Liberia: working with communities is the key to stopping Ebola

Lofa County used to be a hotbed site for Ebola.  Now it is a model on how to control the spread and death rate from Ebola.  Read the WHO’s report of how the local communities worked together:                            Liberia: working with communities is the key to stopping Ebola

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QUESTION: why has the case fatality rate for Montserrado County (Monrovia area) EXPLODED from 58% to 95%?

In epidemiology, a case fatality risk (CFR) — or case fatality rate, case fatality ratio or just fatality rate — is the proportion of deaths within a designated population of “cases” (people with a medical condition), over the course of the disease.  -Wikipedia

There has been a drastic increase in the Ebola case fatality rate (CFR) for Montserrado County (the Monrovia area).  On September 10, 2014, the CFR was 58% in Montserrado County.  But since then, the CFR for the Monrovia area has been steadily climbing and in just 4 weeks reached a staggering high of 95% on Oct. 13-15, 2014, according to MOHSW Situation Reports.  It declined somewhat to 92% by Oct. 20th, 2014.

What is going on?  Can a good reporter out there investigate and get some answers?

Why is the mortality rate so high for Montserrado County?  What are the factors contributing to the unacceptable death rate figure for this area of Liberia?  Is it because there are more cases than beds available in the Ebola Treatment Units?  Is there a lack of food and supplies for patients and health care workers?  Are the sick being left to die due to the fear relatives have of contracting the disease?  Are the MSF home kits for treating Ebola patients insufficient?  Are children left to try to take care of the ill parents and are unable to do so?  Or, as The Guardian has reported (Ebola cremation ruling prompts secret burials in Liberia Treatment centres half-empty as families keep infected at home to avoid presidential decree that Ebola victims must be cremated), have Liberians avoided the Monrovian ETUs because the dead will be cremated?  Are there in fact many EMPTY beds at Ebola Treatment Units in Monrovia?  The Guardian reports that “out of 742 spaces, only 351 were occupied, said assistant health minister Tolbert Nyenswah.”  Is this true?

Is there a gap between needs of the sick and the ability to handle the numbers of Ebola-infected patients in Montserrado County?  Or is there a cultural gap that is causing the horribly high CFR in Montserrado County?  In The Guardian’s article above, one suggestion has been to create a monument with all the names of Ebola victims where relatives can go on Decoration Day when grave sites are cleaned and decorated, to honour their ancestors and remember them.  “The erection of a monument bearing the names of all Ebola victims would not take away the sad memories but it would at least pacify the broken heart somewhat.”

Graph of CFR — for Liberia and the counties of Lofa, Margibi, Montserrado, Nimba                  Oct. 20 2014 Case Fatality Rate Graph of Ebola in Liberia

Other counties of Liberia are seeing encouraging signs of progress against Ebola.  Nimba has seen a drop of 22% in its CFR to 50%.  Both Lofa and Margibi counties seem to be holding steady and are not seeing the dramatic rise in the CFR that Montserrado is experiencing.

It is clear to see that Monrovia and Montserrado County need much more international help and the world is way behind in providing it.

 P1010602

Local Liberians rally to send food, supplies overseas

by Jen Rini, The News Journal 9:18 a.m. EDT October 24, 2014

Sei Boayue’s uncle was just trying to do the right thing.

His uncle had seen how Ebola had seeped into his beloved Ganta, a town nestled on the border of Liberia and Guinea.

The market there was teeming with people forced to purchase food every day because of a lack of refrigeration. But in the market, there is no way to tell who is infected.

So his uncle made the decision to travel there every day alone, and keep his wife, son, daughter-in-law and grandchild at home away from the risk.

It didn’t work.

“They all passed from the virus. No one survived it. The unfortunate thing is this is now becoming a commonplace thing,” Boayue, 57, of Townsend, said. “After my uncle died, you sit here and everything seems to be so daunting. You wonder: is there anything I can do?”

Boayue didn’t sit for long. Just weeks after the deaths of his relatives, Boayue and other Liberians living in Delaware are fueling an effort to send as much food and supplies as they can to their remaining family and friends trying to survive in Liberia.

To date, 4,555 people in West Africa have died from the virus, 2,705 in Liberia. And those numbers continue to grow.

Boayue is working with the Delaware Community Foundation to start a charity dedicated to sending nonperishable foods abroad, a luxury for those living in the heart of the Ebola crisis. His charity is aptly named the Ebola Crisis Orphans Fund.

He still has nine siblings who are living in the affected areas. He hasn’t heard from one sister in over a month. There’s no communication to say where she is, or even if she is alive, he said.

