TIME Infectious Disease

Ebola’s Untold Tragedy: Foreign Families Are Fleeing

The exodus of industry and families from West Africa could have severe implications

Health care is dire in Ebola-affected countries in West Africa. But one of the lesser recognized tragedies is the fact that international families—families of diplomats, missionaries or business people—have fled the country either by choice or at strong recommendation from their homeland. If they don’t return, some fear that their exodus could cripple the countries’ growing economies.

“The health situation in terms of direct risk of infection [for the average person] is really not that bad, but its effects are immense,” says Jeff Trudeau, the director of The American International School of Monrovia (AISM), which has lost well over half of its expected students for the start of the 2014 school year, and has delayed its start date to October. Right now, he’s only 50% confident they will open then.

In Liberia, the government closed public schools. Private schools are subject to fewer regulations and some remain open. However, even if AISM wanted to open on time, it simply no longer has students to fill its chairs. AISM and similar international schools in West Africa cater to kids who come from countries with specific educational standards, typically children of missionary families, diplomats, and international businesses. Last year, 16 embassies were represented at the international school in Liberia.

Closed schools are a serious problem for children’s education, but closures in countries like Liberia and Sierra Leone have implications even beyond lost learning opportunities. Trudeau says the country of Liberia, where he lives, has greatly improved in terms of economy and industry in the last few years. Two years ago, AISM only had 70 students, but as the school season neared this August, AISM was expecting to welcome 150. Trudeau says his school has also lost 20% of its teachers.

“Liberia entered a period of prosperity, and we grew last year,” says Trudeau. It’s reflective of how things improved security-wise and economically. Parents felt comfortable bringing their kids to Liberia.”

Trudeau says that if the school can’t open in October, and doesn’t open until, say, January, they will probably have fewer than 50 students. The other students will, by that time, likely have enrolled in other schools in their home countries or elsewhere.

Similar U.S. Embassy-funded schools in Sierra Leone and Guinea are also struggling. The American international school in Sierra Leone remains closed, and though the school in Guinea is open, it has only 50 students—a 50% reduction in their expected class.

In the wake of the outbreak, kids are left without parents and people are dying of otherwise preventable diseases due to lack of medical attention, Doctors Without Borders has written in TIME. So far, Ebola has infected 2,615, killing 1,427. But the aftermath won’t simply be a clean-up, but also a catch-up—to gain back the momentum they made in the last few years.

“There are three things a country needs to be successful: security, health care, and education,” says Trudeau. “Education is our direct responsibility. If we can attract top-quality people to return to Liberia, we can help them rebuild and restore. Unfortunately, without health care, you can see how quickly this is lost. No matter how well you’ve done in security and education, without health care, it doesn’t work.”

TIME Infectious Disease

Liberia: Doctor Given Experimental Ebola Drug Dies

WEST AFRICA EBOLA
Graphic provides an update on the spread of the Ebola outbreak in West Africa AP

The experimental drug known as ZMapp has been tried in only six people

(MONROVIA, Liberia) — A Liberian doctor who received one of the last known doses of an experimental Ebola drug has died, officials said Monday. Separately, Canada said it has yet to send out an untested vaccine that the government is donating.

Ebola has left more than 1,400 people dead across West Africa, underscoring the urgency for developing potential ways to stop and treat the disease. However, health experts warn these drugs and vaccines have not undergone the rigorous testing that usually takes place before they are used.

The experimental vaccines are at still at a Canadian laboratory, said Patrick Gaebel, spokesman for the Public Health Agency of Canada, who declined to speculate how many weeks it could be before those are given to volunteers.

“We are now working with the (World Health Organization) to address complex regulatory, logistical and ethical issues so that the vaccine can be safely and ethically deployed as rapidly as possible,” Gaebel said.

Earlier this month, Canada said it would donate 800 to 1,000 doses of an Ebola vaccine that it developed. Likely candidates include health care workers treating Ebola patients.

The experimental drug known as ZMapp has been tried in only six people. Health experts caution that since ZMapp was never tested in humans, it is unclear whether it works. The small supply is now said to be exhausted and it is expected to be months before more can be produced.

Dr. Abraham Borbor, the deputy chief medical doctor at Liberia’s largest hospital, had received ZMapp, along with two other Liberians. He “was showing signs of improvement but yesterday he took a turn for the worse,” and died Sunday, Information Minister Lewis Brown told The Associated Press.

There was no update provided Monday on the other two Liberians who received the drug.

Earlier, it had been given to two Americans aid workers and a Spanish missionary priest, who died after he left Liberia. After receiving rigorous medical care in the U.S., the Americans survived the virus that has killed about half of its victims.

