IamA First Responder to the Ebola Virus outbreak in Liberia

Compiled from reddit’s IAmA live question and answer channel, hosted by Sean Casey on Sep 19, 2014:

Source: First responder transcriptMore than Me’s Katie Meyler transcript

Monrovia is generally like this: the food is spicy, the people are warm, the colors are bright. It has a complex history. The infrastructure was completely destroyed in a 14-year civil war and now they’re trying to rebuild.

Q: Is the situation out there as bad as the media portrays it to be?

Situation is indeed vey bad, several studies show that the number of cases double each 2 to 3 weeks. If you remember the story of the chess board and the grains of rice, we have already a lot of cases in the current square, next square will be 2 times bigger. This can arrive with some possibility everywhere but the question is can it be fastly managed. A successful containment stops the problem at square one.

It is exponentiation growth

http://en.wikipedia.org/wiki/Exponential_function

An exponential fit to the number of cases from mid-July through to mid-September suggests that their number now doubles every 24.3 days (as opposed to every 29 days previously).

http://www.geert.io/exponential-growth-of-ebola.html

Exponential Growth’ in the Ebola Outbreak: What does it mean?

http://sacemaquarterly.com/other-infectious-diseases/exponential-growth-ebola-outbreak-mean.html

The effective reproduction number, Rt, of Ebola virus disease was estimated using country-specific data reported from Guinea, Liberia and Sierra Leone to the World Health Organization from March to August, 2014. Rt for the three countries lies consistently above 1.0 since June 2014. Country-specific Rt for Liberia and Sierra Leone have lied between 1.0 and 2.0.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894

If reproduction number is below 1 then it will die out by it self. If it is above 1 then it will spread.

Q: recent murder of several relief workers will lead to aid agencies withdrawing from impacted areas

I don’t think that this will stop agencies from responding, but it will definitely impact how and where they work. Staff safety is paramount for all of us, and we need to know that we can do our work without threat of violence. The violence in Guinea is worrisome, and hopefully the authorities there will do what they can to prevent this from happening going forward.

Q: What do you feel is the source of distrust that Ebola is real/dangerous? I’m specifically thinking of the clinic that was attacked and looted.

That feeling of distrust that Ebola is real isn’t as prominent as before because there are so many people getting sick and dying now. The clinic that was attacked and looted in West Point was a politcal issue. It had a lot to do with the fact that there was no communication between higher ups and the local people. There’s a saying that “nothing good ever comes from West Point” so there’s a feeling in West Point that everyone hates them and when they saw Ebola patients from outside of West Point coming in, they thought that they were trying to bring Ebola into their community because they didn’t believe that Ebola was in West Point at that time

The virus already feels uncontrollable, but I think with the help coming that it will change things, but it needs to get here fast enough.

Q: What is the reaction from the community?

Stigma

We know of one woman named Finda whose whole family died but she survived Ebola. Yes, there’s definitely a stigma for survivors. More Than Me wanted to hire Finda for the awareness team but she didn’t feel comfortable being in West Point anymore because of the stigma.

I don’t see anyone working to change this right now. There are dead bodies and sick bodies everywhere. Right now, people and workers are afraid. The main services happening at the moment are that sick people are being brought to holding centers and dead bodies are being picked up to be cremated. All the ETUs and the one holding center are full right now. (ETU = Ebola Treatment Center)

The West Point Commissioner asks US what to do. The community of West Point is pleasantly shocked to see an international person return and me being here gives us extreme credibility. It makes the community feel they’re not alone, that we actually care, that there’s hope. We aren’t just here when the sun is shining, but here through the storms as well.

The community is helping themselves and I’m supporting them. They want rain boots? I get them rain boots. Their t-shirts aren’t working? We get them new ones. That’s what we’re able to do. On top of that, we can help coordinate the awareness workers’ messages, coordinate meetings with partners on the ground, etc.

In West Point, the awareness team is telling families to wash their hands every 15 min if possible, don’t touch bodily fluids of sick people, isolate any sick people you have in the house, and designate one caretaker for the sick. And make sure the caretaker is hydrated and the sick person but the caretaker must use plastic bags to protect themselves from touching them.

We are bringing home nurses to these families with food, and an ebola kit that has everything a family would need to care for a sick person: new bed sheets, vitamin b, rice, bleach bucket, clorox, oral rehydration solution, etc.

The only hospital I’ve been in, that isn’t an ebola place, is Star of the Sea Clinic in West Point. The doctors see Ebola patients coming in nonstop and they have nowhere to send them so it’s definitely getting more risky for the staff there.

Avoiding infection

I’m not touching people, washing my hands constantly, washing my clothes in chlorox. But the main thing I can do is not touch anyone.

West Point and Capital Hill – the two neighborhoods where we’re working – treat us like family. I don’t feel at risk at all being there. The community protects us. I feel like the bond between me and these communities of Liberia is magical right now.

(This next question shows trust isn’t just a problem in Liberia, but everywhere. Someone didn’t believe this was the person she claimed to be.)

Q: For proof, could you please mention this AMA on the MoreThanMe website or tweet about it from @MoreThanMeORG

We’ve tweeted the link and posted on our facebook page: www.facebook.com/morethanmewww.twitter.com/morethanmeorg

Q: What will be most effective?

Definitely donations. All humanitarian responses require funding, and this one is particularly expensive, given the scale and all the inputs required.

