ebolaproject ajrl392 fall 2014

7/23/2019 EbolaProject AJRL392 FALL 2014

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(DANIEL BEREHULAK/THE NEW YORK TIMES)

Eric Gweah, 25, grieves as he watches members of a Red Cross burial team carry the body his father, Ofori Gweah, 62, a suspected Ebola victim, in a area called Rock Spring Valley incentral Monrovia, Liberia, Sept. 18, 2014. Ofori Gweah had endured Ebolas telltale symptoms for six days, his family took him to treatment centers twice, only to be turned back.

EBOLA SPECIAL REPORT ASSOCIATED PRESS

MISSION UNACCOMPLISHED:

CONTAININGEBOLA

IN AFRICA

(AP PHOTO/CENTERS FOR DISEASE CONTROL, FILE)

This undated file image made available by the Centers for Disease Control (CDC) shows

strands of the Ebola virus.

The Ebola outbreak in WestAfrica has quickly becomea proliferating epidemic since itwas first reported in March 2014,now killing over 5,000 people.Ebola acts as a tyrant leaving kidsorphaned and parents heartbroken.


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EBOLA SPECIAL REPORT: MISSION UNACCOMPLISHED

Ebola in West Africa is very deadly and the World Health Organizationhas declared an international health emergency.

(AP PHOTO/JEROME DELAY)

n this photo taken Thursday Oct. 2, 2014, Promise Cooper, 16, gets her hands cleaned with a chlorine solution by Kanyean Molton Farley, a community activist who visits Promise andher two brothers, Emmanuel Junior, 11, and Benson, 15, on a daily basis at their St. Paul Br idge home in Monrovia, Liberia. The Cooper children are now orphans, having lost theirmother, Princess, in July, and their father Emmanuel in August.

L

ooking back, themistakes are easy tosee: Waiting too long,

spending too little, rely-ing on the wrong people, thinkingsmall when they needed to think

big. Many people, governmentsand agencies share the blame forfailing to contain Ebola when itemerged in West Africa.

Now they share the herculeantask of trying to end an epidemicthat has sickened more than 9,000,killed more than 4,500, seeded

cases inEurope and the UnitedStates, and is not even close to

being controlled.Many of the missteps are

detailed in a draft of an internalWorld Health Organization reportobtained by The Associated Press.

It shows there was not one pivotalblunder that gave Ebola the upperhand, but a series of them thatmounted.

Nearly every agency andgovernment stumbled. Heavycriticism falls on the World HealthOrganization, where there wasa failure to see that conditionsfor explosive spread were presentright at the start .

WHO the United Nationshealth agency had some in-competent staff, let bureaucratic

bungles delay people and moneyto fight the virus, and was ham-

pered by budget cuts and the needto battle other diseases flaring

around the world, the report says.In a statement, WHO saidthe draft document has not beenchecked for accuracy and that the

agency would not comment untilit was f inished. WHOs chief, Dr.Margaret Chan, did not respond to

AP requests for comment, but toldBloomberg news service that shewas not fully informed as thedisaster evolved. We responded,

but our response may not havematched the scale of the outbreakand the complexity of the out-

break, she said.Outside experts say the point

now is not to grab necks or findfault, but to learn from mistakes.

By the time we recognizedthis was serious, the genie wasalready out of the bottle, saidMichael Osterholm, a Universityof Minnesota public health expert.Nobody is to blame becauseeverybody is to blame.

Ebola had caused two dozen

smaller outbreaks elsewhere inAfrica before it appeared in thewestern part of the continentearlier this year, so people werecaught off guard by its rapidspread, said Dr. Irwin Redlener,director of the National Center forDisaster Preparedness at Co-lumbia University. We thoughtwe would do what we usually doand that this would come undercontrol, but that didnt turn out to

be the case.

Early blundersThe first mistake came Jan.

11 at a hospital in Gueckedou,Guinea, where the grandmotherof the first two children known tohave died in this outbreak sought

care. It was a rare opportunity most people just seek help fromtraditional healers. But insteadof detecting and stopping thedisease, the hospital compoundedthe problem: Two new chainsof transmission began, among

patients and health workers, andin another village.

On Jan. 27, local health officialsand Doctors Without Bordersmissed a chance to diagnose Ebolaafter seeing bacteria in bloodsamples they concluded cholera

might be the culprit. Ebola wasntconfirmed until March 21. By theend of the month, it had spread to

Liberia.In April, Doctors Without

Borderswarned that the outbreak was

out of control, but a WHO spokes-man insisted it wasnt. In May, thefuneral of a traditional healer in

Sierra Leone spread the virustohundreds of people.

