, if you can imagine. That’s how—the reach of The Onion. And it’s satirical and correct, right? And so, I think that’s perhaps one of the things that was—that Dr. Brantly was intending in his comments, whether it was yesterday or today. You know, "I hope that this draws attention to the problem in Liberia." I think that’s a very humane and correct thing to say, because 50 white people away, you know, is actually satirical but quite accurate in some senses. The demand for product, and whether that be a vaccine or a diagnostic or a therapeutic, a drug, is driven by market concerns, right? But we funded a lot of that with tax dollars, and so we should have a say. And I’m thrilled to tell you, there are a lot of people in academic medicine and at the National Institutes of Health who regard this in exactly the same way I do, which is why we have PEPFAR and why we had huge programs to help patients with AIDS in Africa, 11 million people now on therapy. It’s not that they’re a market. There is a market, and the prices haven’t changed that much since 1996 in the United States. But for these patients, they’re connected to the modern world by this equity platform. They need lots of other things, but they’re at least getting that.

JUAN GONZÁLEZ: But the amount of money that the pharmaceutical industry and the world spends on research and development of new drugs, all you have to do is turn on the evening news, and you see the drugs for restless leg syndrome, for erectile dysfunction, a variety of them, and yet Ebola has been around now for several decades, and there’s been—we’re only now talking about an experimental drug. What’s the role of government—

DR. PAUL FARMER: Yeah.

JUAN GONZÁLEZ: —in terms of focusing what the research into new drugs should be?

DR. PAUL FARMER: Well, the role of government, I’m suggesting, especially ours, since we’re here, should be very large, right? And because these—you know, one of the ironies that you’re getting at, Juan, is, you know, development of new tuberculosis drugs, those were called "orphan drugs." But the term "orphan drug" was actually designed to describe drugs that would only have a small group of people benefiting from them. And, of course, tuberculosis, when it was described as needing orphan drugs, was the leading infectious killer of young adults in the world. So, again, these ironies are going to be addressed only through a lot of government intervention. And, you know, to its credit, the NIH, in the part of it that focuses on infectious disease, actually did fund, as I said, a lot of the research going into RNA interference agents. And in my experience in the past with people like Dr. Fauci, who heads that branch, they’re very interested in global health equity, right? They’re sometimes behind-the-scenes champions, but we need to call in those chips and say, "Hey, you know, there’s a massive epidemic here because there’s no staff, stuff or systems, and the stuff includes real treatments and vaccines."

AMY GOODMAN: I mean, this goes to the whole issue of public health financing in the United States and the cutback in places like the NIH, because you’re not going to have corporations putting huge resources into developing these drugs, and so it’s up to the governments to do it.

DR. PAUL FARMER: Yeah, I think that’s right. I think we should look for allies in the corporations that make things we need. You know, there’s all kinds of ways to work with them. But the fact is, since it’s market-driven, there will be market failures, as you’re saying, Amy. And, you know, here’s where vigorous intervention by governments can help.

AMY GOODMAN: Not only small amounts of people here, but, of course, then you’re talking about Africa and the question of pharmaceutical companies making drugs for people in Africa.

DR. PAUL FARMER: And, you know, the drugs that we’re using now for millions of people in Africa are largely generic medications now. So that switch from 1996—and I happened to be an infectious disease fellow at the time at Brigham and Women’s Hospital, going between Harvard and Haiti, and we knew that they worked, because our hospitals were full of young people dying of AIDS, leading infectious killer of young adults at that time, and they got up and went home. And so, with the help of AIDS activists, we said, "Well, we want people dying of AIDS in Africa to get up and go home." They were already home, dying at home unattended, but we wanted them to stop dying. And that really happened in the last decade, which a lot of people said would never happen. And it has, and it’s going to go forward. And it should move forward the Ebola response, as well.

JUAN GONZÁLEZ: I wanted to ask you about this tactic of some governments of travel bans on the affected countries and how that plays into the ability of these countries to actually fight these outbreaks. This week, the South African government imposed a travel ban between South Africa and the Ebola-hit West African countries.

AARON MOTSOALEDI: The Cabinet noted, with concern, the extent of the outbreak and the increased cases of—in the three—in three of these countries, which is Guinea, Sierra Leone and Liberia, over the last week. Cabinet recognized that even though the outbreak has been limited to these countries in West Africa, the spread to other countries needs to be contained. So Cabinet further recognized that containing the outbreak at source will be essential and limit the spread and mortality caused by this disease to these particular parts of the world.

