无国界医生组织反思埃博拉疫情

无国界医生组织反思埃博拉疫情

More than a year after the Ebola epidemic 1 began in West Africa the end appears to be near. Liberia has been declared Ebola-free and Guinea and Sierra Leone have reported just a few cases in recent days. Members of the medical aid group that sounded the alarm about the outbreak have reflected on its effects.

在埃博拉疫情开始在西非蔓延的一年后，这场疾病似乎开始结束。利比里亚已经宣布没有埃博拉病例，几内亚和塞拉利昂也宣布最近几天只有几个病例。对这场疫情敲响警钟的医疗援助组织成员反思了其影响。

Doctors Without Borders said while the number of recorded Ebola cases “has decreased, much work remains 2 to be done.” It described health systems as being “ravaged,” as hundreds of health care workers died in the outbreak along with about 11,000 others.

无国界医生组织(MSF)称尽管记录在案的埃博拉病例数量“有所减少，但还有很多工作要做”，称医疗系统已经被“摧毁”，数百名医疗工作者和大约1.1万患者一起死于这场疾病。

Some members of the group – also known as MSF – took part in a panel discussion about how Ebola damaged the lives of both the infected and uninfected.

MSF的一些成员参加了一个有关埃博拉对感染者和未感染者影响的小组讨论。

Ella Watson-Stryker, a health promoter, said a lot of lessons have been learned. In the beginning, MSF focused on supporting the overall intervention 3 efforts to stop the spread of Ebola. But she said more needed to be done.

健康大使艾拉·沃森-斯特赖克说从中吸取了很多教训，一开始，MSF的重点是支持整个干预工作来遏制埃博拉的蔓延，但她说需要做的事情很多。

“What we didn’t do well in the beginning is broaden our scope to really be able to reach into the communities – not just the communities that were most affected 4, but also the communities that were not yet affected. And we stayed very much focused in Guinea in Guékédou Prefecture and we didn’t focus on Guinea as a country, as a whole. And it was months before we had a dedicated 5 health promoter based in Conakry even though we had a lot of cases in Conakry throughout that time -even though we had a fully 6 functioning management center,” she said.

“一开始我们做得不好的地方是扩宽所能抵达的社区的范围，不仅是受感染社区，还包括没有感染的社区。我们非常关注于几内亚的Guékédou县，没有关注整个几内亚国家。尽管我们有完全运转的管理中心，但当时科纳克里出现了很多病例，不过几个月后我们在科纳克里有了一名很敬业的健康大使。”

Another lesson learned, she said, is just how scary Ebola can be.

她说另一个教训是埃博拉有多么可怕。

“Ebola is a disease that creates fear and everyone’s afraid – whether it’s the leader of a small village, whether it’s the president of a country. The doctors and nurses who respond are afraid. The health promoters, who are there - trained to talk about Ebola - are afraid. And our patients are terrified. And so, I think that’s the biggest barrier that we have to overcome.”

“埃博拉这种疾病能制造恐惧，每个人都害怕，无论是小村庄的村长还是国家总统。前去应对的医生和护士们也害怕，当地接受过培训的健康大使也害怕，我们的患者也非常害怕，所以我认为这是我们必须克服的最大障碍。”

Watson-Stryker said when people are that afraid they may refuse to face reality.

沃森-斯特赖克说当人们害怕时，他们可能会拒绝面对现实。

“Something that we learned again and again is that when people are afraid denial becomes a really good fallback for how to deal with that level of fear. And we saw that people were in denial when they were sick. We saw that villages were in denial that anyone in the village had died from Ebola. We saw governments in denial that there was Ebola inside their country and we saw [the] international community deny the severity of the outbreak.”

“我们一再了解到的是，当人们害怕时，拒绝就成了应对这种恐惧的最好办法，我们看到人们在生病时不接受现实，我们看到村里有人死于埃博拉时，这个村子就拒绝接受现实。我们看到当一个国家出现埃博拉时，这个国家的政府就会拒绝接受，我们看到国际社区否认这场疫情的严重性。”

She said to overcome fear of Ebola health workers must build trust in the community. And that, she said, can take a very long time.

她说，要克服对埃博拉医疗人员的恐惧就必须在社区建立信任，她说这需要很长时间。

Dr. Craig Spencer worked as both an MSF physician and epidemiologist in Guinea. He said it’s important to celebrate the victories, but never forget what happened.

克雷格·斯宾塞博士是MSF的医生，也是几内亚的流行病学家，他说庆祝胜利很重要，但永远不要忘记所发生的一切。

“I think the biggest challenge is something that we’ve been dealing 7 with in a different form since the epidemic began over a year ago – and that is complacency. Everyone is rightfully excited that Liberia, as of a few days ago, has passed 42 days and is declared Ebola-free. But West Africa, as a region, and really the global community, as a whole, will not be Ebola-free until Guinea, Sierra Leone, Liberia and everywhere else that’s been touched by this virus makes it out of that window,” he said.

“我认为最大的挑战是自从一年前疫情开始以来我们一直经历的东西，那就是自满，每个人都很激动，认为截止到几天前，利比里亚已经42天没有埃博拉了，已经宣布没有埃博拉病例了。但除非几内亚、塞拉利昂、利比里亚和所有接触过这种病毒的人完全脱险，否则整个西非地区，以及整个国际社会都不会真正没有埃博拉。”

Earlier this year, Spencer traveled back to Guékédou in southern Guinea near the Liberia and Sierra Leone borders.

