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| Empty Ebola Clinics in Liberia Are Seen as Misstep in U.S. Relief Effort | Empty Ebola Clinics in Liberia Are Seen as Misstep in U.S. Relief Effort |
| (about 4 hours later) | |
| MONROVIA, Liberia — As bodies littered the streets and the sick lay dying in front of overwhelmed clinics last year, President Obama ordered the largest American intervention ever in a global health crisis, hoping to stem the deadliest Ebola epidemic in history. | |
| But after spending hundreds of millions of dollars and deploying nearly 3,000 troops to build Ebola treatment centers, the United States ended up creating facilities that have largely sat empty: Only 28 Ebola patients have been treated at the 11 treatment units built by the United States military, American officials now say. | But after spending hundreds of millions of dollars and deploying nearly 3,000 troops to build Ebola treatment centers, the United States ended up creating facilities that have largely sat empty: Only 28 Ebola patients have been treated at the 11 treatment units built by the United States military, American officials now say. |
| Nine centers have never had a single Ebola patient. | Nine centers have never had a single Ebola patient. |
| “My task was to convince the international organizations, ‘You don’t need any more E.T.U.s,’ ” said Dr. Hans Rosling, a Swedish public health expert who advised Liberia’s health ministry, referring to Ebola treatment units. | |
| “I warned them, ‘The only thing you’ll show is an empty E.T.U.,’ ” he added. “ ‘Don’t do it.’ ” | |
| The American response, it turns out, was outpaced by the fast-moving and unpredictable disease. | The American response, it turns out, was outpaced by the fast-moving and unpredictable disease. |
| Facing criticism that his reaction to the devastating epidemic had been slow and inadequate, Mr. Obama announced his signature plan in mid-September, focusing on Liberia, America’s historical ally. | Facing criticism that his reaction to the devastating epidemic had been slow and inadequate, Mr. Obama announced his signature plan in mid-September, focusing on Liberia, America’s historical ally. |
| But even before the first treatment center built by the American military opened there, the number of Ebola cases in Liberia had fallen drastically, casting doubt on the American strategy of building facilities that took months to complete. | But even before the first treatment center built by the American military opened there, the number of Ebola cases in Liberia had fallen drastically, casting doubt on the American strategy of building facilities that took months to complete. |
| The emphasis on constructing treatment centers — so widely championed last year — ended up having much less impact than the inexpensive, nimble measures taken by residents to halt the outbreak, many officials say. | The emphasis on constructing treatment centers — so widely championed last year — ended up having much less impact than the inexpensive, nimble measures taken by residents to halt the outbreak, many officials say. |
| Liberia could be declared free of Ebola as early as next month. But with health officials warning that it is only a matter of time before another outbreak erupts in this region, they are drawing important lessons from the successes and shortcomings of the response by international and West African leaders. | Liberia could be declared free of Ebola as early as next month. But with health officials warning that it is only a matter of time before another outbreak erupts in this region, they are drawing important lessons from the successes and shortcomings of the response by international and West African leaders. |
| Had the Americans and other donors been more flexible, critics and some officials contend, the money could have been put toward rebuilding Liberia’s shattered health care system — or backing the efforts of local communities — instead of focusing on treatment centers that would scarcely be used. | Had the Americans and other donors been more flexible, critics and some officials contend, the money could have been put toward rebuilding Liberia’s shattered health care system — or backing the efforts of local communities — instead of focusing on treatment centers that would scarcely be used. |
| “I knew that most of the E.T.U.s that were being built may not receive a single patient,” said Dr. Francis Kateh, who helped lead the response of the Liberian government, which decided with the Americans where to build the 11 centers. | “I knew that most of the E.T.U.s that were being built may not receive a single patient,” said Dr. Francis Kateh, who helped lead the response of the Liberian government, which decided with the Americans where to build the 11 centers. |
| “But at the same time, you couldn’t put a stop to that process,” he added. “The train was coming full force.” | “But at the same time, you couldn’t put a stop to that process,” he added. “The train was coming full force.” |
