TIME Liberia

Liberian Government’s Blunders Pile Up in the Grip of Ebola

People celebrate in a street outside of West Point slum in Monrovia, Liberia, Aug. 30, 2014. Crowds cheer and celebrate in the streets after Liberian authorities reopened a slum where tens of thousands of people were barricaded amid the countryís Ebola outbreak.
People celebrate in a street outside of West Point slum in Monrovia, Liberia, Aug. 30, 2014. Crowds cheer and celebrate in the streets after Liberian authorities reopened a slum where tens of thousands of people were barricaded amid the countryís Ebola outbreak. Abbas Dulleh—AP

President Ellen Johnson Sirleaf's government was forced to lift a quarantine of one of Monrovia's worst slums last week as errors mount

In a cramped bar down a dark alleyway of Monrovia’s sprawling seaside slum West Point, residents are dancing wildly. They shuffle and stomp across a concrete floor sprinkled with cigarette butts and splashed with beer and homemade liquor.

“We celebrating! We are out of jail!” says Mary Goll, a resident and local bar owner, who leans back to the bar crisscrossed with metal for security for another bottle of beer. Goll’s own bar is in ruins on the shoreline, half eaten by the Atlantic Ocean. Just as the ocean has eroded away the land and driven the community inwards, so too did a government-ordered quarantine imposed last week.

On Aug. 20, the Liberian government enforced a 21-day quarantine aimed at preventing the spread of the virus that has claimed close to 700 lives throughout the country, with cases and casualties mounting in the city. Médecins Sans Frontières has described the outbreak in Monrovia as “catastrophic” and the 120 beds in its treatment center in the capital are already full. The World Health Organization has said the epidemic could last for six to nine months and infect up to 20,000 people in the region before the outbreak is over. Liberia is now the only Ebola-affected nation in the region with rising cases in the capital.

On Friday Aug. 30, just 10 days into the quarantine, the government announced on radio it would be lifting the quarantine the next morning. At 6am the next morning, police and soldiers took away their barbed wire and makeshift wooden checkpoints. West Pointers have been celebrating ever since — but the government seems just as unsure how to combat the virus as it has been since the outbreak began.

The plan to cordon off this community of some 80,000 people was made after a holding center for victims was ransacked on Aug. 15, one week after Liberia declared a state of emergency. Suspected Ebola patients escaped, and looters stole infected materials and mattresses from the center. President Ellen Johnson Sirleaf told Katie Couric the attack had motivated the quarantine because the attack “put the entire community at risk, therefore we had to protect them from themselves.”

But sources monitoring the security sector say the decision was less about the community’s safety and more a political attempt to show the government was in control of the situation. It had already blundered early in the outbreak by failing to prevent Patrick Sawyer, a consultant to the Ministry of Finance, from traveling to Lagos, despite the fact he was under observation having been in contact with a sister who died of Ebola. Sawyer, a naturalized U.S. citizen, died in Nigeria July 25 but not before infecting several people in Africa’s most populous country.

The government compounded that error with its lack of transparency. A day before the quarantine was imposed the Minister of Information Lewis Brown said the 17 patients who escaped were found and taken to an Ebola clinic at John F. Kennedy Medical Center, a claim that was denied by a doctor at the clinic. The Ministry of Health has since failed to provide concrete data on the number of suspected or confirmed cases in West Point despite requests.

Then, the first day of the quarantine came. As armed police wearing helmets and riot shields attempted to prevent West Point residents entering the rest of the city, the town commissioner Miatta Flowers attempted to escape with her family, to the fury of onlookers. Some began throwing rocks at police and others tried to escape across a makeshift checkpoint made of concertina looped between wooden benches.

Security forces opened fire and killed a 15-year-old boy named Shakie Kamara; another two young men were also wounded by gunfire. The teenager’s body was taken by Ministry of Defense officials, according to a news report, and buried without an autopsy. Only later that day did the police commissioner explain to residents food would be distributed and they would be inspected by teams from the Ministry of Health.

It was yet another major mis-step on behalf of the government. The quarantine had not been sanctioned by the international donor community, and Dr. Nestor Ndayimirije, the World Health Organization representative to Liberia, had warned quarantining would only work with the community’s consent, which was neither gained nor sought.

“The force was disproportionate, they were already using batons, sticks, they had access to teargas and equipment to things to control an unarmed crowd,” said Counsellor Tiawan Gongloe, Liberia’s most prominent human rights lawyer. “I find it difficult to believe that there was any justification for shooting a 15-year-old boy who was unarmed. This is not a militarized conflict, it is a disease situation and a biological problem.”

It’s not hard to see why the government felt it needed to act. The cramped quarters, lack of access to running water and poor sanitary conditions of slum communities like West Point put them at a high risk of becoming hot spots for new Ebola infections. But Gongloe says the government has not been clear about what powers it has under a state of emergency, and has not been consistent in how it has used them. “[The government] must have an even handed approach to strengthen public trust in the government in order to fight Ebola,” Gongloe told TIME.

That public trust has been further eroded by the large number of public officials who fled the country after Sawyer’s death. Johnson Sirleaf said on Aug. 11 that government officials who refused to return home from overseas would be declared AWOL, and the Executive Mansion announced last week it had fired all but a handful of those who had still not returned. But she neglected to name those who had been fired, and many are skeptical she will follow through.

The government exodus contributes to a sense among citizens that Liberia’s wealthy and powerful have left the country’s poor to fend for themselves. Many expatriates who work for non-governmental organizations and international companies have been evacuated and their lavish apartments with 24-hour electricity and running water are now empty.

