Opinion: From Dachau to Sierra Leone – will we ever learn?

By Dr. David Cohn

I recently had two unique life experiences, one professional and one personal, that were emotional, inspiring, sobering and thought-provoking. These experiences naturally led me to reflect about certain differences and similarities.

Three months ago I worked as a training director and clinician, fighting Ebola virus disease at an Ebola Treatment Centre in Sierra Leone. I had the opportunity to see first-hand the devastating effects of severe clinical illness among patients, their family members and the immense disruption of life in West Africa. I also got to be part of a dedicated, committed team of physicians, nurses and other support personnel, all working for a common purpose, which was gratifying.

Dr. David Cohn

Dr. David Cohn

Last month, I attended the 70th anniversary of the liberation of Dachau, accompanying my 93-year-old father along with other family members. My dad was a refugee of Nazi Germany, forced to emigrate in 1939, but returned as a U.S. soldier in 1944-45, and was one of the first to see the horrors of Dachau as a liberator and translator. We were guests of the History Channel Germany, which has produced an engaging documentary “Die Befreier” (The Liberators), and the Comité International de Dachau, which sponsored the commemoration of the anniversary.

Some of the differences are obvious: the settings of Europe vs. Africa, war vs. an epidemic, concentration camps vs. hospitals, and well-established history vs. an evolving story.

The most striking differences are the root causes of the two catastrophes. The Holocaust was arguably the worst example of man’s inhumanity to man in the history of the world, and emanated from hatred, discrimination, racism, anti-Semitism and xenophobia.

In contrast, the Ebola epidemic was caused by a virulent virus in a susceptible population; a biological phenomenon, magnified in the setting of poverty and weak infrastructure.

The gate at Dachau (Photo by Dr. David Cohn)

The gate at Dachau (Photo by Dr. David Cohn)

But in several ways these events are more similar than different. Death and suffering are the most prominent and devastating outcomes of both the Holocaust and the Ebola epidemic. Death in the concentration camps could be abrupt from hanging or from the gas chambers, or prolonged with starvation and wasting over months and years. Ebola strikes swiftly, often with severe pain and dehydration over days and weeks. Either way, a horrible outcome.

Another parallel was the delayed responses by others to step up to the plate to stop and/or prevent more human suffering. Much has been written about who knew what and when before and during World War II. How many millions of lives might have been saved if actions had occurred more quickly or differently by the Allies? The analysis of this Ebola epidemic is not complete, but there is little dispute that health organizations, donors and governments were slow to respond last summer when the signals were clear.

A final similarity is the notion and importance of “survivors.”

At the Dachau commemoration, many survivors, i.e., those persons who were in the camps for months to years and managed to escape with their lives, were honored. Their stories were compelling and heroic but all too often involved the loss of many loved ones.

Graves are readied for victims of Ebola in Sierra Leone (Photo by Dr. David Cohn)

Graves are readied for victims of Ebola in Sierra Leone (Photo by Dr. David Cohn)

At the treatment units in West Africa, whenever a patient was discharged who had survived Ebola, there was always a joyous celebration with singing and dancing with the providers. Frequently, the survivor then learned that many of their family members were dead – triumph and tragedy on the same day.

Have we learned anything?

Since the end of World War II, there have been at least four massive genocides (Cambodia, Rwanda, Bosnia and Darfur) and innumerable wars and conflicts resulting in the deaths of many millions. There are several diseases in the world that cause more illness and death than will ever occur with Ebola virus disease.

What is the way forward?

As an infectious diseases and public health physician, one simplistic approach that applies to both these scourges of inhumanity and disease is the adage “an ounce of prevention is worth a pound of cure.” One can only hope that the human conditions that foster hatred and war can be incrementally improved, and that epidemic diseases can best be fought through enhancements in health care for all and public health preparedness.

The specifics of either solution are complex, but both will involve compassion, forward thinking, and considerable support and resources.

David Cohn, MD is an infectious diseases physician at Denver Public Health and professor of medicine at the University of Colorado School of Medicine.



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