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A COMMUNITY-BASED APPROACH TO END EBOLA IN FOUR MONTHS-

By Rufus Darkortey                               Economist Rufus Darkortey

 

 

A SYSTEMATIC HOUSE-TO-HOUSE SEARCH STRATEGY

 

1.0 Executive Summary

This proposal recommends a series of strategic approaches aimed at assisting the government of Liberia, countries that are severely affected by the Ebola virus, and collaborating entities to eradicate the virus within a period of four months. The proposal recommends that the government of Liberia must launch and implement a systematic house-to-house search strategy as a community based approach to eradicating the virus from the country within a timely manner. The objective of this strategy is to identify, isolate, contain, report, and monitor all incidence of Ebola at the community level to ensure the eradication of the disease from the country within the plan period.

 

Because the tracing of infected people and their contacts have become very difficult and highly impossible in Liberia, the virus is spreading exponentially. Since these challenges are driving the exponential rate at which the disease is spreading across the country, a house-to-house search mechanism becomes the best option to quickly eradicate the disease. This proposal also recommends that since the virus has become a threat to the national existence of Liberia, the government must exert every effort to take complete ownership of the fight and must fully finance the eradication of the disease irrespective of whether humanitarian assistance is received or not from friendly countries and organizations.

 

2.0 Introduction

The Ebola virus is spreading at a faster rate in Liberia more than other affected countries. On September 8, 2014, the World Health Organization (WHO) indicated that the virus is spreading exponentially across the country. The President of Liberia, Madame Ellen Johnson Sirleaf has termed the spread of the virus a global health crisis and urges more international help. The Minister of Information of the country, Mr. Lewis Brown, has described the Ebola outbreak a serious threat to Liberia’s existence. The Center for Disease Control and Prevention projects the disease to infect about 20,000 people. The Médecins Sans Frontières (MSF) said this Ebola outbreak is the biggest ever known. H.E. Barack Obama, President of the United States have confirmed that the disease is out of control and spreading exponentially, thus ordering the deployment of 3,000 U.S military personnel in Liberia and other West Africans countries being hit by the virus.

 

Given the enormous rate at which the virus is spreading, Liberia and other severely affected countries must quickly adopt a more robust proactive crisis management approach to contain and eradicate the disease in a timely manner. I am therefore proposing this plan to help eradicate the virus from Liberia and the other affected countries within the next four months. This plan will complement the already existing reactionary approach currently being taken to fight the disease at the hospital level. Ebola must be fought, contained, and eradicated at the community level as a proactive approach. This approach will reduce or eliminate the pressure being put on the inadequate Ebola treatment centers and other medical facilities that are treating patients being infected at the community level. In simple terms, the community is the source of the virus and therefore all efforts must be made to eradicate it at that level.

 

Poverty is a key driver of the exponential spreading of the disease. For example, to date, most affluent individuals in Liberia have not been affected by the virus. Apart from Patrick Sawyer and the affluent medical practitioners who are at risk by fighting the disease, there are little to no deaths being reported among the well-offs in the country. However, about 1,307 impoverished Liberians have died from the disease and thousands more are being infected at a faster rate. A gap analysis of infection data between the poor and the well-off shows that, affluent Liberians are successfully fighting the disease because they are using affordable personal protective equipment (PPEs), while the impoverished individuals are not using those due to the lack of purchasing powers.

 

If implemented, this plan will help to eradicate Ebola from Liberia and other countries within the next four (4) months by proactively empowering impoverished communities to eradicate the virus before it reaches the hospitals.

