29 August 2014

Liberia's Ebola Quagmire - More Patients, Less Beds, 694 Dead

In the newest Ebola Management Center set up by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), a man lay on a plastic sheet protected mattress. His eyes are red and his face is pale; he has no shirt on and he turns from side to side, too weak to move and too sick to call for help with food or water.

One of the nurses in the other partition of the isolation center through a doorway to where the man is laying orders that he be given water mixed with Oral Rehydration Salt. The man is among some 120 patients at the center who are probable, suspected and confirmed cases of Ebola. He lies on the confirmed side.

Dr. Tom Frieden, Director of the United States, Centers for Disease Control is shown around the center and the smell of the high concentration of Chlorine fills the air as the team moves around to get a firsthand view of what is happening. One look at the patients brings despair and the only hope they have is the mobile phones that those who are not too weak to speak are allowed to use to communicate with their families in the outside world. Some of them look as though they feel trapped by a disease that offers no hope for tomorrow.

"This is a difficult situation for them. We allow them to use their phones because they need to communicate with their families out there. But this is the safest place for them to be-away from the rest of the world where they pose no harm to others," MSF's Tim Shenk, MSF Press officer, said in a conversation with journalists on Wednesday at the center.

Rapidly Scaling up

Shenk says when the patients leave the isolation center, all their belongings are no longer usable, so fire is set for them, including cell phones for fear they might be infected with the deadly Ebola virus. He said the center's 120-bed capacity is already overwhelmed and the MSF is putting up more structures to increase the capacity to be able to take on more patients.

On the other side of the partition in what seems an open field, health workers dressed in Personal Protective Equipment (PPE) hand out food in disposable bowls to patients. A woman dressed in PPE holds the hand of a young child about three-years-old. She has stripped off his clothes because he was burning with fever and very sick. The MSF center is the largest in the country at the moment, but the organization states that it is rapidly scaling up its operations to increase the capacity of the area to meet the demands as more patients continue to come in.

"As the global response to the Ebola outbreak in West Africa continues to be chaotic and entirely inadequate. In its first week, MSF's newest Ebola management center--known as ELWA3--in the capital, Monrovia, is already at capacity with 120 patients, and a further expansion is underway," said the organization in a release issued Wednesday.

"Meanwhile, in the north of the country, patients continue to flow into the newly rehabilitated Ebola management center in Foya." MSF stated that the international response to the West African Ebola outbreak has been "chaotic and entirely inadequate". The group plans to construct three additional tents with space for 40 more beds. Doctors Without Borders' guidelines were written for Ebola treatment centers with just 20 beds.

Numbers 'Unlike Anything We've Seen'

"We have to constantly adapt" to address a crisis of this scale, Lindis Hurum, the group's emergency coordinator in Monrovia, said in a statement. "The numbers of patients we are seeing is unlike anything we've seen in previous outbreaks," Hurum said. It stated that the new treatment center can slow the spread of the outbreak by isolating patients, preventing them from infecting friends and family. But added that overworked health workers have had to reduce the level of care they provide, according to Doctors Without Borders. They can no longer administer intravenous treatments, for example, which could limit doctors' ability to help dehydrated patients.

"It is simply unacceptable that, five months after the declaration of this Ebola outbreak, serious discussions are only starting now about international leadership and coordination," said Brice de le Vingne, director of operations at Doctors Without Borders. Referring to other countries that have the potential to help, he says, "They can do more, so why don't they?"

In Monrovia, "much of the city's medical system has shut down over fears of the virus among staff members and patients, leaving many people with no health care at all, generating an emergency within the emergency." On Wednesday at a news conference in Monrovia, Dr. Frieden said that the disease is unprecedented and that the world needs to do more to fight it.

"The situation with Ebola in Liberia today, is dire. There is need for urgent action. The world has never seen an outbreak of Ebola like this," he said on Wednesday. "Unfortunately, not only are the numbers large, but we know that there are many more cases, than have been diagnosed and reported. I wish, I didn't have to say this, but it is going to get worse, before it gets better."

