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Bill Berger: “There is no book on responding to this Ebola crisis… we’re writing it now.”

Morgana Wingard This is the fifth blog in our Profiles in Courage series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight against Ebola. This series records the experiences of our Disaster Assistance Response Team staff on the front lines of the Ebola response – from the security officers, to public health experts, to information specialists – and offers their reflections on this historic health crisis.
General Darryl Williams, Bill Berger, and U.S. Ambasador to Liberia Deborah Malac.

General Darryl Williams, DART Team Leader Bill Berger, and U.S. Ambasador to Liberia Deborah Malac. / Natalie Hawwa, USAID

“There is no book on responding to this Ebola crisis… we’re writing it now,” says Bill Berger, Team Leader for the Ebola Disaster Assistance Response Team (DART) in West Africa.

A seasoned disaster expert, Bill has responded to more than 30 large-scale emergencies across the globe and led several DARTs for USAID’s Office of U.S. Foreign Disaster Assistance.

But how exactly are Bill and his team fighting this unprecedented Ebola epidemic?

“Day by day, pushing at a maximum speed on all fronts,” he says, and with every ounce of compassion and disaster knowledge they have.

As the DART Team Leader, Bill strategizes alongside the local governments and U.S. Ambassadors in the affected countries, the United Nations and NGO partners on the ground to mount the most effective aid effort possible. With Ebola, there are many complex technical pieces that need to come together to help save lives.

“We know the basic things that need to happen, such as building treatment centers, training health care workers, providing testing capabilities and coordination — but we also have a real opportunity here to transfer that capacity and boost national health care systems in West Africa.”

The DART is working across the region in Guinea, Liberia and Sierra Leone – each a unique country with its own dynamic for responding to Ebola. While there are challenges of navigating unknown territory for this unprecedented crisis, Bill draws strength from having the opportunity to help those affected by this tragedy. He’s also inspired by his team and the chance they have to contribute to such a critical and historic global issue together.

“Every DART is like living a full lifetime; you have many experiences and feelings in a short period, with so much confronting you daily,” he says. “Working with others during a crisis brings about wonderful and special bonds.”

Bill jokes that the DART will be giving each other the ‘Ebola bump’ — the new West African greeting of hitting elbows, adopted in lieu of a handshake due to the ‘no touch’ atmosphere — for years to come.

“Our DART is a very special group of dedicated people bringing in every piece needed for this Ebola response. It’s a great gift to lead this team.”

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. Check out her guest posts from USAID’s instagram

First Look at a New Hospital for Ebola Aid Workers: 10 Photos You’ve Never Seen

Morgana Wingard This blog is part of our Daily Dispatches series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. Her photo series and blogs from the team offer unique angles into the many facets of the Ebola story – from life inside a treatment center, to profiles of the health care workers battling Ebola from the front lines, to the many ways the epidemic is impacting the health, economy and future of the nation.

HARBEL, Liberia—”Where have you done this before?” USAID Administrator Raj Shah asked on October 15, as he stepped through the taupe colored tent flap into the new 25-bed critical care hospital being built to treat all health care and aid workers who fall ill to Ebola. “Nowhere, sir. No one has,” replied an army engineer.

Historically, mobile medical units like this one provide versatile trauma care for military operations. In this case, the Department of Defense (DoD) and the U.S. Public Health Service (USPHS) customized the Monrovia Medical Unit to treat highly contagious Ebola patients.

Once complete, the hospital will be operated and staffed by a team of 65 specialized officers from the USPHS Commissioned Corps – an elite uniformed service with more than 6,800 full-time, highly qualified public health professionals, serving the most underserved and vulnerable populations domestically and abroad.

The Commissioned Corps will deploy clinicians, administrators, and support staff to Liberia to treat health care workers with Ebola, and to continue efforts by USAID, DoD and international partners to build capacity for additional care in Liberia.

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The new 25-bed critical care hospital being built in Harbel, Liberia to treat health care and aid workers who fall ill to Ebola. The new hospital is expected to be online in early November.


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Rear Admiral Scott Giberson (Acting U.S. Deputy Surgeon General and Commander of the USPHS Commissioned Corps Ebola Response) gives USAID Administrator Raj Shah a tour of the new 25-bed critical care hospital for all health workers who fall ill with Ebola while on the frontlines of the epidemic in Liberia on October 15, 2014.  


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Colonel Joann Frye, nurse, Officer in Charge, U.S. Air Force Air Combat Command 633rd IPTS and USAID Administrator Raj Shah inside the new hospital.