 

3.0 Problem Statement

Liberia is hit the hardest of all countries that have ever been affected by the Ebola virus since it emerged in 1976 in Zaire. As of September 10, 2014, about 1,307 persons have died from the disease and more than 2,415 persons are infected. The disease entered Liberia from Guinea on March 22, 2014 and caused 129 deaths by July 26, 2014. From July 26, 2014 to September 10, 2014, the disease has exponentially spread across Liberia jumping by 913% from 129 to 1,307 deaths. The WHO is predicting the disease to continue to spread exponentially. Unless a plan such as this is implemented, the WHO approximation could be correct based on the analyses of the following factors:

 

3.1 Poverty – A Key Driver of Ebola

A major driver of the spread of the virus in Liberia is severe poverty. The country ranked the 4th poorest in the world in 2013 in terms of GDP per capita. According to the United Nations, about 83.9% (the 1st and worst in the world) of Liberia’s 4.3 million people live on less than $2.00 per day. Also, about 70-85% of the country’s workforce is unemployed. Additionally, most impoverished families in Liberia are often compelled to pull their resources together by living in clusters of about 10-15 persons per household, thus making it very easy for them to contract and spread the disease at a faster rate.

 

This dismal poverty statistics suggests that 3.6 million of the country’s 4.3 million people lack the income required to buy the necessary PPEs and other medical supplies needed to protect themselves from the disease. Therefore, they are highly vulnerable to contracting the disease and spreading it at an exponential rate as suggested by the WHO.

 

Because of Liberia’s vulnerability and the potential to spread the disease at an exponential rate, the government of the country must take drastic measures to eradicate the disease from the country within a timely manner. Consequently, this proposal is recommending that the government launch and implement a house-to-house search community based strategy to quickly identify, isolate, contain, report, and monitor all incidence of the virus within the community. The proposal is also calling on the government to take full ownership as well as completely financing the cost of the eradication of the disease. This means that the government must adequately supply each household with hand sanitizers, disposable hand gloves, Clorox, food, etc., and other items intended to protect people from contracting and spreading the disease.

 

 

3.2 The Closure of Hospitals & Clinics; Medical Misdiagnosis; Fear

The Closure of Hospitals & Clinics: Many hospitals within Liberia are either voluntarily closed or operating at low capacities due to the Ebola crisis. Most of these hospitals are indicating that they do not have the requisite medical supplies to help fight the disease. Therefore, they have opted to voluntarily close their doors for fear of being infected by the disease in the line of service. As a result, people that are suspected of contracting the disease are left with no choice but to return to their homes and in the process infecting others.

 

MSF and other credible medical organizations currently helping to fight the disease in Liberia have indicated that treatment centers are filling faster than expected, thus leaving no room to accommodate other infected people. As a result, people that are been tested positive are returning to their crowded homes, riding in crowded taxis or buses, and exponentially infecting others.

 

Medical Misdiagnosis: Due to the closure of many hospitals and clinics in Liberia resulting from this Ebola crisis, many Liberians are not getting the proper medical treatments that they would normally receive in the absence of this crisis. Prior to this Ebola crisis, Liberians were observed to incur many ailments, including malaria, cholera, fever, headaches, etc. Because these ailments share the same symptoms as the Ebola disease, many Liberians experiencing any ailment are now being misdiagnosed as Ebola patients and therefore being refused at most medical facilities. As a result, these people return to their homes and infect others if it turns out that they are truly infected with the virus. Because more than 3.6 million impoverished Liberians are being refused medical services, the Ebola virus is expected to spread exponentially due to infected individuals being left at home to be cared for by their families and communities without the medical expertise.

 

Fear: Ebola is being spread exponentially due to fear. Most impoverished Liberians that are ill are not seeking medical attention due to fear of being misdiagnosed or stigmatized as Ebola victims. Also, because the healthcare delivery system of the country has collapsed to a larger extent, there are no medical examinations available to quickly test patients for Ebola versus other ailments. As a result, family and community members are stepping up to provide support and care to their sick family members or friends, thus getting infected in the process. Additionally, many ill patients tend to hide their sickness for fear of being stigmatized or for other reasons. By the time their situation is brought to the community attention, that person has either died or has infected others exponentially.

 

The Ebola crisis has become a national security issue. Therefore, the government of Liberia must move as quickly as possible to subsidize the operation of some hospitals and clinics to build their capacities to help eradicate the disease. The government must also ensure that no one is turned away from any medical facility.

