Africa

Ebola: No one is coming to save us

Reposted from Marc Maxmeister on ChewyChunks

Katie Meyler has been telling stories of how the people of West Point slum in Monrovia, Liberia overcame Ebola:

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This little girl and her brother and sister lost their parents. The auntie is asking me to help her by taking the kids. I asked her, “If someone helped you support and empower her, would you could feel happy raising your sister’s children?”

“Of course!” She said.

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Rebecca tells me she has symptoms and is scared. I took my gloves off and let my hair down because I was leaving for the day. I wasn’t scared, because she looked strong. We are bringing her meds and will keep a close eye on her. Obviously this is agonizing but we are doing all we can. Please pray for Rebecca with me.

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I talked to local medical staff about serving West Point. Everyone I met was really lovely. There were 20 or 30 body bags with deceased people inside. I was scared but also at peace. This place has things under control.

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Community leaders made the rounds in West Point and found 45 sick people in the areas they were able to check. Unfortunately, all of the clinics are at capacity and not able to receive people.

These are stories of people trying to be resilient in the absence of any real government help. These slum dwellers had only two options if they wanted to survive: wait for the Powers to come save them, or become self-reliant. Resilience won, because they were used to being ignored. And while the medicine, supplies, and training were delivered by non-governmental groups like MoreThanMe, the people running the ambulances, screening citizens, and handing out the food were community members. The community saved itself. It illustrates a larger truism that we keep denying: Only the Poor can end poverty. Allow me to explain why.

First, a little more of my backstory. My job for the past few years was figuring out how to give Voice to the Poor. I ran an East African storytelling project with GlobalGiving from 2010 to 2013. It showed that the Poor clearly were the “experts” on what they needed, and knew how their governments could solve big problems. But my straightforward approach – collect their first-hand testimony and present it to those in power – wasn’t enough. Why? Because governments and international agencies are not built for listening. They have no effective mechanisms to redress complaints. They don’t give local leaders and local solutions a fair hearing.

Most people are eager to speak up at first, but experience teaches them that Power doesn’t care about the Poor. If they complain about a program, the donors too-often go elsewhere and start over, leaving those people with nothing. Spurned and punished for their participation, they don’t speak out.

It is not just organizations. Governments and business have also taught the Poor to merely accept what is offered. Business offers the Poor jobs that sacrifice wages or safety through the unregulated markets of Globalization. Governments are “representative democracies” at best, not direct democracies. Few representatives really listen to the Poor. Power listens to Power. The Poor survive on what they get, and only take to the streets and assert their rights when hardship becomes unbearable.

But sometimes a community does come together and builds something. Ebola’s demise in 2015 is the story of local leaders rising out of the chaos and helping neighbors choose resilience over fatalistic resignation, as I profile in my book.

Their stories are often untold, because telling their story to outsiders doesn’t help them along the path of self-reliance or survival. A reporter swooping in to get the story gives the storyteller fresh hope that someone will save him. There are millions of international do-gooders in the world spending their lives in an effort to help the Poor. We live among the Poor. We listen to them. We share their stories with a broader audience. Sometime we raise awareness about an issue. Occasionally we inspire the Poor. But mostly we offer a twisted hope that keeps them off the path of self-reliance. We cannot end poverty for the Poor, only enable to Poor to lift themselves up.

In a famous letter from a law professor to his student, Bill Quigley writes:

“Many come to law school because they want to help the elderly, children, people with disabilities, victims of genocide, victims of racism, economic injustice, or religious persecution. Unfortunately, the experience of law school and the legal profession often dilute that commitment.”

It is a harsh lesson I keep learning over and over. Regardless of my tactic, Peace Corps, science, banking, or medicine, the end result only moves the Poor a few feet from where they once stood. No mix of skills or tools or toys may ever work if I am the one holding the chalk, the shovel, or the smart phone.

Singing “No one is coming to save us!”