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Tents are connected by a covered passageway inside the “Hot Zone.”  Soon the only people inside this area will be health workers either as patients or suited up in personal protective equipment.


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Inside one of the patient wings of a new critical care hospital being built by the U.S. Department of Defense and the U.S. Public Health Service in Harbel, Liberia.


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The new hospital’s supply room.


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CAPT Ed Dieser (Engineer, USPHS Commissioned Corps Safety/Facilities Officer) gives USAID Administrator Raj Shah a tour of the new 25-bed critical care hospital for health workers who fall ill to Ebola while on the front lines of the outbreak in Liberia.

(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. Check out her guest posts from USAID’s instagram

Paloma and Alisha: The Information Gurus Behind the U.S. Ebola Response

Morgana Wingard This is the fourth blog in our Profiles in Courage series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight against Ebola. This series records the experiences of our Disaster Assistance Response Team staff on the front lines of the Ebola response – from the security officers, to public health experts, to information specialists – and offers their reflections on this historic health crisis.
U.S. Information Officers Paloma Clohossey and Alisha McMichael, left to right.

U.S. Information Officers Paloma Clohossey and Alisha McMichael, left to right.

Though Alisha McMichael and  Paloma Clohossey’s jobs on the Ebola Disaster Assistance Response Team (DART) aren’t as high profile as the health care workers who suit up in protective gear everyday, one could argue that their role is just as vital to the U.S. response.

“Alisha and Paloma bring all the threads of the operation together for reporting and information collection — they know the ins and the outs of the response as a whole,” said Bill Berger, the Ebola Disaster Assistance Response Team Leader.

They are the DART’s Information Officers – also known as ‘IOs.’: the information gurus who compile, collate and verify all the information about the U.S. Government’s Ebola response efforts and the crisis at large. After absorbing every last detail and fact, they distribute them to team members on the ground and back to Washington, D.C. so that everyone is on the same page and has the correct information they need, when they need it.

In a disaster response environment – especially one like the Ebola epidemic, where everyday the international community is navigating new territory – information is critical. Alisha and Paloma constantly take in and filter information to ensure they’re up to date on the latest — no easy feat given the ever-evolving situation as the crisis progresses and the U.S. response gains momentum.

In fact, Alisha has been dubbed the DART’s ‘sync-master,’ responsible for tracking daily the progress of Ebola treatment units, community care centers, trainings for health care workers, burial teams, airlifts of relief supplies, and other response efforts – following the military’s Sync Matrix model. Meanwhile, Paloma writes daily updates about the situation on the ground to inform Washington and communicate key gaps, challenges and successes.

Being a DART IO requires a lot of attention to detail and long days, but working 24/7 doesn’t get them down.

“The best part by far,” says Paloma, “is getting to have the opportunity to do work that feels meaningful. I’ve been given a chance to contribute to something that I believe in.”

Adds Alisha, “This is a great team, and I know everyone gives their best everyday. That feels good.”

(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. Check out her guest posts from USAID’s instagram

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“I’ve Never Had a Job Like This”: Life Inside an Ebola Treatment Unit

Morgana Wingard This blog is part of our Daily Dispatches series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. Her photo series and blogs from the team offer unique angles into the many facets of the Ebola story – from life inside a treatment center, to profiles of the health care workers battling Ebola from the front lines, to the many ways the epidemic is impacting the health, economy and future of the nation.

SUAKOKO, Liberia—”It becomes day-to-day life. You get into your PPE [personal protective equipment] and you go in every day and you feel safe,” explains Audrey Rangel – a nurse at the Bong County Ebola treatment unit run by International Medical Corps with support and funding from USAID.

Before landing at Roberts International Airport in Monrovia on September 8,  Audrey worked on a maternal, child health and nutrition program in Timor Leste. “I always wanted to do disaster relief work. The crisis started to take off. It was in the news a lot. People were talking about it. So I went online. I saw a position for an Ebola response nurse. To me it was just the right time. The description just kind of fit me. I was speaking with my husband and I was saying I can’t not do this. I can’t not do this…. They need people. There was an actual need for me. And I just kind of felt like the description was made for me. It was just perfect. I had to do it.”

The Bong County Ebola treatment unit where Audrey was stationed is a four hour bumpy journey from Monrovia. Bong has some of the highest rates of infection after Lofa and Montserrado Counties. Their two ambulances drive for hours every day to pick-up patients in remote locations like Bong Mines where they picked-up 18-year-old Cephas after his father carried him on his back for an hour to a location where the ambulance could reach him.