 

4.0 Plan Definition

The house-to-house search community based Ebola eradication plan is designed to foster clearly defined aggressive proactive strategies at the community level aimed at eradicating Ebola from Liberia and other affected countries within four months. The plan makes a key assumption that Ebola has become entrenched in many Liberian households and is spreading exponentially thus overwhelming the healthcare delivery system and other actors seeking to eradicate the disease. This plan shows that, with the rate at which the disease is spreading, fighting the virus at the hospital level alone is reactionary and lacks the ability to eradicate the virus from Liberia or the other severely affected countries in a timely manner.

 

Since the emergence of Ebola in Liberia on March 22, 2014, not much has been done to trace contacts and contain infected people. As a result, infected people have been moving across the country, thus spreading the disease exponentially. At this moment, it is completely difficult and highly impossible to trace infected contacts in the country. Ebola has moved into many impoverished Liberian households and is just waiting to attack the next victim during the 2-21 days incubation period.

 

Because of the difficulties in identifying which household is actually infected with the disease, the best approach is to go into each house and medically assess everyone and disinfect the house where possible to eradicate the disease from Liberia.

 

5.0 How does the Plan Eradicate Ebola in Four Months?

The Ebola virus requires a human host to survive, otherwise it dies. It spreads through contact with infected body fluids. According to experts, the incubation period of the virus is 2-21 days. So anyone who contracts the virus is expected to die or transmit it on or before the 21st day if not treated. The incubation period starts over for anyone who came in contact with the previously infected person for a total of 42 days (21+21). If a 3rd person got infected on the 21st day of the 2nd previously infected person, the total days count jumps to 63 days (21+21+21). As the trend continues, if 6 persons got infected at the end of each incubation period, the virus will be around for about 126 days (6*21) or approximately four (4) months (126/31).

 

Current estimates suggest that more than 50 new cases are being reported on a daily basis. So assuming those 50 persons also infected 50 more people at their terminal stages, about 1,050 days (50*21) or 34 months (1,050/31) could be added to the Ebola fight.

 

So, to eradicate the continue spread and prolongation of the disease as hypothetically shown above, the first person who contracts the disease must quickly be identified, isolated, contained, treated, and monitored for full recovery. This is how this disease can be eradicated from Liberia within four months. Under this plan, I expect the government to organize and deploy the necessary resources and essential supplies within the 1st 30 days or 1st month of the plan period. Once the resources are deployed, the community vigilante teams will begin the daily house-to-house searches on the first day of the 2nd month. The 2nd month begins to pay huge dividends as almost every infected person is identified, isolated, contained, and treated. During the 3rd month, the daily searches continue resulting into identifying additional individuals who may have gotten infected by people who were identified during the 1st month. By the 4th month, it will be difficult to identify new cases and all existing cases may be discharged from the hospitals at the end of the 4th month.

 

These scenarios show that the house-to-house search community based approach is the best strategy for eradicating the virus from Liberia. On the contrary, let’s assume that the current wait and see reactive approach continues at the hospital level, the hospitals will only treat people who show up at the hospital. So as people are getting exponentially infected, the hospitals will continue to run out of beds, rooms, personnel, resources, and other logistical support, thus prolonging the fight of the disease and thus crippling the country further.

 

I am therefore strongly encouraging the government of Liberia to quickly implement this plan.

 

6.0 Objective of the Plan

The overall objective of this plan is to eradicate Ebola from Liberia within four (4) months as of the date of implementation of the plan by the government of the country.

 

7.0 The Strategic Approaches of the Plan

This section outlines the strategic approaches of the plan. The related strategies of implementation and other supporting motivations are presented in the next sections of this document.

