Even in parts of Liberia where Ebola hasn’t been spreading, frightened doctors have run away and villages lack basic clean, running water, a team of U.S. government experts reported Tuesday.
The report paints a grim picture of even the luckiest parts of Liberia, the country hardest hit by the worsening Ebola epidemic in West Africa. A team from the Centers for Disease Control and Prevention, with Liberian colleagues, visited four counties in southeastern Liberia where no Ebola had been reported.
What they found was sobering, and shows the big job that lies ahead for U.S. and other aid teams trying to build up some kind of rudimentary health care system in Liberia to fight the Ebola epidemic.
"Only three physicians remained; the others had left Liberia because of the epidemic."
“Before the epidemic, six physicians served all four counties (range = one to three per county). At the time of the evaluation, only three physicians remained; the others had left Liberia because of the epidemic,” they wrote.
“In two of four hospitals assessed, nursing staff members were not coming to work or had abandoned facilities; in another hospital, health care providers had not been paid for three months but were still providing basic care.”
But it was hard — hardly a glove was to be found anywhere. Surgical gloves or rubber gloves are a basic precaution for treating Ebola patients. “Hand washing stations rarely were available in the facilities assessed, and if available, were typically located only in operating theaters. Hand washing stations in most health care settings consisted of water jugs, and even these were scarce,” wrote CDC’s Dr. Joseph Forrester, Dr. Kevin DeCock and others.
The health care providers in LIberia didn’t have much soap, hand sanitizer or bleach, either.
Their solution? Jury-rigged sinks made using bamboo sticks filled with water.
Some clinics had no electricity or running water — most communications relied on dodgy cell phone signals.
Communication between the county health office and hospitals and clinics relied on cell phones and radios, with intermittent Internet availability.
There was almost no Ebola training. The U.S.-Liberian team is working to fix this, but they were starting from almost nothing.
"There was insufficient personal protective equipment to care for patients with Ebola."
“Ebola task forces had been established in each county, according to reports from the field, the infrastructure and leadership were hampered by limited resources and difficulty communicating with and mobilizing the local communities. In all counties, there was insufficient personal protective equipment to care for patients with Ebola. Health care providers had not received training on the donning and removal of personal protective equipment.”
Experts believe many of the health care workers who have become infected with Ebola have been exposed when they were taking off contaminated gear. Removal is a tricky process that, to be safe, must be done slowly and meticulously.
The region that the team examined, which borders Ivory Coast, is becoming better prepared but isn’t yet ready to tackle Ebola if it comes, the CDC team said.
The World Health Organization says that more than 7,000 people in Liberia, Sierra Leone and Guinea have been infected with Ebola and that more than half of them have died. WHO projects 20,000 cases by November even with intervention, and aid groups say efforts to get new clinics built and better supplies distributed are slow.
Experts say the only way to protect the rest of the world from Ebola is to stop it in West Africa.