Audrey’s days are spent on the front lines of the Ebola response, suiting up in protective gear and caring for patients like Cephas. Even as she roots for survivors, she admits that it’s easy to get attached to her patients: “For some reason you’re sad to see them go.”

“It’s turned out to be an amazing, amazing experience. I wouldn’t take it back for anything.  I guess you can say it exceeded my non-expectations,” says Audrey.

To learn how qualified medical professionals can join the fight against Ebola, visit: www.usaid.gov/ebola/volunteers.

Watch Audrey’s Story

(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

Justin Pendarvis: “We have to demystify Ebola. It’s not a superhuman and magical thing.”

Morgana Wingard This is the third blog in our Profiles in Courage series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight against Ebola. This series records the experiences of our Disaster Assistance Response Team staff on the front lines of the Ebola response – from the security officers, to public health experts, to information specialists – and offers their reflections on this historic health crisis.
Justin-Pendarvis

Justin Pendarvis: “We have to demystify Ebola. It’s not a superhuman and magical thing.”

Before the United States deployed an Ebola Disaster Assistance Response Team (DART), there was Justin Pendarvis. As one of the Public Health Advisors at USAID’s Office of U.S. Foreign Disaster Assistance, Justin was the first disaster expert tapped to travel to West Africa and assess the growing Ebola situation for USAID.

In early July, Justin traveled to Guinea – home of the epidemic’s ‘patient zero.’ His mission: to observe and gauge the growing outbreak, understand the coordination at play for the response, and identify key challenges.

In Guinea he observed the protocols required to run an Ebola treatment unit (ETU) at one of Medecins sans Frontieres’ first facilities – an intense operation out of the capital city, Conakry. The following week he headed to Sierra Leone where frightening narratives were emerging from Kenema, one of the country’s largest towns hit hard by the virus.

“People were working around the clock, but more Ebola cases kept popping up,” recalls Justin. Health care workers were also falling ill.

By the time Justin landed in Liberia a week later it was clear that a significant amount of resources were needed to support West Africa and help save lives. Weak public health systems fell prey to the disease, and more help was needed. With key insight provided by Justin, USAID stood up the Ebola Disaster Assistance Response Team (DART) – the team of roughly 30 people from across the U.S. Government leading and coordinating the U.S. Ebola response.

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Patients wait outside the JFK Ebola treatment unit in Monrovia, Liberia on September 15, 2014.


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An Ebola patient rests on his bed inside the patient area at the Ebola treatment unit at Island Clinic September 22, 2014 in Monrovia. With the help of USAID, the Government of Liberia and the World Health Organization opened the facility on September 21. Within one day it was filled to capacity with more than 100 patients. USAID provided generators and other supplies to equip the facility with life saving care.


Since then there has been an “evolution of thought,” says Justin, as everyday USAID, alongside the affected countries and international community continue to learn how best to respond to this unprecedented crisis and fight the world’s largest Ebola outbreak in history.

In Liberia’s capital Monrovia, most residents know somebody who has been affected by the epidemic. Justin, like many West Africans, finds Ebola and this humanitarian response to be very personal. He first arrived in Liberia in 2009 and considers it his second home. His first three-and-a-half years in country were spent working with a Liberian NGO to strengthen and rebuild the country’s health infrastructure — systems that had been destroyed by decades of brutal civil war. But progress was being made.

Five years ago, only 11 percent of women in Liberia were delivering babies at health clinics, putting most — those delivering at home often in unsanitary conditions –  at great risk for complications and death. Liberia had one of the globe’s highest maternal mortality rates.

Fast forward to last year, where more than half of Liberian women were safely delivering at hospitals and clinics – a significant health breakthrough.Although maternal mortality is still high, the numbers have started to fall.

Today, in the face of Ebola, any woman who comes to a hospital to deliver her baby and is bleeding becomes untouchable. Staff hesitate to provide medical care due to fear and risk of  contracting the virus, which is transmitted through contact with infected bodily fluids.

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Midwives at John F. Kennedy hospital now wear extra protective gear when they go to work because of fears of the spread of Ebola.


“We have to demystify Ebola, it’s not a superhuman and magical thing. We know how to control it, and we know how to keep people safe – but there is a crippling fear.”

Justin says that many of the challenges in responding to the Ebola crisis are fighting that exact fear, and arming West Africans with knowledge to understand the virus and learn how to weave protective measures into their daily life and cultural traditions.