 

7.1 Strategy #1: Government Must Own and Finance the Cost of Fighting Ebola

7.2 Strategy #2: Elevate the Ebola Fight to the Community Level

7.3 Strategy #3: Uphold the State of Emergency for Four (4) Months

7.4 Strategy #4: Implement House-to-House Search and Monitoring Mechanism

7.5 Strategy #5: Recruit and Organize Community Structures

7.6 Strategy #6: Establish Zonal Managerial Structures

7.7 Strategy #7: Restrict Movements, Isolate, and Quarantine

7.8 Strategy #8: Supply each Household with Food

7.9 Strategy #9: Supply each Household with PPEs

7.1a Strategy #10: Subsidize the Operations of Key Medical Facilities

7.2a Strategy #11: Increase the Size of the Ebola Call Centers

7.3a Strategy #12: Mandate the Prompt Reporting of all Deaths and Ailments

7.4a Strategy #13: Commit Some Government Vehicles to Pick up Bodies and Sick People

 

8.0 Implementation Strategy

The eradication of Ebola from Liberia can only be assured with a clearly defined and properly executed aggressive strategy. The following are carefully researched strategies aimed at eradicating Ebola from Liberia within about four (4) months.

 

8.1 Strategy #1: Government Must Own and Finance the Cost of Fighting Ebola

Ebola is catastrophically impacting every sector of the Republic of Liberia. Therefore, the government of the country must quickly exert every effort to take complete and timely ownership of the Ebola crisis. Additionally, the government must make every effort to gather the necessary resources to finance the full cost of the Ebola fight ensuring the eradication of the disease from the country as soon as possible. Irrespective of the funding and other assistance being received, Liberia must make every effort to eradicate this disease as a national imperative. It is Liberia, not other countries that run the risk of collapsing if this disease is not eradicated within a timely manner. International help is welcomed and applauded, but Liberia must exert every effort to defeat this virus as an independent country.

 

The Ebola virus has become a clear and present danger to the national security of the country. According to the Ministers of Defense and Information of the country, the virus is a serious threat to Liberia’s existence. Since the virus entered the country about 7 months ago from March 22, 2014, the evidence clearly suggests that the virus has had serious catastrophic impact on every sector of the country. The economy is severely shocked. Almost all of the airlines operating within the country have canceled their flights. Shipping lines have also canceled their fleets. A number of domestic and international businesses, including non-profit and for-profit organizations have ceased their operations. The borders of the country are closed thus adversely affecting the import and export sector of the country creating the shortage of goods and services. The shortage and non-production of goods and services are driving higher prices of the remaining goods and services, thus imposing severe economic hardship on the already impoverished people of the country. The government has scaled down operations instructing nonessential staff to stay at home. The healthcare delivery system of the country has collapsed resulting from the voluntary closure of most hospitals and clinics operating within the country. The schools are closed and every other institution within the country is either closed or operating at a low capacity.

 

Unless the government of Liberia takes full ownership by financing the timely eradication of the disease from the country, the country is bound to collapse politically, economically, and socially within a few months to come.

 

Taking full ownership: We must firstly commend the government of Liberia for the level of work already performed at the moment to fight the disease. But given the exponential rate at which the virus is spreading across the country on a daily basis, the government must be required to do more by taking full ownership to bring this virus under control within the next four months.

 

It is currently observed that the fight against the disease is a voluntary one at some levels, mostly undertaken by some renowned local and international non-profit organization, churches, and other community based self-help initiatives. For example, The Médecins Sans Frontières, the United States based Center for Disease Control and Prevention, the Samaritan Purse, the World Health Organization, etc., are some of the organizations actively fighting the disease with little to no government presence in some areas. Currently, there are 3-6 days delays in picking up dead bodies. People who are sick are not getting urgent medical attention, thus leaving them to die prematurely. Some people that are being quarantined are not fed or medically treated, thus prompting them to run into the community to look for food, thus infecting others in the process. It is also reported by MSF and others that Ebola Treatment Centers are inadequate and filling faster, thus resulting into people who are Ebola positive to be turned away, which is leading to new cases.

