In Bardnersville, on the outskirts of Monrovia, Morris Mohammed Kromah survived Ebola, but 12 family members did not. Struggling to hold back emotions after losing the twelfth, his 12-year-old daughter last week, Kromah will no doubt be among the unlucky thousands of Liberians to benefit from Ebola units being constructed by the U.S. government in various parts of the country. For Kromah, he wishes the U.S. had built those Ebola units sooner.
Maj. General Darryl Williams, Joint Task Force Commander, Operation United Assistance, says none of those facilities would be completed and available for use until at least in December. “We are building 17 Ebola Treatment Units,” he says upon arrival in Bomi County, Wednesday to assess the US-funded Ebola isolation units being constructed by U.S. and Liberian troops. “There will be about eight in the southeast. They’ll be in Maryland, Zorzor, Zwedru, Ganta.” These days, Kromah seems more worried about stigmatization issues as residents and neighbors demand that he shows proof that he is no longer infected with the virus.
A Virus Entrenched
Alieu Kanneh, 24, showed up at the newly-constructed Island Ebola Emergency Treatment Center for seven days searching for any information he could gather about his eight-month pregnant wife. He had dropped her off late in September after she began showing signs of the virus, but didn’t find out about her death until two weeks later. He has no idea when she died or how and where she was buried or cremated.
Liberia continues to lead the death toll, with a little over 2,425 out of 4,447 in countries hit by the virus so far. The virus is seemingly entrenched in West Africa according to the World Health Organization(WHO) with large number of cases in Liberia, Sierra Leone, Guinea. Nigeria and Senegal managed to contain the few cases in their countries but Ebola is now becoming a cross border affair, crossing into the U.S., Germany and Spain.
Quietly, some local doctors and task force operators are confident that the virus could be greatly contained by the time the U.S. is fully ready to get the ball rolling although the World Health Organization’s projections see it differently with the numbers expected to hit 10,000 weekly by December if activities are not ramped up to contain the virus.
“Far less bodies are being found in the communities and we are taking most bodies from Emergency Treatment Units (ETU’s), meaning most Ebola patients are now making it into ETU’s,” Says Samuel Tetroien Nimley Jr., Commissioner of Police for Intelligence and Interpol Affairs, also a Security Coordinator between the Liberian Ministry of Health and the Red Cross.
The burial team according to Nimley is now burning on average 10-30 corpses daily. “This number represents all deaths within Montserrado County as compared to August of September of 30-79.” But Nimley cautions: “Even though we are experiencing a reduction in the death rate and low numbers in ETU, authorities need, more than ever, to reinforce the protocol to narrow down the transmission through a national isolation, home by home tracing effort.”
But some political observers see a discord in the numbers now being reported. While Monrovia (Capital City of Liberia) is reporting a dip in the number of corpses, numbers in some rural areas are still rising even as the government announced this week that it would need nearly 80,000 more body bags over the next six months and 989,985 protective suits.
On a recent weekday, a Liberia National Red Cross Burial Team is parked outside of the John F. Kennedy Memorial Hospital ETU where a volunteer health worker Emmanuel Ajamcee died after contracting the deadly Ebola virus months after signing up as a hygienist. His friends had brought a casket because they can’t stand the sight of him wrapped in a body bag and dump in some crematorium.
They plan on accompanying his remains to whatever final resting place has been chosen for him. These are the few bodies that are currently taken out of the ETUs these days. William Broh, Ambulance driver on the First Responders Ambulance says he believes Liberia is seeing remarkable improvement in the Ebola response therefore a shrink in the number of cases. He calls the month of October a bright month because they have seen less and less cases.
“From my own observation comparing what happened in the past to now, there is some level of improvement. There is huge improvement in the process in this month,” he says. “I believe the people of Liberia are now following the preventative measures. People are listening to the awareness based on that people are getting the message so things are going down. So many days when we come here, we see people bringing themselves here to be tested.”
He says due to the level of sensitization at the community level Liberia’s Ebola Response is seeing a boost therefore the drop in cases that are actually coming in and the deaths that are occurring. Broh said now the country is dealing with cases that occur due to the contacts people who are now in ETUs had with others while they were still outside. He said the government should develop a post Ebola healthcare delivery strategy.
I believe there is no secret burial and people are not hiding themselves in homes like they used to. They are coming forward to be tested for the disease and for treatment,” he says. “When it comes to the Ebola situation, the way the ambulances used to be moving around, the way we used to be receiving calls; things are gradually dropping. For me, I believe that since things are improving, the government should try to open other health facilities; so people who have different illnesses can be able to seek treatment.