It was a turning point. It refu-eled the epidemic in Guinea andit was the start of major epidem-ics in Liberia and Sierra Leone,

said Dr. Peter Piot, co-discovererof the Ebola virus and director ofLondon School of Hygiene andTropical Medicine.

Little went smoothly. WHOsGuinea office was accused of nothelping a team of experts get v isasto that countr y. Some $500,000 inaid was held up by red tape.

In early July, Piot called for astate of emergency to be declaredand for military operations to bedeployed, he said.

It didnt happen.

uContinued on next page


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EBOLA SPECIAL REPORT: MISSION UNACCOMPLISHED

Many Ebola victims are dying at home due to a severe shortage oftreatment centers allowing for contamination to be at an all time high.


Gordon Kamara, an ambulance nurse, checks on a body in the middle of the street as residents of Monrovia, Liberia, gather around, Sept. 15, 2014. Only about 15 ambulance teams areavailable to aid Monrovia, a city of nearly 1.5 million people, where hundreds of new Ebola cases are reported each week.

How countries fell shortIn Guinea, the ministry of

health at first would give WHOinformation only on lab-con-firmed Ebola cases, hamperingthe investigation. Messages to the

public about the lethal nature ofthe disease discouraged people

from seeking treatment. Whenmasked teams arrived to disinfecthot zones, people thought theywere spraying toxic chemicals andattacked them.

Early international aid wasmishandled. Guinean PresidentAlpha Conde set up a panel withthe ministers of health, com-munications and social affairs tofight the disease, but the ministerof health couldnt formulate aneffective strategy and little moneywas dispersed. Finally, a newcommittee of independent expertswas appointed and funds beganto f low.

In Liberia, early government

messages stressed that Ebola hadno cure, so sick people saw littlereason to go to a hospital, and thedisease spread even more. In Au-gust, the government quarantineda Monrovia slum, sparking clasheswith security forces that killed ateen. Ultimately, health officialsrealized they couldnt track orlimit Ebola spreading in the slum.Many bodies were dumped intonearby rivers.

In Sierra Leone, the govern-ment sent politicians to warn

people about Ebola rather thanrelying more on charitable groupsand medical professionals, saidJoseph Smith, a community activ-ist in the capital city of Freetown.

Some feared it was a governmentconspiracy to use Ebola to wipeout opposition supporters aheadof a national census planned forDecember.

They believed that the wholesituation was a kind of lie, Smithsaid.

In Spain, where a nurse got

Ebola after taking care of a patientwho died of it, debate raged overwhether protective gear protocolswere being followed. Health work-ers protested about a lack of train-ing; the government overhauledit and adopted new equipmentstandards.

Ebola comes to the U.S.On Sept. 20, Ebola made a

5,700-mile trip to the UnitedStates, when a Liberian man,Thomas Eric Duncan, flew toDallas. His infection was con-firmed on Sept. 30. Two nurseswho cared for him before he diednow have the disease.

The Centers for DiseaseControl and Prevention has beenharshly criticized by many whosay it offered shifting advice on

protective gear to hospitals andfailed to assess correctly what riskDuncans infection posed and towhom.

In fact, the CDC had beenamong the earliest responderswhen Ebola surfaced in Africa,sending five people to Guineain late March and two more toLiberia in April. In late May, thesituation seemed in hand andWHO advised CDC that its staffcould leave.

But cases surged in June andfive CDC workers returned toGuinea. In July, more went toLiberia and Sierra Leone, and to

Nigeria after an Ebola death oc-curred there. By late August, 100CDC staffers were tracing con-tacts, educating health workers,communicating with the public

and training officials on how stopsick passengers from getting onplanes.

Gregg Mitman, a Universityof Wisconsin medical historianwho was in Liberia in June, said

the response by CDC and otherswas slow, but noted that WHO andCDC had tight budgets. After the2008 financial crisis, WHO lostmore than 1,000 staff and was leftwith only two Ebola experts.

Were always quick to blame... and ask why wasnt the CDC ontop of this earlier, he said. But

were not looking at the longerpicture of how have we supportedpublic health infrastructure.

Redlener, at Columbia Univer-sity, agreed.

It shouldnt just be WHO thatwe blame, he said. Nobody else,no other countries, were reallyrushing in to help.

There are contributions fromAP reporters Maria Cheng inLondon; Mike Stobbe in Atlanta;Jonathan Paye-Layleh in Mon-

rovia, Liberia; Boubacar Dialloin Conakry, Guinea; ChristopherTorchia in Johannesburg, South

Africa, and Jorge Sainz and AlanClendenning in Madrid.