 

We should welcome and embrace all international and local voluntary efforts to eradicate this virus. However, because of the catastrophic impact the disease has had on the entire country and the resulting national security threat it has on the existence of the country, the government must take full and complete ownership of eradicating this virus from the country. This country is an independent country and must exhibit every effort to independently lead the charge to defeat this virus even if there are no international or local help available. I am more than 100% convinced that our government has the financial capacity to defeat this virus in a timely manner.

 

Financing the cost of the Ebola fight: The government of Liberia must move quickly to finance the full cost of fighting the Ebola disease or risk dire consequences and repercussions for inadequate actions. Since the emergence of the virus seven months ago, the inadequate measures taken to contain and eradicate the disease have led to the exponential rate at which the disease is spreading across the country, thus threatening the national existence of the country. I would think any threat to our national existence will be coming through military actions from a superpower and not the Ebola virus. No country has collapsed as a result of the virus so Liberia must not allow herself to be the first. Ebola is a very deadly disease but can easily be contained and eradicated if and only if careful measures are utilized.

 

It is currently being observed that most communities, especially the impoverished ones are not being supplied with individualized hand sanitizers, disposable hand gloves, and other requisite PPEs that are necessary for the prevention of the spread of the disease. Most hospitals are voluntarily closed due to the lack of PPEs and other medical supplies that are necessary for the fight against the disease. Additionally, healthcare workers are refusing to work or are protesting to work due to the payment of salary arrears. The evidence also show that there are too many makeshift isolation centers around the country that are being undertaken by community efforts without any support from the government, thus exponentially increasing the infection and death rates of the Ebola victims.

 

A key concern being expressed by the government is that it does not have the monetary capacity to eradicate the disease, thus only funding US$5 million out of a $20 million initial allocation to fight the disease. Despite the recent shock to the economy of the country as a result of the 14 years civil war, I am confident that Liberia is capable of committing about US$200 million dollars to this fight, which is even too high to eradicate this virus if adequate measures are taken as quickly as possible.

 

On May 21, 2014, President Ellen Johnson Sirleaf submitted a draft national budget of US$557 million to the 53rd National Legislature. The budget is expected to invest in key areas of national development with specific focus on roads, security, energy, technology, ports, health, education, etc. Given the dire national security threat the virus is posing to our national existence, the government must reprioritize the budget to shift funding away from the items mentioned above to completely fund the eradication of the disease from Liberia within the next four months as is being proposed. While we must be grateful and continue to embrace the impeccable humanitarian assistance we continue to enjoy from the donor community, Liberia, as an independent country of more than 167 years, must proudly exercise such independence by independently striving to eradicate Ebola from the country.

 

Cost-Benefit Analysis (CBA) of Government’s Inadequate vs. Adequate Actions: The current inadequate measures being taken by the government to defeat the virus could result into dire consequences for the country based on the following cost benefit analysis:

 

CBA of Inadequate Action: The current state of affairs of the country as a result of the Ebola virus suggests that Liberia is in a dire and dismal state. Liberia stands to suffer political and more socio-economic consequences as the virus continue to spread exponentially across the country. As indicated above, since the virus emerged in Liberia about seven months ago from March 22, 2014, it has significantly paralyzed the economy. Almost all of the international airlines operating within the country have cancelled their flights. Those that are still flying to Liberia are practically flying empty to the country. Most shipping lines have canceled their fleets as well. Many companies and nonprofit organizations have either closed or scaled down their operations within the country. International trade has been jeopardized from the combined impact of border closures and air and sea line closures. The supply of goods and services has fallen, thus driving higher prices for the remaining available goods and services on the market. The government of Liberia, a major employer of the country has scaled down its operations instructing nonessential staff to stay at home. The schools are closed. Most hospitals and clinics are voluntarily closed, thus causing other ailments and premature deaths to go on the rise. The fear of the virus has engulfed both local and international investors and others with interest to do business in Liberia. Once this trend continues for the next few months, the economy of the country could completely disintegrate.

