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In Liberia, A New Focus On Tracking Down Rural Ebola Cases

Nov 21, 2014
Originally published on November 23, 2014 6:16 pm
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STEVE INSKEEP, HOST:

We're going now to Liberia where the U.S. military has finished construction on its second Ebola treatment center in that country. The U.S. plans to build more of these state-of-the-art field hospitals in West Africa, although many health experts are asking whether that is the best use of medical resources in the fight against Ebola. NPR's Kelly McEvers is in Liberia. She's on the line. Kelly, where are you? What's happening there?

KELLY MCEVERS, BYLINE: We are about two hours outside of the capital - the Liberian capital Monrovia, just down the coast on the Atlantic Ocean in a town called Buchanan. But we're really outside of the town away from the population center. You can hear the generator in the background. And what we're seeing is basically a series of tents. I mean, when I say tents, I'm not, like, talking about a camping tent. It's more like a tent that's the size of a house. And these will serve as this Ebola treatment unit - places where people can be isolated and treated who are confirmed to have the disease. The construction is complete, but that doesn't mean it's exactly open for business. Other U.S. agencies are going to oversee the training and staffing, and that's going to come online soon.

INSKEEP: So why would these not be a good idea? Sounds like a good idea to get up treatment centers.

MCEVERS: Right, so the Ebola epidemic is really changing here in Liberia. First it started in Guinea and then crossed over the borders into rural Liberia. And then people started going to the capital, to Monrovia, to get care. That's when you really saw the explosion of cases in Monrovia. So at that time, it was a couple months ago, you saw health officials saying, look, we need hospitals and treatment centers out in the counties so people don't come to the capital.

Well, what's happening now is people are leaving the capital and going all the way back into really remote areas when they're sick. And so we're seeing what we are called hotspots all over the country in very remote areas, far away even from one of these ETUs. So what a lot of experts are saying now is that what we need to focus on is what they call rapid response teams - people who can get out into these very remote areas to find people who are sick or people who have been in contact with people who are sick - and decide what to do with them there at the very local level.

INSKEEP: ETUs, we should say that's Ebola treatments units - ETUs, as you said. It's a reminder, I suppose, that while this is a medical problem, it's also a social problem, even a political problem, isn't it? It's almost about crowd control, what you're describing.

MCEVERS: Well, you know, in these very remote areas, it's not even about crowd control; it's about getting just the simplest message out to these people. I mean, we went on a very, very long walk the other day with one of these so-called rapid response teams. And they explained that, you know, rapid means we're just the first to get there. So when you've got this hotspot in this very rural area, people haven't gotten those messages about - don't touch someone who has Ebola, don't bury someone who has Ebola - sort of that basic stuff that they've been able to deal with in the capital, where you can put up posters and have PSAs and messages on your cell phone.

INSKEEP: OK, so what about the people who are found to have Ebola? What are the rapid response teams like the one you followed able to do with them and for them?

MCEVERS: So there's a whole range of things you can do for people, right? The decision might be made to just isolate the people there in the village and work with the community to sort of agree that they should be quarantined and treated right there in the village. Maybe you walk them to the next village over where there's an existing clinic that's part of the Liberian health system. You build an isolation tent next to that clinic, and you care for them there. They may fare well enough to get all the way to one of those ETUs.

So it's not like the ETUs are no good, it's just that they're only good in certain circumstances. So I think the idea is that a decision has to be made on a case-by-case basis, and you need to get in there because the sooner you get someone into treatment, as we know, the better chances they have of survival because treatment is just hydration and medicine to take down your fever, you know? Some people are going to survive that, and some people aren't.

INSKEEP: Kelly, thanks.

MCEVERS: You're welcome.

INSKEEP: That's NPR's Kelly McEvers in Liberia. Transcript provided by NPR, Copyright NPR.