Katie Meyler once said that things started getting better when the people of West Point slum starting singing “No one is coming to save us!” It was a turning point. They understood that local leaders were their best hope for survival. The people were finally taking charge of their own future. The narrative changed from being about the failure of outsiders to the success of the community. And when West Point slum’s death toll fell far short of projections in the months that followed, locals could look at each other and say with pride, “We did this ourselves!

This isn’t about outsiders abandoning the Poor, but about truly Serving the Poor.

But in our world, when stories like these are told by outsiders, the people who supply the materials take the credit. The bags of rice are stamped ‘US AID from the American People’.

CENTRAFRICA-UNREST-US-AIDThe medicines and the trucks and the soldiers all have branding. But the people remain anonymous because they are the community being helped. It is a false narrative to separate the helpers from the helped. Serving the Poor means being in the community, without identity.

Instead, the locals are given supporting roles, first in the narrative, and later in the power restructuring following success (during the elusive “project replication” phase that funders seek). The meeting rooms usually look like this (a bunch of acronyms working together):

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Newsmakers and storytellers and politicians must unlearn bad habits. Every success story is, at its core, about people helping themselves. We outsiders are mere bystanders. But with hard work we can become true servants.

Take another example, this time from the 1960s US Civil Rights movement. One witness tells the story of the political parade that was the funeral for Rev. James Reeb, who was brutally murdered in Selma in 1965:

From the balcony I saw a sea of dignitaries clearly unrelated to the events in Selma. Many faiths had come to pay tribute in this memorial to James Reeb. Until Dr. Martin Luther King himself spoke, it is hard to imagine a more jumbled collection of prepared prayers and speeches rattled off in a patronizing way. It was ecclesiasticism at its worst. James Reeb’s death was described as the most monstrous example of brutality, when in fact it was one more instance in a long series. Men who had not taken the time to meet any young people praised them for their courage. The men and women who had come “thousands of miles” for the memorial were extolled. I thought that it was not too difficult to come and go in 24 hours and have the vicarious experience of heroism through singing a few freedom songs.

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When King began to speak, however, it suddenly seemed right that we should all be there. Everyone moved a bit in his or her seat when King asked rhetorically,

“Who killed Jim Reeb?”

He answered: A few ignorant men. He then asked,

“What killed Jim Reeb?”

and answered: An irrelevant church, an indifferent clergy, an irresponsible political system, a corrupt law enforcement hierarchy, a timid federal government, and an uncommitted Negro population. He exhorted us to storm the bastions of segregation and see to it that the work Jim Reeb had started be continued so that the white South might come to terms with its conscience.

This account captures the movement as well as a pan-out to illustrate the circus around the movement. Power lives a circus life. I too had that experience and blogged about it.

So if local efforts do succeed, outsiders swoop in and take all the credit, and the Poor are pushed out of the limelight. Outsiders get promotions and the Poor find themselves only a few feet from where they began. Though nothing is won entirely without cooperation – and everything is at least partly enabled by those in Power – the distortion of who deserves credit is so large in the International Aid world that we’ve forgotten why it ever works at all. Everything starts because a community buys-in, and ultimately survives because a community takes ownership. We are just drifters and gamblers in their story.

Only the Poor can end poverty. But the rest of us can make that journey lighter. 

One way is by emulating organizations like MoreThenMe.

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It was no accident we find them in the slum at the center of a strong network of relationships. Katie spent 9 years there working for the community as a humble servant. Then in December of 2014, Time Magazine anointed her “Person of the year.” Now she’s brunching with billionaires instead of begging for books. But it is the same Katie, doing the same work. Serving Pearlina and Rebecca and other girls who deserve to go to school. She is part of the community. She was amazing and unknown before; now she amazes a bigger audience with grace:

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They did not invent the process of community-building. It has been known for thousands of years. It is explained in Sun Tzu’s The Art of War:

“Come among the people.

Live among them.

Work with that they have.

Build on what they know.

And when the work is finished, they will say,

‘we have done this ourselves!'”

There has never been a better credo for fighting poverty, nor a better description of resilience. There are many technical ways to stop Ebola, but underneath every successful strategy is an appetite to empower resilient communities in precisely the way that Katie has. She didn’t know much about Ebola, but she knew a whole lot about inspiring people and organizing groups.

