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PostPosted: Tue Aug 19, 2014 6:21 pm 
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NY Times quotes MSF on Ebola "complete disaster" beyond report scope due to poor surveillance.

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PostPosted: Tue Aug 19, 2014 6:27 pm 
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Ebola Is ‘Disaster’ of Scale Still Unknown, Relief Official Says
By DONALD G. McNEIL Jr. and SHERI FINK
AUG. 19, 2014

The Ebola outbreak in West Africa is “a complete disaster,” and health agencies do not yet grasp its scope, the president of the relief group Doctors Without Borders said Tuesday.

“No one yet has the full measure of the magnitude of this crisis,” the president, Dr. Joanne Liu, said in an interview. “We don’t have good data collection. We don’t have enough surveillance.”

With two treatment centers in each of the three hardest-hit countries — Guinea, Liberia and Sierra Leone — her organization is treating more patients than any other entity.

Dr. Liu said agencies like the World Health Organization, the Centers for Disease Control and Prevention and other aid groups should become more involved in prevention and surveillance, including tracing the contacts of people who are sick.

“We need more people in the field,” she said.

The lethal virus has bred a larger medical crisis, Dr. Liu said. In Liberia’s capital, Monrovia, the health system collapsed as workers and patients fled hospitals out of fear of Ebola, allowing diseases like malaria, pneumonia and diarrhea to kill children who would otherwise have been saved.

Image
Graphic: What You Need to Know About the Ebola Outbreak

She said she learned from her staff about six pregnant women who lost babies because they could not find an open maternity ward.

Her colleagues at Doctors Without Borders — often called M.S.F. for its French name, Médecins Sans Frontières — are overwhelmed, she said. In one center, until recently, five people were caring for 100 patients. During crises, many doctors work for the group on rotations of up to six weeks, for which they get small stipends.

The supply of volunteers is drying up. Although the group now operates in a number of war zones — including Gaza, Iraq, Syria, and Ukraine — West Africa is the hardest to staff, Dr. Liu said.

“The reality is, it’s difficult to recruit for Ebola,” she said. “You have to learn to live with fear. Not everybody is equipped to do that.”

Hiring local people is equally hard, she said, because their families fear they will bring the virus home.

And the treatment of Ebola is exhausting. When Dr. Liu worked in Syria, she said, there were lulls after aircraft dropped barrel bombs and the wounded were treated in the emergency room. Ebola patients need constant care, and the numbers are still growing in Sierra Leone and Liberia.

The W.H.O. said Tuesday that there were “encouraging signs” in Nigeria and Guinea even though 113 new cases were reported in those countries and the two other affected nations. That brought the total number of cases to 2,240, with more than 1,200 deaths.

In Nigeria, the 12 people known to have been infected by a Liberian-American who died on July 25 do not seem to have passed it on. In Guinea, the situation is “less alarming” than in Liberia or Sierra Leone because more people are cooperating with the health authorities.

No matter how many patients her organization treats, Dr. Liu said, the outbreak will not end until other agencies can halt the progression of new infections.

Asked how much money she estimated it would take to win, she said: “I don’t know. We’re making history. We’re facing something we’ve never faced before.”

http://www.nytimes.com/2014/08/20/world ... =auto&_r=0

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PostPosted: Tue Aug 19, 2014 6:46 pm 
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August 19, 2014 6:59 pm
MSF criticises global response to Ebola crisis
By William Wallis in London
Image
Medicins Sans Frontieres medical staff members wearing protective clothing work at the MSF facility in Kailahun, on August 14 2014. Kailahun along with Kenama district is at the epicentre of the world's worst Ebola outbreak. The World Health Organisation (WHO) revealed that the latest death toll from the Ebola virus in Guinea, Sierra Leone, Liberia and Nigeria had claimed more than 1000 lives. Health Organisations are looking into the possible use of experimental drugs to combat the latest outbreak in West Africa©AFP

The continuing spread of the Ebola virus in Liberia and Sierra Leone is threatening to undermine efforts by other west African states to contain the worst-ever outbreak of the fatal disease, which has now officially claimed at least 1,229 victims.

Yet the international response to appeals by the stricken countries for more help remains “non-existent”, according to Médecins Sans Frontières, the main aid agency battling to contain the epidemic in Guinea, Liberia and Sierra Leone.

MSF, which has a long history of involvement with Ebola outbreaks elsewhere on the continent, said it was struggling to set up enough isolation wards to cope with the number of infected patients in the near total absence of other international assistance and in the face of a total breakdown in Liberia’s public health service.

The crisis is also having a calamitous knock-on effect for the wider economy in Liberia, which like Sierra Leone is still in the early stages of a recovery from civil war in the 1990s.

In Liberia’s Lofa county, the epicentre of the outbreak, there are 125 patients infected with the disease occupying an MSF isolation ward designed to hold no more than 60. In the capital, MSF is intending to scale up a 125-bed facility – already the largest it has ever created for an Ebola outbreak – to hold as many as 700 patients.

“We have never faced a crisis of this scale and type, with this virulence and mortality,” said Brice de le Vingne, who is co-ordinating MSF’s response across the region.