Some Survivors

Despite the despair caused by the deadly Ebola virus there are some survivors coming out of isolation. On Monday, the ELWA Liberian government run center release six persons from isolation, including two Catholic nuns and a ten-year-old boy. Health workers at the center have not lost hope in combating the disease and despite the death of the second John F. Kennedy Medical Doctor Abraham Borbor. "Of the suspected cases that came, you have three of them coming out, who have shown negative on a number of days- multiple days," said Dr. I. B. Pabs-Garnon.

"Now a word of caution, they have not contracted Ebola, but they may still contract Ebola outside so, everybody must be careful. Wash your hands, stay away from sick people, dead bodies. For now we say thank God for their safe delivery." Health worker Benedict E. E. Reeves told journalists that this week has been a bright one as there continue to be a positive signal for many who came in with the disease.

"Up to 60 were here, but the number has reduced and so far we have between 30 to 35. We are getting mostly negative results this week," he said. "We do the test three times because under three days you can't show anything. You have to wait for three days then you do it. We have done some people's tests up to five times."

Impact on travel

The deadly Ebola virus continues to affect the free movement across borders that travelers getting to and from West Africa have become more difficult as airlines have canceled flights because of the epidemic. In Sierra Leone's Kailahun district, there are four ambulances for a region of 470,000 people. The World Health Organization states that Ebola has infected more than 2,600 people and killed more than 1,400 in the four affected countries - Guinea, Sierra Leone, Liberia and Nigeria. A separate Ebola outbreak has been reported in the Democratic Republic of Congo but appears unrelated.

The United Nations Children's Fund (UNICEF) airlifted 168 tons of health and hygiene supplies to Liberia in the past week. AmeriCares sent a shipment of antibiotics, medical supplies and "desperately needed safety equipment," including 15,000 pairs of gloves and nearly 10,000 protective masks the group said.

MSF's Emergency Coordinator Lindis Hurum, states that there is no more space at any of Treatment Units in Liberia for Ebola patients. "ETU at ELWA has stock-out of Loperimide, anti-malaria drug, hoods, duct tape and cefixame, PPEs will also run out in 5 days," said the MSF official.

According to the latest Ministry of Health numbers, in Montserrado County1,126 out of 1,247 contacts (90%) were seen by the four tracing teams. JFK, ELWA-2 and ELWA-3 are currently full to capacity and the medical humanitarian group, MSF states that currently, there are 38 bodies that need to be removed from ELWA. The West Point transit center was reopened and took in two cases - as of late afternoon on the August 25, 2014, Food and water were delivered to them. "The tracing team has been working for the past three days to generate line lists for contacts in West Point," stated MSF.

20,000 More Deaths Likely, WHO says

"So far, 129 contacts have been listed, and the contact tracing team has identified 32 deaths (occurring over the period from July 29th to August 24th) that are suspected of being Ebola. The team is working to complete investigation forms for these deaths." Regionally, the outbreak has killed 1,552 people, the World Health Organization said Thursday.

The total number of cases stands at 3,069, with 40% occurring in the past three weeks. "However, most cases are concentrated in only a few localities," the WHO said. The outbreak, the deadliest ever, has been centered in Guinea, Sierra Leone and Liberia, with a handful of cases in Nigeria. The overall fatality rate is 52%, the WHO said, ranging from 42% in Sierra Leone to 66% in Guinea.

The WHO is predicting that the Ebola outbreak in West Africa could eventually infect more than 20,000 people - more than six times as many doctors currently know about. The organization made the statement Thursday, as it called for a global response to the spread of the virus. The United Nations' health agency warned that it needed $490 million to combat Ebola over the next six months as it set out a "roadmap" for tackling the outbreak. The death toll has climbed to 1, 552 and "continues to accelerate," the agency said.

The Ebola crisis continues to claim the lives of many Liberians as the days go by and those currently in isolation would need all the support from the public to overcome a disease that has no cure.


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