This is the most important lesson in my Ebola book for how we deal with the next crisis. Local leaders exist in every community, but too often our international systems co-opt their power and authority, replacing them in a state of emergency instead of empowering them. The sooner we can get a community singing, “No one is coming to save us,” the sooner that community can come together to save itself. Only then – and only through pre-existing local relationships – can international help be effective. No one from the Red Cross, WHO, CDC, and US army can live Sun Tzu’s credo in every town that might face a disaster in the future, and so these institutions need thousands of local allies. Only local voices can sing the melody in the resilience song.

A pro-Poor environment

If we want to hear the Poor speaking up, we must give them space to lead. We can create mechanisms to connect local voices with better performance in foundations and government (Keystone Accountability’s mission). We can reign in our proxy-democracy and make it more direct through functional citizen feedback loops (FeedbackLabs’s mission). We can listen to the Poor and let them speak in their own words (GlobalGiving’s Storytelling Project). These are all steps on the path to prosperity, but they are not the whole path.

I offer a deeper dive into these issues in my book, Ebola: Local Voices, hard facts on Amazon.

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Ebola: Still outpaced, nurses strike, and why West Africa?

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Ebola crisis: ‘We are still being outpaced by epidemic,’ MSF head tells MPs

Via The GuardianEbola crisis: ‘We are still being outpaced by epidemic,’ MSF head tells MPs. Excerpt:

The Ebola epidemic is still outstripping efforts to contain it, according to doctors from Médecins Sans Frontières who have mounted most of the early response in west Africa. Speaking to MPs from the House of Commons international development committee, MSF’s head of UK programmes said the apparent decline in numbers in Liberia did not signal the end of the epidemic. “We are still being outpaced,” said André Heller-Perrache . ”There are far more actors on the ground but we are still being outpaced by it, with Sierra Leone being the most concerning case we have.” Dr Javid Abdelmoneim, a UK-based doctor in emergency medicine who has recently returned from Sierra Leone where he was a volunteer with MSF, said there was “too little of everything being done in terms of intervention”. He described how doctors in MSF’s treatment centre in Kailahun would don protective suits to meet an ambulance that could have been travelling across the country for 10 hours expecting dead bodies, which are highly infectious. “Usually there is a patient who is dead,” he said. “There was [in one ambulance] one dead woman and two who were alive but terrified. They have watched this poor woman die a wretched death and they are thinking, ‘I’m now going to die as well.’” Prof John Edmunds, from the London School of Hygiene and Tropical Medicine, who in September called the outbreak a potential doomsday scenario, said he would not say that the nightmare had been averted. “Things have improved dramatically in Liberia now – cases were doubling every two weeks. Now there is a turnaround and they are declining. “The number of cases in Liberia has flattened out. The increase has stopped and come down, but we haven’t got rid of Ebola. In Guinea and Sierra Leone the rate of increase hasn’t really changed much at all.”

Ebola in Sierra Leone: Health workers go on strike

Via BBC News: Ebola crisis: Sierra Leone health workers go on strike. Excerpt:

More than 400 health workers involved in treating Ebola patients have gone on strike at a clinic in Sierra Leone.

The staff, who include nurses, porters and cleaners, are protesting about the government’s failure to pay an agreed weekly $100 (£63) “hazard payment”.

The clinic, in Bandajuma near Bo, is the only Ebola treatment centre in southern Sierra Leone.

In Mali, a nurse and the patient he was treating earlier became the second and third people to die from Ebola there.

Nearly 5,000 people have been killed in the outbreak of Ebola in West Africa, mostly in Guinea, Liberia and Sierra Leone.

The World Health Organization (WHO) has declared the outbreak a global health emergency.

The Bandajuma clinic is run by medical charity MSF, which said it would be forced to close the facility if the strike continued.

MSF’s emergency co-ordinator in Sierra Leone, Ewald Stars, told the BBC that about 60 patients had been left unattended because of the strike at the clinic in Bandajuma.

