COVER STORY

The Ebola Web

Columbians race to stop an epidemic.

by Paul Hond Published Winter 2014-15
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“The effects of the outbreak are going to be much larger than just the human toll of the medical crisis itself,” he says. He points out that the Sustainable Development Institute, shut down by the crisis, was one of the few groups scrutinizing the practices of foreign investors in Liberia. “There are still logging companies moving logs out of the country, mining companies moving resources out, plantation companies expanding into land that might be customarily owned by local communities,” he says. And, of course, small businesses have suffered, health services have evaporated, and basic social structures like the church and the family have been ravaged.

“It’s not just how many people die from Ebola,” Mukpo says. “It’s how the crisis reverberates throughout the whole country. I believe in the strength and resilience of Liberians, but it’s very unpredictable how this is all going to pan out in the next couple of years.”


GUINEA - Anne Liu arrives in Guinea in mid-November to a welcome development: the United Nations Mission for Ebola Emergency Response (UNMEER) has collected thousands more mobile phones from donors. Liu has all the phones she needs: her long-range goal of building a comprehensive national information portal for Ebola response is becoming tangible. Liu and her team begin training the people who will train the contact tracers in the mobile-phone software. The November visit sees the first seventy-seven new contact tracers trained in Conakry, and some five hundred contacts entered into the database — people who have been exposed to Ebola patients, and whose health can now be tracked in real time.

Adeyinka Akinsulure-SmithThough news reports say that the spread of Ebola in Guinea has stabilized, November turns out to be a bad month: five hundred new cases, the highest monthly total yet in a country of twelve million — about the size of Ohio. By late December, a year from when little Emile Ouamouno got a fever in Gueckedou, the virus has killed more than 1,600 Guineans.

Still, Liu, back in Guinea for a third time in December, does not see a country turned upside down. In Conakry, kids play soccer in the streets. The markets are busy. People are “living as normally as they can,” Liu says. On the work side, there is a greater UN presence because of UNMEER; and interagency coordination, though not devoid of tensions, is stronger than it was in October. By late December, 130 contact tracers and twenty-seven supervisors have been trained and deployed; Liu anticipates another 650 contact tracers to be trained by January. The number of contacts being monitored has grown to nearly 1,300.

On December 24, WHO reports that more than three hundred new cases have been confirmed in the last three weeks, with “intense transmission” in Conakry.

To catch up with and beat Ebola will take valuable time. Liu’s wireless dragnet has been cast, and the race will go to the swift.

 

SIERRA LEONE - Across the border, the situation is far worse. By year’s end, the number of cases in Sierra Leone has climbed past nine thousand. Nearly three thousand people are dead (the true toll is thought to be much higher, due to unreported deaths). Hot zones have flared up in the western area of Freetown and in the eastern district of Kono, where eighty-seven bodies have been discovered, many of them piled up in a cordoned-off corridor of a hospital.

It is during this upsurge that ICAP sends a five-member team, led by Susan Strasser, back to Freetown. The British government has asked ICAP to evaluate the community care centers that have been going up. The original plan was to train laypersons to run the centers. But as the British military deployed these workers, it became clear that the severe conditions called for professionals. And so health workers from other African countries — Zimbabwe, Kenya, Ethiopia, Uganda — have been recruited to supplement the local workforce.

Out in the field, Strasser is encouraged by what she sees. The centers are up and running, and some have more beds than patients — “a good indicator that services are available and meeting the needs,” Strasser says. Still, in some places, “patients are dying in their homes, which is a separate issue of people not wanting to go to any health service.” At the units Strasser visits, she sees a caring treatment environment, where patients can be brought outside to see their family members. There is a growing perception, she says, that going to such a place is not necessarily a death sentence.

Strasser is heartened, too, by the sight of much more international activity than she’d seen in October. She tempers her optimism with caution: “The follow-on quality, support, supervision, and oversight of these units are things that need to be focused on,” she says. “You always have tension between quantity and quality.”

In a country with little more than a hundred doctors, outside help is vital. The foreign workers, says Strasser, “are doing an amazing job.” But they, too, will need help. On December 18, Sierra Leone took another hit: the country’s most senior doctor, Victor Willoughby, sixty-seven, succumbed to Ebola, five days after testing positive. He is the eleventh doctor to die.

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