The horror

Mike recently posted about Emory’s state-of-the-art isolation unit, where the only two Ebola-infected patients in the U.S. have been treated. Compare that unit with this Ebola isolation unit set up in an abandoned school in Monrovia, Liberia.

 Or with this new Ebola treatment center being set up by Doctors Without Borders, in Monrovia, soon to be the largest Ebola treatment and isolation center in history. Large open tent, mattresses on the ground just feet from each other, no modern plumbing (see wash station in the corner)—it is easy to see how personal protective equipment might also need to be adjusted for those who spend hours on end caring for sick and dying patients in this environment. 

The recent news from Liberia is horrendous. Earlier this week the residents of West Point, described by one journalist as “the worst slum in Liberia, which makes it one of the worst slums in Africa, which makes it one of the worst slums in the world”, looted a school-turned-Ebola-isolation unit, freeing the isolated sick patients and making off with blood soaked sheets and mattresses. The entire community is now under quarantine, and is responding violently.

I spent several weeks in Liberia about 30 years ago, and I’ll never forget the conditions I saw at West Point. From the Washington Post:

"According to the United Nations Office for the Coordination of Humanitarian Affairs, which reported on the slum in 2009, there were only four public toilets servicing 70,000 residents. Using the toilet cost 3 cents, and bathroom operators estimated they got about 500 patrons per day. “The facilities can be smelled 50 meters away, with the floor of each squalid cubicle 15 cm deep in soiled newspaper that residents use to wipe their posteriors,” the service reported. “Staff use gloved hands to scoop the used paper into a wheelbarrow, which they lug to the nearby river or beach to dump its contents into the water.” Other residents prefer not to deal with all that, and instead use the beaches as public bathrooms. “Before I can take my first step into the sand [I see] the small black and brown piles underfoot,” a Providence Journal missive says. “A few yards ahead, a scattering of about a half a dozen or so small children squat, eyes towards the sea.”"

Most Ebola outbreaks to date have been smaller events, confined to rural areas. This is much different, and now that the epidemic involves a huge population center with no health care or public health infrastructure, it is hard to see how it will come under control anytime soon.


First two photos, by John Moore/Getty Images, third photo of West Point taken by me in 1983.