Meanwhile, Reuters reports that in the US, National Nurses United are organizing strikes and rallies over inadequate protection for healthcare workers.

Ebola: Why West Africa?

Thanks to Greg Folkers for sending the link to this conditionally accepted paper in PLOS Neglected Tropical DiseasesWhat factors might have led to the emergence of Ebola in West Africa? The abstract:

An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent.

The emergence of this deadly disease in West Africa invites many questions, foremost among these: Why now and why in West Africa?

Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need.

A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease.

Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa.

Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily.

To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community.

Stunned silence after scathing analysis of Ebola response

VIENNA—After Oyewale Tomori finished his talk on Ebola here at the International Meeting on Emerging Diseases and Surveillance, there was stunned silence. Tomori, the president of the Nigerian Academy of Science, used his plenary to deliver a scathing critique of how African countries have handled the threat of Ebola and how corruption is hampering efforts to improve health. Aid money often simply disappears, Tomori charged, “and we are left underdeveloped, totally and completely unprepared to tackle emerging pathogens.”

Trained as a veterinarian, Tomori was the World Health Organization’s (WHO’s) regional virologist for the African region in 1995 during the Ebola outbreak in Kikwit in the Democratic Republic of the Congo (DRC). ScienceInsider sat down with him at the meeting in Vienna; questions and answers have been edited for brevity and clarity.

Q: You said in your talk that Ebola was “swimming in an ocean of national apathy, denial, and unpreparedness.” What did you mean?

A: We were totally unprepared. After the first cases occurred in West Africa, it took almost 3 months for WHO to know. When the first patient came to Sierra Leone and died, his son brought him back to Guinea and as far as Sierra Leone was concerned, it was Guinea’s problem. People abandoned their duty, they denied the problem, and when it became a big problem they became incapable of handling it.

This is not the first time Ebola has appeared in Africa. There have been more than 20 outbreaks since 1976. Not one of them has been declared a global problem. Of course, circumstances are different this time. But if we had been prepared, if we had learned from the past, we wouldn’t be where we are today.

Q: You seem angry.

A: Yes, I am, because I know Africa has the capacity and the capability to solve most of her problems, but Africa will not enable her human resources to perform effectively and efficiently. African leaders have little or no respect for their experts and would rather act on advice from external sources. In the end, they become the experts on Africa’s problems, not the Africans. This is why I am angry with Africa.

We have seen so many Ebola cases before, in the DRC, in Sudan, in Gabon. … Ebola is Africa’s problem. We should have put something in place. I remember in 1995, when we had the Kikwit epidemic, at the end we sat down at a table and discussed what we should do. There was a laboratory in Kinshasa built by the French; it was almost completed, but then abandoned. We had raised almost $2 million at the time. And we said: “Why not take a bit of that money and complete this lab and maintain it? Then at least when we have issues like this we can do quick testing.” But nothing happened. The carcass is still there. Each time I pass the place, I think: “What a waste.”

Q: But your own country seems to have been prepared. Nigeria managed to contain the virus after it was carried to Lagos by a traveler in July. There were only 19 infections, and WHO called the containment of the virus “a spectacular success story.

A: We were not prepared, we were lucky. Patrick Sawyer was already sick when he arrived, so he went straight to the hospital. And because our doctors were on strike, the public hospitals were not open, so he went to a private hospital. If Sawyer had gone into a public hospital, we would have had a bigger problem.

But within 2 to 3 days of Sawyer coming in, we knew it was Ebola from laboratory tests done in two of our university laboratories, and then action was taken. I praise Nigeria for that. We had this emergency center from the polio network and we brought people in and traced almost 1000 contacts. This was not passive tracing; people went to contacts’ homes on a daily basis.

Q: So why are African countries so badly prepared? Is it a question of money?