FLORIAN PLAUCHEURFLORIAN PLAUCHEUR/AFP/GETTY IMAGESVolunteers in protective suit stick to village customs and burry the body of a person who died from Ebola in

Waterloo, some 30 kilometers southeast of Freetown, on October 7, 2014.

qContinued from preceding page


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EBOLA SPECIAL REPORT: CAREGIVERS

BY SHERI FINK

New York Times News Service

SUAKOKO, Libe-ria The firsttime Dr. StevenHatch suited up in

protective gear atan Ebola treatment

center, he was confronted withthe weight of his decision to vol-unteer here. A patient, sweatingand heavily soiled, had collapsedin a corridor. Literally everysurface of his body was covered

in billions of particles of Ebola,he recalled.

The physician introducinghim to the routine, Dr. PranavShetty, said they needed to getthe man back to bed, so they

picked him up. Shetty focusedon calming the patient, whowould not live through the night.He diluted a Valium tablet inwater, and cut some intravenoustubing into a crude st raw for himto sip.

It was a beautiful momentbecause I was like, hes a doctor,he was taking care of his pa-tients, said Hatch, an Americanvolunteer. Thats what we do

here.

In his first two weeks inLiberia at a new clinic run by thecharity International MedicalCorps, Hatch has learned theways of the Ebola ward.

Much of West Africa is fol-lowing a no-hands rule to avoidcontagion from the deadly virus,

but doctors and nurses here,protected by layers of plastic andrubber armor, routinely touchthe sick. Without a drug thatcan cure the disease, they offer

patients fluids and medicationsto treat symptoms, but also thesimplest of comforts, like feed-ing them or cleaning them up.They follow their instincts Hatch turned out to be right thatan elderly man suffered from achronic illness, not Ebola, as alab test mix-up showed buttry to restrain their impulses,

because old habits might not besafe.

Hatchs journey to this remotecenter in a t ropical forest beganlast month at a training courserun by the Centers for DiseaseControl and Prevention at aformer Army base in Anniston,Alabama. An infectious diseasespecialist in Worcester, Massa-

DAUNTLESS DOCTOR

BATTLES TO SAVE MANY


Dr. Hatch is assisted by a colleague while dressing into protective clothing before a shi ft at a clinic run bythe International Medical Corps in Suakoko, Liberia, Oct. 12, 2014. An infectious disease specialist fromWorcester, Mass., Hatch spent weeks training at a former Army base in Anniston, Ala. before heading to West

Africa, where he quickly had to adjust to the rituals and realities of the Ebola ward.


Dr. Hatch carries Blessing Gea, 9, from the suspected ward to the confirmed high-risk ward after a blood test showed her positive for Ebola, at a clinic run by the International MedicalCorps near Gbarnga, Liberia, Oct. 10, 2014. Three days later, after the close attention of medical staffers here, Blessing had recovered.


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chusetts, Hatch, 45, joined abouttwo dozen other medical work-ers heading to West Africa.

Outside a battered warehouseat the base, with peeling wallsand rising temperatures thatserved as a mock Ebola treat-ment unit, mannequins weresprawled on the ground. Hatchand Bridget Anne Mulrooney,an American nurse who wasvolunteering with the same non-

profit organization, spent nearly20 minutes putting on gear: twoto three pai rs of gloves, aprons,head coverings, goggles, masksand chemical protection suitsthat were hot and crinkled whenthey walked. Hatch had troubletying a knot with the doublegloves. I was never good atsurgery, he confessed.

As Mulrooney, Hatch and twoothers lifted the first mannequinonto a stretcher, an instructorwatched. She warned Hatch thatthe edge of his mask had comeout from under his goggles,leaving part of his face exposed.

We put him down and wego straight out, Hatch told theteam, his voice muffled by themask. Second time in two daysIve breached here. Is it becauseIm 6-foot-2?

Last year, in the Liberian cap-ital, Monrovia, Hatch had helpedteach medical residents withone of the countrys top physi-cians, Dr. Abraham Borbor. We

laughed for two weeks, Hatchsaid. I just loved him.

Borbor died from Ebola inAugust, which spurred Hatchto join the effort his friendhad begun. He signed on for a

four-week rotation with Inter-national Medical Corps, a LosAngeles-based relief group that

was starting its first Ebola treat-ment unit, with funding from theU.S. Agency for InternationalDevelopment.