“We are completely amazed by the lack of willingness and professionalism and co-ordination to tackle this epidemic. We have been screaming for months. Now the situation is even worse – we are today on the verge of seeing an entire country collapsing.”

The fear among health workers is that if the disease is not brought under control in Liberia – and to a lesser extent Sierra Leone – it will continue to infect other west African countries and reinfect those such as Guinea that have been more successful in containing the virus.

West Africa Ebola map
Lofa county recorded 124 new cases last week and 60 deaths. The World Health Organisation and Liberian officials have warned that, because healthcare workers have little access to more remote jungle areas, the actual toll may be far higher.

Guinea, the first country in the region to be affected by the deadly virus, said it would reopen an Ebola clinic in its remote southeast as sick people living in Liberia and Sierra Leone spill over the borders in search of better treatment.

Ebola kills more than half of those who catch it and causes fever, vomiting, haemorrhaging and organ failure. But transmission of the disease is slow by comparison with other killers such as cholera and in previous outbreaks in countries such as the Democratic Republic of Congo and Uganda, its spread has remained relatively contained.

In Liberia, the government was slow to respond to the initial outbreak, only stepping up public information campaigns on preventive measures once it had gained a grip on the capital.

At the weekend in Monrovia, Liberia’s capital, slum dwellers attacked and looted a clinic in their neighbourhood, apparently fearing it was bringing the disease to them. The incident led to the disappearance of 17 infected patients and the dispersal of potentially contagious bedding and other materials across a densely populated part of the capital.

The situation in Liberia is catastrophic and I am not using that word lightly
- Brice de le Vingne, MSF

Nigeria, which has had a total of 13 confirmed Ebola cases since the Liberian-American health consultant Patrick Sawyer travelled into the country with the disease last month, has been far more successful at containing it. Five of the 13 victims have made a full recovery and dozens more primary and secondary contacts at risk of infection have been released from quarantine.

Guinea, where the disease is thought to have originated in a remote jungle area bordering Liberia and Sierra Leone at the end of last year, has also recorded a marked decline in the number of fresh cases.

According to MSF, the main UN and other international agencies with the capacity to assist have been reluctant to deploy qualified teams on the ground in Sierra Leone and Liberia – both weak states whose healthcare workers have been among the main casualties.

“The situation in Liberia is catastrophic and I am not using that word lightly,” Mr de le Vingne said. “In Monrovia, a city of 1.3m people, there are no hospitals open whatsoever so you have an emergency inside the emergency – people have nowhere to get medical care. If you have a car crash there is nowhere to go.”

http://www.ft.com/cms/s/0/0bb32b28-27bd ... z3AsfUcP21

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PostPosted: Tue Aug 19, 2014 6:59 pm 
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World leaders 'failing to help' over Ebola outbreak in Africa
Médecins Sans Frontières chief claims response to catastrophe is 'almost zero', with nations most concerned with self protection

The Guardian, Tuesday 19 August 2014 15.36 EDT

Health inspectors demonstrate an Ebola isolation stretcher
Image
Moving an Ebola sufferer in an isolation stretcher is demonstrated at a quarantine bureau in Shenzhen, China. Photograph: China Stringer Network/Reuters

The international community has made "almost zero" response to the Ebola outbreak in west Africa, with western leaders more interested in protecting their own countries than helping contain the crisis that has now claimed more than 1,200 lives, a senior international aid worker said on Tuesday.

Brice de la Vigne, the operations director of Médecins Sans Frontières (MSF), said politicians in industrialised countries urgently needed to take action, or risk the outbreak spreading much further. "Globally, the response of the international community is almost zero," he told the Guardian. "Leaders in the west are talking about their own safety and doing things like closing airlines – and not helping anyone else."

His comments came as the World Health Organisation announced that the death toll in the world's worst Ebola outbreak has now exceeded 1,200. The haemorrhagic disease, which kills up to 90% of those infected, is ravaging Liberia, Sierra Leone and Guinea, and also has a toehold in Nigeria, Africa's biggest economy.

De la Vigne, who has just returned from a tour of Guinea, Sierra Leone and Liberia, said the scale of the outbreak was comparable to a catastrophe such as the 2010 Haitian earthquake, which killed 300,000 people.

"The solution is not that complicated but we need to have political will to do so. Time is running against us. But you need very senior people with high profiles, the kind of people who can co-ordinate a response to a million people affected by an earthquake," he said.

His words were echoed by Dr Gabriel Fitzpatrick, who is working at the MSF field hospital in Kailahun, the epicentre of the crisis in Sierra Leone.

"If this Ebola outbreak happened in a western community, in London, you'd get a few cases and that would be it," he said. "The main objective here is not to dramatically increase the person's chance of survival, it's to contain the spread"

At least 810 cases of Ebola have been reported in Sierra Leone, and 348 people have died from the virus in the country, according to World Health Organisation figures. Since June Fitzpatrick has been working in the MSF field hospital, processing patients through three stages with a "suspect tent", a "probably tent" and a "confirmed tent". Once in the final tent, their chances of coming out alive are slim.

He described one family of nine wiped out after a grandmother contracted the disease on August 4. Death is swift – usually within four or five days.

