Full statement, as delivered on November 13, 2014

By: Ellen Johnson Sirleaf, President of the Republic of Liberia

My fellow Liberians:

Since March of this year, our nation has been stricken by an unprecedented outbreak of the deadly Ebola Virus Disease. This outbreak overwhelmed and disrupted the rebuilding of our health system. It also undermined our normal economic, social, cultural and political activities. Many of our fellow citizens became infected and died. Many more died of treatable illnesses as hospitals were shut down and beds were insufficient to treat the infected.

 

 

"Liberia cannot be declared Ebola free until our neighbors are also Ebola free. This means that we cannot let down our guard nor can we afford to reduce our vigilance."

The nation was shaken by this strange and dangerous enemy. Amid the clamor and criticism, we remained calm and undeterred. We acted decisively, closing borders, imposing curfew, ordering quarantines, closing schools, and restricting public gatherings.

As the outbreak progressed, posing a clear and present danger to the State, our neighbors and the rest of the world, we were compelled to declare a State of Emergency and obtained the concurrence of the Legislature in keeping with the Constitution. We took on the fight. We appealed to the world. We appealed to our citizens. Our citizens listened and the world responded.

Today we can all be proud of the progress.

Thus, having consulted relevant stakeholders, the National Health Team and partners, I have informed the leadership of the National Legislature that I will not seek an extension to the State of Emergency. This is not because the fight against Ebola is over.

It is because in our estimation, and that of those with whom we have consulted, the progress we have witnessed, coupled with the various measures and ongoing interventions – all of which can be continuously adopted and sustained under the relevant provisions of the public health law – have combined to re-position our efforts to sustain the fight against the virus until it is finally eradicated from our country.

 President Johnson Sirleaf says she will not be asking the National Legislature to extend the State of Emergency.

President Johnson Sirleaf says she will not be asking the National Legislature to extend the State of Emergency.

Today, we can all be proud of the progress we have made, which would have been impossible without the resilient response to our call by all of our citizens, especially our health care workers. In those dark hours, they stood and fought back. From the active identification of cases to improved contact tracing; from the proper management of the outbreak through an Incident Management System to the social mobilization of communities; from the global mobilization of resources, to the strategic support of partners, we continue to fight back and remain thankful to all for the responses we have received.

Notwithstanding these gains, a number of our compatriots are still lying in ETUs, hot-spots are springing up in rural areas, and many of our compatriots are still dying of Ebola. We also know that Liberia cannot be declared Ebola free until our neighbors are also Ebola free. This means that we cannot let down our guard nor can we afford to reduce our vigilance.

This is why, in keeping with the public health law, and determined to enable the maintenance of the required vigilance, community mobilization and awareness, as well as sustain the gains; until we can start the progressive count down of 21 days, until the national goal of zero-new-cases by Christmas is achieved all across the country, we will keep many of the previous measures in place with appropriate adjustments, consistent with the progress in our fight.

Therefore, I am pleased to announce that the curfew is extended to midnight, except those in proximity to hotspots, weekly and border markets are open and school authorities upon immediate passage of the budget will organize young people in communities to start the renovation and clean-up of school facilities in preparation for the opening at a time that will be decided by the progress that we make in this fight.

Finally, my fellow citizens, I am confident that we can win this fight against Ebola. I believe that the resilience and commitment of the people remain strong and resolute in this fight. I believe that our partners will continue to be with us as we move to rebuild our health care delivery system. I believe that the world has shown that they do care.

I believe in the future of our country and the very strong will of our people.

May God bless us all and preserve our great nation.

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AuthorLiberia Philanthropy Secretariat

 

For the week of October 21st- 26th, the data released in the Government of Liberia’s (GoL) Ministry of Health and Social Welfare (MOHSW) report assessed the Ebola death rate and cases reported at ETUs concluding that the decline in cases during the past few weeks suggests that transmission rates have stabilized.  However, a few more weeks of analysis are needed to confirm that rates are tapering off, since not all patients with Ebola visit ETUs.

