Ebola in Liberia

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 Volunteers of International Medical Corps (IMC) suiting up in personal protective equipment (photo by J.M. Souers)

Volunteers of International Medical Corps (IMC) suiting up in personal protective equipment (photo by J.M. Souers)

MONROVIA, Liberia — Though the Ebola epidemic that put the world on edge may be waning in parts of West Africa, there is much more work to do be done to ensure this underserved region of the world does not continue to suffer from a potentially endemic and devastating disease.

From the start of the Ebola epidemic in West Africa there have been almost 10,000 reported deaths and 14,269 confirmed cases in Sierra Leone, Guinea and Liberia, according to the World Health Organization (WHO). The U.S. Centers for Disease Control and Prevention (CDC) was here in Liberia during the initial outbreak but pulled out in May thinking everything was under control. In August, months after the CDC left, the real Ebola crisis struck Liberia.

In January, I applied to Adventist Health International (AHI) to work as a volunteer physician at SDA Cooper Hospital in Liberia. The hospital is run as a general hospital that has been providing health services during the epidemic to patients that are not suspected of Ebola while screening and referring patients with signs of the illness to Ebola Treatment Units (ETUs).

On February 9, 2015, I arrived at the hospital in the capital city of Liberia. Upon arrival I learned of a confirmed case at our hospital that had been transferred to an Ebola Treatment Unit (ETU) just a few days earlier. The hospital now had to shut down the inpatient services for decontamination and everyone who had contact with the case agreed to be quarantined for 21 days as a precautionary measure. Since I did not have contact with the Ebola patient, I continued working at the hospital in the out-patient department and continuous infection control and prevention training.

The hospital was soon overwhelmed by representatives of the WHO, CDC, Medicins Sans Frontieres (Doctors without Borders), International Medical Corps and the Ministry of Liberia. In a semi-coordinated effort, representatives of the different organizations came to our hospital to offer their advice and services.  We were pleased to see that these organizations were finally giving our hospital assistance and aid, but staff was frustrated that the offer had not come earlier during the actual crisis.

The situation in Liberia is now finally starting to stabilize. There was a period of more than 25 days with no confirmed cases, according to sources at the CDC in Monrovia. Though, on March 19th a patient presented to Redemption Hospital in Monrovia and was confirmed positive on March 20th. It is rumored that the patient contracted the illness from Sierra Leone, not unlikely due to the very porous border between the two countries. Another theory is that the patient contracted the disease through sexual transmission from her partner over three months after he had been released from an ETU. This reality does not heed well for the already pronounced stigma towards survivors.

It is concerning that many organizations are already talking about decommissioning the ETUs to redeploy aid and services to Guinea and Sierra Leone, where the situation is much worse. There is no doubt that the epidemic must be further addressed in these countries to ensure the safety of Liberians and all of West Africa, but it is important to continue to support efforts in Liberia to eradicate the illness. The health system still needs major improvement to reduce the risk of an uncontrolled and devastating outbreak in the future.

Community leadership seems to have had the most impact on curbing this disease in Liberia. Recognition of the disease, plus changing traditional practices and customs was more widely accepted and accomplished in Liberia than in Sierra Leone or Guinea. This shows how important it is for healthcare organizations to work directly with community leaders at the local level, educating the general population to cooperate in changing habits and customs (i.e. burial customs, consumption of bush meat, hand washing and sanitation) that propagate such an infectious illness.

Education is critical, which is most apparent when working with hospital staff that has very little basic knowledge of infectious disease prevention and control. This is in part because we are in a country with extremely limited health infrastructure including hospitals without running water, dependable energy sources or proper waste management.  What does exist is hardly adequate to provide even some of the most basic health care needs of the population. It is a shame that an epidemic like Ebola was necessary to bring this to international attention.  It is even worse that the short-term solutions are almost exhausted and very few long-term solutions have been established.

Volunteer of International Medical Corps (IMC) working in hospital triage at SDA Cooper Hospital in Monrovia, Liberia (photo by J.M. Souers)

Volunteer of International Medical Corps (IMC) working in hospital triage at SDA Cooper Hospital in Monrovia, Liberia (photo by J.M. Souers)

Focus has turned towards effectively training health care workers in the hospital setting with the proper equipment and precautions for infection control and prevention. Transitioning care from the ETU setting back to the hospital setting has been aided by the “Keep Safe, Keep Serving” curriculum provided by the Liberian Ministry of Health.  Still, there are too few properly established hospital protocols to protect staff and patients from another outbreak. This creates insecurity for the hospital staff.  Proper onsite training, triage staff, laboratory testing, contact tracing teams, supply chain availability, international support and local community education are still needed to continue to address this transition.

The international community can help by not allowing this epidemic to be just another news flash.  Instead, they should make it their long-term mission to help developing countries create sustainable healthcare reforms and infrastructure for long-term outcomes.  Their incentive should be to limit the spread of communicable diseases like Ebola that are no longer confined to remote areas of the world given our new global economy.  Unless these diseases are recognized quickly and controlled effectively at their source, they can and may spread rapidly and become an international pandemic that threatens everyone.

Joanna Mae Souers is a medical doctor, native of upstate New York, and graduate of the Latin American School of Medicine in Havana, Cuba.

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