Ebola can cause a grisly death with bleeding from the eyes, mouth and ears. The virus can only be transmitted through direct contact with the bodily fluids of the sick or from touching victims’ bodies, leaving doctors and other health care workers most vulnerable to contracting it.

International relief efforts have included shipments of gloves, gowns, face masks and other protective equipment, although it’s not clear how many have reached health workers struggling to contain the epidemic in West Africa, where even such basics as sterile fluids can be in short supply.

But just getting enough gear isn’t the whole story: Health workers can infect themselves while taking off contaminated equipment if they don’t do it properly, a trio of infectious disease experts wrote Monday in Annals of Internal Medicine.

“The physical exhaustion and emotional fatigue that come with caring for patients infected with Ebolamay further increase the chance of an inadvertent exposure to bodily fluids on the outside of the” personal protective equipment, wrote Dr. William A. Fisher II of the University of North Carolina, Chapel Hill, along with Drs. Trish Perl and Noreen Hynes of Johns Hopkins University.

“In addition, the impulse to wipe away sweat in the ever-present hot, humid environment” after taking off some gear, and before washing up, could be enough, they added.

Meanwhile, the family of 29-year-old William Pooley, the first British citizen confirmed to be infected withEbola, said he is receiving excellent care at an isolation ward in London’s Royal Free Hospital after being evacuated from the capital of Sierra Leone.

“We could not ask for him to be in a better place,” they said in a statement.

Pooley, a volunteer nurse, was flown back to Britain from Sierra Leone where he was working at an Ebolatreatment center.

The WHO is also in the process of trying to evacuate a Senegalese doctor who contracted Ebola while working in Sierra Leone, said WHO Assistant Director General, Dr. Keiji Fukada on Monday.

The U.N. on Monday also spoke out against the limitations placed on flights into and out of the affected countries, saying they are slowing aid organizations’ work in sending personnel and equipment and contributing to the countries’ “economic and diplomatic isolation.”

“We shouldn’t do anything that stokes fear and stigmatization,” Stephane Dujarric, spokesman for the U.N. secretary-general, told reporters.

On Monday, Japan also said it is ready to provide a newly developed anti-influenza drug as a possible treatment Ebola. The drug, with the brand name Avigan, was developed by Fujifilm subsidiary Toyama Chemical Co. to treat new and re-emerging influenza viruses, and has not been proven to be effective against Ebola.

Gillies reported from Toronto. Associated Press writers Lauran Neergaard in Washington, Cara Anna at the United Nations, Mari Yamaguchi in Tokyo, and Clarence Roy-Macaulay in Freetown, Sierra Leone contributed to this report

TIME ebola

Nigeria Confirms 2 New Ebola Cases

Nigeria Ebola
Nigerian health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria on Aug. 4, 2014. Sunday Alamba/AP

The two are the first infected people who didn’t have contact with the ill traveler

Nigeria’s health ministry confirmed Friday two new cases of Ebola in the country, the first people to come down with the disease who didn’t have direct contact with an infected traveler who brought the virus into the country from nearby Liberia.

Nigerian Health Minister Onyebuchi Chukwu said both newly infected people are the spouses of two caregivers who contracted the virus and later died after giving treatment to Patrick Sawyer, the Liberian-American man who flew into the country infected with the virus last month.

Sawyer passed Ebola on to 11 other individuals before he died. The two new infections plus Sawyer bring the total number of Ebola patients in Nigeria during this outbreak to 14, five of whom have died while another five have recovered.

[AP]

TIME Infectious Disease

Liberia’s West Point Slum Reels From the Nightmare of Ebola

Residents of the West Point slum receive food aid during the second day of the government's Ebola quarantine on their neighborhood on August 21, 2014 in Monrovia, Liberia. John Moore—Getty

Food prices skyrocket overnight after the Monrovia slum is quarantined

A few weeks ago, West Point was merely the worst slum in war-racked Liberia. Today, it is both that and the most notorious urban center of the world’s worst Ebola outbreak.

It is also quarantined from the rest of the Liberian capital Monrovia, and its dank alleyways subject to a nightly curfew. Barricades and barbed wire have gone up, and troops posted. Ships started patrolling the waterfront on Wednesday to further restrict the movement of the 70,000 or so residents. Food prices have skyrocketed. On Thursday, hundreds of people lined up for government handouts of rice and water.

“At the moment West Point is stuck at a standstill and is in an anarchy situation,” Moses Browne of aid group Plan International told the Associated Press.

