When people started dying of Ebola in Liberia, Clarine Vaughn faced a wrenching choice: Should she send home, for their own health and safety, four U.S. doctors working for HEARTT, the aid group she led there? Or should she keep them in the country without proper supplies or training to fight the virulent, contagious disease, which was already spreading panic?
After much agonizing, Vaughn, who lives in Liberia, pulled the doctors out and canceled plans to bring in more. The African physicians and nurses left behind told her they understood, but felt abandoned. They said, “We need you guys here,” she recalled.
Since then, Vaughn has wondered if the U.S. doctors might have made a difference, and she asked the aid group AmeriCares to help. It sent in a planeload of supplies that landed in Monrovia, the Liberian capital, last Sunday.
The departure of many Western development workers from Guinea, Liberia and Sierra Leone, the West African countries hit hardest by Ebola, has further weakened the region’s decrepit, understaffed health systems at the moment they are facing one of their gravest public-health crises.
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Liberia, population 4 million, has fewer than 250 doctors left in the country, according to the Liberia Medical and Dental Council. Seven doctors there have contracted Ebola, and two of them have died.
“The locals’ seeing this mass exodus of expatriates has contributed to the sense that there’s an apocalypse happening and they’re in it on their own,” said Raphael Frankfurter, executive director of the Wellbody Alliance, which provides clinical services in a diamond-mining district of Sierra Leone bordering Guinea, where the outbreak began.
Frankfurter, too, sent his four U.S. volunteers home for fear they might fall ill. They left behind 160 national staff. “It’s certainly not in line with our values, because it’s just such a glaring inequality,” he said. But “it’s a very scary place to get sick right now.”
As an array of international organizations, wealthy countries and charitable groups gear up to provide resources to fight the outbreak, the absent doctors and volunteers are a reminder of the daunting practical obstacles.
Many African health workers battling Ebola are contracting it themselves. At least 170 workers have gotten the disease, according to the World Health Organization (WHO), and more than 80 have died.
Those sickened include Dr. Kent Brantly, an American now recovering in an Atlanta hospital after receiving ZMapp, an experimental drug. Three Liberian health-care workers infected with Ebola received ZMapp on Friday, a senior Liberian health official confirmed. The patients signed consent forms stating that they understood the risks of the untested drug and waived liability for any adverse effects.
The doses had been flown into Liberia with the agreement of the drug’s San Diego-based producer and the U.S. government, after appeals from President Ellen Johnson Sirleaf of Liberia to President Obama and senior U.S. officials. Its arrival last week lifted morale and “raised the hope of everybody,” Johnson Sirleaf said in an interview.
Even as some leave, other international workers are arriving in the affected areas. Still, fear is complicating the aid effort: food for people in areas that have been cordoned off; laboratory supplies to test for the disease; gloves, face masks and gowns to protect health workers; body bags for the dead; bedsheets to replace those that must be burned.
Airlines have canceled flights that could have carried in such supplies, despite assurances from WHO that properly screened passengers pose little risk. Positions on aid rosters remain unfilled.
Hundreds of workers for Doctors Without Borders have fought the outbreak since March. The group’s president, Dr. Joanne Liu, said there was an acute need for materials and for more human resources on the ground — and not just experts and bureaucrats, but also the kind of person who is ready to “roll up his sleeves.”
“What we have to keep in mind is we are facing today the most devastating and biggest Ebola epidemic of the modern times,” Liu said. “There is fear, there is a front line, the epidemic is advancing, and there is a collapse of infrastructure.”
With commercial flights dwindling, the U.N.’s World Food Program began an air service for humanitarian workers on Saturday. “The virus is spreading, and we’re all suddenly realizing we need to do more,” said Denise Brown, the agency’s emergency coordinator for the crisis.
The director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, said the CDC had sent 50 experts to help local governments keep track of where people are getting sick and set up emergency-operations centers. It’s a challenge, judging from a Liberian Health Ministry report that in the hardest-hit area of the country, the County Surveillance Office has no computer for data management.
The U.S. military says it has trained more than 230 Liberian soldiers to use protective equipment and support health efforts.
Units for Ebola patients at ELWA Hospital, just outside Liberia’s hard-hit capital, Monrovia, overflowed with about 70 patients, more than twice as many as the units were designed to hold. An additional unit with 120 beds opened Saturday, said Tolbert Nyenswah, an assistant minister of health and social welfare. Many hospitals were shuttered, and Nyenswah said supplies and experts were needed on the country’s periphery.
In Sierra Leone, as the number of contacts of Ebola patients spiraled far beyond efforts to trace them during the 21-day incubation period of the virus, some counselors visited residents at home. Radio programs, posters and even parades were not enough to persuade everybody with symptoms to report to isolation centers, or their relatives to refrain from risking their lives to care for them.
“They’re actively rejecting those messages,” not failing to understand them, said Frankfurter, the Wellbody director. Health-care workers, he added, are treating community members “more as disease carriers than as humans with families” going through an “incredible, devastating emotional process.”
Frankfurter, who was in Sierra Leone until a week ago, said the number of patients seeking regular medical care at his group’s clinic in Kono had dropped to about 10 a day from more than 75, most likely because of fear.
Vaughn, with the HEARTT program, said she hoped that trained infectious-diseases doctors and CDC experts would help bring the outbreak under control and create mechanisms to protect health workers. That would allow her organization to convince U.S. universities that their medical residents can safely return to Liberia. “We’re not there yet,” she said. “Right now, we’re still in crisis mode.”