Here is a letter that I just received from my friend "Mustafa" who is working with the ebola response in Monrovia. This is very important to read.:
Dear friends and partners,
I bring you a thoughts on the current ebola crisis in my country, Liberia.
Since I begun working with the ebola response in Liberia, I have never been as sadden as I was today. I stood with my tracers and watched the ambulance team transferring two of the Catholic Sisters from their St, Joseph Catholic Hospital Compound. As the two innocent young Nuns from the Democratic Republic of Congo mounted the ambulance to be taken to the treatment unit at the ELWA, I shared tears. I share tears because we could have prevented them from contacting this deadly disease. They had trusted us and our ability to manage the ebola response; we cause all of them to be infected. After serving this country for over 40 years and saving thousands of lives, is this the way we could repay them. As the ambulance made its way out of the deserted hospital with the first badge of two nuns, I became too overwhelmed with sorrow. The ambulance was returning for four of them including a medical doctor. How could we have disappointed them....I reflected painfully:
Three weeks ago, Brother Patrick, the business manager from Cameroon got infected by a case that was brought to the hospital. He was a contact until he started showing symptoms. The laboratory had taken his specimen and his result was negative. Based on this result,the other sisters and brothers decided to nurse him back to health. Despite their treatment he progressively began to shown signs and symptoms that were typical of ebola. He decided that he would leave for his home country, but the airline recognizing the signs and symptoms ask for a repeat of the test. Behold! This came back positive.
The sisters, brothers and doctors who treated him were in a state of shock and dismay. Brother Patrick was kept in one room of the hospital for treatment. The confidence of the brothers and sister in our ebola response system was seriously corroded. Brother Patrick became weaker and weaker and others stop coming around as they pondered over their own status. Then Brother Patrick died. His body was among the 52 bodies that were buried in a mass grave one week end ago. Then the sisters and brothers as well three of the Liberian health care worker (including a laboratory technician, a social worker and and a nurse) started getting sick. In all seven of them became positive for ebola. One of them, a Nigerian Medical doctor, was told he was negative. However, he told us that every symptoms in his body indicated to him that he too had contacted the disease. We then ordered for a new result. We are awaiting this result, but he is getting sicker and sicker each day.
Even as I write to you, we are arranging to take the remaining two cases tonight. We were told that previous attempts to take them to the treatment unit were met with resistance with resistance. But their reluctance was due to the fact that we destroyed their confidence in our ability to handle this Ebola crisis. They had decided that they would rather die in their compound then follow us to the treatment unit. If we had failed them with our laboratory results, how could they trust us to provide the kind of intensive care that is required in the treatment unit? As if to make matters worse, the Liberian Social Worker who was confirmed with ebola escaped today in the population. Her daughter came and took her away, when she heard we were moving them to the treatment unit. This is worrisome as she could be a source of new transmissions in the community. Are we really winning this war against ebola?
I would say NO!!! Just a few days ago, our only internist was suspected to have been a contact with Dr. Samuel Brisbane who had died from ebola. Dr. Brisbane had contacted ebola from a patient because he refused to use gloves and barrier nursing. Dr. Borbor was asked to do his laboratory test. It came back negative about one week ago. To our greatest dismay, he was taken to the treatment unit last night when he started manifesting severe symptoms of ebola. They are now repeating his test. Such inconsistent test needs tos top because it only exposes more people to the infection.
I have investigated the laboratory procedure and I noted several sources for potential errors. There is a single team of laboratory technicians that are working over ten hours a day and seven days a week without any time to rest. This would lead to lapses and increased risk for errors. One of the technicians told me sadly that they worked these very long hours and no one provides them with food. They begged for food and were given a 100 pound bag of rice with no soup kind and no one to cook for them. Many of them had not being paid for three months. How could we trust our lives in in the hands of people that are overworked, staved and not given their just compensation? Are we wining this war against Ebola?
I was trying to get the burial team to pick up a body that had being lying out for two days. The dispatcher from the Red Cross, who is a friend said to me, “ I beg you Dr. , the number of bodies we have in Monrovia is more than the two vehicles and two teams we have today.” She said that even as I was speaking to her, two of their vehicles were already filled with bodies.
Even, where we have our clinic, a man had started vomiting and toileting blood two days ago. I was called to intervene. I call the ambulance team but no one responded. I called those of my colleagues in authority at the Health Ministry, but they too were powerless as the system and the logistics were not in place to respond to such a call. The treatment unit was overflowing with sick people. They just could not pick any one up in the community because there no bed available in the unit. Then the man died. His body stayed in the house for two days, while his poor wife and children slept in the open. No one wants to come closer to them. After two whole days of begging every authority I knew, they finally removed the body today. The home was never spread. The poor woman and her children are again sleeping outside today. I have tried to call the guy on spraying but his phone is off. But, I will press on and will call again tomorrow.
This evening the Catholic Bishop asked that Sister Shanta (who died around 2 am this morning, the second victim from the Catholic Hospital) be buried in the compound. The authorities honored his wish and her remains were lay to rest on Liberian soil thousands of miles from her native DRC. We can point to her grave and memorialize her in the future. But, Brother Patrick and the over fifty bodies that were buried a few weeks ago will never have such honor. The remains of the over 60 bodies that have so far being cremated in the Indian crematorium on the Marshall Highway will never have these memories.
I pray that their memories and the memories of those who will survive this deadly ebola will remain in our hearts. As I walked out of the deserted St. Joseph Catholic Hospital, I remembered that it was here my father was treated during his last days on earth in 2011 and it was here my sister Marie receive her treatment before we transferred her to Ghana. But today, the hospital is a ghost town.
Maybe, as some of us fight each day to make some kind of difference, it will at least amend for all of our mistakes and failures in the Ebola Response. May God save our country and those countries affected!!!!
John Berestecky can be reached at johnb at hawaii dot edu