The decline in numbers reported by the Ministry of Health reflects data that has been collected by other international organizations.  According to Medscape, the number of ETU admissions in Liberia declined during the week of October 26th by 67% from their high in September. This is also reflected in the laboratory data coming in.  This week about 51% of laboratory tests came back positive for Ebola in comparison to about 79% that we were seeing in August.[i]

Previously, we discussed how there are external variables that could affect these changes in numbers, but the continued decline suggests a more permanent progression towards the 42 day marker.  The graph below shows the rates of ETU admissions for Lofa county, Liberia over the last five months.

In Montesserrado County the contact tracers were able to conduct follow-ups with 99.1% of their listed contacts and 226 of these completed their 21 day observation periods.  Additionally there were burial teams established in Careysburg, Todee, and Bensonville. 

During the week in Grand Cape Mount County the Ebola Task Force provided food for children that are quarantined in Bo-Water Side. The CDC in conjunction with the Ministry of Health’s Social mobilization team conducted awareness training in Jenewonde.  While MTI provided rain gear, folders and ledgers for health facility staff members, it was reported that ETU’s and hospitals were out of survival kits and Personal Protection Equipment (PPEs).

In Nimba County, there were two new admissions to the Ganta ETU but neither of the cases is yet to be confirmed with lab results.  Meanwhile, 8 of the quarantined health workers at the Saclepea health center completed their 21 days of follow-up without becoming symptomatic.

The clinics in Bomi County are about to run out of chlorine and PPEs.  Four bodies were buried but only one of these came from the health clinic.

In response to reports last week that Grand Kru County did not have a functioning ambulance the Global Communities have provided a new ambulance for Ebola response.

Lofa County received 17 new pickup trucks to support burials across the districts.

While bringing donations to River Cess county personnel of Global Communities and the County Health and Social Welfare Team (CHSWT) were attacked in Boegeezay Town.  The Global Communities team still completed their training of two new burial teams and donated five vehicles to assist their activities.

http://www.medscape.com/viewarticle/835081#vp_2

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1114a1.htm?s_cid=mm63e1114a1_w

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AuthorLiberia Philanthropy Secretariat

President Ellen Johnson Sirleaf spent two days this October visiting community leaders and health care workers in Lofa County assessing the Ebola situation in the country.  During her meetings with health care workers she encouraged them to maintain their commitment to their jobs and expressed gratitude for all the work they were doing.  She made stops at several health clinics and hospitals during her tour where she donated Personnel Protective Equipment (PPEs) and food items to health care workers in order to show appreciation for their services. 

As part of the President’s visit through Lofa county data was collected about survivors and children that were affected.  In total they received a list of 109 survivors, the youngest of which was a baby girl not yet 6 months old and the oldest being 100.  The median age of survivors in Lofa was 29.

The logs of affected children are sorted by household, which helps to show the transmission patterns within families.  There is no data on how many children out of each household became infected with Ebola, but you can see that under a single household as many as 6 children are listed as infected.  As of October there were 436 children listed as having been infected in Lofa County. 

These families have had a terrible burden on them the last 8 months as the people in Lofa have struggled to contain the spread of Ebola while taking care of their ill loved ones.  The President’s visit to Lofa helped to bolster moral and encourage people to continue their collaboration with organizations in fighting Ebola while bringing hope that this struggle is almost over.

From the information the President received during her visit, to the numbers we are seeing in the chart to the left from WHO.  There is rising hope that the worst is behind us.

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AuthorLiberia Philanthropy Secretariat

For the week of October 16th- 20th, the data released in the Government of Liberia’s’ (GoL) Ministry of Health and Social Welfare (MOHSW) report included information on people who are still refusing quarantines and the ongoing trainings in communities.

