analysisBy Tami Hultman
Washington, DC — Imagine this choice. Your child has Ebola symptoms. You have no protective gloves to help keep you alive to care for her. But she needs comfort, so you wash her and wipe away her vomit – and you both die.
Liberia, one of the three most-affected countries, doesn't have enough gloves even for medical staff. Overwhelmed international caregivers – like the uniquely engaged Médecins Sans Frontières/Doctors Without Borders (MSF) – are expressing disbelief at the 'too little, too late' international response.
"We are completely amazed by the lack of willingness and professionalism and coordination to tackle this epidemic," the group's operations director, Brice de le Vingne, told the Financial Times, saying Liberia, where MSF is scaling up treatment centers, is a country on the verge of collapse. "We have been screaming for months," he said.
The group says there is nowhere near the assistance needed, despite recent efforts. Only after a traveler from Liberia took the virus to oil-rich Nigeria, Africa's most populous nation and host to large international investments and businesses, did the global response reach even the current modest levels.
The World Health Organization this month is launching a U.S. $100 million disaster plan, after exhausting previous contributions of $7 million. The U.S. Centers for Disease Control (CDC) has sent 19 people to work in Liberia, and Public Affairs Director Barbara Reynolds says at least 60 CDC people are in Liberia, Guinea and Sierra Leone, plus Nigeria.
Nobody who has been working on the Ebola crisis in Guinea, Sierra Leone or Liberia thinks that's close to what's needed.
Contrast that with the world response to the 2010 Haitian earthquake. Over $3.5 billion was donated by governments, organizations and individuals. Within 24 hours, the small nation of Israel had equipped a plane with emergency medical supplies, and 40 doctors and 20 nurses and 20 medics were able to set up a field hospital on arrival – including a patient identification system and electronic medical records. More than 300 CDC staff went to Haiti to assist in the recovery, including battling the ensuing cholera epidemic. In much of North America, Latin America and Europe, commercial businesses put out collection boxes for relief donations. Individuals responded massively.
Nothing like that is in place for west Africa.
"The virus has devastated the entire health infrastructure of the country," says Riva Levinson, whose Washington,DC-based KRL International works with the government of Liberia to get its message out. That means Liberians are dying in large numbers every day from easily treated but common diseases in one of the world's poorest countries routine gastrointestinal infections, pneumonia, complications of pregnancy, and malaria – which is at its highest levels in the current rainy season – due to the absence of care. [See AllAfrica's Boakai Fofana's blog about the heightened worry about finding treatment when his young son developed malaria.]
Clinics and hospitals have closed, not only from losses of staff but from for lack of infection control supplies and disinfectant to make buildings and wards safe for caregivers or other patients following treatment of Ebola sufferers. That lack of capacity forced Dr. James Sirleaf, medical director of the medical assistance group Heartt Foundation, to pull its volunteers out of John F. Kennedy Hospital (JFK) in Monrovia, the country's main teaching and referral facility. "It was an agonizing decision," he said.
Heartt has formed ties with at least 19 major U.S. medical schools and universities and has a program that takes volunteers to JFK on short rotations to teach medical students and other health professionals while providing patient care. Last month the epidemic claimed JFK's top medical consultant, Dr. Samuel Brisbane.
Dozens of health workers have died, in a country that – before Ebola struck – only had around 50 doctors for a population of over four million. AllAfrica's Patience Dalieh's cousin, a nurse, died last week, after treating patients in a cross-roads market town of Kakata, in central Liberia; eleven other nurses in the facility died. (Patience didn't let fear stop her from trying to prevent Ebola's spread in Monrovia, Liberia's capital. See her blog.)
On Friday, in a rare bit of good news for Liberia, Dr. Phillip Ireland, who was treated at the same Ebola treatment center as Brisbane, walked out of the center, arms raised as he greeted family and supporters.
Heartt's Sirleaf first met Ireland when the then-medical student approached him for help in augmenting his emergency medicine skills. "When I heard he had contracted Ebola, I cried," says Sirleaf. "His recovery is wonderful news!"
But there is little good news for the country that already was struggling to recover from a quarter century of conflict that killed 250,000 people and dislocated three-quarters of the population, while destroying almost all the infrastructure – clinics, schools, roads, bridges and public buildings. The administration of President Ellen Johnson Sirleaf has been battling to rebuild, and there were clear signs of recovery against the odds. [See Briefing: Moving From Stabilization to Transformation] .Now, much of that hard-won progress has been erased – and is threatened with reversal. Schools have closed, Peace Corps teachers have left, companies working on critical development projects have withdrawn staff. The government announced that essential work on dams and roads has stopped.
Without strong intervention, widespread famine looms. In-country trade in agricultural products has ground to a standstill, and essential grain and rice shipments, as well as imports of fuel for electric generators has slowed, as ships bypass the Port of Monrovia. All but two airlines – as of this writing, Brussels Air and Royal Air Maroc were still flying – have halted service to Monrovia.
What's desperately needed, says Levinson, is a global response on the model of the assistance for Haiti. "If we don't recognize that we need to fight Ebola and contain it in a big way and provide the countries with support, we're not going to be capable of arresting it. And right now the support is not even scratching the surface."
"In Haiti, everyone wanted to go there and volunteer," she says. "The challenge now is the level of fear. The focus has been on preventing the disease 'coming to us', and it has completely missed the devastation it has caused."
Blaming the Victims
Much of the early warnings about Ebola came from policy experts who pinned responsibility for the slow response on the governments of the three countries – and media reflected that view.
Former National Public Radio reporter Laurie Garret - author of The Coming Plague, which warns about emerging diseases such as Ebola – is now senior fellow for global health at the Council on Foreign Relations. In an opinion piece for CNN, she gives a nod to the history of regional conflict, but puts the blame squarely on poor governance:
"Fear, suspicion, poverty, pain and superstition are the norm, the noise that everybody lives with, every minute of their lives. Ebola is simply a new scream heard above that terrible background din. The challenge today in these barely functioning states is to find ways to lower the overall noise, focus on stopping the Ebola virus, and bring governance and peace to three countries that have rarely experienced either."
Garret's position was widely echoed in other media and by other pundits during the critical period for containing the virus and minimizing the loss of life and the long-term economic catastrophe. The failure of the international organizations that had the scientific expertise to warn African governments and advise them on effective mitigation received little scrutiny.
A New York Times editorial on 15 August citing a "painfully slow" international response was an important corrective to the 'blame the victim' narrative, saying the World Health Organization had "snoozed on the sidelines for months" and commending the heroic efforts of MSF and Samaritan's Purse.
Two intrepid media professionals, photojournalist John Moore of Getty and reporter Jina Moore of Buzzfeed have been posting heart-wrenching images and stories – a key component to mobilizing public pressure for political action. National Public Radio has a team in Liberia this week.
Levinson and other advocates for the affected countries would like to see former American Presidents Clinton and Bush, who established the Clinton Bush Haiti Fund take similar action on behalf of Ebola victims and to stimulate more helpful media coverage of the needs in Liberia, Sierra Leone and Guinea. She says it can't be soon enough.
"All of the governments are democratically elected, all post-conflict success stories, all inherited non-existent infrastructures that had to be re-built from close to zero. With so much to lose, what is the world waiting for?"
The AllAfrica Foundation is launching a Give a Glove campaign – to call attention to the need for international action and to support the Ebola BlockAID campaign of the Heartt Foundation. Watch for information.