Thus far the federal government has resisted calls for Australia to send assistance other than funding to fight the growing ebola crisis in West Africa citing an inability to guarantee treatment for infected personnel close by. In this open letter  visiting Professor Larry Hollingworth CBE, Institute of International Humanitarian Affairs, Fordham University, New York explains that, while evacuation routes for patients are required, in AusMAT,  Australia has the means and expertise to make a difference.

Professor Hollingworth writes:

I believe there is considerable debate in Australia about the barriers to deploying AusMAT teams to West Africa.  As someone who has trained many AusMAT leaders and worked with some, I wish with respect to add my commentary to this issue.

This is my independent view.

I write simply as a humanitarian.

In my years as a humanitarian worker I have never heard the strength of language currently being used from Governments, UN, WHO, prominent NGOs and workers on the ground. We will have a crisis of unimaginable consequences if the world does not act now. We remember crises like Rwanda, where hundreds of thousands died whilst the world watched. In the countries affected by ebola public health care has been severely tested.  Care for ‘day to day’ illnesses such as malaria, pneumonia, and gastroenteritis is limited by resources diverted to the ebola response

Australia has a long and proud history of responding to international crises. In recent years AusMAT teams have deployed to Indonesia, Pakistan, Samoa, New Zealand, Solomon Island and The Philippines. Each and every crisis had issues of risk planned for and sensibly mitigated. The Australian Defence Force is no stranger to Africa deploying to Rhodesia/Zimbabwe, Namibia, Rwanda, Somalia, and Sudan over the years. Australia has and can run successful operations in Africa.

The AusMAT and ADF teams are self sufficient, being able to house, feed, and look after themselves with no burden on the community. The teams are very used to collaborating with governments, different agencies, and the various clusters managing the outbreak.

In deploying a team, many issues will need to be addressed. One is the logistics around getting teams into a location and resupplying them. It is easy to identify and use a pre existing hub to do this – whether this is in Africa or Europe. Supply routes have now been established by the UN and early responders. The correct protective equipment would need to be obtained, trained in and used with rigorous protocols, as are being used by many agencies at the moment. Protocols of treatment exist and would be used.

The facility would be set up along the lines of others currently dealing with the ebola crisis, such as the Red Cross or MSF. Patients are screened and then isolated until a test result is available. If infected they would go to a specific isolation ward for their illness and receive supportive care.  Standardised processes around dealing with the dead would be followed.

The major issue is if a health care worker becomes infected, and it is gratifying to see the level of concern over this issue by the Australian Government.

The teams would need to take their own “lifeboat”. That is, the capability to treat their own if someone gets sick. They have done this before, although granted not for an ebola outbreak. The AusMAT teams have the ability to do this with outstanding staff, drugs and equipment, and it can be done – look at the example of the military providing excellent clinical care in Iraq and Afghanistan often in a tented or temporary medical facility.

All staff deploying would have the risks clearly explained and agree to accept both the risk and the solution of treatment in the “lifeboat”, and potentially not being medevac’d.  My understanding is that this is the UK military medical team plan as well. Any UK personnel who become unwell due to ebola will be treated in an on shore ebola treatment facility in Sierra Leone.

Solutions to evacuating patients still need to be pursued, but this is an issue for all agencies (UN, NGO, governments). Solutions do need to be found. Australia could preposition a suitable medevac aircraft (from the private operators if the ADF is unable to) for such a role. Australia used US/European facilities to treat Australians during the war in Afghanistan, even if this means pre deploying Australian staff to such a facility.

The UK RFA Argus has been deployed to provide a hospital capability for ‘non ebola’ illness and injury. Arrangements could be made for the Australians to access this if needed. Then again the Australian teams have the equipment and training to deal with these themselves.

In leaving the region Australia would need to plan a 3 week quarantine location, maybe prior to returning to Australia, to allay fears about transmission in Australia. Again this would need to have access to a medical facility.

It is time for all capable nations to step up to this unfolding catastrophe.  Australia has highly regarded experienced medical teams with an excellent track record of responding to crises.  The response to this crisis needs all the support it can get.  Australia has the means and the expertise to make a difference.  I know from my humble contribution that the teams are ready and willing and able.

My plea is that Australia deploys the teams and helps defeat the crisis.

I remain

Yours faithfully

Larry Hollingworth

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