There continue to be reports of people across the different counties refusing to be quarantined.  We aren’t receiving all of the reasons for this, but some people are reporting that their refusal is based on facilities lacking beds and proper equipment.   Refusals to be quarantined can result in greater exposure to the disease within the community, but the source of their refusal is very important.   Response teams should be focusing on these groups to understand their reasons for refusing in order to better address specific concerns and needs within communities. 

A contact tracing team in Nimba County has been working with five police officers who are refusing to be quarantined although they have al been identified as having contact with an Ebola patient.  One area of concern is a patient who is exhibiting signs of Ebola although they had previously been discharged from the GBarnga ETU after testing negative for Ebola.  Meanwhile, the Ganta ETU discharged six patients who have recovered from the illness and only one death was reported at the clinic this week.

Currently a UNICEF team is conducting a rapid assessment in the county on nutrition, education, child protection and social mobilization in order to determine what the community needs are moving forward.  We will be looking to this assessment along with others to help gauge where local and global partners can be focusing their efforts.

There is an increased focus in Grand Cape Mount County on contact tracing and community search as UNFPA continues the training of 83 individuals.  Previously 22 contacts had lost touch with tracing teams and 21 of them have now received follow-up and are refusing quarantine due to the lack of mattresses in Bo-waterside.

During the week Montserrado counties contact tracers were following 4003 individuals.  By the end of the week 557 people had completed their 21 days of follow-up.  By the end of the week contact tracers were tracking 4337 individuals, over 300 more than at the beginning of the week.  Currently none of these contacts have become symptomatic.   This week there were 59 reported deaths in the county.

In Sinoe County they received buckets and chlorine from the County Task Force.  This coincided well with the conclusion of the meeting between UNMIL, Medical Teams International (MTI) and local community leaders including the District Superintendent on Ebola training and response.

In Grand Kru County the Global Community completed a health education training program for district staff and community members.  However, they have reported that they currently do not have a functioning ambulance in the county. 

 

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AuthorLiberia Philanthropy Secretariat

Dear World

In just over six months, Ebola has managed to bring my country to a standstill. We have lost over 2,000 Liberians. Some are children struck down in the prime of their youth. Some were fathers, mothers, brothers or best friends. Many were brave health workers that risked their lives to save others, or simply offer victims comfort in their final moments.

There is no coincidence Ebola has taken hold in three fragile states – Liberia, Sierra Leone and Guinea - all battling to overcome the effects of interconnected wars. In Liberia, our civil war ended only eleven years ago. It destroyed our public infrastructure, crushed our economy and led to an exodus of educated professionals. A country that had some 3,000 qualified doctors at the start of the war was dependent by its end on barely three dozen. In the last few years, Liberia was bouncing back. We realized there was a long way to go, but the future was looking bright.

Now Ebola threatens to erase that hard work. Our economy was set to be larger and stronger this year, offering more jobs to Liberians and raising living standards. Ebola is not just a health crisis – across West Africa, a generation of young people risk being lost to an economic catastrophe as harvests are missed, markets are shut and borders are closed.

The virus has been able to spread so rapidly because of the insufficient strength of the emergency, medical and military services that remain under-resourced and without the preparedness to confront such a challenge. This would have been the case whether the confrontation was with Ebola, another infectious disease, or a natural disaster.

But one thing is clear. This is a fight in which the whole world has a stake. This disease respects no borders. The damage it is causing in West Africa, whether in public health, the economy or within communities – is already reverberating throughout the region and across the world.

The international reaction to this crisis was initially inconsistent and lacking in clear direction or urgency. Now finally, the world has woken up. The community of nations has realized they cannot simply pull up the drawbridge and wish this situation away.

This fight requires a commitment from every nation that has the capacity to help – whether that is with emergency funds, medical supplies or clinical expertise.

I have every faith in our resilience as Liberians, and our capacity as global citizens, to face down this disease, beat it and rebuild. History has shown that when a people are at their darkest hour, humanity has an enviable ability to act with bravery, compassion and selflessness for the benefit of those most in need.