| The United States has spent $1.4 billion on its Ebola mission in West Africa, with most of it going to Liberia. Deploying the military cost $360 million, not including the construction, staffing and operating expenses at the treatment centers it built. | The United States has spent $1.4 billion on its Ebola mission in West Africa, with most of it going to Liberia. Deploying the military cost $360 million, not including the construction, staffing and operating expenses at the treatment centers it built. |
| As the world’s biggest donor to the Ebola campaign, the United States also supported a wide range of important efforts, like building a new cemetery and increasing body-collection teams. But the vast majority of aid, about 90 percent, came after Ebola cases in Liberia had already begun to drop. | As the world’s biggest donor to the Ebola campaign, the United States also supported a wide range of important efforts, like building a new cemetery and increasing body-collection teams. But the vast majority of aid, about 90 percent, came after Ebola cases in Liberia had already begun to drop. |
| Of the 11 centers built by the American military, all but one opened after Dec. 22. By then, Ebola cases had already fallen to the point that Liberian and foreign officials were discussing the closing of treatment units built by other organizations that were no longer needed. | Of the 11 centers built by the American military, all but one opened after Dec. 22. By then, Ebola cases had already fallen to the point that Liberian and foreign officials were discussing the closing of treatment units built by other organizations that were no longer needed. |
| American officials point out that building treatment centers made sense given the epidemic’s trajectory when the decision was made. | American officials point out that building treatment centers made sense given the epidemic’s trajectory when the decision was made. |
| The raging outbreak in Liberia peaked just one week after Mr. Obama’s announcement, with countless Ebola patients unable to find beds in hospitals and clinics. Dire estimates were suggesting that as many as 1.4 million people in Liberia and Sierra Leone alone could be infected if the world did not act immediately. | The raging outbreak in Liberia peaked just one week after Mr. Obama’s announcement, with countless Ebola patients unable to find beds in hospitals and clinics. Dire estimates were suggesting that as many as 1.4 million people in Liberia and Sierra Leone alone could be infected if the world did not act immediately. |
| Jeremy Konyndyk, who headed the Ebola response for the United States Agency for International Development, which was in charge of the American campaign, said there had been no “template” for tackling an epidemic of this scale, as there was for conventional disasters like famines or earthquakes. | Jeremy Konyndyk, who headed the Ebola response for the United States Agency for International Development, which was in charge of the American campaign, said there had been no “template” for tackling an epidemic of this scale, as there was for conventional disasters like famines or earthquakes. |
| “Our initial expectation, based on some of the models and some of the experiences and precedents from past Ebola outbreaks, was that the way you would beat this would be to get enough E.T.U. beds,” he said. | “Our initial expectation, based on some of the models and some of the experiences and precedents from past Ebola outbreaks, was that the way you would beat this would be to get enough E.T.U. beds,” he said. |
| He added, “On balance, I think we took the right approach. The challenge in this kind of a response is you don’t know where the fire is going to break out, but you’re going to need a fire station there when it does.” | He added, “On balance, I think we took the right approach. The challenge in this kind of a response is you don’t know where the fire is going to break out, but you’re going to need a fire station there when it does.” |
| The epidemic quickly defied the ominous predictions. Liberia has had 9,862 total infections and the most recorded deaths — 4,408. Worldwide, more than 25,500 cases and more than 10,500 deaths have been recorded, with new infections continuing in Guinea and Sierra Leone. | The epidemic quickly defied the ominous predictions. Liberia has had 9,862 total infections and the most recorded deaths — 4,408. Worldwide, more than 25,500 cases and more than 10,500 deaths have been recorded, with new infections continuing in Guinea and Sierra Leone. |
| As Ebola cases in Liberia ebbed, American officials said they adapted by dropping plans for the military to build three additional centers and reducing the size of others. | As Ebola cases in Liberia ebbed, American officials said they adapted by dropping plans for the military to build three additional centers and reducing the size of others. |
| In an interview before his troops ended their mission here a few weeks ago, Maj. Gen. Gary J. Volesky noted that the American soldiers trained 1,500 Liberian health workers to operate the centers, transferring skills that will be useful long after the outbreak. | In an interview before his troops ended their mission here a few weeks ago, Maj. Gen. Gary J. Volesky noted that the American soldiers trained 1,500 Liberian health workers to operate the centers, transferring skills that will be useful long after the outbreak. |
