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Are Hospitals Part of the Ebola Problem? Charity Wants New Strategy

It may be time to take a whole new approach to fighting Ebola, moving patients away from hospitals to special containment units, experts say.
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It may be time to take a whole new approach to fighting Ebola — one that looks outside hospitals, the head of the Christian mission group that’s been helping lead the fight against Ebola says.

Hospitals have been helping to spread the virus — 240-plus health workers have been infected, including some of Sierra Leone’s top doctors and four U.S. workers. And Ebola patients are overwhelming hospitals in Liberia, Sierra Leone and Guinea, driving away patients with other conditions.

President Barack Obama is poised to make an announcement about new U.S. aid to fight the epidemic on Tuesday. But aid workers in West Africa complain that so far, help being offered is too little, too late.

Franklin Graham, head of Samaritan’s Purse, suggests ditching hospitals and pivoting to a completely different strategy. He says his teams are starting to set up stand-alone isolation units, and he calls for protective gear to be distributed directly to families caring for victims.

After all, they are being turned away from hospitals anyway.

“It is a very difficult to fight Ebola with a hospital,” Graham, who is president of Samaritan’s Purse, told NBC News. “The reason is that the Ebola got into the hospital and infected the hospital.”

In Monrovia, Liberia, St. Joseph’s Catholic hospital closed because so many staffers got infected. Four government hospitals closed in Sierra Leone in a single week last month. Phebe Hospital in central Liberia virtually closed after five nurses died of Ebola.

It’s clear to Graham that large, centralized hospitals, where sick patients may expose many others before they are even seen, are not the answer to fighting Ebola. “My recommendation is the hospital has to be removed and separated quite a bit from Ebola,” he said. “There has to be better triage before you even let a person get into the hospital.”

“My recommendation is the hospital has to be removed and separated quite a bit from Ebola."

Doctors believe Dr. Kent Brantly became infected with Ebola while seeing patients he did not realize were infected. He wasn’t always wearing protective gear when seeing general patients at the ELWA hospital outside Monrovia. Brantly thinks so himself. “We think that Dr. Brantly was infected in the hospital. It wasn’t in our Ebola treatment center,” Graham said.

Samaritan’s Purse, a Christian aid organization that helps other groups build hospitals, among other things, is already modifying its Ebola strategy.

“You have to have a containment center where someone who has Ebola comes in and you are able to contain them,” he said. And these centers shouldn’t be anywhere near hospitals, where vulnerable children, pregnant women, and sick people can be exposed.

“Containment centers are where you can have very strict procedures — a gown, double and sometimes triple layers of protection,” Graham said. “But in a hospital your staff are not gowned like that.”

Medecins Sans Frontieres (MSF or Doctors Without Borders) is beginning to take a similar approach.

“Already we are running a number of isolation units,” says Sophie Delaunay, executive director of MSF New York. “It is very simple. You need an empty field and you set up an isolation ward.”

There’s no good way to treat Ebola, which the World Health Organization says has infected more than 4,700 people and killed 2,400 of them since the outbreak started in February in West Africa. Patients like Brantly lucky enough to be treated in more modern facilities have done well with balanced rehydration salts. But even a little saline and careful care has saved the lives of half the patients — a good sign for a virus that has been known to kill up to 90 percent of its victims.

“It is very simple. You need an empty field and you set up an isolation ward.”

What’s most important now is to stop the spread, and to do that, patients must be kept away from the uninfected, Delaunay says.

“It is clear that what is needed at this moment is isolation,” she said. “To cut the transmission chain, the only way is to isolate the sick patients. This is why we need more beds.”

It’s not hard to understand and it’s not hard to carry out, says Delaunay, who is perplexed by the negligible international response to the epidemic, despite constant pleas from MSF, WHO and other organizations.

“If an NGO (non governmental organization) like MSF does what we are doing, states can do it and even at a larger scale,” Delaunay said. “This is all we are asking. If a few states get their acts together, their means are much bigger than MSF’s means.”

The International Federation of Red Cross and Red Crescent Societies is taking a similar tack in an emergency appeal for money to build a 60-person Ebola treatment facility in Sierra Leone.

And Graham wants to take the decentralization even further.

“The most important thing, I believe as we move forward, is to give people a way to protect themselves — giving people gloves, giving them gowns, giving them masks,” he said. “Let’s say you had Ebola. Your family could come and they would be given protective equipment so they could take care of you.”

Ebola is spread via bodily fluids, and hundreds of people have been infected as they cared for infected loved ones, cleaning up vomit and diarrhea and wiping feverish brows.

“What we are wanting to do is give Liberians the same knowledge, the same gloves and gowns (that our staff have) so that they can protect themselves,” Graham said.