Over 1,400 people have died in the five-month Ebola outbreak, and Liberia is the country that has been worst hit. Almost a thousand people have been confirmed infected, and more than half of them have already died. Rural Lofa County is worst hit part of the country, but when it was found that Ebola had made its way into West Point, authorities became alarmed.

“There’s a higher risk of contagion for any infectious disease in an environment that is so crowded and that lacks running water and proper sanitation,” Kamalini Lokuge, a research fellow at Australian National University’s College of Medicine, Biology and Environment tells TIME.

With only four toilets, that environment would be West Point.

Adds Lokuge: “Ebola is nowhere as contagious as the flu, but you need to spread knowledge about how it is transmitted in order to control it.”

Over the past week, this has proven to be one of the gravest problems in West Point. On Saturday, a health center was looted and Ebola patients sent running, after a rumor spread that infected people were being brought in from other parts of the country. Others refused to believe the disease existed. “There is no Ebola,” some protesters attacking the clinic shouted.

“There is a high level of disbelief in the government in West Point,” Sanj Srikanthan, the International Rescue Committee’s emergency response director in Liberia, tells TIME. “The government has made a concerted effort to reach out to community leaders, youth groups and churches with the message that the only way to contain the disease is to understand it. But some people still believe Ebola is a conspiracy, and those people we need to reach.”

But even in West Point itself, conveying the gravity of the disease is a challenge. “There’s a degree of anger, people are feeling they are being neglected for others,” Srikanthan says. “This makes it harder to convince people of the seriousness of Ebola.”

Clashes erupted between West Point residents and police when the barricades were first raised and the 9 pm to 6 am curfew imposed, and the area is still tense.

On Thursday, senior United Nations officials arrived in Africa to oversee the Ebola response, including Secretary General Ban Ki-Moon’s pointman David Nabarro. Srikanthan, like other aid workers, believe the presence of dignitaries is of utmost importance .

“This is a forgotten corner of the world facing an unprecedented situation,” he said. “This is still a containable outbreak, but local resources are simply overwhelmed. It would be great to see some recognizable faces taking control over certain aspects of the response.”

He also believes that the situation is not entirely hopeless.

“The situation may be catastrophic, but it is one that can be turned around,” he says. “I think the risks have been overhyped, and that even humanitarians are, to an extent, affected by the fears reported by media. Being in Monrovia, you’re not necessarily going to get Ebola, it’s not airborne.”

TIME Infectious Disease

1,400 Are Dead From Ebola and We Need Help, Says Doctors Without Borders President

Workers prepare the new Doctors Without Borders (MSF), Ebola treatment center on Aug. 17, 2014 near Monrovia, Liberia. Tents at the center were provided by UNICEF.
Workers prepare the new Doctors Without Borders, Ebola treatment center on Aug. 17, 2014 near Monrovia, Liberia. Tents at the center were provided by UNICEF. John Moore—Getty Images

The epidemic won't be contained without more treatment centers, coordinated action, logistical assets and health workers 

Entire families are being wiped out. Health workers are dying by the dozens. The Ebola outbreak raging in Guinea, Liberia and Sierra Leone has already killed more people than any other in history, and it continues to spread unabated.

And the death toll is being exacerbated by an emergency unfolding within an emergency.

People are also dying from easily preventable and treatable diseases like malaria and diarrhea because fear of contamination has closed medical facilities, leading to the effective collapse of health systems. While I was in Liberia last week, six pregnant women lost their babies over the course of a single day for lack of a hospital to admit them and manage their complications.

Over the past two weeks, there have been some welcome signs but not enough action: the World Health Organization (WHO) declared the outbreak a “Public Health Emergency of International Concern” and announced additional funds to fight the disease; the World Bank announced a $200 million emergency fund; and the UN Secretary General appointed a special envoy for Ebola.

But 1,350 lives have already been lost. To prevent more deaths, these funding and political initiatives must be translated into immediate, effective action on the ground.

We need medical and emergency relief workers to trace those who may be infected, to educate people about protection measures and to work in treatment centers. Many more people are needed in the field, right now.

Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams have treated more than 900 patients in Guinea, Sierra Leone and Liberia. We have 1,086 staff operating in these countries and we have just opened a 120-bed treatment center in Liberia’s capital, Monrovia, making it by far the largest Ebola center in history. But it is already overwhelmed with patients and we simply do not have additional response capacity. Others must enter the breach.

In Kailahun, Sierra Leone, 2,000 people who came into contact with Ebola patients must be urgently followed up. But we have only been able to trace about 200 of them.

Health promotion campaigns and body collections are stalled for lack of vehicles or fuel. Epidemiologists are unable to work because of a lack of logistical support. And pervasive fears among communities that had never encountered Ebola have provoked riots against health workers.