As USAID continues to work toward bringing more Ebola treatment units online, the DART is also prioritizing messaging campaigns that educate communities on how to protect themselves. These efforts have already proven to be life-saving.

“Liberia is definitely a special place to me. I feel lucky to be in a position where I can hopefully contribute, and am proud of the momentum we’re now seeing – it’s this impact and the collective commitment alongside the Liberian people to fight Ebola that drives me forward every day.”

(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Natalie Hawwa is a USAID Press Officer for the Disaster Assistance Response Team on the ground in Monrovia, Liberia

Calling all Innovators to Help Fight Ebola

Saving lives at birth. Powering clean energy solutions in agriculture. Inventing new tools to teach a child to read. Across development, we’re calling on the world’s brightest minds to tackle our toughest challenges. In the last few years, we have helped launch five Grand Challenges for Development that have rallied students and scientists, innovators and entrepreneurs to tackle some of humanity’s toughest problems.

Today, we face just that kind of challenge—a global health crisis that is in dire need of new ideas and bold solutions. From Guinea to Liberia to Sierra Leone, Ebola is devastating thousands of families, disrupting growth, and fraying the fabric of society. The United States is helping lead the global response to the epidemic, but we cannot do it alone. That is why President Obama launched our sixth Grand Challenge. Fighting Ebola: A Grand Challenge for Development is designed provide health care workers on the front lines with better tools to battle Ebola.

To help kickstart this Grand Challenge, some of our nation’s most innovative problem-solvers will gather in DC today and tomorrow to work on this issue.  We’re also inviting people from all over the country to share their ideas. You can add your thoughts and see what other people saying here.

As the United States and the international community work to contain the worst Ebola epidemic on record, courageous men and women are performing critical tasks every day to save lives and prevent the spread of the virus. Personal protective equipment (PPE)—the suits, masks and gloves the health care worker wears—is their primary protection, but it is also the greatest source of stress. In these hot and uncomfortable suits, health workers must administer to the patients and remove contaminated materials.

Together with the White House Office of Science and Technology, the Centers for Disease Control and Prevention, and the Department of Defense, Fighting Ebola seeks new practical and cost-effective solutions to improve infection treatment and control and provide better care to those who need it most.

The first part of the initiative is an open innovation platform powered by OpenIDEO, one of the world’s top design firms. Through it, the global community can brainstorm, collaborate, and comment on new ideas that generate practical solutions to the Ebola epidemic. The strongest ideas may be encouraged to apply for funding later in the Grand Challenge. Our aim is to begin funding ideas in a matter of weeks.

Over the last several years, we’ve found that Grand Challenges not only generate inventive tools and breakthrough technologies, but inspire us to confront seemingly insurmountable challenges—and succeed.

Get started by joining the conversation. To learn more, please visit http://ebolagrandchallenge.net/

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic in Monrovia, Liberia on Sept 22. 2014. PPE is their primary protection, but it is also the greatest source of stress

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic in Monrovia, Liberia on Sept 22. 2014. PPE is their primary protection, but it is also the greatest source of stress. / Morgana Wingard, USAID

At the Heart of Ebola — Health Systems That Need Strengthening

A man at Texas Health Presbyterian Hospital in Dallas tested positive for Ebola September 30th, the first case of the disease to be diagnosed in the United States. According to many experts, it was only a matter of time.

Health officials in the U.S. have been preparing since summer in case an individual traveler arrived here unknowingly infected. With stringent isolation protocols in place, infection-control steps to prevent the virus from spreading in health facilities, and efforts to trace people who have had close personal contact with the ill person, the director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, was confident addressing media, saying “I have no doubt that we will contain this.”

But in West Africa, the Ebola epidemic is a sobering reminder of the lethal consequences of limited infectious disease surveillance and response capacities, and the vast development needs that persist in some of the region’s poorest countries despite rapid economic growth and investment.

At the heart of the Ebola epidemic sweeping across Africa, is a matter of health systems.

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic / Morgana Wingard

Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic / Morgana Wingard

Much like cholera preys on weak water systems after a disaster, Ebola is preying on a weak public health system after years of conflict and upheaval in Liberia. And health system perfor­mance in many partner countries is challenged by critical health worker shortages, inadequate financing, poor or disjointed information systems, lack of essential information on public health threats, and inexperienced leadership.

Countries that already have limited ability to provide health care for their citizens can ill-afford to lose health care workers to sickness and death, close health facilities, or redirect resources for other development priorities to battle this epidemic.

