The rain beat down relentlessly this week – and although many people stayed home – the Ebola virus remains relentless too. Already over taxed to meet the essential care needs of Liberia, ambulances and health care facilities buckle under the increased burden of the Ebola virus.
Currently there are only four government owned ambulances that cover the entire county of Montserrado (poplulations 1.1 million in 2008) and an additional four that are privately owned – two by Representative Saah Joseph of District 15 and the other two by the Islamic community.
Reports that ambulances are not responding to calls to collect the infected - both living and dead – abound. Fear and frustration at the situation were causing some to set up road blocks in the capital in an attempt to force the government to remove their sick and their dead.
But the number of calls that the dispatch team receive exceed the capacity of the Red Cross and the Ebola Treatment Units (ETUs) to respond.
Reports that private ambulances are not following protocol exist, including the fact that they are not screening their patients for Ebola before carrying them to holding centers or treatment units – and leaving them at facilities which are already full to capacity. In addition, allegedly, the private ambulances are not collecting data for contact tracing, and keep no record of the people they take to the holding centers. Private ambulances are charging up to US$50 per trip to remove the dead from in the communities.
People are turning to taxis to transport themselves and their loved ones to a care facility. Back on the roads after delivering their fare, these taxis have become a source of contamination.
Hospitals, ETU’s and Holding Centers
Like ambulances, the ETU, hospitals and holding centers receive more sick people than they can take in. Monrovia’s largest, ELWA and JFK, currently have no space.
Redemption Hospital Holding Center is regarded as the “worse place to be taken” because as the name suggests, it is not a treatment facility but rather a place where they keep the sick until spaces open up in the ETUs or until they die.
Most clinics are not accepting new patients at all, and many screen patients before they even enter the grounds. Those registering a higher than normal temperature are turned away. In addition, most of these facilities will only accept patients that they’ve treated before – all others are referred to area hospitals, which are already full to capacity.
This week another foreign doctor had been infected with Ebola at the ELWA ETU. The unit was shut down for a few days and did not accept new patients. ELWA is carrying out an investigation to determine how the doctor became infected.
The National Call Center
The National Call Center is the central data collection unit for the Ebola response. Calls provide vital statistics for the Government of Liberia’s (GoL) in terms of contact tracing, virus location, as well as providing the data which the government distributes to the public. The Call Center answers questions and also screen the calls to ensure that the sick person exhibits three or more symptoms of the Ebola virus before forwarding the call to the Ministry of Health (MOH) dispatch, who will send the appropriate response team.
The Call Center consists of 30 volunteers and three shifts – volunteers receive a stipend and a half bag of rice. The MOH Dispatch Team consists of nine people and two shifts of 12 hours each. National Call Center volunteers are in need of individual laptops and headphones to assist them in their duties and protect them from possible Ebola exposure from shared telephone units. Transportation for the volunteers is also one of the major challenges that the call center faces – those who work the late shift require transport to get home.
Civil Society Organizations
Member organizations of the Civil Society Organization (CSO) Task Force were working in counties across Liberia. These local organizations are predominantly carrying out Ebola awareness and distribution activities.
There is currently no coordination between CSOs and Community Based Organizations (CBOs) and the Government of Liberia. While CSOs are mentioned in the National Ebola Response Plan, their role is not clearly defined. Currently the national response has not been decentralized and the resources at the county and community level remain limited.