今年早些时候，斯宾塞回到利比里亚和塞拉利昂接壤处几内亚南部的Guékédou。

“It was amazing to me just driving back through town for the first time in months how life just kind of got back to normal. There were teenagers on the streets holding hands. Markets were bustling 8. You wouldn’t know that this is the same place that merely months before Ebola was ravaging 9 and destroying communities,” he said.

“这是几个月来我首次驱车回到这里，看到生活恢复正常，我很惊讶。有少年们在街头握手，市场很繁荣，你不会知道仅仅几个月前，这里出现过肆虐并摧毁这些社区的埃博拉。”

Thousands of people survived the outbreak. But Dr. Spencer said its effects linger, including joint 10 pain and vision and hearing problems, as well as post-traumatic stress and stigma 11.

有数千人在这场疫情中幸存了下来，但斯宾塞博士说其影响仍存在，包括关节疼痛、视力和听力问题，提及创伤后压力和耻辱。

He said, “It will be great when all of these countries are officially declared free of Ebola. But in many ways the hard work really starts at that point. A transition to a post-Ebola healthcare system is going to be an incredibly difficult and fragile task.”

“如果所有这些国家都正式宣布无埃，那是很棒的。但很多情况下艰难的工作就是从这时开始的，向后埃博拉医疗体系过渡将是非常艰难和脆弱的任务。”

He said healthcare must include prevention and treatment for a wide range of illnesses, and nutritional 12 support to help the body heal. Spencer added that MSF has learned the importance of psycho-social support to help people get through – what he called – an “unbelievably difficult and trying time.”

他说医疗卫生必须包括对一系列疾病的预防和治疗，以及帮助身体康复的营养支持。斯宾塞说，MSF明白了用社会心理支持来帮助人们度过所谓‘异常艰难且难熬时候’的重要性。

MSF-USA Executive-Director Sophie Delaunay said the organization had experience with Ebola in central Africa. But it didn’t have enough qualified 13 personnel in the beginning to cope with an epidemic this size. She said MSF was forced to leave its “comfort zone.”

MSF的美国执行董事苏菲·德劳内说该组织经历了中非的埃博拉疫情，但一开始并没有足够多有资质的人员来应对这么大规模的疫情，她说MSF被迫离开其“舒适区”。

“The fact that for the first time in our history the teams had to build a crematorium is very exceptional for us. It’s been a very traumatic experience on top of, you know, not having the expertise 14 to do that.”

“在我们组织的历史上我们团队首次遇到必须建造火葬场的情况，这对我们来说很不同寻常，除了没有做这件事的专门知识外，这是非常惨痛的经历。”

Delaunay said the medical aid group also had to deal with economic collapse 15 as livelihoods 16 and trade were disrupted.

德劳内说医疗援助组织还必须处理当生活和贸易中断时的经济问题。

“Of course, we’re operating in war zones where there isn’t much most of the time. But in these countries there was an infrastructure 17. There was a lot of business. And in the course of a few weeks and months this business just stopped. So, we had to rely on our own supply chain. We could not rely anymore on the usual airlines. And also we could not rely anymore on the medical evacuation that we usually have,” she said.

“当然我们是在战争区运营的，但这些国家过去有基础设施，有很多商业，后来有几周和数月这些商业都停了。所以我们必须靠自己的供应链，我们不能再依赖航空公司了，我们也不能像往常那样在医疗撤离中依靠什么了。”

MSF reported that children under five and adults over 45 had higher mortality rates from Ebola. And those who had more of the Ebola virus in their bodies, which can be shown through tests, also did worse.

MSF报告称，5岁以下的孩子和45岁以上的成年人更容易死于埃博拉，那些在化验中显示体内有更多埃博拉病毒的人也很糟。

MSF was opposed to the imposition of quarantines as a means of containing the epidemic and finding new patients. Watson-Stryker said they were often imposed in a brutal 18 way. She said families would find out loved ones had been diagnosed with Ebola when armed police or soldiers showed up and cordoned 19 off their homes.

MSF反对将隔离措施作为遏制疫情和寻找新患者的途径，沃森-斯特赖克说这些措施通常是以野蛮的方式实施的。她说当武装警察或士兵出现并封锁住宅时，家人会发现自己的亲人已经诊断出了埃博拉。

Often pregnant women had to deliver babies unassisted because they were in the quarantine zone. Gillian Burkhardt, an obstetrician and gynecologist, explained other problems of being pregnant during the Ebola outbreak.

通常在隔离区的孕妇必须在没有帮助的情况分娩，产科医师兼妇科专家吉莉安·伯克哈特解释了埃博拉疫情期间怀孕遇到的其他问题。

“Women who go into labor 20 during the time of the epidemic have similar symptoms that may be confused with Ebola. And so the first problem is how do we care for pregnant women that don’t have Ebola when a health system has shut down? We saw a lot of women, actually, who were pregnant, and had Ebola survive. But none of the fetuses 21 have survived. And so all women have delivered a stillbirth, who have been Ebola positive and survived,” she said.

“在疫情期间即将分娩的孕妇会出现一些能和埃博拉混淆的症状，所以第一个问题是在医疗系统关闭时如何护理那些没有埃博拉的孕妇，我们看到很多患有埃博拉的孕妇存活了下来，但胎儿都没有幸存。所以所有埃博拉阳性并存活的妇女都分娩出死胎。”

Eventually, Guinea and Sierra Leone will join Liberia in being declared Ebola-free. But MSF said celebrations will be tempered by what’s been lost.

几内亚和塞拉利昂最终会像利比里亚那样宣布无埃，但MSF称遭受的损失会让庆祝打折扣。