As Ebola spreads, citizens are impacted not just by the virus itself, but also by the loss of other critically needed services. As hospitals and clinics become overwhelmed by the epidemic, they are unable to provide necessary maternal and child care and life-saving treatment for malaria, tuberculosis and other diseases.

Dr. Ariel Pablos-Mendez, USAID’s Assistant Administrator for Global Health, said, “The state of the health workforce and health systems has hampered the ability of these countries to respond to the Ebola epidemic – but these countries are hardly alone in having inadequate training, support and numbers of health workers.”

Zaira Alonso, a finance and administration director for USAID’s Rebuilding Basic Health Services project in Liberia implemented by John Snow International, paints a bleak picture. “The entire Liberian landscape has changed dramatically in just a matter of weeks. Many government ministries are practically empty, as non-essential staff were placed on 30 days compulsory leave. Roads are empty, as many Liberians are staying at home to remain safe, and a large part of the expatriate community has left the country. Most people are just simply scared.”

The U.S. Government, including USAID and Centers for Disease Control and Prevention, the World Health Organization, and others are using a broad disaster management approach to contain the epidemic. Since the spring of 2014, the United States has been providing health equipment and emergency supplies, training and supporting health care workers on infection control and case management, supporting public outreach campaigns and helping build the capacity of local health care and emergency response systems.

As part of the overall U.S. Government response effort, the United States recently provided support to the African Union’s urgent deployment of trained and equipped medical workers to West Africa to help combat the Ebola epidemic. This support is helping transport doctors, nurses and other essential personnel to manage and run Ebola treatment units that isolate and treat those affected by the disease, helping minimize the spread of Ebola. It will also provide urgent emergency supplies and health equipment to help these medical workers respond.

A health care worker checks on patients admitted to the Ebola Treatment Unit in Island Clinic. / Morgana Wingard

A health care worker checks on patients admitted to the Ebola Treatment Unit in Island Clinic. / Morgana Wingard


And President Obama earlier this month announced a major surge in U.S. assistance in West Africa to help recruit, organize and train new health care workers and build treatment clinics.

Adding qualified and trained health workers will make a big difference. Guinea, Liberia and Sierra Leone are among 83 countries worldwide that the WHO last year reported to have below the minimum ratio of doctors, nurses and midwives (22.8 per 10,000 people) needed to provide basic health services to a population. WHO and the Global Health Workforce Alliance estimate at least 7.2 million doctors, nurses and midwives are currently needed globally – a gap that could creep to nearly 13 million by 2035 if we keep with the status quo.

Dr. Larry Barat, senior advisor with the U.S. President’s Malaria Initiative said one distinguishing factor of countries in Africa that have controlled malaria from those who still struggle to do so is the functionality of their health systems and their skilled human capacity. “Countries like Rwanda, Senegal, Ethiopia and Zambia have successfully reduced malaria burden, in part, because their health systems are able to deliver essential commodities to all parts of their countries, and people can access health services, with trained personnel.”

Haja Wurie, of COMHAS and the ReBUILD Consortium in Sierra Leone, where she has been working on health systems research, painted a vivid picture of a health system already weakened by years of war. Ebola first hit isolated, remote communities with limited access to health services. Their reliance on traditional healers and informal providers of health care may have exacerbated the spread of the illness. “Health staff face a very uncertain future as they bravely respond to Ebola,” she said. “They have inadequate supplies of the commodities they need to protect themselves. Many have watched their colleagues succumb to the illness die. They need urgent support and solidarity from the international community to motivate and incentivise them to face the tough times ahead.”

The Ebola epidemic reminds us that our global efforts to build the capacity to prevent, detect, and rapidly respond to infectious disease threats like Ebola have never been more vital. If we use all of our might to ramp up the response to Ebola while also investing in strengthening critical health care systems (including the components that prevent, detect, and respond to infectious diseases), we can help bring the current epidemic under control and reduce the possibility of future outbreaks.

ABOUT THE AUTHOR

Chris Thomas is a Communications Advisor in the Bureau for Global Health providing strategic counsel to political and civilian leadership and technical staff on matters of public interest.

Standing with Liberia to Reverse Ebola’s ‘Spillover’ Effects

 With funding and support from USAID construction crews work quickly to build a new Ebola Treatment Unit in Monrovia in front of the former Ministry of Defence Building. / Morgana Wingard

With funding and support from USAID construction crews work quickly to build a new Ebola Treatment Unit in Monrovia in front of the former Ministry of Defence Building. / Morgana Wingard

The Ebola Virus Disease, and the pressing need for rapid containment over the next 3 to 9 months, presents the global community with a formidable challenge. More than 7,000 cases have already been confirmed in Guinea, Liberia and Sierra Leone (the three core countries of the epidemic), and more than 3,300 people have already died. The epidemic is strengthening, but so too is the international response.