Most Liberians didn’t have that choice. Francis, a 15-year-old homeless youth who sometimes sleeps in one of the roughest communities in West Point, had to grease a palm to escape before the quarantine was lifted. He says he made his way out of West Point by paying an army man 150 Liberian Dollars (about $1.77 in U.S. dollars). The back of Francis’ head aches with an infected wound he says was made by a policeman who hit him with a baton as he tried to break free on the first day of the quarantine. It will be a while before Francis returns to West Point.

TIME

In West Africa, Medical Workers Risk Becoming Victims in the Fight Against Ebola

Dr. Jefferson Sibley, the medical director of Phebe Hospital Carielle Doe

At Phebe Hospital in Liberia, only one of four wards is open after the deadly virus claimed the lives of five nurses

Less than a month ago, there were around two hundred doctors, nurses and hospital staff at Phebe Hospital in Liberia’s central Suakoko district. Today, that number has plummeted to less than twenty five, and all but one of the hospital’s four wards are closed. The waiting room is bare and there is only one patient, a one-year old admitted with malaria.

The sudden shift in the hospital’s fortunes can be explained with one word: Ebola, the deadly virus that claimed the lives of five of its nurses in July. As the virus spreads across West Africa, Phebe Hospital’s story spotlights the challenges faced by doctors and nurses on the frontline of the fight to contain the worst Ebola epidemic on record. Over 1,100 people across the region have died in the current outbreak, including over 400 in Liberia. In nearby Guinea, 380 people have died from Ebola, according to the World Health Organization.

The nurses at Phebe Hospital were infected after coming into contact with a patient from nearby Lofa County. The patient knew she was infected, according to Dr Jefferson Sibley, the medical director at the hospital, who said they later heard from a hospital in Lofa County that she was on the run after she presented symptoms for Ebola. She did not share the diagnosis with Phebe’s doctors and later died in the hospital. One of Phebe’s physicians, Dr Melvin Korkor, was also infected; he was treating the patient and a nurse who, unbeknownst to him, had also contracted the deadly virus.

Eventually, one of the nurses was tested for Ebola, and the infected doctor and five nurses were moved to isolation centers in the Liberian capital Monrovia. Korkor was the sole survivor from Phebe Hospital.

“Five of them and they all died, five of them died, we took them to Monrovia and they all died,” Sibley says.

Ebola’s arrival at Phebe Hospital triggered panic among the remaining staff members, who left work soon after their infected colleagues were taken away in ambulances. They refuse to return unless proper measures are taken to protect them. Though many have undergone basic infection training, Sibley demands that his staff be provided with hazmat suits—protective gear to guard against a virus that spreads via bodily fluids such as saliva and blood—before they return to the frontline. He also wants the government to set up an Ebola treatment center in the local county.

The government has admitted that it wasn’t prepared for the outbreak, with Liberia’s President Ellen Johnson Sirleaf saying on Aug. 9 that the authorities were lacking in “terms of the material, the training, the people, the expertise.” An effort is underway to remedy the situation, with Johnson Sirleaf sanctioning additional funds to fight the spread of the illness, closing the borders and quarantining communities. But for Sibley and his colleagues, the measures have come too late.

“It should have been done long since when Ebola started in Lofa,” he says. “This shouldn’t have happened,” he says, referring to his colleagues who lost their lives.

Sibley’s colleagues weren’t alone. Across Liberia, at least 39 health workers have died as a result of Ebola. Over 80 have been infected. During the first week of August, 15 health workers at a hospital near Monrovia were infected; they’re currently in isolation at a treatment center in the capital and some have died. At Monrovia’s main treatment center, almost half of the 52 patients are health workers.

Sibley spoke to TIME shortly after returning from self-imposed quarantine. Ebola has an incubation period of up to 21 days—the time Sibley spent in isolation before being tested for Ebola to ensure that he hadn’t contracted the virus when it arrived at his hospital. A negative result allowed him to return to his family. He says he’s relieved that he is no longer living on “the edge”. But he is still shaken by the loss of his colleagues.

When his nurses began to show symptoms of Ebola, Sibley put on a hazmat suit and placed them in isolation. He continued to treat them with fluids before they were taken to the treatment center in Monrovia. There, he spoke to them through a plastic window. “I assured them they would be alright, they were in good hands,” he says.

He likens the Ebola crisis to the Liberian civil war that ended in 2003 with more than 250,000 deaths. He began working at Phebe Hospital as a doctor in 2001, during the final throes of the war. Throughout the 14-year conflict the building was ransacked at least three or four times, and the staff had to be evacuated.

“Now you have the battlefront all over,” he says. “The good thing about the war was you heard the gun sounds, you could hear a group of people shooting somewhere coming [and] you could run and take cover, but Ebola is not like that, Ebola, you never know where it is coming from or who is bringing to you. It’s killing like the way the bullets were killing.”

Part of the problem in halting the spread of the virus is the lack of sufficient supplies of gloves and other protective equipment, along with lax regulations regarding hygiene and sanitation, according to a former senior nurse at the trauma unit of the John F. Kennedy Medical Center, the nations largest, in Monrovia. All of the beds in the two Ebola treatment centers in Monrovia and Foya, where Liberia’s outbreak began, are full, and the country’s major hospitals are closed due to high levels of infection amongst staff.

Meanwhile, as the outbreak continues to claim lives, bodies have been appearing on streets of Monrovia, and Liberia’s foreign minister, Augustine Kpehe Ngafuan, says the health system is “collapsing.”

At Phebe Hospital, only the obstetrics department is open and doctors are available to deal with emergencies such as caesarean sections. But Sibley says he will not accept any patients showing signs of Ebola until he has enough Hazmat suits and rubber gloves to protect his staff. They are not going back in the building until they are battle ready.

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