JUAN GONZÁLEZ: That was South Africa’s minister of health, Aaron Motsoaledi. Your response to these kinds of approaches?

DR. PAUL FARMER: Well, remember, I mean, Ebola is not spread through casual contact, right? I mean, those kinds of responses can play a role, right? It’s just like the debate about what’s smart quarantine. You know, what does that look like? It’s got to be smart, compassionate quarantine. Now, when I came into Rwanda, I, just like every other passenger on a plane, had to fill out a form, that I had never seen before, because it’s an Ebola form, and then every passenger was—our temperatures were checked. And if you have a fever, you go into a quarantine, right? That’s a smart procedure. Now, the quarantine is not, again, place that’s dirty and there’s nobody to give you medical care. Even in Rwanda, they’re getting that right. They’re not trying to shut their borders. And, you know, stopping non-essential travel, I get that. But it can slow down, when you stop supplies going in—and staff, stuff, supplies—then it slows down the effective response. And so, you know, it’s that same tension. You want ready movement, not just of the pathogens, across the border, but the stuff and staff who can help. And that—we need more of that. And, you know, unfortunately, there’s a tendency for some rigid, as he said—Larry Gostin said, cordon sanitaire, not to promote the kind of smart quarantine that we need.

AMY GOODMAN: Speaking of borders, when we come back from break, I want to ask you about what some Republicans are saying in Washington about the Ebola virus crossing the border and what that means for immigration policy. We’re talking to Dr. Paul Farmer, infectious disease doctor, medical anthropologist, founder of Partners in Health, professor at Harvard Medical School. This is Democracy Now! We’ll be back in a minute.

[break]

AMY GOODMAN: That’s Arcade Fire performing their song "Haiti," longtime supporters of our guest, Dr. Paul Farmer, and Partners in Health. Every dollar of every—one dollar of every ticket goes to Partners in Health, and they’ve been doing that for years. They’re playing at the Barclays Center this weekend in Brooklyn, New York. This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, with Juan González.

Several Republicans have suggested migrants from Central America could bring the Ebola virus with them when they cross into the United States. The trend began in July, when Republican Congressmember Phil Gingrey of Georgia wrote a letter to the Centers for Disease Control and Prevention that noted, quote, "reports of illegal immigrants carrying deadly diseases such as swine flu, dengue fever, Ebola virus and tuberculosis are particularly concerning," unquote. Then, this month, Representative Todd Rokita of Indiana expressed similar fears during a radio interview on WIBC.

REP. TODD ROKITA: We sent a letter to the president saying, "Look, first of all, you know, we have got to know—not from the press. We have got to know ahead of time, so we can plan for this." So we did that. Dr. Buschon was helpful—and I’m not sure if this made the final draft of the letter or not, I think it did—to your point about the medical aspects of this. He said, "Look, we need to know just from a public health standpoint," with Ebola circulating and everything else—that’s my addition to it, not necessarily his. But he said, "We need to know the condition of these kids."

AMY GOODMAN: That’s Congressman Todd Rokita. And the Dr. Buschon he refers to is Congressman Larry Buschon of Indiana, who’s a heart surgeon. Well, our guest is Dr. Paul Farmer, infectious disease doctor, medical anthropologist, founder of Partners in Health, professor at Harvard Medical School. Your response?

DR. PAUL FARMER: Well, I mean, you kind of know my response, because if the pathogens don’t have borders, you know, or don’t respect borders—Partners in Health was founded with the idea that every human life has equal value and, in fact, that we should pay more attention to poor people. So, I would say, if we have resources, that we should bring them in. So, I mean, I’m already not even allowed to be part of that conversation. First of all, that’s also epidemiologically absurd, right? Because we don’t have any reports of Ebola or other hemorrhagic viruses in the border he’s referring to, which is our big one to the south. So, you know, it’s sort of the opposite of a—

JUAN GONZÁLEZ: I’m wondering, next week they’ll have a new story of ISIS fighters bringing in—suicide bombers bringing in the Ebola virus through Central America.

