Countries like Uganda in east Africa have tackled previous rural outbreaks through online reporting systems and rigorous surveillance, said Uganda’s Director of Community and Clinical Services Dr. Anthony Mbonye. But in the West of the continent, weak healthcare systems were unprepared.[eap_ad_2]
Liberia, one of the world’s least developed nations, has poor Internet and telecommunications, and only around 50 doctors for a population of over 4 million. Traditional funerals, where family members bathe and dress highly contagious corpses, have expedited Ebola’s spread to 9 of the country’s 15 counties.
In recognition of the region’s inability to cope, the World Health Organization this week declared Ebola an international health emergency – only the third time in its 66-year history it has taken this step.
Neighbors Guinea and Sierra Leone have placed checkpoints in Gueckedou and Kenema, creating a cross-border quarantine zone of roughly 20,000 square km, about the size of Wales, called the “unified sector”.
Within this massive area, Information Minister Lewis Brown described more intense quarantine measures in Lofa county, ring fencing areas where up to 70 percent of people are infected.
“Access to these hot spots is now cut off except for medical workers,” he said in an interview this week.
Reaching the sick in isolated villages there is critical because the county’s main Foya health center is full. The site was run by U.S. charity Samaritan’s Purse until it pulled out after two of its health workers contracted the virus in Monrovia.
Medical charity MSF, which has now stepped in, says 137 patients are packed into the 40-bed site.
Health workers hope to train locals to create isolation units in schools and churches within their own communities.
“Quarantines expose healthy people to risk – which is why the effectiveness of states is so important in supporting preventive measures that will minimize this,” said Robert Dingwall, specialist in health policy responses to infectious diseases at Nottingham Trent University.
Such measures include prevention education, crematorium facilities and protective equipment, he said.
ISOLATED
But Liberia’s response team is struggling to keep up.
The main health care center in Lofa is “overwhelmed” by new patients, a health ministry report said. A total of 13 health care workers have already died from Ebola in the county while its surveillance office lacks computers to manage cases.
Liberia’s Brown also acknowledged the risk: “We can establish as many checkpoints as we want but if we cannot get the food and the medical supplies in to affected communities, they will leave.”
Even if the resources arrive, help might be chased away.
Unlike in other areas of the country, where Ebola awareness campaigns are helping to draw people out of hiding, in this isolated border region, far from the otherwise ubiquitous ‘Ebola is Real’ government billboards, denial is still strong.
According to a local rumor, merchants dressed as health workers are taking people away in order to sell human organs, provoking violent reactions from locals, Karbarr said.
In late July, an ambulance was stoned in the Kolahun district as it tried to take a body for burial. In the same area, a group of hand pump technicians were told to leave or have their vehicle torched. The police arrested a man this week for Ebola denial.
SUPPLY DISRUPTIONS
Brown said that people in unaffected counties in Liberia’s east have so far welcomed the quarantine, but sentiment could swing if supplies start to run short.
The Italian roots of the word quarantine – meaning 40 days – refers to the isolation period for ships arriving into Venice from plague regions. But Liberia’s operation could go on for three months or more, creating the need for a long-term plan.
As well as increasing the feelings of isolation and criminalisation felt by those in quarantine, the duration of the quarantine risks creating national supply disruptions. Already the price of oil and rice has doubled, residents say.
While those in Lofa are located within the country’s sweet potatoes and palm fruit-growing food belt, the unaffected eastern counties cannot feed themselves.
The World Food Programme intends to distribute food to more than 1 million people living in the cross-border quarantine zone, but there are not yet plans for the unaffected counties.
“My worry is how the southeast will get food. You could have trade with Ivory coast but they might not want to for fear of the virus,” said UNICEF’S Scott, referring to the landlocked River Gee and Maryland counties.