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    Aid groups see long-term planning as key to Ebola fight

    Conquering Ebola in West Africa will require not just building new treatment units, but sustained efforts to shore up health services, provide a steady stream of workers, and prepare for future outbreaks, say leaders of two aid organizations who recently returned from trips there.

    “We do need to control the disastrous effects of this outbreak, but we also have to rebuild,” said Dr. A. Frederick Hartman, infectious disease specialist for Management Sciences for Health, a global agency that has helped build locally run health systems in poor countries around the world.

    Hartman recently returned from a trip to Liberia, where he assessed ways his agency, which focuses on organizing health systems, can help with an epidemic that continues to claim 2,000 lives a month.


    At a press briefing Thursday, Hartman said that Liberian health officials implored him: “Please, please don’t invest all these millions of dollars and fold up your tent and run away. . . . Please make sure whatever you do builds our capacity to respond.”

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    Dr. Jonathan D. Quick, Management Sciences president, noted that Ebola in West Africa is not the last epidemic the world will face, and it has exposed failures on local and global levels. “This epidemic was preventable,” Quick said. “This is the first time in 40 years that you’ve got an [Ebola] epidemic that’s gone more than a few hundred cases.”

    Another Boston-based aid agency, Partners in Health, is working in both Liberia and Sierra Leone, struggling to establish small treatment units and recruit staff. In a phone interview, Dr. Joia Mukherjee, chief medical officer, called for organized efforts to supply health care workers.

    “We need way more people,” Mukherjee said. “We’re relying on volunteerism in a massive international crisis. I don’t think that’s the way we should collectively approach this.”

    Each volunteer with Partners in Health faces a minimum commitment of nine weeks: two for training, four to work, and three for quarantine to ensure they have not been infected. “You can’t go and do this, at great personal risk, for free,” she said. “We need to institutionalize a response.”


    Mukherjee proposes that teaching hospitals and big medical practices get together and donate staff, each providing a few doctors or nurses who would like to help out. “People could sign up and not fear losing their jobs,” she said. “Right now people are pulling in favors, they’re using their vacation.”

    She also said that a global indemnification program should be put together to cover workers’ liability.

    In Liberia, said Hartman, the pace of new infections seems to have leveled off, with some Ebola treatment centers only half-full. But the epidemic could resurge at any time, especially as people move around the country: migrant workers involved in the harvest, rural dwellers visiting relatives in the city for Christmas, city residents returning to relatives in the country to be cared for when ill.

    Also, he added, “We’re concerned there may be a lot of hidden cases. Liberia has started cremating all victims, all cadavers. Liberians hate that; it’s not their cultural practice. People may prefer to stay and die at home.” The treatment centers are large and impersonal, and relatives are banned.

    “All hidden cases are a potential reservoir of new infection and new outbreak,” he said.


    That’s why developing community care centers, located close to victims’ homes and staffed by trusted local workers, is one of three goals that Management Sciences for Health established after the recent trip. The agency hopes to raise money to pursue these goals, which also include restoring essential health services for all sicknesses, and strengthening efforts to identify new cases of Ebola.

    ‘You can’t go and do this, at great personal risk, for free. We need to institutionalize a response.’

    Hartman said his trip left him with glimmers of optimism.

    In Bomi County, about two hours north of the Liberian capital of Monrovia, he spoke with women who had survived Ebola and then volunteered to care for others at a “ramshackle, two-building community treatment center” established by a local doctor. As survivors, they are immune from reinfection with Ebola.

    “They described Ebola as a very painful, very dreadful disease, brought them to their hands and knees, severe abdominal pain. And then all of sudden they got better. [One of the women] said, ‘We are here to help our brothers and sisters so they don’t have to go through all the pain that we did.’ . . .

    “I sort of came away from that pretty optimistic that the people of Liberia haven’t lost faith, that they feel they can confront this challenge and overcome it.”

    Felice J. Freyer can be reached at Follow her on Twitter @felicejfreyer