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MSF Ebola Briefing, dec 2014 : The outbreak is far from over in Liberia

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  • MSF Ebola Briefing, dec 2014 : The outbreak is far from over in Liberia

    LIBERIA

    Progress being made, adapted response still required

    In terms of the number of cases, Liberia has been the worst hit by this outbreak, and Monrovia and the
    capital region the most gravely affected area of the country. Case numbers have begun to drop in
    Monrovia, and the four case management centres (CMCs) in the capital currently have spare bed
    capacity. However, elsewhere in the country, such as in Bong, Margibi, Gbarpolu, Grand Cape Mount
    and River Cess counties, new cases are appearing. The outbreak is far from over, as a single case can
    start a localised epidemic.


    Case management facilities with large bed capacities are now being built by foreign governments and
    NGOs. Beds for Ebola patients are currently concentrated in the capital, and 16 more CMCs are to be
    built across the country. However, the staffing of these planned case management facilities will fall
    largely to “implementing partners”, such as local healthcare workers and NGOs. A number of actors
    are providing training to these implementing partners; but it will take some weeks before these
    individuals are trained up and ready to safely care for patients.

    Striving to deliver on what was promised two months ago, many international actors seem unable to
    adapt to the rapidly-changing situation in Liberia.
    The result of this is that resources are being
    allocated to activities that are no longer appropriate to the situation. For example, the Chinese
    government has just built another 100-bed CMC in Monrovia – where there were already 580
    operational bedsin four existing CMCs – while there are only 178 operational beds in CMCs in the
    rest of the country. Two more CMCs are planned to open in the same neighbourhood.

    Though seemingly sufficient in Monrovia for the moment, isolation and supportive medical care for
    patients are still urgently needed in rural parts of the country. In some cases, such as in River Cess
    county, patients must travel for up to 12 hours by road in order to reach a functioning laboratory and a
    CMC. Getting care to patients in rural, hard-to-reach areas poses major challenges in terms of logistics
    and transport.

    In many places, personnel at regular healthcare facilities have not received training on infection
    control and how to manage Ebola patients,
    should one walk through the door; nor have they received
    medical equipment required to protect themselves. Healthcare facilities are fast becoming sites of
    Ebola transmission and many have closed as a result: in Monrovia, for example, most healthcare
    facilities have shut their doors. To allow them to safely reopen, triage points must be set up in these
    structures, and activities to restore trust in healthcare facilities must be carried out.

    There are still active chains of transmission in almost every part of the country, demonstrating the
    need for further awareness-raising and community engagement. MSF teams are still finding that
    misconceptions about Ebola are widespread and stigma is intense, leading some to avoid seeking
    treatment or report cases. On a recent exploratory mission to Bong county, for example, MSF found
    that people who had been in contact with the sick were fleeing into the bush so as not to be traced as a
    contact or taken to a case management facility, fearful of what may happen.

    Other activities that require urgent support – especially in remote, rural parts of the country – are
    laboratory services(with transport if necessary for quick turnaround),safe burials, alert and
    surveillance systems, ambulance services and contact tracing. Though Ministry of Health (MOH)
    teams have been dispatched to all countiesto carry out these activities, they sometimes lack the basic
    equipment necessary to do it and are not paid for their work. On an exploratory mission to Margibi
    county two weeks ago, MSF found that contact tracing and active case finding teams lacked essentials
    like vehicles and SIM cards for their mobile phones. Support from foreign actorsis starting to appear
    in some affected rural counties; but there are others where this is not the case.

    MSF has seen that a comprehensive response to Ebola that includes all of the necessary elements can
    help to reduce transmission. In Foya, Lofa county, where the full complement of Ebola response
    activities has been carried out and the local community has been very engaged, there has not been a
    single confirmed case for more than four weeks. In this fluid and rapidly-changing outbreak, all actors
    involved in the response to it must take a flexible approach and allocate resources to activities when
    and where they are most needed.

    MSF
    “Addressing chronic disease is an issue of human rights – that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~
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