Discord in Death Toll
Mary Williams, Manager of the local radio station, Love FM is puzzled by the numbers. “If the confirmed, suspected and probable cases are almost five thousand and the Ministry of Health and Social Welfare is reporting that the number of persons in ETU’s are about 500, the question really is: If you have about five hundred people in ETU’s, then where are the remaining 4,000 plus cases? The answer obviously is that they are out in the community meaning we’re not yet out of the woods and that is where the problem really lies because as long as we don’t get our hands on those cases, the death and infection rates will continue to go up. Mind you, we had that period in March, April when things were quiet only to spike back up in May and June, and then by August and September it all went haywire.”
Samuel P. Jackson, a political scientist and an economist warns that Liberians should be wary of a false sense of security, similar to one which caused the death toll to spike when there was a period of quietude in deaths back in March only to see those numbers rise again. Says Jackson: “It does appear that there is a lull in the cases of Ebola infections and there is growing optimism that the disease is on the decline, prompting Liberia’s political leaders to openly challenge the authenticity of scientific predictions. Experts say this period of the apparent decline in the number of cases could indicate that there is an incubation period that could see the virus rise exponentially in the next several weeks. Still, I am hoping the experts are very wrong.”
Patients Flee Abandoned Redemption
International health organizations such as the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) are urging Liberia not to be lulled into a false sense of security that Ebola is drastically on the decline, when in fact the scientific evidence is predicting otherwise.
All indication shows that Liberia is making progress in its fight against the deadly Ebola outbreak, but the stark reality is that the disease could spiral out of control with just one mistake thus leading the country to start all over. Early Sunday morning all hell broke loose and the New Kru Town community bran amok when five suspected patients who were held at the Redemption hospital ran out into the community.
Residents say the suspected patients complained of lack of food at the facility. It took the Ebola Task Force to get them and move them to the Island Clinic ETU. This scenario leads many to worry that carelessness from health centers like the Redemption hospital could lead to problems stabilizing Liberia’s Ebola situation.
The WHO says the data acquisition continues to be a challenge in Liberia and that Evidence obtained from responders and laboratory staff in the country suggests that the situation in Liberia is getting worse, and that transmission remains intense in the capital, Monrovia. As has been the case over the past four weeks, very few confirmed cases were reported from Monrovia between 6 and 11 October (figure 2), reflecting ongoing delays in matching laboratory results with clinical surveillance data. By contrast, 138 suspected and probable cases were reported from Monrovia during the same period, many of which are likely to be genuine cases of EVD.
WHO says that outside Monrovia, most newly reported cases have come from the districts of Bong (75 cases) and Margibi (28 cases). It states in its October 16, 2014, situation report and Ebola roadmap that the recent fall in the number of new cases reported from Lofa, which borders Gueckedou in Guinea, appears to have continued, with reports from observers in the area suggesting that there is evidence of a genuine decline.
“It should be noted, however, that the 13 new cases that were reported in Lofa between 6 and 11 October represents a high number in the context of an EVD outbreak, and a concerted effort will be required to halt all transmissions in the area,” states WHO. But many observers believe the WHO report might be a one of caution because according to the figures from the field of over 700 bed in ETU’s in Liberia only a little over 300 is occupied and people continue to turn themselves in to ETUs to be checked.
So while many are quietly suggesting that Ebola would be out of Liberia by the time the U.S. completes its Ebola treatment units, things may be far from over, and this is the reason Maj. General Williams says the U.S. mission remains a humanitarian effort, explaining that U.S. troops are in Liberia to support the Liberian people against a common enemy. “This is a great enemy and it takes all these different forces; the Liberian army, our army, our marines, our airforce. You see the joint USAID, all these different organizations with the military are required. So it is not a fight in the traditional sense, it is a humanitarian fight.”
Caution to the wind: Don’t Rely Too Much on U.S.
Last week, Rajiv Shah, Administrator of the United States Aid for International Development (USAID) was in Liberia along with the Norwegian Minister of Foreign Affairs Børge Brende, pledging more support and assessing international aid to the post-war nation engulfed in an Ebola crisis.
The center that we are at right now is one that we have helped to support the United Nations to build, that will be one of the largest Ebola Treatment Centers anywhere in the world, Shah said after a meeting with Sirleaf last Wednesday. “There is enough expertise and knowledge, on how to do that here in Liberia and our goal was to learn about what’s happening here and try to accelerate the efforts so that fewer people die and more people survive so that we really turn the tide on this epidemic. While in various parts of Monrovia, sentiments are high that the arrival of American troops will save the day but many, including opposition politician Charles Walker Brumskine, are wary of relying too much on America’s support and presence to end the surge of cases and ward off projections by the World Health Organization of 1.4 million infections by January. Brumskine cautioned, “as we welcome the intervention of the United States of America to help deal with the national health catastrophe, occasioned by the Ebola outbreak, let us not forget that the responsibility of containing the outbreak and eventually eradicating the Ebola virus from Liberia remains ours, as a Government, a nation, and a people.
