Doctors Without Borders: What We Need To Contain Ebola

Originally published on August 19, 2014 8:51 pm

With the continuous uptick in the number of cases and deaths in the current Ebola outbreak, the few agencies that are on ground are stretched thin.

That includes Doctors Without Borders, also known as MSF. It's one of the main health care providers in West Africa, where there are more than 2,000 cases of Ebola and 1,200 deaths. Even with roughly 1,000 volunteers spread among the three Ebola-stricken countries, the agency says that still isn't enough.

In an interview on All Things Considered, MSF's international president, Dr. Joanne Liu, tells NPR's Audie Cornish that they opened a new Ebola care center in Monrovia, Liberia, this weekend. It was equipped with 120 beds, and "all the beds got filled in one day."

"We're thinking about expanding, "she says. "But the reality is, we don't have a definitive picture of how many cases there are in the city right now."

Liu says that caring for patients is only one of the three "pillars" for controlling the Ebola outbreak. The other two are tracing possible Ebola cases and educating the community.

"Right now the only thing we're facing is fear," she says. "Fear is normal when you don't understand what is going on."

To eliminate that fear, the agency not only needs more funding but also more volunteers to talk to the community. "We need people who are going to go and ... talk to the elders, talk to the religious leaders and tell them about Ebola," she says. "[To] mobilize the population and make them understand what is going on."

She adds that MSF is also looking for volunteers to find out how many cases are in each village. "Right now we don't have a full picture of the magnitude of the epidemic," she says.

Enlisting help from the international community hasn't been easy. "NGOs that I used to see in some other crises, like after the Haiti earthquake or even in [Central African Republic] or South Sudan, are not present right now in Western Africa."

That's why Liu's on a tour, speaking to U.N. leaders and NGOs about how they can help. "There is some reluctance, I guess," she says. "Everybody has to overcome their own fear before coming to the field."

She says that MSF has been "ringing the alarm" since the beginning of the epidemic, but it's been slow wake-up call for the other NGOs. That's likely because past Ebola oubreaks were contained in a matter of weeks.

"But what is happening now is that we have cases in a highly dense, populated area like Monorovia, with 1.3 million," she says. Without the involvement of other organizations, she says, "we will not be able to contain the Ebola epidemic."

And it's not only Ebola victims who suffer. With hospitals and care centers crowded, it's also been difficult for people seeking other types of care like for malaria or for maternity issues — what Liu calls an "emergency within the emergency."

"We were faced with the really hard reality of welcoming six women who were pregnant and who lost their children because they were walking around the city trying to find a place to deliver their babies," she recalls. "By the time they got to our centers, the babies were not alive anymore."

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AUDIE CORNISH, HOST:

In West Africa, the numbers continue to mount in the worst Ebola outbreak the world has ever seen. Ebola has now claimed more than 1,200 lives, almost all of them in Guinea, Liberia and Sierra Leone. More than a thousand others are known to be sick. Doctors Without Borders is the main organization on the ground caring for patients. And their staff face a dangerous challenge, dealing with a highly contagious virus. Amos Tuba (ph) was disinfecting an isolation center on the outskirts of the Liberian capital, Monrovia.

AMOS TUBA: I have to be brave to do it. That's the only way we can attack the virus. We need brave people to do it. The fear is that we have to put a (unintelligible).

CORNISH: Earlier I spoke with Joanne Liu, the international president of Doctors Without Borders, who's just been in West Africa. This week she's in New York, trying to drum up international support for what she's calling a public health disaster of unprecedented magnitude.

JOANNE LIU: The reality is all of us who are dealing with Ebola in this particular epidemic are breaking new grounds. We never faced an epidemic of Ebola of that kind of magnitude and that much spread in the past. And so all of us are reviewing our, I would say, standard operation because what was applied in some isolated remote villages in the past, you cannot do a cut and paste right now of what is going on and in the urban area like Monrovia.

CORNISH: At this point, what additional resources are you looking for?

LIU: We're looking for mobilization in terms of hands-on in the field. So right now, I think the world is looking at what's going on in Western Africa with Ebola. There has been some uphill in pledge in terms of money, that's one thing. We're going to need to make sure that the money will have some fast-track in terms of being available quickly and not in two or three or four months. We need money now. But in addition to that, we need people who's going to go and talk to the community, talk to the elder, talk to the religious leader and tell them about Ebola, and in order to mobilize the preparation and make them understand what is going on, how to avoid it, how to prevent it. That's one thing. But we need, as well, people who are going to walk around and find out how many cases we have in each villages, because right now, we don't have a full picture of the magnitude of the epidemic.

CORNISH: But where do you think this is going to come from? I mean, do you sense some reluctance here on the part of the international community?

LIU: I would say NGOs that I used to see in some other crises, like after the Haiti earthquake or even in CAR or South Sudan, are not present right now in Western Africa.

CORNISH: Are not present?

LIU: No.

CORNISH: What have you heard from these organizations? I mean, have you reached out to them and said hey, you know, help us?

LIU: Yeah, this is what I'm doing right now. I'm doing a tour. I have meeting here, the U.N. - but I'm meeting, as well, some bilateral state government representative. I'm meeting other NGO. We have been ringing the alarm since the beginning of the Ebola epidemic.

CORNISH: But what has been the response? Are they basically saying to you we don't want to endanger our people? Are they saying that we don't think the local government support on the ground is there to help us and make our work possible? What are their arguments?

LIU: I don't think people are giving arguments. I think they were a bit, I would, of a slow wake-up call. I think it comes from our past experience. In the past, we used to have Ebola epidemic in some remote isolated villages, and it was a business of a few weeks because basically the chain of transmission will die off very quickly. But what is happening now is the fact that we have cases in a highly dense populated area like Monrovia with 1.3 million, and we have no clue how it will evolve and how will be the chain of transmission.

And this is why we need much more actors now. And the reality is, I cannot predict you how long it's going to last, but the reality is it will not be a matter of weeks. It's going to be a matter of months. And if there's no other actors coming to the field and stepping up to the plate and helping, we will not be able to contain the Ebola epidemic. The only way to contain is to work and increase the capacity locally and it starts by barricading ourselves in our home country in the Western world.

CORNISH: Given the effect that this has had on the health worker community, where doctors and nurses have been infected and even died of Ebola, what has this done to the health infrastructure of these countries? I mean, what is it like if you don't have Ebola and you're trying to get care?

LIU: Yeah, this is actually what I call the emergency within the emergency. And right now, it's really one of the big problems besides Ebola. It's the fact that if you're sick today in Monrovia and you're seeking care for malaria, you might not be able to find anyone to give you your malaria treatment. We were faced with the - I would say, really hard reality of welcoming six women who were pregnant and who lost their children because they were walking around the city trying to find a place to deliver their babies. By the time they got to our centers, the babies were not alive anymore.

CORNISH: Dr. Joanne Liu. She's the international president of Doctors Without Borders. Thank you so much for speaking with us.

LIU: Thank you. Transcript provided by NPR, Copyright NPR.