In Liberia, the tragedy is there is no such thing as “local” food. Traditionally, most of the food ending up on Liberians’ plates has been imported, he said. After a string of civil wars over 14 years, and now the Ebola disaster, food prices have doubled and tripled.

Even if he raises enough money to buy food, copious amounts of red tape stands between his group and getting those goods on the ground to the people that need it most.

“How many kids will die within that time period,” he said.

“The situation in Liberia is such that cultural attitudes also had a big part to play in the out-of-control nature of this crisis. What would help most people is food security.”

Jarso Jallah Saygbe, a Liberian living and working in Dover, agreed that sanitizer and Clorox are not enough.

“The approach needs to be holistic,” Jarso said. Her family living in Liberia takes each day at a time. Jarso talks to her sister almost every day and tries to send as much money and supplies as she can.

“You never know when the phone rings what’s going to happen,” she said.

Jarso’s brother-in-law, Moses Ndama, pastor of the Freedom Christian Fellowship in Dover, held an informal meeting Wednesday evening to jump start planning for an organized donation effort for children in need abroad.

Food, clothes, rain boots and school supplies are all needed, said her husband, Moses Saygbe, who is Ndama’s brother. The church is hosting a meeting Saturday at 10 a.m. to gather Delawareans from all walks of life, from West Africa to Seaford, to mobilize against the Ebola crisis.

As the planning takes off to send aid abroad, Moses said it is important for the local Liberian community to work with the state to preemptively prepare for an Ebola case in Delaware.

He’d like to see the state institute special residential centers in Delaware used to screen and house West Africans traveling into the state from the affected areas. Efforts like this would erase the stigma that every Liberian is living with Ebola, he said.

“We need to end prejudice. We are not the virus,” Ndama added.

For now, the Freedom Christian Fellowship is working to send goods directly to a sister organization in the Brewerville community in Liberia.

Last weekend, the community received Clorox, hand sanitizers and soap, Ndama said. It still took a month for the goods to get there, but it’s better than nothing.

They hear stories every day that are heartbreaking, but the kids are the hardest hit, Ndama said. Schools have been closed since late July. Children, many orphaned, are forced to beg on the streets and scrounge for money.

The future of Liberia rests with nurturing these children, he said.

“If we don’t invest in the kids, we will lose the future generation,” Ndama said.

“We can defeat Ebola, but can we survive after?”

Jen Rini can be reached at 302-324-2386 or jrini@delawareonline.com. Follow @JenRini.

CHURCH OUTREACH

What: A statewide meeting hosted by the Freedom Christian Fellowship to discuss donations, plans for more community outreach.

Where: Freedom Christian Fellowship, Dover, 4164 North DuPont Hwy. (North Dover Shopping Center)

When: Saturday, 10 a.m.

DONATIONS

Ebola Crisis Orphans Fund

Delaware Community Foundation

100 W. 10th St, Ste. 115

PO Box 1636

Wilmington, DE 19899

(302) 312-5865

www.delcf.org

Source:  http://www.delawareonline.com/story/news/local/2014/10/23/local-liberians-rally-send-food-supplies-overseas/17807169/      Local Liberians rally to send food, supplies overseas

Liberian Slum Takes Ebola Treatment Into Its Own Hands

Capital’s West Point Neighborhood Takes Steps to Quell Outbreak After It Rebelled Over Government’s Quarantine in August

In West Point, the largest slum in Monrovia, Liberia’s capital, many residents now use chlorinated water from buckets to wash their hands—one step toward preventing the spread of Ebola. In West Point, the largest slum in Monrovia, Liberia’s capital, many residents now use chlorinated water from buckets to wash their hands—one step toward preventing the spread of Ebola. Heidi Vogt/The Wall Street Journal

MONROVIA, Liberia—Two months after Liberia’s largest slum fought a government-imposed Ebola quarantine, residents are in a desperate push to conquer the deadly virus—with or without the government’s help.

It is a marked change from August, when many in West Point argued Ebola was a hoax and some residents even dumped the highly contagious corpses of Ebola victims into a nearby river to avoid handing them over to the government’s body-collection teams.

Ebola is still spreading through West Point, but so are changes to habits and traditional practices that offer a glimmer of hope in an impoverished country’s fight against the deadly virus. The shift is also key to the international effort to contain the disease.

West Point isn’t the only place where attitudes are shifting, but it is particularly remarkable because the slum—where more than 50,000 people live in closely packed tin-roofed shacks—is one of the poorest districts of the capital city and because the government almost gave it up for lost.

When President Ellen Johnson Sirleaf imposed the quarantine in mid-August, Ebola was threatening to consume the slum. Angry about being sealed off and abandoned by the government, residents of West Point rioted in anger and overran a school that was being used as an Ebola holding center.