| “While some of those E.T.U.s may have never seen an Ebola patient, you had health care workers in those communities that completely understood Ebola,” General Volesky said. | “While some of those E.T.U.s may have never seen an Ebola patient, you had health care workers in those communities that completely understood Ebola,” General Volesky said. |
| American assistance came in other forms, too. One center, planned before Mr. Obama’s announcement and built by a private organization with American aid, treated 160 Ebola patients. Five other Ebola patients were treated at a similar facility. Many other patients have come to American-built centers with symptoms, but were sent elsewhere after testing negative for the virus. | American assistance came in other forms, too. One center, planned before Mr. Obama’s announcement and built by a private organization with American aid, treated 160 Ebola patients. Five other Ebola patients were treated at a similar facility. Many other patients have come to American-built centers with symptoms, but were sent elsewhere after testing negative for the virus. |
| Labs were also set up to test for Ebola. Teams were deployed to rural areas to quell flare-ups before they could spread. Critical supplies were airlifted across a nation with many impassable roads. Money poured in to education and awareness-raising in communities. | Labs were also set up to test for Ebola. Teams were deployed to rural areas to quell flare-ups before they could spread. Critical supplies were airlifted across a nation with many impassable roads. Money poured in to education and awareness-raising in communities. |
| Dr. Moses Massaquoi, the head of Ebola case management for Liberia’s health ministry, said that the American support “came too late” to have an impact at the height of the epidemic. | Dr. Moses Massaquoi, the head of Ebola case management for Liberia’s health ministry, said that the American support “came too late” to have an impact at the height of the epidemic. |
| But “what it has done for us is that it has built our capacity to sustain the gains we had,” he said, “and that’s why we are here today.” | But “what it has done for us is that it has built our capacity to sustain the gains we had,” he said, “and that’s why we are here today.” |
| President Ellen Johnson Sirleaf, asked whether the American response had been too slow, said “no one could have anticipated the success” that Liberia had before the American-built treatment centers were finished. | President Ellen Johnson Sirleaf, asked whether the American response had been too slow, said “no one could have anticipated the success” that Liberia had before the American-built treatment centers were finished. |
| How exactly the epidemic was contained in Liberia — and what that means for big, international responses in future outbreaks — will be researched and debated for years. | How exactly the epidemic was contained in Liberia — and what that means for big, international responses in future outbreaks — will be researched and debated for years. |
| But to many on the front lines of the battle against Ebola, the answer is already clear. | But to many on the front lines of the battle against Ebola, the answer is already clear. |
| “Communities taking responsibility for their own future — not waiting for us, not waiting for the government, not waiting for the international partners, but starting to organize themselves,” said Peter Graaff, the leader of the United Nations intervention in Liberia. | “Communities taking responsibility for their own future — not waiting for us, not waiting for the government, not waiting for the international partners, but starting to organize themselves,” said Peter Graaff, the leader of the United Nations intervention in Liberia. |
| In the neighborhood where the outbreak in Monrovia started in June, a 200-volunteer task force formed in July, with residents buying chlorine and buckets to put in public places and donating two vehicles so volunteers could monitor the sick. | In the neighborhood where the outbreak in Monrovia started in June, a 200-volunteer task force formed in July, with residents buying chlorine and buckets to put in public places and donating two vehicles so volunteers could monitor the sick. |
| In another neighborhood, residents collected $2 per home, buying rubber boots and megaphones so that volunteers could fan out to counter rumors that Ebola was a hoax and implore people not to hide the sick and the dead. | In another neighborhood, residents collected $2 per home, buying rubber boots and megaphones so that volunteers could fan out to counter rumors that Ebola was a hoax and implore people not to hide the sick and the dead. |
