As Ebola Rages, Poor Planning Thwarts Efforts

On a freshly cleared hillside outside the capital, where the trees have been chopped down and replaced with acres of smooth gravel, the new Ebola treatment center seems to have everything. There are racks of clean pink scrubs and white latex boots, bathrooms that smell like Ajax, solar-powered lights, a pharmacy tent, even a thatch-roofed hut to relax in.

But one piece is missing: staff. The facility opened recently with a skeleton crew. Now, in an especially hard-hit area where people are dying every day because they cannot get into an Ebola clinic, 60 of the 80 beds at the Kerry Town Ebola clinic are not being used.

It is like this with a lot here: good intentions, bad planning. Aid officials in Sierra Leone say poor coordination among aid groups, government mismanagement and some glaring inefficiencies are costing countless lives.

Some officials argue that the whole response system seems to be begging for a McKinsey & Company, or some other troubleshooter, to rush in and problem solve.

Ambulances, for example, are being used to ferry blood samples, sometimes just one test tube at a time, while many patients die at home after waiting days for an ambulance to come.

Half of the patients in some front-line Ebola clinics do not even have Ebola, but their test results take so long that they end up lingering for days, taking beds from people whose lives hang in the balance and greatly increasing their own chances of catching the virus in such close quarters.

Even after patients recover, many treatment centers delay releasing them for more than a week until there are enough other survivors, sometimes dozens, to hold one huge goodbye ceremony for everyone — again, keeping desperately needed beds occupied. “I just wanted to get home and see my wife,” said Suliman Wafta, a recent Ebola survivor treated nearby. “But I had to wait eight extra days.”

The latest Ebola numbers are ominous. This past week, Sierra Leone reported almost 100 new cases in a single day, nearly double the number just 10 days before — and those are only the confirmed cases, which health experts say may be a third of the total. At this rate, the swelling roster of the gravely ill will far outstrip even the most optimistic projections for new hospital beds.

The recriminations are beginning to fly, especially against Britain, which, in a carve-up of Ebola-afflicted countries, is the international power taking the lead here. “Why are the British here? To end Ebola, or party?” read a headline in a local newspaper. It added, “While their American counterparts are working hard to end Ebola in Liberia, our so-called colonial masters are busy living the life of Riley.”

British officials say that is not true, and that the 800 or so soldiers deployed here, who are building new treatment centers and training medics, are not allowed even a beer. “We’re working from 7 a.m. to 10 p.m., seven days a week,” said Maj. Simon Reeves, a spokesman.

A big question people here are beginning to ask is whether the American military, which has sent 2,400 troops to Liberia, has any appetite to come to Sierra Leone. Many aid officials say the Pentagon’s role in building treatment centers, establishing mobile blood labs and ferrying Ebola supplies around Liberia has helped slow the epidemic there.

An Obama administration official in Washington said that no decision had been made to shift American troops from Liberia to Sierra Leone or send in large numbers of reinforcements, but that “nothing is off the table.”

Like others, the official kept citing the “Brits’ primacy” in Sierra Leone — a reference to how, several months ago, Western powers divided Ebola responsibilities in West Africa along historical lines, with the United States helping Liberia, a nation founded by freed American slaves in 1822; France helping a former colony, Guinea; and Britain helping its own former colony, Sierra Leone.

According to several other American officials, the Pentagon was not enthusiastic about getting involved in Liberia in the first place and is resistant to going deeper into the region.

“They basically said, ‘We know conflict, but we don’t know Ebola,’ ” said one American official in West Africa. The military is also tired from fighting two long wars, the official said.

The Pentagon press secretary, Rear Adm. John F. Kirby, said the Defense Department was continuing to “monitor the spread of Ebola,” and was “mindful that it doesn’t just exist in Liberia.” In the next month, it will send two mobile blood labs to Sierra Leone to help reduce the bottlenecks caused by delays in testing.

Many aid officials in Sierra Leone said they crave a more effective command structure. The government runs a national emergency center, but aid officials said that with scores of foreign experts, government delegations and private charities flocking here, coordination was still messy, with many gaps and overlaps. It is extremely difficult, they said, to get even the most basic information, including how many treatment centers exist.

There are also growing questions about corruption, with the government announcing recently that it had found 6,000 “ghost medical workers” on its payroll, even as real Ebola burial teams and front-line health officers say they have not been paid in weeks.

Nothing, though, has raised more eyebrows than the new Kerry Town Ebola clinic, about a half-hour’s drive from the capital, Freetown. The clinic is an impressive campus of blue and white buildings lined up in perfectly straight rows, with all the orderliness of a military camp. It remains quiet, though, without enough trained nurses or hygienists to operate safely at anywhere close to capacity.

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Dan Mullin is an active writer and editor for the Pluto Daily who covered the 2014 Ebola Outbreak. Mullin attended the Wake Forest School of Medicine before leaving to pursue his lifelong science goal of allowing humans to live forever via a computer/brain transfer.