Ebola is a highly contagious virus, but only if you come into contact with certain bodily fluids of those infected. What do scientists know about how it’s transmitted? WSJ’s Jason Bellini has #TheShortAnswer.

Mrs. Johnson Sirleaf lifted the quarantine after 10 days, but the measure became a catalyst for the community. When the lockdown ended and international aid organizations poured into West Point with bleach, rubber boots and information, community leaders decided they needed to take action fast.

Prince Mambu, the head of a community group called Health Education, Sanitation and Sensitization Group, started going house to house talking with people who have had contact with victims. It is now routine. He reminds his neighbors to stay in their houses and asks about symptoms.

“I ask them, ‘Do you have a headache?’ But also I watch their eyes. Sometimes they say no but if I detect that they look weak, I will report it to the others. If they are willing, I will call for an ambulance,” Mr. Mambu said.

The group also spreads the sanitation message throughout the community: Wash your hands with a bleach solution. Don’t touch anyone who is sick.

Streets police once blocked off to pedestrians and cars now teem with local residents recruited as workers to distribute bleach and hand out advice. One recent afternoon, 22-year-old Mechie Seih told charcoal seller Mamie Kollie how to lower infection risk if a family member falls ill: “You put clean plastic bags on your hands. You wear a thick jacket with long trousers. You put shoes and socks on your feet.”

Community health worker Mechie Seih gives charcoal seller Mamie Kollie bleach and soap to help her protect herself and her family against Ebola. Community health worker Mechie Seih gives charcoal seller Mamie Kollie bleach and soap to help her protect herself and her family against Ebola. Heidi Vogt/The Wall Street Journal

Ms. Kollie nodded. She is being careful: Already outside her shop is a bucket of chlorinated water for washing hands. A woman selling dried fish nearby said she had stopped eating meat from animals like monkeys and rodents—commonly called bush meat—a suspected source of infection. A few doors down, a barber said special body-collection teams are receiving calls from families when someone dies.

Pharmacist Doris Nyenkan says she now tells customers complaining of fever to get tested for Ebola. She also now stays a few feet away from customers and washes her hands at least once an hour.

“People clean their homes every day now. Now they are washing their hands, buying this gel,” Ms. Nyenkan said, pointing to a bottle of hand sanitizer. “Before Ebola you didn’t see people doing such things.”

Such steps are important: The Liberian man who brought Ebola to the U.S. contracted it in Monrovia when he tried—without proper protection—to help a pregnant neighbor who had fallen sick.

The Liberian government isn’t absent from West Point: The clinic here is helping triage patients and government workers are among those handing out information and collecting bodies.

Tolbert Nyenswah, the head of the Liberian government’s Ebola response, applauded West Point as one of a few Monrovia neighborhoods where residents have taken charge of the effort.

“They have their own active case finding, and they are quarantining households and checking for strangers. If people are sick, they report that to the call center,” Mr. Nyenswah said.

But many in West Point say they are taking responsibility because the government deserted them. Even now, they would be much worse off had they depended on the government.

“During the quarantine, medical teams were not coming here. There were no ambulances, things were just terrible here,” Mr. Mambu said. It is better now, but the government is still too slow to respond: Ambulances sometimes take a day to arrive, he said.

Pharmacist Doris Nyenkan takes money from a customer at her store in the West Point slum in Liberia's capital. She says that since the Ebola outbreak started she stands far back from her customers to avoid contact. Pharmacist Doris Nyenkan takes money from a customer at her store in the West Point slum in Liberia’s capital. She says that since the Ebola outbreak started she stands far back from her customers to avoid contact. Heidi Vogt/The Wall Street Journal

Now, when West Point residents need an ambulance, many call Kenneth Martu —who works for a U.S.-funded charity that hired a private ambulance. Mr. Martu’s ambulance team averages about 10 calls a day and gets to people within about 30 minutes of the call, he said.

The charity, called More Than Me, ran a school for girls from West Point before the Ebola outbreak. Now, it is paying for nurses to do rounds in West Point and providing lunch for Ebola response workers, in addition to sponsoring the ambulance service.

The sad reality is that it still may not be enough. Mr. Mambu has tracked Ebola deaths in the community and says that although the numbers have gone down in recent weeks, bodies are still being carried away every day. Even though those who have had contact with Ebola patients are told to stay home, Mr. Mambu said no one is dropping off provisions, so many still go out in the evening to buy food.

And some are still treating their sick at home because of fear or lack of beds at centers.

Paris-based Doctors Without Borders is distributing home-care kits in West Point and other neighborhoods so those who are treating their sick at home don’t have to resort to covering their hands with plastic bags. That is itself an acknowledgment of failure to get people into treatment centers.

