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Four Blocks from Hell

Ebola and Health Care Collapse in Liberia

by Geordie Gwalgen Dent

Ebola in Guinea PHOTO European Commission DG ECHO
Ebola in Guinea PHOTO European Commission DG ECHO

Authors Note:  The main person interviewed for this story (John) has had his name changed due to fear of reprisal from work.

John was working for an Ontario mining company doing exploration drilling in Liberia.  He had been there on and off for a couple years when the ebola outbreak hit Monrovia, the capital.

The outbreak started in Liberia in April when it had come over from Guinea.  There were 7 cases in Liberia right on the border of Guinea.  "That was the first outbreak and cause they had no new cases for 3 weeks after that, they figured it was gone from Liberia,"  he said.

"At that time everyone took it as a joke in the newspapers for trying to make it into a big thing.  Some politicians aware trying to make it into a big deal while others were slamming them for striking fear into the public.  But that was the first one." 

Five months later, John fled the capital.  

"When I left, the government had issued a state of emergency - same thing as our Martial Law - no people had rights, the government was trying to stop movement of people."

West point  - a slum - was isolated by the government.  After putting up big iron gates to cut if off from the rest of the City, there were riots and a 15 year old boy was shot and killed.

At that point according to John, the health system in Monrovia slowly melted down. 

"They were building, right in the middle Monrovia, ebola isolation tents about 4 blocks from where I was staying down the road," next to a big hospital compound.  "The hospital was overflowing," said John. When the outbreak started, everyone was going to the most common form of health care in Monrovia: small health clinics.

"All these little clinics, everyone one there was nurses and doctors.  They started getting sick with ebola. So they shut down and the only place people could go were these ebola isolation compounds."

John, who got malaria in March, was at the compound before the outbreak hit.  "They were overflowed with patients…they only had 80 - 100 beds."  The biggest problem was for people who didn't have ebola.  Because typhoid and malaria have very similar symptoms of ebola, it is very hard to determine who has what, and many people with those symptoms were being put in the isolation compounds regardless.

Worried about his malaria flaring-up, John started making calls and found there was one clinic left.  "They told me that if I was in there, they would diagnose me at the gate and they would give me what I would need to go home. I was afraid of getting these other things [malaria and typhoid].  If I do, what am I going to do, where am I going to go? Basically their health system collapsed."

When John left in August there were over 350 deaths due to ebola.   As of writing there were  over 1,500 in Liberia and 3,000 in the region.   

According to John, the government started getting excavators from various companies and digging holes in the communities to act as mass graves.

"This wasn't going well in the community," he said.   "This wasn't just ebola…this could have been a baby dying or a guy hit by a truck.  This caused an uproar in the community because they have strict burial practices.

"People would bury the dead and wash and kiss the body when people had died.  At the funerals, lots of people would kiss the bodies and that's when the bodies are most contagious, when they are dead."  

When John left, people were starting to take it seriously.  Every station had a chlorine and bucket station and every business had a place to wash your hands before you enter.   "But still a bunch of the population that thought it was a conspiracy," he said.  "People were hiding that they were sick because they didn't want to get stuck in the isolation hospitals.   Families were hiding their sick members [to avoid the isolation hospitals] and then the family would get sick."  

When John left to come back to Canada he was surprised at the number of questions he got form the American and Canadian border guards: there were none.  

"I thought for sure they were going to ask me where I was. I thought I would have been questioned and screened, something as simple as like checking your temperature, because that's your first symptom, but there was nothing."  

According to John, no one from his flight was checked in New York or Canada.  "I was 4 blocks from an isolation centre, Monrovia was infected everywhere."

In an interview with the Toronto Media Co-op, Dr. Michael Gardam, director of infection prevention and control at the University Health Network, said that this is actually normal.

"We learned during SARS that admission screening is not a useful way of detecting cases--it is far too inefficient. Screening on leaving a country is more effective (stopping ill people from boarding planes)," he said.

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