A: People say African countries are poor. But it’s not poverty. It’s misuse of what we have. As we are talking, with all the crises that are going on, the presidents of our countries are still traveling in the best of conditions. Some will come to New York in their private jets, although their national airlines collapsed years ago; in addition, they will bring along a long retinue of private, personal, and public assistants, all lodged in the best hotels. I am not saying the president should not be treated well, but these are issues we need to look at.

Take my country: We do not have a national airline, but the number of private jets we have is more than all the airlines in Africa have together.

It’s a matter of priorities. I do not believe there is an African country that cannot buy gloves for its staff. Personal protective equipment may be very costly, they may need assistance on that. But let us participate. As long as we are wringing hands waiting for the next glove to come, we will never be ready. There are certain things we can do now, with the resources we have.

Q: So African leaders should be held more accountable for what they spend money on?

A: GAVI [a public-private partnership that funds vaccines for low-income countries] just sanctioned Nigeria after a critical audit report. GAVI gave us money to do certain things, and we could not account for $2 million or $3 million of it. GAVI insisted that Nigeria must pay back that money, and the government agreed. But our government should not just agree to pay back the money, the government should find out who misused the money, get the money back from those persons and not from public coffers. And those people should be brought before the courts to answer for the deaths of the children who did not receive the vaccines that the GAVI money would have provided.

Q: So how should African countries contribute to fighting the Ebola outbreak?

A: To give you one example, there are 600 Nigerian health care workers who want to go to Liberia. But the process of getting them there has been going on for months. If the African team, the African Union, the Economic Community of West African States, and the West African Health Organisation all get their acts together, there are more than enough people in Africa—health care workers from Gabon, DRC, Uganda, Sudan—who have experience with this.

But we must find the funds to provide insurance for all national and international health workers who are currently working or have volunteered to work in the Ebola-affected areas of Africa. Bear in mind, in Africa we do not have a welfare system. I am the welfare system for my family, my brothers, my uncle. So when I go to an Ebola region, I am thinking of the 23 other people that depend on me. If there is no insurance, I will stay home.

Q: There has been a lot of criticism of the WHO regional office in Africa.

A: I am angry at them, too. They should take the lead of Ebola control efforts—not Geneva, not Washington, not New York. The [Centers for Disease Control and Prevention] can help, [Doctors Without Borders] can assist, but it is WHO’s African region that should coordinate and take the lead. It’s all meetings and reports. Nothing on the ground.

Q: As it happens, they are meeting in Benin this week; on the agenda is the election of a new regional director.

A: These elections are just horse-trading. If the person who wants to get elected requires the vote from Nigeria for example, because it is the ministers of health who do the voting, I might say: “OK, I will vote for you, but I need one directorship from my country.” If he accepts that, he has to accept whoever I bring, regardless of how competent the person is. That is what has messed up Africa. WHO’s regional office has never been able to solve Africa’s problems because of this system of electing its leaders.

You want to find the most competent person. Vote on that basis. Not because I visited you and I promised you this or that.

Q: Do you think this unprecedented outbreak will change things?

A: I wish I could say with confidence that in 10 years’ time we will not be where we are now with Ebola. But the countries have totally lost control of what is going on. If you go to Sierra Leone or Liberia today, there must be at least 10 international groups there. At the end of this epidemic, everybody will pack their bags and leave. The African countries will be left not really knowing what has happened to them. Like someone hit them smack in the face, totally disoriented. There will be millions of scandals about how money was misspent and so on. We will focus on those and move on. Ten years from now, people will have forgotten that there was Ebola and we will be back to where we started.

source: The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.

News mashup: Life goes on amidst ebola

MONROVIA, Liberia — The girl in the pink shirt lay motionless on a sidewalk, flat on her stomach, an orange drink next to her, unfinished. People gathered on the other side of the street, careful to keep their distance.

Dr. Mosoka Fallah waded in. Details about the girl spilled out of the crowd in a dizzying torrent, gaining urgency with the siren of an approaching ambulance. The girl’s mother had died, almost certainly of Ebola. So had three other relatives. The girl herself was sick. The girl’s aunt, unable to get help, had left her on the sidewalk in despair. Other family members may have been infected. Still others had fled across this city.