Ebola threatens not only lives, but livelihoods. The main driver of economic impacts is not the loss of labor to sickness and death, or even the major diversion of resources into health care, but rather the much broader spillover effects from peoples’ fear of contagion.

Isolation of infected persons is critical to controlling transmission, and wider restrictions including land border closings and partial community quarantines can interrupt economic activity on a temporary basis. But in an atmosphere of uncertainty about personal and business risks, activity can decline across the entire economy. Self-protective aversion behavior shuts down businesses, disrupts transportation and agriculture, and sidelines employment-creating investment plans – all of which drives down peoples’ livelihoods by undermining a country’s production and trade.

Liberia, where the outbreak is worst, has been rebuilding its economy since emerging from a long civil war in 2003. While economic growth has been strong in recent years, the country remains one of the poorest in Africa, with a per capita income of only $440 dollars and nearly 60 percent of the population below the poverty line. Liberia remains both institutionally weak and aid dependent, so a swift international policy reaction to this epidemic is crucial.

Food prices have recently begun to rise sharply in urban areas in Liberia, reflecting slowdowns in container shipping and uncertainty about future supplies. Regional trade has been reduced by land border closings. Internal transport has slowed down, reflecting official and unofficial restrictions on movement and higher fuel costs. The expatriate economy – with its incomes and expertise – has thinned out.  Some urban enterprises are shedding workers as many government contracts are being cut back, or put on hold.

The World Bank’s latest estimate of economic losses for 2014, in the three core countries, is $359 million. Under a rapid containment scenario, losses in 2015 are projected to be roughly $100 million, with the bulk of these in Liberia where per-capita incomes are not expected to begin rising again until 2016. Left unchecked, however, this epidemic could grow exponentially and drive up both human and financial costs by as much as 8 to 10 fold.  So the international community needs to act quickly and decisively, along a number of fronts.

Simply put, an Ebola epidemic that is not effectively contained and mitigated could reverse years of development progress for the affected countries, with harsh negative impacts on some of the world’s most vulnerable communities. Failure to contain would also increase the risk of outbreaks in neighboring countries, driving economic losses into the tens of billions of dollars.

 Washing is a vital part of the operation of the Ebola Treatment Unit at Island Clinic in Monrovia. All scrubs worn under PPEs and shoes must be washed thoroughly in chlorine water and then with soap. / Morgana Wingard

Washing is a vital part of the operation of the Ebola Treatment Unit at Island Clinic in Monrovia. All scrubs worn under PPEs and shoes must be washed thoroughly in chlorine water and then with soap. / Morgana Wingard

This epidemic calls for concerted international response including health workers, new treatment facilities, and medical supplies to the health sectors of the core countries, food security assistance to stressed and especially isolated and quarantined areas, and preparedness training for health systems in neighboring countries.

The United States, along with our international partners, is stepping up to this challenge. With Liberian clinics overwhelmed with new patients, we are providing 2,000 new beds, 130,000 sets of personal protective equipment, and 50,000 hygiene kits, along with plans to rapidly construct new health clinics.  To prevent further infections within Liberia, the USG and its partners will also provide 400,000 protection kits to reduce transmission in community settings.

To help offset declining government revenues and skyrocketing health costs, we are providing base salary support for civil servants in Liberia’s Ministry of Health, and working closely with the World Food Program to provide emergency food supplies to 1.3 million people across the region, including Ebola patients and communities under quarantine.

We’re also working closely with President Ellen Johnson Sirleaf to intensify our response across a broad range of areas, including supporting the country’s health system so that the focus on Ebola does not come at the expense of providing care to pregnant mothers or newborn infants.

Additionally, we’re working with the Government of Liberia and partners to mitigate the economic impacts of the crisis outside of the health system. This includes the crucial area of public messaging about the safe resumption of normal economic activities.

We’ve seen outstanding teamwork across our Agency, the U.S. Government, and our Disaster Assistance Response Team on the ground in Liberia, Guinea, and Sierra Leone—but we cannot win this fight alone.

We need qualified health care workers—nurses, doctors, and physician assistants—who could be a part of this historic response. We’re encouraging them to register at www.usaid.gov/ebola, and we’ll put them in touch with a network of organizations that are standing by to train volunteers. We’re also identifying care and evacuation procedures to support these professionals in their heroic humanitarian work.
With the same creativity and rigorous efficiency that we have applied to previous disasters, we can—and will—stop this epidemic. By working together with our partners from government, business, civil society, and the military, we can lay the groundwork for a brighter future in vulnerable communities grappling with Ebola’s devastation.