From governments to international organisations, financial institutions to NGOs, politicians to ordinary people on the street in any corner of the world, we all have a stake in the battle against Ebola. It is the duty of all of us, as global citizens, to send a message that we will not leave millions of West Africans to fend for themselves against an enemy that they do not know, and against whom they have little defence.

The time for talking or theorizing is over. Only concerted action will save my country, and our neighbours, from experiencing another national tragedy. The words of Henrik Ibsen have never been truer: “A thousand words leave not the same deep impression as does a single deed.”

Yours sincerely,

Ellen Johnson Sirleaf

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AuthorLiberia Philanthropy Secretariat

For the week of October 5th - 9th, the data released in the Government of Liberia’s’ (GoL) Ministry of Health and Social Welfare (MOHSW) reports show an increase in outreach by Contact Tracers.

Last week we reported over 10 different trainings that were happening around Liberia, many of which focused on training military and civilians in contact tracing.  This is a key component of understanding the direction of the spread of the virus as well as enabling communities to slow its transmission rates. Contact tracing has been happening since day 1 of the Ebola outbreak, but the surge in cases that we have seen in recent months has overwhelmed the demand for contact tracers.

As more contacts are tracked, and as more labs are set-up we will see a shift in the data results.  From this week’s data we see more cases of people testing positive for Ebola.  These numbers don’t necessarily reflect an actual increase in the spread of the disease but rather the improvements that have been made in recent weeks to the reporting and testing systems in the country.

The Ebola Treatment Units (ETUs) in Montserrado have begun reporting the list of patients in their centers.  This may help to reach those who are currently being missed by contact tracers.  As of October 11th, 3255 (98%) of 3297 contacts under follow-up in the county were seen by contact tracing teams. Out of these individuals being followed only 3 have so far become symptomatic and 183 people completed their 21 days of follow-up.  This week there were 110 new deaths reported, 33 of these were reported outside the ETU’s.

In the Grand Cape Mount County a new holding center began construction.  Cases of unsafe burial practices and a patient’s refusal to leave her children in order to be transferred to an ETU may indicate a need for more community engagement in this area.  Of the individuals being followed by contact tracers 21 people completed their 21 day follow-up and one person became symptomatic.

Nimba county has seen a spike in vehicles being donated to help transfer patients, deliver supplies, and support burial teams, but poor roads are limiting access to certain areas like Tapitta.   During the visit of Her Excellency, Ellen Johnson-Sirleaf, she donated two vehicles and other medical supplies, while Global Communities hired 9 vehicles, and UNHCR donated a bus and a pickup truck.  Four of the people being monitored by contact teams became symptomatic and have been transferred to the new holding center in Ganta.  Additionally, The Ebola Task Force is monitoring the town of Yalanz as a possible new hot spot.

There are two new vehicles to assist the disinfection and burial teams in Grand Kru and work has begun to fence off the Ebola Care Center there.

In Gbarpolu there is a need for more training and supplies.  While in Bomi there are 14 patients waiting in a holding unit while the construction of the ETU continues.

In Bong County we have reports of 12 bodies being buried this week but no information on the state of the treatment centers or inputs of supplies.

The County Health and Social Welfare Team (CHSWT) in collaboration with WHO hosted a feedback meeting with the Sinoe district response teams to understand the response efforts county wide and gauge where to focus new energy.  The task force also participated in the training of new Community Health Volunteers. The county received Protection and Sanitation equipment from Medical Teams International (MTI).

There have been reported complaints in both Grand Bassa and Margibi counties about the slow feedback about patients in the ETUs.  This presents problems for the CHSWT on where to allocate resources and time.