DR. PAUL FARMER: Well, you know, interestingly, some of the work is being funded—in West Africa, is being funded with Defense Department dollars. To me, that’s a better use of them, right? To use them to fight an Ebola—you know, the bioterrorism money—I mean, it’s kind of silly, in a way, right? But it’s a better use of it, in my view. And, you know, I should mention, if I can, Juan and Amy, that we do have partners in both Liberia and Sierra Leone, you know, partners of Partners in Health. And, of course, we’re sending people the other way, and they’re sending people the other way, to help with the epidemic, including, you know, again, largely Sierra Leoneans and Liberians, but including Americans. And one of them is called Wellbody Alliance, the one in Sierra Leone. The other one has the name that we’re really talking about, which is Last Mile Health, right? Because they’re talking about going the last mile to serve the rural poor. And, you know, I think that the congressmen who were quoted, it would be great if they could pay attention to that part of it, that we should work harder to serve poorer people, I mean, especially kids. They’re talking—they used the word "kids."

AMY GOODMAN: There’s a front-page article in The New York Times today, the headline of the article, "In Redesigned Room, Hospital Patients May Feel Better Already." And the caption says, "Butaro District Hospital in Rwanda opened in 2011, designed for beauty and fighting disease." And it’s talking about it being a model, though it talks about a place in New Jersey, actually, it starts. Now, this is a picture of your clinic in Rwanda, is that right?

DR. PAUL FARMER: Yeah, it is. It’s a hospital, actually, and Partners in Health built it for the public health authorities. And it was designed for beauty and fighting disease. We—

AMY GOODMAN: What’s the relationship?

DR. PAUL FARMER: Well, I mean, again, this is hypothetical—I can’t always show it to you—but if you’re sick and you’re feeling horrible, you know, do you want to be in an ugly place? And if it’s ugly, it’s probably dirty, right? And it’s probably got tuberculosis flying around in the air. That’s one of the leading killers of patients in hospitals in the southern part of Africa. So its design, it was designed with the help of a group called Mass Design, which is focused on, again, a preferential option for the poor—in architecture. And—

AMY GOODMAN: What do you mean? What does the—money needed to go into this?

DR. PAUL FARMER: Well, that cost $4.3 million, which is under probably $50 a square foot. So, you know, when we hear about these huge amounts of money going into foreign aid with, you know, enormous overhead, that beautiful hospital—it made the front page of The New York Times; I had no idea that it would be on there today—is beautiful. The beds are facing courtyards. You know, this is the place I was saying I wanted you to come visit. I was there last week seeing patients. And I think it’s beautiful.

Now, how is it safer? Well, let’s just take infection control, because we’ve been talking about it. The air is circulated. Some of the louvers can’t even close. There is a giant fan circulating the air for a reason, so that people don’t get infected with tuberculosis while they’re patients in that hospital. And there’s also the capacity for isolation, meaning someone’s sick with an infectious pathogen that could be spread to staff or to other patients, we have the capacity there. And that is in a place that only 10 years ago had not one doctor, no hospital, no electricity. You know, it’s on the border with Uganda. And, you know, if you can do it there and make the front page of The New York Times, then you can do it in Liberia, Sierra Leone and Guinea, and for rural people, for poor people. And if that had happened, right—that’s where these epidemics came from. They came from rural areas. And the people living there don’t have access, as I said, to modern medical care, and they should. And you can, and it’s not expensive.

JUAN GONZÁLEZ: What about the international response so far to this Ebola epidemic? I mean, you’ve worked with the Clinton Health Initiative in the past.

DR. PAUL FARMER: Yeah.

JUAN GONZÁLEZ: I’m wondering, other than Doctors Without Borders and some of the missionary groups, how do you think—how do you rate the international response on what needs to be done by governments and by the major foundations that are involved in public health?

DR. PAUL FARMER: Well, I mean, first of all, the Clinton Health Access Initiative is still working there, right, especially in Liberia, and just as these groups I mentioned, Wellbody Alliance and Last Mile Health, they’re all still there. And as far as the international emergency response, that’s what Doctors Without Borders does, right? It goes into troubled areas and tries to respond in emergency fashion. And, you know, the CDC—I think it’s great that we sent 50 people there. It’s a terrific investment of U.S. taxpayer dollars, in my view. But that’s not going to build the systems, right, and rebuild local capacity that would make this less likely to happen in the long term. Yet we can channel more of those dollars to local capacity—I mean, I hate that jargon, but whatever you call it, it means training people from Liberia, Sierra Leone, etc.—Haiti, Rwanda, in our case—to respond to their public health crises. That doesn’t mean we can’t be of use. The whole world can be of use. But it needs to be linked to this long-term approach.