The epidemic will not be contained without a massive deployment on the ground. WHO in particular must step up to the challenge. And governments with the necessary medical and logistical resources must go beyond funding pledges and immediately dispatch infectious disease experts and disaster relief assets to the region.

Additional resources are needed to properly map the epidemic, implement efficient general hygiene measures in all medical and public places, run safe treatment centers, trace suspected cases, train health workers, set up functioning alert and referral systems and, crucially, spread accurate information about how people can protect themselves from infection.

Equally important is fighting fear. Quarantines and curfews will only breed more of it. People need to have access to information, otherwise distrust of health workers will only increase and provoke further violence. Communities and governments need to work together to control the epidemic and care for the sick.

Some measure of humanity must also be restored in the fight against Ebola.

As doctors, we have been forced to provide little more than palliative care because of the sheer number of infected people and lack of an available cure. The extreme measures needed to protect health workers, including wearing stifling protective suits, also means we cannot remain bedside with patients to ease their suffering, or allow family members to do so. In their final hours, many people are dying alone.

While we try to find creative solutions to enable families to communicate with their sick relatives, they should at minimum be supported to participate safely in the burials of loved ones. This would also help rebuild trust between communities and those trying to contain the epidemic.

At the same time, additional support is needed to prevent health systems in Liberia and Sierra Leone from further collapse. After years of civil war, these countries already struggle to meet the basic health needs of their people, let alone cope with a public health emergency of this magnitude. Sierra Leone and Liberia, for instance, have just 0.2 and 0.1 doctors per 10,000 people, respectively (a rate 240 times less than in the United States).

Last week, all of Monrovia’s hospitals were at one point closed. There is no surgical care available in the entire country right now. Pregnant women cannot receive emergency C-sections. Health facilities must be re-opened or established to treat common illnesses. We will otherwise face a second wave of this health catastrophe.

Slowing and then halting this outbreak requires much more than money and statements. The only way to contain the epidemic is to increase the response capacity in affected areas, not by closing borders and suspending air travel.

Meaningful and coordinated action is needed on the ground today if we don’t want to be reduced to counting the dead for many weeks to come, whether from Ebola or other far less sinister diseases.

Dr. Joanne Liu is the international president of Doctors Without Borders/Médecins Sans Frontières (MSF).

TIME Infectious Disease

4 Injured in Violent Clashes as Liberians Storm Ebola Barricades

Liberia Battles Spreading Ebola Epidemic
A Liberian Army soldier, part of the Ebola Task Force, pushes back local residents while enforcing a quarantine on the West Point slum on August 20, 2014 in Monrovia, Liberia. John Moore—Getty Images

The clashes mark a deepening sense of mistrust at official responses to contain the Ebola outbreak

At least four people were injured in clashes with Liberian soldiers and police after the government laid barbed wire barricades around a densely populated slum in an attempt to contain the spread of Ebola.

Young men surged towards the barricades and hurled stones at troops, who responded by firing live rounds of ammunition, the New York Times reports. Agence France-Presse reports that at least four people were injured in the skirmish.

The unrest highlights a deepening sense of mistrust among residents of West Point, a district that government officials designated as a quarantine zone on Wednesday morning. Tensions flared in the area earlier in the week as the opening of an Ebola treatment clinic in a local school fueled fears that health officials were bringing in infected patients from other parts of the city. The clinic was ransacked on Saturday, enabling several quarantined patients to escape.

The death toll from suspected and confirmed cases of Ebola across west Africa climbed to 1,350 people, the World Health Organization said on Wednesday.

[NYT]

TIME Liberia

Liberia President Declares Ebola Curfew

Liberia says escaped Ebola patients returned to quarantine
Liberian nurses retrieve a looted generator stolen from the M V Massaquoi Elementary school that was used as an Ebola isolation unit in West Point, Monrovia, Liberia, Aug. 19, 2014. Ahmed Jallanzo—EPA

(MONROVIA, Liberia) — Liberia’s president has declared a curfew and is imposing a quarantine of a major slum in the capital Monrovia as the death toll mounts from Ebola.

President Ellen Johnson Sirleaf announced late Tuesday that movements now would be restricted between 9 p.m. and 6 a.m.

The country is already under a state of emergency, and the latest action also will block all movement in and out of West Point, home to at least 50,000 people.

Over the weekend, residents angered over the placement of an Ebola center in West Point looted the facility and 37 patients left who were supposed to be under surveillance. Health officials said that all of those later returned.

At least 466 people have died from Ebola in Liberia, and panic already has led to social unrest.

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