We especially want to raise funding to support training and equipment for Liberian first responders. This is something we integrate into all of our work, but it’s particularly important here, as this response requires enormous human resources. Around 90% of our staff here are Liberians, and our first priority is to support them to work safely and effectively. www.firstresponderscampaign.org

Biggest needs are qualified staff, nurses that know how to control infection. Secondly, put pressure on your governments to help. Donations in kind are tricky because the need to respond to specifications. Money for buying those items is better.

We need all kinds of things, but many of them are quite specialized – like doctors and nurses, and specific models of personal protective equipment. The most useful input that the average person with some interest in helping can provide is money to support the operations. Ebola response is very expensive – operating one 70-bed treatment unit can cost up to $1 million/month!

Q: Where to find local accounts?

I don’t know any local Liberians sharing their stories anywhere. Carielle Zoe is a Liberian journalist who’s sharing on her social media, and I’m sharing stories constantly on instagram. (@katiemeyler)

Just today, this morning i prayed and sat with a 15-year old sick boy and he died this afternoon. I went to the courthouse in the afternoon and the people handcuffed were vomiting everywhere and asking me to take them to the hospital.

The burial team, Dr Fallah (mentioned in NYT) and hospital workers, journalists, awareness workers and me are all in the midst of this outbreak, but I’m not sure that any one of them besides journalists are sharing their personal stories.

This is hitting uneducated people who don’t know how to use social media. And for health workers, they are so overwhelmed with the situation that there’s no time to share stories.

Q: I’m worried about some American doctors in Monrovia at Cooper Hospital. I’ve heard rumors that all the other medical facilities closed except EWLA Hospital or possible JFK government hospital. Can you speak to the risks they are facing or give some local knowledge about their neighborhood, etc? I’m realizing I know very little about Morovia (though a reasonable amount about Ebola).

If anyone is interested in reading about their experience, one of the surgeons keeps a diary here.

http://www.ahiglobal.org/main/news/?title=ahi-doctor-heads-to-liberia-to-aid-ebola-crisis–james-appels-personal-log-of-daily-events/

Q: How does it affect you?

It’s hard to see, for sure. I went to pick up a 12-year-old patient on Monday and spoke to him briefly before he boarded the ambulance. An hour later he was dead and the next day I saw his body being carried away for burial.

Q: What is UN/WHO doing?

WHO has staff supporting several ETUs. There are currently six open in Liberia: – Fyoa (MSF) – ELWA III (MSF) – ELWA II (Ministry of Health) – JFK (Ministry of Health with WHO) – Island Clinic (Ministry of Health with WHO) – Bong (IMC)

There is a body in WHO called the GOARN, Global Alert and Response Network. They publish regularly on alerts or updates.

Q: Sean what does your ‘average’ day look like?

Hectic! It usually starts at around 6am and ends at around midnight. In Monrovia, lots of coordination meetings. In Bong, troubleshooting at the ETU, coordinating with government representatives, and sometimes chatting with patients. No two days are ever the same – it’s one of the things I love about my job.

We have a psychosocial team that provides support to our staff and their families.

We provide IV fluids, oral rehydration solution, pain medication, presumptive malaria treatment and symptomatic care.

I think there are lots of untold stories about the very brave health workers here. They’re the real first responders, and they’re continuing to work despite the fear and risk. One of our nurses saw six of her colleagues die from Ebola, but she’s continuing to fight the disease by working with International Medical Corps at the Bong ETU.

We’re seeing quite a few families present together. It’s normal for relatives to care for each other when they’re sick, so this is a common vector for transmission.

Q: Some people there think it is a hoax.

Sadly very true. Ebola is not an hoax. The consequences of negating it are yesterday’s news about killings in Guinea.

Q: On the likely number of cases:

Q: Why don’t they close the airports and put military at all exits of the cities infected? It boggles my mind they haven’t done this yet.

Closing an airport increases risk in bordering countries as people that want to travel, will, but not via official land crossings to the information can not be collected, the temperature can not be taken.

MoreThanMe – latest ebola project report via GlobalGiving

In this together – By Emily Bell – Project Leader

School Nurse Iris handing out care packages

School Nurse Iris handing out care packages

Dear MTM Family,

Thank you for your continued support. Our report this month is going to be a little bit different. As your probably know, there is an Ebola outbreak in West Africa affecting Liberia, Sierra Leone, and Guinea. On July 30th, President Sirleaf recommended that schools close to avoid large gatherings. We decided we needed to close the MTM Academy for the safety of our girls, staff, and community.

On July 31st, the girls and their families came to the school. We gave students care packages that included workbook pages to keep them busy and learning, medicine for fever and bacterial illnesses, Ebola awareness posters, health care referral forms, oral rehydration solutions, chlorine, soap, and rice. All students, parents, and staff also attended an awareness class led by doctors and staff from UNICEF, the IRC, and Ministry of Health. While the school is closed, all expat staff members are being relocated to the US.

To date, we’ve had no reported cases of Ebola related illness in students or staff.

On Friday August 22nd, our founder Katie Meyler arrived in Liberia to help the West Point community, where the majority of our girls live. She has been meeting with community leaders, government officials, health officials, and police to coordinate a faster response to Ebola in West Point. You can follow her journey at http://racingheartblog.tumblr.com/.

Thank you for your continued support. We hope to reopen school as soon as it’s safe for our girls. Until then, we will keep fighting for a better, faster, more organized response to the outbreak, both in West Point and across Liberia. Please direct any questions, comments, or words of support to emilyb@morethanme.org.

In this together,

Emily & the MTM Team

Katie in West Point checking on students

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