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AuthorLiberia Philanthropy Secretariat

Yesterday, Her Excellency Ellen Johnson Sirleaf, President of the Republic of Liberia, spoke at the World Bank’s High Level Meeting on the Impact of the Ebola Crisis.  She was joined by the Presidents of Guinea and Sierra Leone to provide perspectives from their affected countries.  The World Bank Group and International Monetary Fund Annual Meeting utilized the gathering of Finance and Development Ministers to bring greater global urgency and action to the Ebola crisis response.

President Ellen Johnson Sirleaf shared Liberia’s specific top challenges and immediate health and social economic needs. Since the end of the civil war Liberia has made remarkable headway in its post conflict development and started seeing progress and improvements in implementing its Millennium Development Goals (MDGs).  The government’s development agenda has now been interrupted by the outbreak of the Ebola virus which has outpaced the country’s ability to contain the disease.  Liberia only has 119 doctors to serve its population of 4 million and the Ebola outbreak has further reduced the number of available health care workers.  Out of the 2,199 reported Ebola deaths, 92 of them have been health care workers.

"WE NEED MORE RESOURCES FOR ESTABLISHMENT OF COMMUNITY CARE CENTERS WITH OWNERSHIP AND PARTICIPATION BY COMMUNITIES THEMSELVES."

President Sirleaf echoed much of what Liberia Philanthropy Secretariat (LPS) has been advocating the last few weeks. She spoke about the urgent need to construct Ebola treatment, testing and burying centers staffed with health care workers.  At LPS, we have shared with many of our partners the need to drive philanthropic dollars towards community based initiatives. In Liberia, people trust and turn to their local community leaders and clinics far more than the larger institutions. These institutions need to be strengthened and empowered.

"WE MUST MITIGATE THE ECONOMIC CONSEQUENCES OF THE EBOLA CRISIS."

All major and desperately needed development projects have been put on hold due to the crisis.  Every government agency and some local NGOs have turned their focus towards stopping the spread of the Ebola virus. This means projects like the Hydro, which would have electrified all of Monrovia and other parts of the country thus contributing to economic growth, have been put on hold.  Other major infrastructure projects such as road constructions, modernizing our ports and clean water initiatives which would have helped to improve access to health care have also been put on hold.  The already struggling local economy has slowed down to a crawl.  The World Bank estimates that Liberia’s GDP in 2014 will drop from 5.9 percent to 2.5 percent.  Inflation and food prices are increasing thus snowballing the vulnerability of the poor.  At LPS, we are advocating for dual prong support comprising aggressive support initiatives which are helping to stop the spread of Ebola while also supporting grassroots and community initiatives that can help to spur activity in the local economy.

It was encouraging to see philanthropic organizations like the Open Society Foundation and the Bill and Melinda Gates Foundation actively participating in these meetings.  The world is starting to understand that the Ebola outbreak is not just a West African problem but a global threat that needs to be stopped.

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AuthorLiberia Philanthropy Secretariat

For the week of October 1st- 5th, the data released in the Government of Liberia’s’ (GoL) Ministry of Health and Social Welfare (MOHSW) report included information on improvements in Ebola case reporting and focused on the numerous trainings that are being conducted.

International and National technical assistants arrived in many of the counties in order to provide training and support to medical staff and supervisors.  Trainings are being conducted by groups including the CDC, Peace Corp and the Liberian Scout association among others.  The trainings range in content from proper burial practices to Ebola prevention measures.

Currently there is no uniformity in terms of how trainings are conducted or by whom.  While most counties now have regular international support staff training medical personnel and building a base of local experts to assist in further training community members, to date we have seen minimal collaboration.  This raises concerns about messaging and ensuring that the information reaching all of the counties is accurate and relevant.

Based on the data from the National Reference Lab, there has been a decline in the number of Ebola cases that were confirmed positive through the first week of October.  In this chart we see a variation in the total number of samples tested, but of those tested there is a decline in cases found positive for Ebola.  One of the possible reasons for the variation in number of samples being taken may be due to low supplies and problems with transportation, as have been reported in Sinoe.