AMY GOODMAN: A recent Washington Post column reads, "Over the past two years, the [World Health Organization] has seen its budget decrease by 12 percent and cut more than 300 jobs. The current budget saw cuts to WHO’s outbreak and crisis response of more than 50 percent from the previous budget, from $469 million in 2012-13 to $228 million for 2014-15."

DR. PAUL FARMER: I think that’s a big mistake. You know, we need global—I call them—you know, I just called them earlier "global health equity platforms." That’s not the language of the World Health Organization. But we need global institutions, because the pandemics are global, or they’re not just regional. When I say "global," they’re not, you know, down there waiting in Mexico to jump up over our borders in the bodies of those devious kids. But they are translocal. All right, you know, I shouldn’t use silly academic jargon, but they’re not contained in national borders. So, you need robust translocal institutions like the World Health Organization. And when I hear these figures, you know, about budget cuts like this and I think about—I’ve just been reading Matt Taibbi’s book; I’m sure he’s been on this show quite a bit, or his books—I just—it drives me nuts to think that we’re arguing over this tiny, little pie, this tiny, little pot, for global health equity, or public health, whatever you want to call it, and these vast amounts are being squandered on foolishness, or they’re being literally stolen. And we can’t do public health without more resources. We can’t. We need more money to do this. And it’s cost nothing, next to these, you know, again, foolish endeavors, or worse. And cutting, shrinking these budgets and always thinking about contracting and contracting the public sector is a huge mistake.

AMY GOODMAN: The New York Times reports, "A teenage boy who was wounded on Wednesday during clashes at an Ebola-stricken neighborhood in Monrovia, Liberia, died of bleeding and hypothermic shock after being shot in his legs. ... The teenager, Shakie Kamara, 15, was part of a large crowd of young men who tried to storm out of the neighborhood, West Point, which was placed under quarantine the night before. Soldiers fired live rounds to drive the protesters back into their neighborhood." That was the piece in The New York Times. So, as we wrap up, what needs to be done right now? What is your assessment of what Liberia is doing? And what can the U.S. do?

DR. PAUL FARMER: Well, first of all, you know, that’s—a 15-year-old is not a young man, but a child. And, you know, that just is an awful way to respond, even if he had been—it doesn’t matter how old, but shooting a child, who then dies of the injury, right—so, hypothermic shock and bleeding just means he died of his gunshot wound, of course. And, you know, anything on that side of the response is not smart, it’s not humane, it’s not going to work. On the other hand, you know, you have the response—I mentioned Last Mile Health, who worked with the public sector. It’s not like we’re saying NGOs, you know. These are people working with local authorities in Kono district to build a completely different kind of response, which is, let’s have community health workers help us find the patients, let’s have proper care for the patients, and let’s find everything we can to get them better and prevent spread in that way. And that’s what we should all be focused on right now. And there’s no reason we can’t stop this with the adequate investment in, again, staff, stuff, systems right now.

JUAN GONZÁLEZ: And the health workers on the front line in these countries now, what they’re going through?

DR. PAUL FARMER: You know, I was in Kono Hospital with colleagues of mine from—a colleague of mine from England, from King’s College. And, you know, looking around the hospital—they were getting ready to set up an Ebola ward.

AMY GOODMAN: This is in Sierra Leone?

DR. PAUL FARMER: This is Sierra Leone. I’m just thinking, "What a tragedy, what’s about to happen to them," because they just—no wonder the health workers are frightened, right? They know they don’t have—the people know that they don’t have the personal protective equipment that they need. They know that they don’t have what it would take to treat people with dignity and compassion. And, you know, it’s a very frightening thing. I’ve lived through situations like that—you know, the earthquake in Haiti—when you know you just don’t have what you need to help people survive. And it’s frightening, you know? And it’s demoralizing.

AMY GOODMAN: Five seconds. That note, we want to say thank you so much to Dr. Paul Farmer, infectious disease doctor, medical anthropologist, founder of Partners in Health, professor at Harvard Medical School.