To all my friends who have been following my Liberian summer adventure at the University of Liberia. Yes, Liberia, where we are having just a bit of an Ebola epidemic, here is my take on what is going on in Monrovia at the moment: The news from Monrovia isnt good. There are cases all over the place and the response until this week has been mysteriously relaxed and unorganized; and now weve got an emergency that could easily unravel in unpredictable ways. The Ministry of Finance shut down Monday for decontamination, many top people have been told to stay home for 21 days because of their official, Patrick Sawyer, who exposed an amazing number of people by traveling extensively all around Monrovia and finally to Nigeria while being acutely ill with EVD. Among other things this raises serious questions in my mind about the official mantra that only visibly ill patients and dead bodies are significant sources of contagion. Here we had a guy who apparently did not look that ill for days until he finally collapsed after getting off his flight to Lagos, Nigeria. Ministry of Education shut down yesterday because of a death, (I dont know the details). Meanwhile NGOs are starting to react. I have some NGO friends that are being ordered to leave today, (and as that happens it will leave a big hole in my support network and so Im feeling a little exposed.) The embassys word is business as usual, just take precautions. The University is open but there is also a rumor that it might close down next week. For the moment I am trying to mobilize a group of students to become neighborhood information officers. Im finding that the average person just really doesnt seem to know what to do. They dont know who to call if they are sick. They dont know how to respond to sick people. They dont know how to differentiate this disease from the many other febrile diseases prevalent here. Many health care workers have been infected and this has caused walkouts and absenteeism, thus most hospitals and clinics in Monrovia for all practical purposes are closed and that means that all the other health problems that exist here are currently untended. In a word, this is just a big, big mess. I rode around town with a contact tracing team on Saturday. It took me out into some of the neighborhoods, and then a meeting with a number of officials at the Ministry of Health and then finally out to ELWA hospital to interview the husband of newly deceased patient. On Saturday we were the only one of three Contact Tracing Teams that were in the field. The other two were not operating because of one broken vehicle and the lack of fuel for the other vehicle. (Meanwhile there was no shortage of operational government vehicles in the Ministry parking lot, they just were not assigned to contact tracing.) I learned that day there was only one Case Investigation Team operating. This crucial team goes out to investigate and classify all symptomatic patients and any suspicious dead bodies in the various communities of ALL of Monrovia. The case load is enormous and the team is days behind in investigating reported cases. My experience on Saturday destroyed my meager confidence in the efficacy of the response so far. There has got to be a major shift in the way this is being handled. Nothing has been done to curtail the movement of people around the city and the country and I think that is a major problem. Sick people continue to move and fearful contacts scatter, panicked community members chase contacts and decontamination teams away. Id summarize the basic sentiment as every man and woman for himself. There has to be a major effort to enlist the cooperation of everybody in helping to bring this epidemic under control. Here is my suggestion for what its worth. 1. Sick people must be convinced to cooperate in keeping themselves isolated at home until the case investigation team can make it to them to classify them as ebola or not ebola. (Clearly more case investigation teams are needed.) 2. Family members of sick people must also be convinced to stay home with the sick person to care for them and themselves until they too can be examined and classified. 3. Neighbors and community members must also be enlisted and convinced that is in their best interest to support and help these sick houses. The community can supply food and water to these houses in a controlled way so that residents are kept comfortable and the community is kept safe. 4. Similar shelters need to be set up for homeless and transient people, sick and not sick. 5. Some kind of curfew or holiday should be established to restrict non-essential movement and help facilitate community and neighborhood organization 6. It would be really really helpful if more testing centers could be established, the current turnaround time is too slow We need to think about the use of experimental vaccines for non-sick health care personnel. And we need to use immune serum and or monoclonal antibodies as therapy. aloha --jb
Posted on: Wed, 30 Jul 2014 22:57:26 +0000
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