Mulrooney, 36, was alreadyon the char itys emergency ros-ter. She had volunteered in othercrises and had worked four yearsin Haiti. After the Ebola epi-demic erupted, she put off a planto move in with her boyfriendnear London. I feel like I havesomething to offer, she said.

Mulrooneys first days atthe treatment center were a gut

punch. This morning I carrieda baby to the tent morgue, shewrote in a Facebook message.The infant had appeared to bedoing well. It was a shock anda testament to how rapidly situa-tions can change.

She cared for a 13-year-oldgirl whose intravenous sitewould not stop bleeding. Icleaned her up, and put her in a

pair of still-tagged jeans, Mul-rooney wrote. She half smiledand took some medicines I askedher to. I wont forget her smile.

Nor her soft moans as her bodywas fading away. The nurseadded, Im sorry for beinggraphic.

Hatch came about a weeklater. He noticed Mulrooney hadlost weight. Shes a different

Bridget, he observed.At high noon the day after his

arrival, he was struggling physi-cally due to the circumstances.Inside his protective equipment,after only 30 minutes on the

ward, his mask was wet. It feelsconstantly like being pusheddown, like suffocating, he said.His goggles were steaming up.He was sweating so much thetemperatures often reached more

than 90 degrees outside and evenmore inside the ward that hefelt like he was swimming insidehis suit.

He gave some water topatients and cleaned them over

the course of nearly two hours.Longer than I should have beenin, he said after his gear wassprayed down in bleach solutionand then carefully removed. Hewas breathing hard.

EBOLA SPECIAL REPORT: CAREGIVERS

Dr. Steven Hatch is the primary doctor that has risked his life topersonally help the sick and downtrotten suffering in West Africa.


Dr. Hatch draws blood from a patient suspected of having Ebola at a clinic run by the International MedicalCorps in Suakoko, Liberia on Oct. 7, 2014. Hatch spent weeks training in order to have the proper precautionsand procedures before caring for his new paitents.


Dr. Steven Hatch cools down in the rain after disrobing from protective clothing following a shift at a clinic run by the International Medical Corps in Suakoko, Liberia, Oct. 5, 2014. Aninfectious disease specialist from Worcester, Mass., Hatch spent weeks training at a former Army base in Anniston, Ala. before heading to West Africa.


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EBOLA SPECIAL REPORT: THE SURVIVORS

FIGHTING

OFF THEVIRUS

(PHOTO BY JOHN MOORE/GETTY IMAGES)

PAYNESVILLE, LIBERIA - Ebola survivor Sontay Massaley, 37, high-fives with Doctors Without Borders (MSF) staf f after being released from the MSF treatment center on October 12,2014 in Paynesville, Liberia. She said she was there for eight days, after having first arri ved sick and tested positive for the disease. Massaley has three children, all healthy, and works asa vendor an an outdoor market. She did not know from whom she contracted Ebola.

PHOTOGRAPHY BY JOHN MOORE

GETTY IMAGES

This epic plague has a 70percent mortality rate, ac-cording to the World HealthOrganization, but leaves the

survivors immune to the sick-ening strain. These are theportraits of those who sur-vived the disease at the Ebolatreatment center in Paynes-ville, Liberia. Their lives areforever changed by the loss offamily members and others

that are close to them.


MONROVIA, LIBERIA - Nancy Paye, 20, stands outside the JFK Ebola treatment center after recovering fromthe disease and being released from the center on October 13, 2014. Paye, who works selling dry goods in an

outdoor market, said she thought she contracted the disease from a friend, who died in her care.


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EBOLA SPECIAL REPORT: THE SURVIVORS


PAYNESVILLE, LIBERIA - OCTOBER 16: Ebola survivor BenethaColeman, 24, standing after a survivors meeting. Her husband and twochildren died due to the disease. The disease has 70% mor tality rate.


Jeremra Cooper, 16, wipes his face from the heat while in the low- risk section of the MSF, Ebola treatmentcenter on October 16, 2014 in Paynesville, Liberia. The student said he lost six family members to the virusbefore being sent to the MSF center, where he recovered after one month.


Mohammed Bah, 39, lost his wife, mother, father and sister to Ebola. According to him, the stigma of having

had Ebola as been difficult. Im rejected and alone with my two children, he said.


James Mulbah, 2, stands with his mother, Tamah Mulbah, 28, who also recovered from Ebola in the low-risk section of the Ebola treatment center after the survivors meeting.


PAYNESVILLE, LIBERIA: 12th grade high school student, EmanuelJolo, lost six family members but survived the disease himself.

ebolaproject ajrl392 fall 2014

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