Dr. Fallah, 44, calmly instructed leaders of the neighborhood — known as Capitol Hill, previously untouched by Ebola — how to deal with the family and protect their community. He promised to return later that day, and send more help in the morning. His words quelled the crowd, for the moment.

Dying of Ebola at the Hospital Door

Months into the Ebola outbreak, Liberia remains desperately short on everything needed to halt the rise in deaths and infections — burial teams for the dead, ambulances for the sick, treatment centers for patients, gloves for doctors and nurses. But it is perhaps shortest on something intangible: the trust needed to stop the disease from spreading.

Dr. Fallah, an epidemiologist and immunologist who grew up in Monrovia’s poorest neighborhoods before studying at Harvard, has been crisscrossing the capital in a race to repair that rift. Neighborhood by neighborhood, block by block, shack by shack, he is battling the disease across this crowded capital, seeking the cooperation of residents who are deeply distrustful of the government and its faltering response to the deadliest Ebola epidemic ever recorded.

“If people don’t trust you, they can hide a body, and you’ll never know,” Dr. Fallah said. “And Ebola will keep spreading. They’ve got to trust you, but we don’t have the luxury of time.”

With his experience straddling vastly different worlds, Dr. Fallah acts as a rare bridge: between community leaders and the Health Ministry, where he is an unpaid adviser; between the government and international organizations, which have the money to back his efforts.

But the scale of the task is daunting. He is trying to beat Ebola in a city of 1.5 million people where the disease is expanding exponentially, where entire families search in vain for medical care, and where the main hospital is dangerously overwhelmed, plagued by electrical fires, floods and the deaths of health workers infected with the disease.

Dr. Fallah has slowly begun winning over the city’s toughest neighborhood, West Point, the seaside slum where he spent two years of his childhood. Deadly clashes between angry residents and soldiers erupted recently after Liberia’s government placed the entire neighborhood under quarantine. The 10-day cordon, enforced by the army and the police, merely deepened the mistrust of the government in the city’s slums, the very neighborhoods most affected by Ebola.

They divided West Point into zones, much as was done during the war to ensure that everybody received food and other vital supplies. Surveillance teams of volunteers overseen by Dr. Fallah now scour West Point, searching for information about a dead or sick person, hoping to identify victims and remove the bodies before the disease can be passed on.

His teams visit every morning, tracing the circle of people around Ebola victims to see who else develops fevers or starts vomiting. This painstaking process, repeated until an outbreak is eventually contained, has extinguished past Ebola outbreaks in rural Africa — and may be the only hope of stopping it now.

“Dr. Fallah has taken the situation in West Point as if he were living here,” said Kenneth Martu, a political organizer in West Point. “We can say openly: Had he not been here, things would have gotten far worse.”

Two days after the government lifted the quarantine in West Point, the Health Ministry asked Dr. Fallah to start using the civil war-era zone system in two other Ebola-stricken neighborhoods, perhaps another signal of the government’s turn away from force in its campaign against Ebola.

“We feel that using the communities to provide the leadership for us to do the Ebola work is more effective,” said Dr. Bernice Dahn, a deputy health minister.

Dr. Fallah’s team of contact tracers pushed deep into West Point one morning, into a labyrinth of hovels and alleys that became ever narrower. A group of young men appeared abruptly, blocking the only exit, their intention clear. They went away, with a $10 bill.

“I usually carry small bills,” Dr. Fallah said. “But I forgot to break this bill this morning.”

Monrovia is the first city to face the full onslaught of Ebola. Tracing the contacts of Ebola victims has never been attempted on this scale, yet Dr. Fallah’s team has only five vehicles to monitor hundreds of thousands of people. One vehicle was in the shop for five days, so Dr. Fallah used his own.

In West Point, a slum of up to 120,000 people, Dr. Fallah deployed 15 volunteers to track 150 people who may have been exposed to the virus. The tracers fan out early in the morning to catch the people at home — they are supposed to stay indoors, but many do not — and to minimize contact with an often hostile community.

