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Liberia is Making Progress Against Ebola but Cases Continue

By Cheryl Pellerin
DoD News, Defense Media Activity

WASHINGTON, Nov. 12, 2014 – New U.S.-funded Ebola treatment units and diagnostic laboratories are stoking progress on the ground in Liberia, but new cases of Ebola arise daily, U.S. officials reported today during a teleconference from the Liberian capital, Monrovia.

Click photo for screen-resolution image
Simple red lines on the floor are what mark the boundary between the low-risk zone and the high-risk zone in the Monrovia Medical Unit, a facility designed for health care workers who become infected with the virus. U.S. Army photo by Sgt. 1st Class Nathan Hoskins, Joint Forces Command, United Assistance Public Affairs

(Click photo for screen-resolution image);high-resolution image available.

Army Maj. Gen. Gary Volesky, Operation United Assistance Joint Force Commander, Deborah Malac, U.S. Ambassador to Liberia, and Bill Berger, U.S. Agency for International Development Disaster Assistance Response Team Leader, spoke with the Pentagon press corps on the U.S. response to the Ebola outbreak.

There are positive indications on the ground West Africa, Volesky said, “but there are new cases of Ebola every single day here in Liberia, so we are supporting … USAID in building Ebola treatment units, training health care workers,” and sustaining treatment units.

Malac agreed, “Numbers of cases continue to increase. We are not out of the woods by any stretch of the imagination.”

The rate of increase is much lower than it has been over the last couple of months, she added, but it’s important to continue following the government of Liberia's plan, adapting as the epidemic itself adapts and changes.

For the moment, she added, more treatment units and more medical personnel are needed to help treat patients.

Just under 2,200 U.S. troops are in West Africa today, Volesky said. “We will top out in the middle of December just short of 3,000 and that's the most we'll bring into the country.”

The number is about 1,000 troops less than the initial estimate, but the general said there’s more capacity in Liberia than planners thought because of work by lead agency USAID, whose personnel had been in Liberia for months before American troops arrived, and because of efforts by the government of Liberia and many non-governmental organizations.

Thanks to pre-deployment and continuous training and monitoring, he added, no military personnel have showed symptoms of Ebola.

“We continue to sustain their training and talk about how to make sure they don't put themselves at risk. And our chain of command and leadership are very involved in making sure our soldiers, sailors, airmen and Marines are adhering to those standards,” Volesky said.

“You won't see soldiers roaming all over Liberia,” he added. “We've got it very controlled. They go places where there's a mission and we make sure we're following all those protocols.”

On the ground in Monrovia, the first two treatment units have opened.

The Monrovia medical unit for health care workers opened its doors a week ago. Volesky called it a strategic treatment unit “because it is hopefully giving the international community confidence that if they have people come to Liberia [who] get infected, there's a place for them.”

Another unit, the Tubmanburg ETU, opened a few days ago -- a joint venture with members of the Liberian armed forces, who Volesky said did much of the work, with U.S. oversight for electricity and plumbing.

Eventually there will be 17 treatment units, with three or four more completed before the end of November and, depending on weather and other considerations, the rest should be completed before the end of December, the general said.

In addition to treatment units, an increase in mobile diagnostic labs in and around Monrovia has been a game-changer, he added.

It used to take days to determine from a blood sample whether an individual had Ebola, Volesky said. “Now that's determined in a few hours,” he added, reducing the chances that people waiting for diagnoses might infect each other with Ebola or another disease.

Of the nine labs in or near Monrovia, Volesky said, seven are DoD labs, one is a Centers for Disease Control-National Institutes of Health mobile lab, and the other is a European Union-donated mobile lab.

Liberia also has a permanent national reference laboratory that DoD and NIH have supported to help build the facility’s testing capacity. A reference lab is one that performs quality, high-volume or specialty testing of biological samples for physicians, hospitals and other laboratories.

DoD’s military response to the Ebola outbreak in hardest-hit Liberia is part of a whole-of-government response led by USAID.

In August and September, the early days of the U.S. response to the outbreak, some of the first people on the ground included a 28-member USAID Disaster Assistance Response Team, or DART team.

Team members -- from USAID, DoD, CDC, the U.S. Public Health Service and the U.S. Forest Service -- deployed to West Africa to coordinate and prioritize the government’s outbreak response.

Berger, the DART team lead in Liberia, said the team’s composition and size change according to needs on the ground.

“The size of our team varies … depending on which technical specialists we need, but we're at around 30 people. We have two CDC folks on the team but CDC itself has over 60 people in country working out in all the communities,” Berger said.

“We can draw on almost any agency within the U.S. government as needed to augment the capacity of the USAID mission and the embassy here to fight this battle with Ebola,” he added.

When the DART team first arrived they hit the ground running, Berger explained.

“At that time the [infection] curve was going up and nobody was sure if we were going to be able to break that, he added.

“We helped set up an [emergency operations center] so the government could do the kind of coordination it needed for itself and with the international community. We helped get safe burial teams out on the ground. We started working on supporting the [Liberia Institute of Biomedical Research] Lab and getting that back into shape,” Berger said.

When the Ebola treatment units were coming online, if they needed a generator the DART team went to Power Africa and got one. If they needed gravel, the DART team got that.

“We were working flat out,” he said. “Now we're working more with our partners, working on the community-care strategy, with partnerships that are building ETUs, getting public messaging out to change behaviors, and finding more NGOs and international partners to help with the clinical and management care of the ETUs.”

Berger said the U.S. response is everything it was meant to be – truly a whole-of-government response.

“We’ve brought every asset of the U.S. government to bear to fight this disease,” he said, “and there's been tremendous cooperation among all of the agencies. The coordination has been outstanding.”

On the ground, officials agree that much more work is needed.

“We are still very much at the beginning of this effort, although we've been all working very hard for many weeks, some of us for many months, on this issue,” Malac said. “It's nice to know that we’ve been able to have some impact on the curve, but until we have everything down to zero and we haven't had a case for a couple of months, none of us will be able to rest easily at night.”

For the members of Operation United Assistance, Volesky said the mission is going well.

“I can tell you without a doubt, they are all very proud to be here. They feel like they're making a difference. Everywhere I go soldiers, sailors, airmen and Marines are telling me they're happy to be here,” the general said.

“They can see confidence in the people's eyes here,” Volesky said, “so this is a great mission for all of our servicemen and women.”

(Follow Cheryl Pellerin on Twitter @PellerinDoDNews)


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