At the Arcelor Mittal hospital in Nimba County there was only one new reported case of Ebola and there were two patients that were referred to the Ebola Treatment Unit (ETU) were discharged.  The hospital also sponsored the training of 17 new contact tracers. In Bomi County there were 6 patients that are in the holding center waiting to be transferred to a treatment facility. Additionally, in several communities it’s believed that families are still hiding sick family members in their homes.  The CDC is currently working to help train medical personnel.  The picture below shows the isolation ward that is currently being used for sick patients. Health workers at the Bong ETU went on strike this week and were demanding better incentives for their work caring for patients with Ebola.  There have been unprecedented numbers of health care professionals getting ill, making their work very risky for them and their families. Meetings are being held among the CHSWT, IMC and other partners to resolve the health workers boycott. 

Edward B. Kesselly Military Barrack located in Montserrado county has been a hub for training.  The Health Promotion division that is part of the Ministry of Health has utilized these facilities to train 42 members of the Liberia Scout association, and educate over 25 new trainers from the military and civilian communities.  An important milestone was also met this week, with all Montserrado ETU’s having reported their data using the new standardized forms.  These forms allow the government to more accurately track ebola cases and monitor follow-up appointments with individuals who have come in contact with an ill person.

There is an urgent need in Grand Kru County for Personal Protective Equipment (PPE) where supplies are running low.  The CHSWT received two new vehicles that will be used to assist the disinfection and burial teams but in order to maintain these operations PPE’s are also needed.

The distribution of drugs and supplies to health facilities in Sinoe county has continued but there is a shortage of test tubes needed for taking blood samples.  Cheborken Town in Jedepo district has been quarantined by the local authorities after they were likely exposed to an infected individual and are refusing specimen collection and are not following safe burial guidelines.    Material supplies are being received, like the vehicles from UNDP and UNMIL, but there are still critical needs, like the test tubes that need to be met.

One of the areas that needs increased attention to help slow the virus is community outreach. Reports of high rates of disbelief about Ebola from River Gee county, and the quarantine that went into effect in Cheborken town highlight the need for increased cooperation and communication with communities.

A new holding center has been constructed at the Pleebo Health Center, however Maryland county is one of the few areas that has reported no training activities.  They have a strong need for contact tracers, burial materials, as well as designated transportation for Ebola patients and the specimen samples that must get to Monrovia for case confirmation.

There have been several thermo-monitoring checkpoints for travelers in Grand Cape Mount County in an effort to stop the spread.  An additional burial team was trained in Sinje, where 6 new deaths were also reported.

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AuthorLiberia Philanthropy Secretariat

For the week of September 16-22, 2014 the data released in the Government of Liberia’s’ (GoL) Ministry of Health and Social Welfare (MOHSW) report included data on Ebola subject testing for the first time.

Data on blood samples originates from the two mobile labs run by the United States Center for Disease Control (CDC) and National Institute for Health (NIH). The new labs reduce the amount of time it takes to learn if a patient has Ebola from several days to a few hours. Both labs are located in Monrovia, one at ELWA hospital and the other at Liberian Institute for Biomedical Research (LIBR). 

Counties continue to report Ebola incidences differently.  Some in terms of new admissions or cases, and others in terms of total admissions or Contacts (a terms used to describe a person who has had contact with an infected person).  But reporting the number of suspected and confirmed Ebola deaths remains constant.  When viewed over time,this data would suggest that suspected Ebola deaths remain highest in Montserrado County (the country’s most populous county, and seat of the capital, Monrovia).

Early data also seems to suggest that there may be an increase in numbers from other counties such as Lofa, Nimba, and Bong.

Lofa County remains the most consistent in providing statistics, which emanate largely from Foya Case Management Center (CMC) run by Samaritans Purse in Northern Liberia.