“On the field, as we are going, they are cursing us, passing around, talking plenty,” said Marie Harding, a tracing supervisor.

At one house — a large one by West Point standards, with eight rooms and, even more unusual, a restroom — about 20 people came to the entrance, emphatically stating that everything was fine. A man named Junior, who rented a room, had died in late August, apparently of Ebola, and a burial team had come to pick up his body three days later.

David Yeah, 75, the home’s owner, said that he had locked the room. Sprayers had come to decontaminate it; they had thrown the dead man’s clothes into the sea. The house’s other occupants had avoided the man before his death, bringing him neither food nor water, he insisted.

Dr. Fallah had seen this many times before. The government’s failure to provide basic services keeps undermining the trust he is trying to build. Burial teams take days to pick up the dead; ambulances — there are only about a half-dozen in the capital — respond to only a fraction of emergency calls. Those lucky enough to be transported to a treatment center are often turned back, taken home because of a shortage of beds, or left pleading at the gate for admission.

“The government has to keep its part of the bargain,” Dr. Fallah said, adding, “The community can do one thing for us. They can limit the spread. But they must see that their labor is leading to some fruit.”

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Dr. Mosoka Fallah, center, an epidemiologist and immunologist, with residents of New Kru Town, a district in Monrovia, Liberia.CreditDaniel Berehulak for The New York Times

The government’s lifting of the quarantine after 10 days also gave West Point a conflicting message. Many rejoiced at the move but interpreted it as proof that there was no Ebola in their community.

On the Sunday after the quarantine was lifted, churchgoers celebrated what many saw as West Point’s deliverance from Ebola. Inside the Dominion Life Church, next to an Ebola holding center, the faithful danced and — disregarding awareness campaigns to avoid touching and risk exchanging body fluids — shook hands and grasped one another’s arms with fervor.

“No, no, no, no,” the Rev. William Morlu, the church’s senior pastor, said when asked whether Ebola was present in West Point.

At the Church of Pentecost, Emmanuel Oben, 45, the chairman of a local P.T.A., said that the government was “not sincere.” But Dr. Fallah, whom he had met twice, was “a man that everybody wants to work with,” he said.

“People trust him,” he said. “He was once like us.”

When Dr. Fallah was 10 years old, his father lost his job as a driver for an American mining company, so the family moved to Monrovia. The family lived in West Point for two years and then moved to a squatter’s area called Chicken Soup Factory, where his parents eventually built a house. His mother still lives in it.

During Liberia’s civil war, he spent 11 years completing his college studies at the University of Liberia, and worked for Doctors Without Borders. A friend’s support led to graduate studies in the United States, where he earned a doctorate in microbiology and immunology at the University of Kentucky in 2011 and a master’s degree in public health at Harvard in 2012.

A project to open a maternal care clinic in Chicken Soup Factory brought Dr. Fallah back to Liberia after Harvard. The clinic opened in June but was shut down a month later because of the Ebola outbreak.

On an afternoon of heavy rain, Dr. Fallah drove out to two neighborhoods where local residents had begun organizing Ebola awareness campaigns on their own. In the face of the hysteria gripping the capital, they were joining forces and fighting back.

In one area, volunteers like Obediah Daykeay, 22, who had read up on Ebola in an Internet cafe, were instructing neighbors on the use of bleach and water to wash their hands. They had invited Dr. Fallah after hearing him on the radio.

“We are trying our best with the few resources we have,” Mr. Daykeay said. “Nobody else has come here.”

In another neighborhood, a group of youths had raised money to print an eight-page pamphlet on Ebola. Dr. Fallah spoke to them inside a church, urging them to organize monitoring teams.

The youths listened intently, fear visible on many faces, craning forward in their pews toward Dr. Fallah as rain beat noisily on the church’s corrugated roof.

“I’m not saying I know the answer,” Dr. Fallah said later. “I’m struggling like any other person to find the answer — just have a lot of spirit and God. But one thing I’ve realized is that the people in the community, some of them have the answers.”

