As Ebola gained ground, CDC report on healthcare resources in Liberia’s remote counties highlights vulnerabilities

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Nearly five months after Ebola came to Liberia, three doctors served four counties on Eastern border, hospital hand-washing relied on water jugs, training, surveillance, means to safely bury the dead remained nonexistent

cdcfourcountiesNestled between Guinea and Sierra Leone, the Liberian county of Lofa was, along with the coastal county of Montserrado, an epicenter of the Ebola outbreak when patients were reported in the country in late March, with cases recorded, and the challenges to the fragile healthcare infrastructure there noted.

But nearly five months later, the impact of the outbreak, and the readiness of four remote counties on Liberia’s South-Eastern edge bordering Côte d’Ivoire remained unknown when staffers from the U.S. Centers for Disease Control and Prevention went there in early August. Working with government health officials they took stock. A brief report of their findings, released by the CDC today paints a portrait of complete helplessness to confront, much less control an outbreak of the disease with resources diminished, rather than fortified by responses to the growing epidemic.

Six doctors had served the four counties of Grand Gedeh, Grand Kru, River Gee and Maryland before Ebola had come to Liberia. But after the outbreak, three had left the country. In two of the counties four hospitals, nurses had stopped coming to work. In one, they worked without pay. Supplies of surgical gloves, soap, bleach, alcohol were running out or gone altogether. In operating rooms, water jugs supplied the hand-washing facilities. With little or no internet, communication was by phone, radio, or travel. Training for the outbreak, surveillance of suspected patients, and ways to safely bury the dead didn’t exist.

It was only after basic training in the wake of the discovery of all of those deficiencies that a patient who had died was identified as a possible Ebola patient. The identification of patients 1 and 2 followed, as well as the discovery that patient 2 had probably caught the virus from patient 1. In the time since, preparedness for Ebola cases has improved in the region the report says, but “obstacles to preventing spread of Ebola remain,” it notes. That includes lack of equipment, staff, transport and diagnostic capacities, all of which the report concludes,  are “urgently needed.”

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