Ebola in Africa

Ebola Response in Liberia Is Hampered by Infighting
New York Times, 2014-11-20 (Thursday)

The global response to the Ebola virus in Liberia is being hampered by poor coordination and serious disagreements between Liberian officials and the donors and health agencies fighting the epidemic, according to minutes of top-level meetings and interviews with participants.

Even now, three months after donors began pouring resources into Liberia, many confirmed cases still go unreported, countries refuse to change plans to erect field hospitals in the wrong places, families cannot find out whether their relatives in treatment are alive or dead, health workers sent to take temperatures sometimes lack thermometers, and bodies have been cremated because a larger cemetery was not yet open.

The detailed accounts of high-level meetings obtained by The New York Times, the most recent from Monday, lift the veil on the messy and contentious process of running the sprawling response to Liberia’s epidemic, one that now involves more than a hundred government agencies, charities and donors from around the world.

Despite these problems, with help from donors, Liberia, one of the three most afflicted West African countries, and the one with the highest death toll, has seen new cases drop to about 20 a day from about 100 a day two months ago. Experts attribute that to fearful Liberians touching one another less, more safe burials of bodies and distribution of protective gear to health care workers. But they also warn that cases are now holding steady and could explode again.


Also, the support documents with the minutes indicate that there is no national plan for Ebola survivors — either for reuniting them with their families or for using them to do nursing tasks because they are thought to be immune.


In the minutes, Liberian officials regularly complain about the donors, and the donors argue back. On Nov. 12, James Dorbor Jallah, the task force’s deputy manager, said: “People will sit in D.C. or Geneva and want to direct what is happening here.”

The health minister, Dr. Walter T. Gwenigale, backed him up, complaining that “the U.N. and other agencies got their money before the ink was even dry,” while, he said, a group run by a Liberian pastor to teach rural people about Ebola “has not gotten one cent.”

On Sunday,
President Ellen Johnson Sirleaf replaced Dr. Gwenigale without explaining why,
but said he would remain an adviser.
Dr. Emmanuel T. Dolo, Ms. Johnson Sirleaf’s youth adviser,
complained that
the donors were “showing a level of disrespect”
by judging Liberian community groups
by “harsh standards” and “Western standards.”


Two days later, Shiyong Wang, the World Bank representative, confirmed that United Nations agencies had received nearly all their money and that the Liberian government had received only 7 percent of the $23 million allotted to it. But, he said, the government had not produced required documentation — not even, for example, names of dead health workers whose families awaited compensation. He criticized the government’s “overly complex and bureaucratic approval process,” including three signatures on each document.

Dr. Rosling said the three signatures were an anticorruption measure. Beneficiary lists are hard to produce, he said, when Liberians have children whose births are often not officially recorded. And it was “arrogant,” he said, for donors, for example, to assign contracts to operate field hospitals without Health Ministry permission.

The Nov. 12 meeting appeared to end on a bitter note, with Mr. Nyenswah telling every agency to document within 48 hours what people it had and what their jobs were. “If you don’t give us this list,” he concluded, “you are not allowed in this meeting.”

The meeting of Nov. 14 opens with Mr. Nyenswah reminding scientists not to do research without permission from a government ethics review board. On Nov. 17, Dr. Dolo complains that “There are a lot of people in this room who never contribute anything to this meeting.”

Sierra Leone to use scare-tactics campaign in Freetown to curb Ebola
by Sarah Boseley in Freetown
The Guardian (UK), 2014-12-16


At the moment, swab tests show that 30% of bodies picked up by burial teams after calls from families are positive for Ebola. People are still nursing the sick rather than having them taken to holding centres for testing and then moved into treatment centres where half will probably die. It is in the last stages of the disease that victims are most infectious.

“We know it is out there. We have got to turn it around so that 2% to 3% of these bodies are actually positive,” said Brown.

The reluctance to make the call is rooted not only in family values but also cultural tradition around burials. In normal times, relatives would wash the bodies of those who die and dress them for the funeral. Many are still doing so – and calling the authorities afterwards, which means they have already exposed themselves to great risk.

“The behaviour change is not working,” said Brown. “We need to get to much more active surveillance, rather than passive surveillance.” Many thousands of people will be employed to visit communities and spread a tough new message in the course of the campaign, which will last for two to three weeks over the Christmas period. People now understand what Ebola is and what the risks are, but they are still in denial because they do not think it will happen to them, he said.


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