Stephen O’Connell

ABOUT THE AUTHOR

Stephen O’Connell is USAID’s Chief Economist. He guides the Agency on economics-based decision making and provides expert advice to Agency leadership and staff in the field of economic growth.

Andrew Hill: “There’s no standard blueprint for an Ebola treatment unit.”

Morgana Wingard This is the second blog in our Profiles in Courage series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. This series will record the experiences of our Disaster Assistance Response Team staff on the front lines of the Ebola response – from the security officers, to public health experts, to information specialists – and offer their reflections on this historic health crisis.
Andrew Hill

Andrew Hill
U.S. Army Civil Engineer

The buzzwords here in Monrovia are “unprecedented” and “exponential.” Everything about the Ebola epidemic in West Africa is unprecedented as it spreads exponentially.

U.S. Army civil engineer Andrew Hill is part of the USAID-led Disaster Assistance Response Team (DART) tasked with implementing an unprecedented response to the Ebola crisis.

An essential part of that response is constructing and staffing new treatment facilities that can isolate and care for the growing number of people infected with the virus.

On the ground in Liberia, one of the first tasks by Andrew and the U.S. military engineers was to conceptualize and design an ETU. Working hand-in-hand with members of the Armed Forces of Liberia (AFL), they consulted the experts with a gold standard ETU model: Médecins Sans Frontières (MSF) and the World Health Organization (WHO). Building off of their expertise, they tailored the designs to create Department of Defense and AFL-specific versions, which could be built and implemented with their resources.

The plans started with a hand-drawn sketch that Andrew created while driving in a car on his way to various sites. That sketch formed the basis for what would become a full concept and material list needed to begin ETU construction.

Photo of Andrew Hill sketching

Photo of Andrew Hill sketching

The U.S. Army Africa engineers, led by Lieutenant Colonel Scott Sendmeyer, pooled their collective professional engineering knowledge and tools in order to continue developing and finalizing the design, and to determine the remaining requirements needed for implementation.

The first site to use the design is scheduled to begin construction imminently — and this model will be replicated and constructed across Liberia by a team of 150 AFL engineers to help save lives and stop the spread of Ebola.

(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

Facing Death, Six Days a Week

Morgana Wingard This is the third blog in our Daily Dispatches series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. Her photo series and blogs from the team will offer unique angles into the many facets of the Ebola story – from life inside a treatment center, to profiles of the health care workers battling Ebola from the front lines, to the many ways the epidemic is impacting the health, economy and future of the nation.

What do you say to a mother who just lost her child? To a neighbor who just lost her best friend? How do you comfort them before you carry away the body of their loved one in a black bag in the back of a dark green pick-up truck? Varbah Dolley faces these scenarios six days a week. Varbah is tough – like most Liberian women who have lived through two civil wars. She is now fighting another a war, against an enemy she can’t see.

Varbah is a member of a Liberian Red Cross burial team. Funding from USAID and support from the U.S.-based NGO Global Communities is providing burial-team support activities in all 15 counties of Liberia, as well as engaging with communities to share information on proper hygiene practices and preventing transmission through workshops, community meetings, and radio campaigns.

From the moment they start showing symptoms, someone who has contracted the Ebola virus is highly contagious. The virus is spread through direct contact with bodily fluids including vomit, diarrhea, blood, and saliva. After the person dies, the body is even more contagious.

In Liberia, rituals to prepare bodies for burial are contributing to the rapid spread of the virus. The dead body is typically washed and dressed by multiple people before being carried to a grave — a ripe situation for the virus to spread. Graves are also important landmarks for Liberians. Decoration Day, a government holiday, is dedicated to visiting and decorating family graves. It’s where they can speak with their ancestors and commune with them. As the burial team prepared to take one body, I heard a woman wail: “I will have nothing to decorate on Decoration Day.”

To stop the spread of Ebola, burial teams have been mobilized across Liberia to provide safe disposal of contagious bodies, which often includes cremation. With the epidemic on the rise, every dead body is now considered an Ebola body. Varbah’s team leaves central Monrovia every morning to respond to reports of deaths. These calls often lead them to communities deep in rural Liberia. Last week, we drove for more than two hours over rough dirt terrain to reach Arthington – which also happens to be the birthplace of former warlord Charles Taylor.