Political observers say, turning the tide will require a lot more than goodwill, but a greater sense of urgency on the part of Liberia and Liberians, still trapped in a period of past errors that led the country to war and the mistakes that caused to outbreak to get out of hand and control of the government.
International observers say the crisis in Liberia is a humanitarian fight for a post-war nation looking to complete its transition from war to peace, eclipsed by a debate pitting the president against the national legislature in her request to arrogate more powers to the executive branch of government under a State of Emergency and suspension of portions of the Liberian constitution protecting certain fundamental rights such as freedom of speech, movement and religion.
Sirleaf had sought the powers back in May when the outbreak was at its peak. Now she wants more, eyeing suspension of parts of the constitution and seeking to restrict peaceful assembly and limit the movements of certain individuals, groups or communities; restricting certain practices and preventing citizens, groups of citizens or any entity protected under Article 15 of the Constitution from making any public statement in person, by print or electronic, which she claimed may have the tendency of undermining the State of Emergency. Critics of the measure fear that the powers the president is seeking are too broad, leading many to ask: What constitute undermining the state of emergency and how do they help stop Ebola?
Today, even in the midst of aid distribution, residents in local communities are complaining that they are being made to pay for food and other items donated by the international community and the government has so far been reluctant to publish the results of an internal investigation into how it expended US$5 million of its own contribution to the fight stop Ebola. Members of the national legislature have called for a probe and many Liberians are unsure of what to make about the seeming lack of sincerity from those at the helm of power.
Epicenter Liberia Trampling Rights, Speech
Despite the lapses, international donors continue to promise support although not in hard cash as the government would prefer but in goods and in-kinds out of fear that past donations have not been utilized transparently. For example, the Norwegian Foreign Minister Brende announced this week that there are 160 doctors and nurses in Norway that have volunteered, to go to the region hit hard by the outbreak. “We will then send Norwegian health personnel and we will also look into logistics, using military aircraft to make sure that the materials and in-kind materials like hospital beds will arrive and also having an emergency that we can bring people out if they have Ebola.”
Today, goodwill is pouring in but even amid fears that the presence of U.S. troops could be absolving the Liberian government of its own responsibility to step up and solve the problem to the best of its ability, complicated by the fact that the overwhelming international goodwill and attention to what has now become the epicenter of the outbreak, could be distracting the world from what many see as very bad governance and anti-democratic decisions and practices the Liberian government is making in the name of containing the crisis: Shutting down of newspapers, jailing of journalists and intimidation of those viewed as opposition to the powers of the day.
A Nation in Denial
But even amid the goodwill, concerns are mounting that donations are not being handled properly; nurses and doctors continue to wail about the lack of protective gears, gloves and masks and healthcare workers are continuing to die even though conditions in some areas have improved. More importantly, most of the donated foods are already spoiling because they’re not reaching the targets fast enough, complicated by the government’s unwillingness to bring closure to the issue of health works salary arrears, which has gotten the attention of its key international partner, the United States of America.
Ambassador Deborah Malac said during a tour with U.S. troops to Bomi County where a US-funded ETU is being constructed, that the government must pay the health workers salaries so that they can focus on saving lives, indicating that the U.S. has given Liberia additional US$5 million, making it a total of US$10 million to pay health workers salaries.
For some, the sad reality is that Liberia is a nation in denial and still falling short of realizing the core issues that could put Ebola to bed for good: Containment, Quarantine and Contact Tracing. In Nigeria, where Patrick Sawyer, a Liberian-American transported the virus before his death, the transport led to 20 infections and 990 contacts that were successfully traced by 120 tracers.
In contrast to Liberia, those numbers pale in comparison with very little being done to quarantine and trace sources of infections. Liberian Thomas Eric Duncan, whose Ebola virus have now affected two American nurses in Texas, is a case in point. The Liberian Ministry of Health indicated that it did not know until after 10 days that the pregnant woman Duncan assisted died of Ebola.
For the time being, Americans are pressuring their leaders to temporarily place a ban on travel to the United States from countries suffering an outbreak of the Ebola virus and a lot of our neighbors on the continent have already done the same. We pray that it does not come to that as Liberia and all those nations hit by the virus, need all the help we can get, abandoning us now would mean the death of us all.
In spite of all the international assistance, Liberians see the massive spread of the Ebola virus as a symptom of a larger problem: Bad Governance, Corruption and lack of accountability and transparency. Until America and the West can help solve these problems, it is more likely to re-occur.