Montserrado County is the only county that reports on Contact data with some regularity.  Contact data is central to efforts to contain the spread of the virus, and efforts in Montserrado remain in the upper 90 percentile:

In Nimba motorcycles were distributed to Contact Tracers this week to enable more effective data collection in that county.  A traditional healer, who claimed to have the cure for Ebola, and his apprentice were amongst the Ebola deaths reported.  The County received a donation of an ambulance, although poor road conditions are posing a challenge to the transfer of patients from the county to the hospital in Tapitta.  Community training in sensitization and professional operations and holding/treatment center management training have been taking place.

The SDA Cooper Hospital in Monrovia was closed on September 22 following the death of one of its health care workers (suspected to be Ebola) and also the infection of another staff member with the virus. Closure of this hospital reduces the number of Ebola treatment centers in the area from four to just three. Training for health care workers and volunteers continues in Montserrado County.  Four new training sites have been selected to host the training of 100 Community Health Volunteers (CHVs).

The Phebe and C.B. Dunbar Hospitals were reopened this week in Bong County after receiving donations of Personal Protective Equipment (PPEs).  Bong was hit hard by the Ebola outbreak, leaving some of its nurses and other health care workers dead.  A new holding center at Gbarnga Football Field is also nearing completing in the county.

In Bomi County an assessment was complete by the Armed Forces of Liberia (AFL) and US Engineers to identify a suitable location for the construction of an Emergency Treatment Unit (ETU) for the Western Region.  Orientation on the use of PPEs and case management was conducted for additional staffs at the holding unit, and contact tracing activities in the county are ongoing.

Lead by MOHSW, WHO and the CDS training has begun for Contact Tracing field teams in Sineo County.  The County Health Team (CHT) also provided food and psychosocial counselling for all 22 Contacts in Greenville City.  District Ebola taskforce were established in Jedepo, Jeadea and Dugbe River districts by the county authorities, and 42 members of the Ebola response team were trained and received rain boots.

The United Nations Mission in Liberia (UNIMIL) donated supplies to the Grand Kru County Ebola Response Team.  County Health and Social Welfare Teams (CHSWT) have drawn up a plan for health facility based training for health workers, and the selection of a site for the county holding unit is awaiting approval.  The county lacks a functional ambulance, and poor road conditions are preventing the delivery of food donated by the World Food Program (WFP). 

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AuthorLiberia Philanthropy Secretariat
  The National Call Center

The National Call Center

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.

Ambulances

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.

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AuthorLiberia Philanthropy Secretariat
County Map of Liberia

Trends from this weeks’ report indicate that the country is embracing the World Health Organizations’ (WHO) call for greater data mapping in an effort to stop the transmission of the virus in 6-9 months. 

We are now seeing reports that include statistics from areas outside of Monrovia including Lofa, Nimba, Bomi and Bong Counties.  In addition, the report also includes data on the number of ‘Contacts’ (i.e. persons who are under 21 day surveillance after having come into contact with an infected person) and those who have completed the 21 day surveillance period for Montserrado County – Liberia’s oldest and most populous county (estimated at 1.1 million people in 2008) houses the capital, Monrovia, and the GoL.

This data collection is in its infancy and is yet sporadic, but could yield some insight into how the virus is spreading, and also into the effectiveness of the efforts to contain it.

At the beginning of the week, Montserrado reported having four Contact Tracing Teams who followed up with 98% of the Contacts (1,828 people).  As you can see from the graph below, the number of contacts rose by 23% over the course of the week, and the Follow Up Rate did not keep pace with this.

The Red Cross made available 12 Contact Tracers that will be assigned in New Kru Town, just outside of Monrovia, where there is an increase of more than 300 Contacts.  In addition, 30 volunteers from SEARCH, a local NGO, were trained in contact tracing.  As the number of Contacts escalates, there is an increased need for Tracers, and we welcome the opportunity to speak to those in the international donor community who would be interested in assisting.

We were also able to get some data on the number of reported deaths this week from five counties: Bong, Bomi, Lofa, Montserrado, and Nimba. Montserrado County, which holds the capital city of Monroiva is reporting the highest number of deaths.

