Ebola: Beyond the Headlines by Dr. Paul Farmer (Transcript)

Paul Farmer, Founder of Partners In Health and Harvard professor talks about the global response to Ebola. This Talk at Google event took place on October 3, 2014.

Jacquelline Fuller – Director, Google.org

Okay. Well, welcome everybody. I’m Jacqueline Fuller. I lead Google.org. It’s Google’s philanthropy, focused on catalyzing the best tech solutions around the world for humanity. And today, we have Dr. Paul Farmer in the house.

Paul Farmer – Founder, Partners In Health and Harvard professor

Oh, thanks. Nerd fest.

Jacquelline Fuller – Director, Google.org

Yes. Yes. So this is such a thrill for so many of us. In fact, as we were getting the word out, and we had so many people who were interested, Dr. Farmer, that we’ve got people from Google offices in 41 different locations around the world. We’ve got Germany, New York City, Brazil, Mexico, Austin. Everyone wants to hear from you today. So we’re so, so very grateful that you’ve come.

And so the flow that we’re going to have is we will have a conversation and discussion for about 20 minutes. We’re going to then open it up for live questions, so get your questions ready. And if you’re in one of our offices, off location, we also have a Dory. You can find it. Just go Paul Farmer, if you want to submit Dory questions, because we’ll want to take all of your questions.

Paul Farmer – Founder, Partners In Health and Harvard professor

I’m having that tattooed on my arm.

Jacquelline Fuller – Director, Google.org

Go, Paul Farmer.

So let me start by just giving a little bit of an introduction for the man who needs no introduction.

Dr. Paul Farmer is a medical anthropologist. He’s a physician. He’s also an expert in infectious disease, which makes him the spot-on-guy we want to have for our discussion today, which is going to focus, in large part, on the Ebola epidemic. He’s one of the founders of Partners in Health along with Jim Kim, who’s now at WHO.

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Paul Farmer – Founder, Partners In Health and Harvard professor

World Bank.

Jacquelline Fuller – Director, Google.org

Oh, sorry. World Bank.

Paul Farmer – Founder, Partners In Health and Harvard professor

Makes a big difference. They’re the ones with the money.

Jacquelline Fuller – Director, Google.org

Yeah. Even better. Even better. And Partners in Health, if you’re not familiar with their work, is really proving what’s possible to deliver health care in the poorest settings. And Paul is also chair of Global Health and Social Medicine at Harvard Medical School, where you started, right, stealing medicines for the poor. He’s the chief of —

Paul Farmer – Founder, Partners In Health and Harvard professor

That goes direct to NSA here.

Jacquelline Fuller – Director, Google.org

He’s the chief of Global Health Equity at Brigham and Women’s Hospital. He’s an adviser to the UN Secretary General on community-based medicines and lessons from Haiti. He’s an author, of course, most recently To Repair the World: Paul Farmer Speaks to the Next Generation. And we do have copies for sale in the back, if folks would like to get his book.

Many people know of Dr. Farmer and heard of him because he’s the subject of Tracy Kidder’s biography, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World.

In fact, show of hands. Raise your hand if you’ve read that book. So most of the room is raising their hands. Actually–

Paul Farmer – Founder, Partners In Health and Harvard professor

Raise your hand if you’ve read Women, Poverty, and AIDS. Thanks loads.

Jacquelline Fuller – Director, Google.org

Yeah. All right, but I’m going to ask a serious question actually. Raise your hand if that book, Mountains Beyond Mountains, changed your life in a significant way.

Paul Farmer – Founder, Partners In Health and Harvard professor

Raise your hands if Women, Poverty, and AIDS.

Jacquelline Fuller – Director, Google.org

So just one last note that Paul is also speaking tonight in San Francisco at City Arts and Lectures at 7:30. So if you don’t get enough this morning, or you want to bring friends, invite friends, there’s another opportunity tonight.

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So we also want to say thanks to Paul’s colleagues and team who are here. Cassie is Chief of Staff, his cousin Ann is also a Googler, so well represented.

So Paul, why don’t we start just with a little bit of background about Ebola itself. So, tell us what are the most important things that we need to know. Why is this epidemic scaring people like no other, and where do you see it headed?

Paul Farmer – Founder, Partners In Health and Harvard professor

You know, one of the things that’s important to know is — you don’t have to know the kind of virus it is. That’s not that important.

What you need to know is I’m pretty sure we know where it comes from and how it’s transmitted. It’s a zoonosis, as everybody knows. But what’s happened —

Jacquelline Fuller: Meaning it comes from animals.

Paul Farmer: It comes from animals. It jumps from animals to humans. And what happened — and this has happened with every outbreak — is that primates or not, human or nonhuman, or not that the host, right? We’re accidental hosts. And so there’s a lot of speculation – you’ve probably already read about this that it’s from eating bushmeat, or a fruit bat with butterfingers — very clumsy fruit bat drops a piece of half-eaten fruit, and some kid.

Wherever it came from, that’s not what’s going on now. What’s going on now is person to person transmission because of a failed health care system or systems, because it’s a region, right? It’s also — that’s one thing. And there are other ways it can be transmitted. It’s person to person. When you hear about burials or funeral rituals, still that’s person to person transmission. The virus can be excreted after someone dies – is excreted and infectious.

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But as far as we know, it’s not airborne. It’s spread through infected secretions.

Second point, I think, I would just move up on the list is that you hear that the case fatality rate is really high, but what does that mean? It means that a lot of people who get the virus are dying. But it doesn’t mean that they should die. And just for the sake of argument, I’ve been saying — again, just for the sake of argument – what if it’s not the case fatality rate that should be 90%, it’s the survival rate? And if we had that as our supposition, then we’d say, as you guys say at Google, how are we going to work against this goal or this plan? And if the goal or plan is let’s make sure everybody survives, then we have to work really hard to make sure that people are diagnosed early, that they’re given proper care. Because even without a specific therapy in anti-viral — and there are people — I don’t want to talk about this — we do have treatments for people who have — present very often in what’s called hypovolemic shock.

Ebola – Initial symptoms

So when you have Ebola, some of the first things that happen are abdominal pain, fever. Even with a fever, you start losing fluids. And then you have vomiting, diarrhea, and just as with any other cause of those symptoms, you’re losing electrolytes, you’re losing fluids, and the treatment is fluid resuscitation. And any American emergency room can do that. Even when someone can’t drink, oral rehydration, like Pedialyte.

So we’ve got to remember that we’re losing people who — there’s not a lot of T in the ETU – Ebola treatment units. That’s the second thing. I’m only putting it in this order because these are things I’d like everybody to know.

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