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Empty Ebola Clinics in Liberia Are Seen as Misstep in U.S. Relief Effort
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NEW YORK TIMES by NORIMITSU ONISHI April 12, 2015
MONROVIA, Liberia — As bodies littered the streets and the sick lay dying in front of overwhelmed clinics last year, President Obama ordered the largest American intervention ever in a global health crisis, hoping to stem the deadliest Ebola epidemic in history.
A drop in Ebola cases in Liberia lessened the need for treatment units such as this Defense Ministry center. Credit Daniel Berehulak for The New York Times
But after spending hundreds of millions of dollars and deploying nearly 3,000 troops to build Ebola treatment centers, the United States ended up creating facilities that have largely sat empty: Only 28 Ebola patients have been treated at the 11 treatment units built by the United States military, American officials now say.
Nine centers have never had a single Ebola patient.
“My task was to convince the international organizations, ‘You don’t need any more E.T.U.s,’ ” said Dr. Hans Rosling, a Swedish public health expert who advised Liberia’s health ministry, referring to Ebola treatment units.
....American officials point out that building treatment centers made sense given the epidemic’s trajectory when the decision was made.
Read complete story.
http://www.nytimes.com/2015/04/12/world/africa/idle-ebola-clinics-in-liberia-are-seen-as-misstep-in-us-relief-effort.html?_r=0
Comments
A Better Approach to Fight Ebola: Resilience Systems and MPHISE
As we have said many times before, community-based intervention through Resilience Systems and Medical and Public Health Information Sharing Environments (MPHISE) is the only way to get ahead of a fast moving epidemic and quickly stop the spread of disease.
An appropriately funded Resilience System / MPHISE would be able to track and document disease outbreaks in real-time through crowd-sourcing. The data obtained through this documentation process would be quickly categorized and analyzed in order to provide a common operating picture of the current status of the epidemic in any location, at any given time. Thus enabling our rapid response teams to deploy where / when necessary in order to assist communities with education and medical interventions as needed.
The education provided through an appropriately maintained Resilience System / MPHISE enables communities to not only stop the spread of disease, but it also enables communities to prepare for, and avoid any other obstacles that would have a negative effect on public health.
Please see the links below for additional supporting information.
. . . “there is strong evidence . . . that the biggest change came from the precautions taken by residents themselves” . .
http://resiliencesystem.org/ebola-ebbs-africa-focus-turns-death-life
A Community-Engaged Infection Prevention and Control Approach to Ebola
http://resiliencesystem.org/community-engaged-infection-prevention-and-control-approach-ebola
Kathy Gilbeaux
Director of Knowledge Management
Global Resilience System
http://resiliencesystem.org
Re: Community-Centered Responses to Ebola
Also see additional information below . . .
WHO - Liberia succeeds in fighting Ebola with local, sector response
http://resiliencesystem.org/liberia-succeeds-fighting-ebola-local-sector-response
RESEARCH - Community-Centered Responses to Ebola in Urban Liberia: The View from Below
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003706
Abstract
Background
The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.
Conclusions/Significance
Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
Under use of US units should not be shocking .
VOX by Julia Belluz April13, 2015
...So: the United States built 11 treatment units in Liberia, drawing from the $1.4 billion allotted for the Ebola mission. Eighty percent of those units have never seen a single Ebola patient.
This may seem shocking, but it actually shouldn't be.
The timelines of global health and short-term-ism of politics are usually not aligned. World leaders react to global health crises slowly (instead of taking a proactive approach), and they prioritize politically expedient (read: ineffective but sexy) fixes over real fixes.
If the world truly wanted to address Ebola and its root causes, the focus of the Ebola response should have been on things like training more health professionals, building up health systems and disease-surveillance networks in the country, and working with countries to prioritize health in their national budgets — all efforts that could take decades and wouldn't immediately produce results for bragging rights.
Many of the investments that would most help West Africa deal with diseases like Ebola wouldn't go to health care at all. They'd go to boosting education (the single biggest predictor of health) and literacy, and building infrastructure (so that people can get to hospitals and clinics when they need to).
Read complete article.
http://www.vox.com/2015/4/13/8402613/Ebola-US-response
A.I.D. officials and other letter writers take issue
NEW YORK TIMES LETTERS TO THE EDITOR April 20, 2015
Excerpts from letters criticing the NY Times article:
"While you focus on military-built Ebola clinics, the full American response was far more comprehensive and supported exactly the early community-based activities you credit with stopping the epidemic."
--JEREMY KONYNDYK, Director, Office of Foreign, Disaster Assistance, U.S.A.I.D.
"Your article did not discuss the alternatives the United States could have taken to deliver medical care months before the Ebola treatment centers actually arrived...."
GARY H. MAYBARDUK, retired Foreign Service officer, deputy chief of mission in Freetown, Sierra Leone, from 1988 to 1991.
" ...even a flawed response is better than no response at all. Such “global health diplomacy,” though imperfect, is nonetheless to be welcomed and supported, not least for the added rationale it generates for international development funding.
SEBASTIAN KEVANY, research associate at the Institute for Global Health Delivery and Diplomacy, University of California, San Francisco.
Read complete letters and response to an earlier Ebola article.
http://www.nytimes.com/2015/04/20/opinion/the-american-response-to-ebola.html?partner=rssnyt&emc=rss