The hand-over of an Emergency Treatment Unit (ETU) took place in Bong County this week, where County Authorities and the County Health Team accepted the newly completed facility from Save The Children and the International Medical Corp.

 Photo Credit:  The US Embassy in Liberia

Photo Credit:  The US Embassy in Liberia

This week, the President Obama announced that the United States is committed to a total of $750 million and 3,000 troops, including engineers, medical and security personnel to help fight the Ebola outbreak in West Africa.  Called Operation United Assistance, the commitment also includes 10,000 units of Personal Protective Equipment (PPE) for those at the forefront of the epidemic. 

President Obama referred to the outbreak as a growing threat to global security threat, as the numbers continue to rise. 

Major General Darryl A. Williams will take command of the US Army: Africa position to lead this unprecedented US military intervention in an infectious site.  This highly decorated and experienced General landed in Monrovia where he held discussions with President Ellen Johnson-Sirleaf.

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AuthorLiberia Philanthropy Secretariat

Early news reports for September herald that Liberia’s Ebola crisis is escalating at an alarming rate, and government data concurs.  Reports from September 5 and September 9 from two Liberian hospitals: Liberia’s national healthcare facility, the John F. Kennedy Medical Center in the Sinkor District, and the missionary run ELWA (Eternal Love Winning Africa)  hospitals in the suburb of Paynesville support evidence of this trend.

ELWA has two Ebola divisions: ELWA II (the first Ebola treatment center) and ELWA III (the second Ebola treatment center) both built by MSF . ELWA  III maintains the highest total number of Ebola cases, with a larger percentage of new cases than the other healthcare facilities.  The number of deaths has remained relatively constant, and on a positive note, the hospital has more than doubled its number of survivors in the past week.

Similarly, JFK Medical Center has seen a rise in new cases, over a relatively consistent death rate.  By contrast, however, JFK has seen the largest increase in total number of cases in the first two weeks of September.  On a positive note, it’s also seen a 4 fold increase in the number of survivors.

Bucking the trend, ELWA II is the only facility of the three to see a decrease in total number of cases and also new cases.  In the second week of the month, ELWA II increase both its survivors from zero to four, and also its deaths from zero to five.

Liberia’s President Ellen Johnson-Sirleaf toured hospitals and healthcare centers to ascertain the needs of these critical facilities on September 9, 2014. 

Healthcare facilities across the country are in dire need of:

  • Ambulances
  • Mattresses
  • Chlorine
  • Personal Protective Equipment (PPE) for healthcare workers
  • Medical Gloves
  • Infrared Thermometers
  • Water Treatment Units
  • Plastic Sheeting for tents used in the construction of Ebola Treatment Units
  • Body Bags

The WHO Roadmap calls on key development partners to prepare to scale up their current efforts 3 to 4 fold to meet the challenge of stemming this epidemic.

On August 28, 2014 the World Health Organization (WHO) released its Ebola Response Roadmap and the Government of Liberia (GoL) released its National Ebola Response Strategy shortly thereafter.  Both documents seek to stop the transmission of the Ebola virus within 6-9 months. 

Talk of Ebola orphans has begun to emerge as local organizations begin to devise a plan to help, including the GoL newly announced Social Safety Net Program that aims to provide assistance to orphans, Ebola survivors and the families of the deceased.

At the national level, President Ellen Johnson-Sirleaf announced the creation of a “Central Command” this month.  The Central Command is to take over from Ebola operations based at the General Services Agency (GSA) in Monrovia.  The Ebola Task Force (ETF) offices at the GSA are vastly understaffed and completely overwhelmed by the needs of the country’s growing Ebola response needs. 

We welcome the philanthropic community to reach out to us so that we can assist you in meeting your foundation and philanthropic objectives in putting an end to Ebola in Liberia.

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AuthorLiberia Philanthropy Secretariat