“The key is—in addition to the community being aware of how you get the disease and what the symptoms are—is find the sick person as fast as possible and put them in isolation in a treatment center,” said Laurence Sailly, the emergency coordinator for Doctors Without Borders in Liberia.

With Ebola, she said, “one case is an epidemic.”

Write to Heidi Vogt at heidi.vogt@wsj.com

Local Liberians rally to send food, supplies overseas

by Jen Rini, The News Journal 9:16 p.m. EDT October 23, 2014

Local Liberians rally to send food, supplies overseas

Sei Boayue’s uncle was just trying to do the right thing.

His uncle had seen how Ebola had seeped into his beloved Ganta, a town nestled on the border of Liberia and Guinea.

The market there was teeming with people forced to purchase food every day because of a lack of refrigeration. But in the market, there is no way to tell who is infected.

So his uncle made the decision to travel there every day alone, and keep his wife, son, daughter-in-law and grandchild at home away from the risk.

It didn’t work.

“They all passed from the virus. No one survived it. The unfortunate thing is this is now becoming a commonplace thing,” Boayue, 57, of Townsend, said. “After my uncle died, you sit here and everything seems to be so daunting. You wonder: is there anything I can do?”

Boayue didn’t sit for long. Just weeks after the deaths of his relatives, Boayue and other Liberians living in Delaware are fueling an effort to send as much food and supplies as they can to their remaining family and friends trying to survive in Liberia.

To date, 4,555 people in West Africa have died from the virus, 2,705 in Liberia. And those numbers continue to grow.

Boayue is working with the Delaware Community Foundation to start a charity dedicated to sending nonperishable foods abroad, a luxury for those living in the heart of the Ebola crisis.

He still has nine siblings who are living in the affected areas. He hasn’t heard from one sister in over a month. There’s no communication to say where she is, or even if she is alive, he said.

In Liberia, the tragedy is there is no such thing as “local” food. Traditionally, most of the food ending up on Liberians’ plates has been imported, he said. After a string of civil wars over 14 years, and now the Ebola disaster, food prices have doubled and tripled.

Even if he raises enough money to buy food, copious amounts of red tape stands between his group and getting those goods on the ground to the people that need it most.

“How many kids will die within that time period,” he said.

“The situation in Liberia is such that cultural attitudes also had a big part to play in the out-of-control nature of this crisis. What would help most people is food security.”

Jarso Jallah Saygbe, a Liberian living and working in Dover, agreed that sanitizer and Clorox are not enough.

“The approach needs to be holistic,” Jarso said. Her family living in Liberia takes each day at a time. Jarso talks to her sister almost every day and tries to send as much money and supplies as she can.

“You never know when the phone rings what’s going to happen,” she said.

Jarso’s brother-in-law, Moses Ndama, pastor of the Freedom Christian Fellowship in Dover, held an informal meeting Wednesday evening to jump start planning for an organized donation effort for children in need abroad.

Food, clothes, rain boots and school supplies are all needed, said her husband, Moses Saygbe, who is Ndama’s brother. The church is hosting a meeting Saturday at 10 a.m. to gather Delawareans from all walks of life, from West Africa to Seaford, to mobilize against the Ebola crisis.

As the planning takes off to send aid abroad, Moses said it is important for the local Liberian community to work with the state to preemptively prepare for an Ebola case in Delaware.

He’d like to see the state institute special residential centers in Delaware used to screen and house West Africans traveling into the state from the affected areas. Efforts like this would erase the stigma that every Liberian is living with Ebola, he said.

“We need to end prejudice. We are not the virus,” Ndama added.

For now, the Freedom Christian Fellowship is working to send goods directly to a sister organization in the Brewerville community in Liberia.

Last weekend, the community received Clorox, hand sanitizers and soap, Ndama said. It still took a month for the goods to get there, but it’s better than nothing.

They hear stories every day that are heartbreaking, but the kids are the hardest hit, Ndama said. Schools have been closed since late July. Children, many orphaned, are forced to beg on the streets and scrounge for money.

The future of Liberia rests with nurturing these children, he said.

“If we don’t invest in the kids, we will lose the future generation,” Ndama said.

“We can defeat Ebola, but can we survive after?”

Jen Rini can be reached at 302-324-2386 or jrini@delawareonline.com. Follow @JenRini.

CHURCH OUTREACH

What: A statewide meeting hosted by the Freedom Christian Fellowship to discuss donations, plans for more community outreach.

Where: Freedom Christian Fellowship, Dover, 4164 North DuPont Hwy. (North Dover Shopping Center)

When: Saturday, 10 a.m.