On Sept. 26, 2014, Varbah, a member of  Liberia Red Cross and Global Communities burial team, listens to the mother of  Phelica Anthony, 6, explain the events leading up to her daughter’s recent death. Although  Phelica was taken to several hospitals, the cause of her death was not determined, and now her father is exhibiting symptoms of Ebola.

On September 26, 2014, Varbah, a member of the Liberian Red Cross and Global Communities burial team, listens to the mother of  Phelica Anthony, 6, explain the events leading up to her daughter’s recent death. Although Phelica was taken to several hospitals, the cause of her death was not determined, and now her father is exhibiting symptoms of Ebola.


Monrovia, Liberia - September 26, 2014: Burial team members take notes for their end-of-day report as  Phelica’s mother describes the events leading up to her 6-year-old daughter's death.

Burial team members take notes for their end-of-day report as Phelica’s mother describes the events leading up to her 6-year-old daughter’s death.


Varbah climbs out of the mud-splattered jeep and calmly walks over to a crowd with her notebook and pen. She jots down as much information as possible about each patient and their family for the report she submits every evening. “I know what you people are going through. But take courage,” she counsels the family of 6-year-old Phelica as they describe the events leading up to her untimely death. Phelica became inexplicably sick while playing outside. Her mother carried her to multiple hospitals for treatment. After spending a couple days at one hospital where they ran several lab tests, the doctor said she would not survive and Phelica died on the way home. Her father, who had cared for her, later began exhibiting symptoms of Ebola. A health team transported him to an Ebola treatment unit the day before we arrived.

Like many in West Africa, when it comes to the current public health crisis, Phelica’s family is suspicious.“You don’t know what killed the person because they are hiding the truth from us,” Varbah tells me later in the car.

Melvin Payoh, the assistant team leader of the burial team, suits up like an astronaut in the middle of the hot, rural village as onlookers gather and stare. A few minutes after disappearing past the first row of earth-walled homes, the team returns carrying a black bag. Everything about this Ebola outbreak feels unreal until men in white spacesuits walk through a town with a body-filled bag. A mother wails, “My baby, O. My baby, O.” Then it is painfully real. Numbers have names. Tears flow. Relatives fall on the ground. Hands flail. Melvin and his team lay Phelica’s little body in the back of a dark green pick-up truck.

I think Varbah and Melvin have the hardest job fighting this Ebola outbreak. They face death six days a week in order to save more lives. When I asked Varbah why she applied for the position she replied, “I do this for my country.”

"The body is over there," says Arthington's town chief pointing past the mother of Phelica, a 6-year-old girl that had recently died on Sept. 26, 2014.

“The body is over there,” says Arthington’s town chief pointing past the mother of Phelica, a 6-year-old girl that had recently died on September 26, 2014.


Melvin, a member of a burial team, suits up to remove the body of 6-year-old Phelica Anthony as onlookers from Arthington town film with a cell phone.

Melvin, a member of a burial team, suits up to remove the body of 6-year-old Phelica Anthony as onlookers from Arthington town film with a cell phone.


Varbah helps Melvin put on his personal protective equipment and ensures there are no gaps from the outside world to his skin before he goes in to pick-up the body of 6-year-old Phelica .

Varbah helps Melvin put on his personal protective equipment and ensures there are no gaps from the outside world to his skin before he goes in to pick-up the Phelica’s body.


The mother of Phelica Anthony, 6, says goodbye to her daughter as a burial team takes her body away. USAID is supporting the safe burial teams and Agency partners are working with communities to share information on proper hygiene practices and preventing transmission through workshops, community meetings, and radio campaigns.

The mother of Phelica Anthony, 6, says goodbye to her daughter as a burial team takes her body away. USAID is supporting the safe burial teams and Agency partners are working with communities to share information on proper hygiene practices and preventing transmission through workshops, community meetings, and radio campaigns.


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Melvin, a member of the Liberian Red Cross and Global Communities burial team removes the body of Phelica Anthony from her family home in Arthington.


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Phelica’s mother sings, “My baby O. My baby O” as the burial team removes her body.

Family, friends, and neighbors grieve as the body of Phelica is removed from their family home.

Family, friends, and neighbors grieve as the Phelica’s body is removed from their family home.


Family, friends, and neighbors grieve as the body of Phelica is removed from their family home.

Melvin lays the body of 6-year-old Phelica in the back of a pickup truck. They are under a mandate by the Government of Liberia to take all bodies they collect in Montserrado County to the crematorium.


(All photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

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