| “We didn’t want to see our people dying, and there was no one coming in” to help, said Amos Marjohn, 37, a task force leader in one neighborhood. “We had to respond very quick and mobilize ourselves.” | “We didn’t want to see our people dying, and there was no one coming in” to help, said Amos Marjohn, 37, a task force leader in one neighborhood. “We had to respond very quick and mobilize ourselves.” |
| In a weak state like Liberia, people were used to getting by with little or no help from the government, an ability reinforced by the country’s 14-year civil war. And the government did not reach out to them as the outbreak gathered steam. | In a weak state like Liberia, people were used to getting by with little or no help from the government, an ability reinforced by the country’s 14-year civil war. And the government did not reach out to them as the outbreak gathered steam. |
| Experts and officials now say that an official push should have been made to help those communities early on. | Experts and officials now say that an official push should have been made to help those communities early on. |
| “We should have seriously worked on the communities starting in July,” when cases were rising but had yet to explode, said Dr. Massaquoi of Liberia’s health ministry. | “We should have seriously worked on the communities starting in July,” when cases were rising but had yet to explode, said Dr. Massaquoi of Liberia’s health ministry. |
| Soon, the toll was becoming clear: New Ebola cases rose from a total of about 40 a week in mid-July to 350 in mid-August. | Soon, the toll was becoming clear: New Ebola cases rose from a total of about 40 a week in mid-July to 350 in mid-August. |
| The government made matters worse in mid-August when Ms. Johnson Sirleaf deployed soldiers and the police to enforce a quarantine in West Point, the nation’s biggest slum. Residents rioted, and the security forces killed a 15-year-old boy. Ms. Johnson Sirleaf later said that her initial “security approach” in West Point had been a mistake and that she had adopted the opposite tactic, to “engage our communities.” | The government made matters worse in mid-August when Ms. Johnson Sirleaf deployed soldiers and the police to enforce a quarantine in West Point, the nation’s biggest slum. Residents rioted, and the security forces killed a 15-year-old boy. Ms. Johnson Sirleaf later said that her initial “security approach” in West Point had been a mistake and that she had adopted the opposite tactic, to “engage our communities.” |
| In early September, the government began a listening tour of affected communities and enlisted an epidemiologist who had earned residents’ trust. | In early September, the government began a listening tour of affected communities and enlisted an epidemiologist who had earned residents’ trust. |
| Soon, he was carrying out workshops for the countless volunteer task forces across the city, supplying them with low-tech tools to track the sick and stop Ebola’s spread: a notepad, a pen and an identity badge. | Soon, he was carrying out workshops for the countless volunteer task forces across the city, supplying them with low-tech tools to track the sick and stop Ebola’s spread: a notepad, a pen and an identity badge. |
| As the United States and other donors increased aid, these volunteer groups assumed a more formal role. In November, thousands of volunteers began receiving training from international health workers and earning $80 a month from the United Nations. | As the United States and other donors increased aid, these volunteer groups assumed a more formal role. In November, thousands of volunteers began receiving training from international health workers and earning $80 a month from the United Nations. |
| “That was the only means that helped us maintain the volunteers,” said Eric Vaye, community chairman for 72nd SKD Boulevard — home to Thomas Eric Duncan, the Liberian who died of Ebola in Dallas in early October. | “That was the only means that helped us maintain the volunteers,” said Eric Vaye, community chairman for 72nd SKD Boulevard — home to Thomas Eric Duncan, the Liberian who died of Ebola in Dallas in early October. |
| Without the money, Mr. Vaye added, volunteers would have been forced to return to their regular jobs. | Without the money, Mr. Vaye added, volunteers would have been forced to return to their regular jobs. |
| Just as previous generations learned how to deal with smallpox before vaccination, communities here have “learned how to deal with Ebola” — greatly decreasing the chances of another explosive outbreak, said Dr. Frank Mahoney, who has been leading the effort in Liberia for the United States Centers for Disease Control and Prevention. | Just as previous generations learned how to deal with smallpox before vaccination, communities here have “learned how to deal with Ebola” — greatly decreasing the chances of another explosive outbreak, said Dr. Frank Mahoney, who has been leading the effort in Liberia for the United States Centers for Disease Control and Prevention. |
| “Everybody knows right now that the best way to fight Ebola is to prevent it,” said Joseph Boye Cooper, a volunteer leader in one Monrovia neighborhood. “People learned a severe lesson from Ebola.” |