The Outbreak is Ebola. The Emergency is Bigger.

There are moments when courage is easy to recognize.

The doctor entering an Ebola ward. The health worker doing the careful, dangerous work of stopping a virus before it spreads further. But in an outbreak, courage is not only found where the disease is most visible.

It is also the midwife showing up for a delivery. The nurse treating all the health needs that don’t stop just because Ebola started.

In eastern Democratic Republic of Congo, too many doctors, nurses, midwives, and other health professionals are doing that work without adequate protective gear. They’re risking their own well-being to care for others.

That’s the definition of courage. But courage should not require preventable exposure.

Already, as many as thirty-four health care workers across the region have been infected, according to the Africa CDC. At least seven have died.

When health workers become patients, the consequences are both tragic and far-reaching.

That is what makes this outbreak so dangerous. There is the virus itself, which is deadly. And then there is the pressure the virus places on an already strained health system.

In the United States, when a doctor or nurse gets sick, a colleague can usually cover the shift.

In the DRC, it is not that simple.

World Bank data show the DRC has roughly one physician for every 5,000 people. The United States has about one for every 270 people – roughly 18 times more physicians per person.

The point is not that the loss of a health worker matters less anywhere else. It is that in the DRC, the system has far less margin for loss. One clinician becoming infected can ripple across an entire community.

This is why personal protective equipment matters. It helps preserve the fragile line between a community and the care it urgently needs.

And it’s why Direct Relief is airlifting more than 250,000 3M-donated N95 respirators to Ituri province, where the Ebola outbreak is concentrated, with more supplies on the way.

The shipment is substantial, but Ebola consumes protective gear at an extraordinary rate — shift by shift, patient by patient. In such high-risk settings, one health worker can require six N95 respirators, six gowns or coveralls, and twelve sets of gloves each day. Over a month, that’s 180 N95s, 180 gowns or coveralls, and 360 sets of gloves.

But protecting health workers is only part of the response. Direct Relief is also sending insulin and other essential medicines. If that seems surprising, it should not.

Ebola does not exist in isolation.

The same health system responding to the virus still must care for everyone else. Since the outbreak was first confirmed by the DRC on May 15, Direct Relief has delivered more than $10 million in medications for chronic diseases and other conditions, helping health providers continue care even as they respond to the virus.

A person with diabetes still needs treatment on schedule. Mothers still go into labor. Children still get malaria. People still need surgery. Patients still need blood pressure medicines, antibiotics, IV fluids, oral rehydration salts, diagnostic testing, maternal care, and treatment for infections.

Direct Relief’s longtime partner Jericho Road Wellness Clinic in Goma is a case in point. Its clinical staff are continuing to deliver an average of nearly seven babies per day and provide primary care services, while screening patients for fever, symptoms, and recent travel from affected areas.

That is what health-system continuity looks like in an outbreak: keeping essential care available while reducing the risk that Ebola spreads through the very facilities people depend on.

When that care is interrupted, the harm can extend far beyond the people infected with Ebola. During the 2014-2016 West Africa Ebola outbreak, researchers estimated that reduced access to treatment for malaria, HIV/AIDS, and tuberculosis led to more than 10,000 additional deaths — a toll comparable to the 11,325 deaths directly attributed to Ebola.

That is the lesson for this moment.

An effective Ebola response must do two things concurrently: contain the virus and preserve the broader health system’s ability to function.

That means supporting the Ebola ward — and the maternity ward, the diabetes clinic, and the pharmacy.

It means protecting the people who protect others.

It means recognizing that courage should be met not with admiration alone, but with the tools required to do the work safely.

The outbreak is Ebola. The emergency is bigger.

And the people showing up, in response to Ebola and despite it, should not have to do so unprotected.

— Amy

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