Fear, rumours and conspiracy theories have conspired with poverty and high illiteracy to allow the disease to flourish in two countries whose infrastructure is already weak. "Both Sierra Leone and Liberia were at war 10 years ago and all the infrastructure was destroyed. It's the worst place on earth to have these epidemics," De la Vigne said.

Sierra Leone and Liberia have already declared a state of emergency, but health provision is reaching breaking point.

Sinead Walsh, who is working on the Sierra Leonean presidential Ebola task force, said the crisis was already causing deeper problems. She said more than 1 million people are in quarantine in Kailahun and neighbouring Kenema alone, businesses are closing, farmers are unable to trade and fears are rising about food shortages.

The disease is having a knock-on effect, with sick people afraid to go to hospital for fear of catching Ebola. Health workers fear deaths from malaria and in childbirth could now also escalate.

"We are gone beyond the stage of a health crisis. This is a humanitarian emergency now." said Walsh, Ireland's ambassador to the country and head of Irish Aid in Freetown. "We need to start working on the secondary crisis."

Fitzpatrick said the priority was to contain the disease, using local volunteers to find suspected cases and bring patients to hospitals where they can be isolated: "The second thing is to trace those who we know have been in contact and keep them under observation. We are not doing any contact tracing at the moment," he said. "It's not rocket science to do on a large scale across west Africa. But it needs an organisational structure and good leadership." David Heymann, professor of infections disease epidemiology at the London school of hygiene and tropical medicine, who headed the global response to SARS while working for WHO said that oubtreak took three months to contain.

He also said containing ebola was "not rocket science" identifying "contact tracing" and public communications as the key factors.

One of the differences with SARS is the outbreak happened in industrialised countries where systems for "infection control" were in place, he said.

http://www.theguardian.com/society/2014 ... frontieres

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PostPosted: Tue Aug 19, 2014 7:20 pm 
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AUDIO

Doctors Without Borders: What We Need To Contain Ebola
by NPR STAFF
August 19, 2014 5:22 PM ET
Listen to the Story
All Things Considered 5 min 20 sec

Image
Dr. Joanne Liu (left), international president of Doctors Without Borders poses with a member of the MSF medical team at the organization's Ebola treatment center in Kailahun, Sierra Leone.


P.K. Lee/Courtesy of Doctors Without Border
With the continuous uptick in the number of cases and deaths in the current Ebola outbreak, the few agencies that are on ground are stretched thin.

That includes Doctors Without Borders, also known as MSF. It's one of the main health care providers in West Africa, where there are more than 2,000 cases of Ebola and 1,200 deaths. Even with roughly 1,000 volunteers spread among the three Ebola-stricken countries, the agency says that still isn't enough.

In an interview on All Things Considered, MSF's international president, Dr. Joanne Liu, tells NPR's Audie Cornish that they opened a new Ebola care center in Monrovia, Liberia, this weekend. It was equipped with 120 beds, and "all the beds got filled in one day."

"We're thinking about expanding, "she says. "But the reality is, we don't have a definitive picture of how many cases there are in the city right now."

Liu says that caring for patients is only one of the three "pillars" for controlling the Ebola outbreak. The other two are tracing possible Ebola cases and educating the community.

"Right now the only thing we're facing is fear," she says. "Fear is normal when you don't understand what is going on."

To eliminate that fear, the agency not only needs more funding but also more volunteers to talk to the community. "We need people who are going to go and ... talk to the elders, talk to the religious leaders and tell them about Ebola," she says. "[To] mobilize the population and make them understand what is going on."

She adds that MSF is also looking for volunteers to find out how many cases are in each village. "Right now we don't have a full picture of the magnitude of the epidemic," she says.

Enlisting help from the international community hasn't been easy. "NGOs that I used to see in some other crises, like after the Haiti earthquake or even in [Central African Republic] or South Sudan, are not present right now in Western Africa."

That's why Liu's on a tour, speaking to U.N. leaders and NGOs about how they can help. "There is some reluctance, I guess," she says. "Everybody has to overcome their own fear before coming to the field."
Image
A man sits on a bed that will be part a new Ebola treatment center in Monrovia, run by Doctors Without Borders.
Goats and Soda
Hit Hard By Ebola, Liberia Now Has A Third Treatment Center

She says that MSF has been "ringing the alarm" since the beginning of the epidemic, but it's been slow wake-up call for the other NGOs. That's likely because past Ebola oubreaks were contained in a matter of weeks.

"But what is happening now is that we have cases in a highly dense, populated area like Monorovia, with 1.3 million," she says. Without the involvement of other organizations, she says, "we will not be able to contain the Ebola epidemic."

And it's not only Ebola victims who suffer. With hospitals and care centers crowded, it's also been difficult for people seeking other types of care like for malaria or for maternity issues — what Liu calls an "emergency within the emergency."

"We were faced with the really hard reality of welcoming six women who were pregnant and who lost their children because they were walking around the city trying to find a place to deliver their babies," she recalls. "By the time they got to our centers, the babies were not alive anymore."

http://www.npr.org/blogs/goatsandsoda/2 ... a-outbreak

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