Five ways UNICEF is fighting Ebola

BY ON 17 SEP 2014 via UNICEF BLOG

UNICEF Ebola Survivors Sierra Leone

1. Delivering supplies

We are delivering supplies that are important for the treatment and care of people who are sick with Ebola, and for continued supply of basic services. We continue to airlift essential supplies to the affected countries on a massive scale. By the first week of October we will have delivered 1300 metric tonnes and mobilized 55 flights. Read about what goes into making these deliveries happen.

2. Helping families protect themselves

In the coming weeks, we will be focusing on packing and shipping 50,000 Household Protection Kits. These kits contain gloves, gowns, masks, soap, chlorine and buckets. The first 9,000 of these will leave this week for Liberia. The Household Protection Kits complement the Family Hygiene kits which are already being packed and distributed in the country.

3. Preparing at-risk countries

UNICEF is also working with Governments in at-risk and neighbouring countries to prepare them for possible Ebola outbreaks. We are already sharing information with communities and developing contingency plans and stockpiles. Learn more about the work being done with communities in affected countries to raise awareness about Ebola.

4. Sending in extra staff

Building on our existing country presence in Liberia, Sierra Leone and Guinea, we are bringing in 67 additional staff members to these three most-affected countries. Another 37 staff members will be deployed in the coming weeks. We’re seeking committed professionals to join our Ebola emergency response team in West Africa.

5. Raising more funds to fight Ebola

We sent more than USD 7 million of our own resources to respond to the Ebola outbreak, including almost USD 4 million to Liberia alone. We have received approximately US 7.5 million from donors, but this is only 4 per cent of the total of USD 200 million we need to respond to this crisis.

UNICEF - Ebola is RealUNICEF - Ebola PreventionUNICEF - Ebola SpreadUNICEF - Ebola Symptoms

Why the ebola drama remains compelling

Ebola-victims

Originally posted July 26, 2014 and edited by me.

Nigerian doctor flaunts quarantine, infects 60

The hopes that Nigeria’s Ebola outbreak could be quickly stamped out have evaporated. The World Health Organization (WHO) this afternoonissued its first detailed report of the spread of the virus in Port Harcourt, Nigeria’s oil hub. Last week, authorities announced that a doctor there had died of the disease, after secretly treating a diplomat who had been infected in Lagos by a traveler from Liberia.

The doctor had close contact with family, friends, and health care workers during his illness, but he did not disclose his previous exposure to the virus. His infection wasn’t confirmed until 5 days after his death. Experts are now following hundreds of the doctor’s contacts, 60 of which had “high-risk or very high-risk exposure,” WHO says.

The diplomat had been instructed to stay in Lagos in quarantine. Instead he flew to Port Harcourt, where he was treated—in a hotel room—by the doctor from 1 to 3 August. The diplomat survived and returned to Lagos, presenting himself again to health authorities, who confirmed he was no longer was infected. He did not tell them that he had sought treatment in Port Harcourt.

The doctor who treated him became ill on 11 August. He continued treating patients at his private clinic for 2 days, operating on at least two of them. Between 13 and 16 August, he was ill enough that he stayed home, but, according to the WHO report, he received multiple visitors who came to celebrate the birth of a baby. On 16 August, he was hospitalized. He did not tell doctors there that he had been exposed to Ebola.

The WHO report is grim: “During his 6 day period of hospitalization, he was attended by the majority of the hospital’s health care staff,” it says, and members of his church community visited and performed a healing ritual that apparently involved laying on of hands. “On 21 August, he was taken to an ultrasound clinic, where 2 physicians performed an abdominal scan. He died the next day.”

It was not until 27 August that tests confirmed he was infected with Ebola.

His wife (who is also a doctor) and another patient at the hospital where he sought treatment are also infected. Twenty-one trained teams are monitoring more than 200 contacts, and a 26-bed isolation facility is set up. WHO says two decontamination teams and a burial team “are equipped and operational.”

The diplomat, associated with the Economic Community of West African States, may face manslaughter charges, according to Nigerian press reports.

*The Ebola Files: Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.