 

Politically, the country could face enormous challenges if this virus is not defeated in a timely manner. Currently, there are some individuals calling for the resignation of President Sirleaf. I don’t agree and support the resignation of the President. I believe, whether an opposition or not, we should make that ultimate sacrifice at all times to nurture the growth of our democracy irrespective of the performance of a sitting government. Calling for the resignation of a president is a democratic right available to Liberians, but such right should be exercised as a last resort, rather than the first as often demonstrated by Liberians. However, given the economic and social paralyses mentioned above, the government could face enormous political challenges if this virus is not eradicated from Liberia in a timely manner.

 

CBA of Adequate Action: Liberia stands to obviously benefit from the timely eradication of this disease. The opposite of the economic and political challenges mentioned above are benefits that the country stand to enjoy with a timely eradication of the disease.

 

Therefore, it is in the best interest of the government of Liberia to establish profound ownership over the timely Ebola eradication process and to also strive to fully fund the process, irrespective of any international assistance.

 

7.2 Strategy #2: Elevate the Ebola Fight to the Community Level

The source of the spread of the disease is at the community level, so the virus must be eliminated at that level, instead of mostly treating people after they are infected. Prevention is the best approach to eradicating this disease.

 

The government of Liberia and other stakeholders must attack the Ebola virus at the community level as a proactive measure to efficiently eradicate the disease out of the country in a timely manner. As indicated above, Ebola has become entrenched within some Liberian households and it has become difficult or impossible to clearly determine which household has it or not. Therefore, every household within the country must be medically assessed, monitored, and disinfected, if possible.

 

7.3 Strategy #3: Uphold the State of Emergency for Four (4) Months

The government of Liberia must prudently uphold and extend the nationwide state of emergency only for the sole purpose of eradicating the disease within the plan period of four months. The goal of the state of emergency is to establish the seriousness about the disease among Liberians and to also eradicate the spread of the disease by reducing the movement of people as much as possible.

7.4 Strategy #4: Implement House-to-House Search and Monitoring Mechanism

Given the exponential rate at which the virus is spreading across the country, the government of Liberia must immediately launch a house-to-house search strategy to contain, isolate, and eradicate the disease. As indicated, the government has lost the ability to trace contacts and infected individuals. According to the CDC, WHO, MSF, and other experts that are currently fighting the disease in the country, tracing of infected persons and contacts have become very difficult and impossible. As a result, most infected people cannot be identified. Additionally, according to experts, the virus can only be eradicated in a timely manner if and only if victims are quickly identified, isolated, and treated.

 

Since the country and healthcare practitioners have lost the ability to trace infected people and contacts, it is now highly difficult to precisely forecast and plan treatment centers to hold and treat victims. According to the MSF, hospital beds are filling faster and infected people are being refused to return to their communities, thus infecting others. Given the inability of the country to trace infected people, it is now highly inefficient, ineffective, and costly to only focus on treating people at the hospital and treatment centers level as the main approach for eradicating the disease from the country. The house-to-house search approach is the only effective, efficient, and cost effective strategy that can eradicate this disease from Liberia and other critically effected countries in a timely manner.

 

The following are some measures that must be applied to ensure the successful implementation of the house-to-house search strategy:

 

A. The government of Liberia must establish community based vigilante teams to execute the searches. This measure is necessary because it is assumed that each community member has a better understanding of their communities.

B. These vigilante teams must be quickly trained in a manner to identify, report, isolate, and monitor each household within their communities ensuring that no incidence of Ebola is left unreported within the communities.

C. Each household within the community must be supplied with enough food and PPEs during the plan period of four months. The acquisition of food supplies and PPEs cannot be left as a voluntary effort by the households of these communities because voluntary efforts are not binding and most of these households are too poor to acquire these supplies by themselves. Government risks the continuous spread of the disease if they don’t supply these items.

D. Each household searched by the vigilante team must be accompanied by a medical practitioner and a police officer to ensure that everyone is prudently implementing the plan with mutual respect for all. The community or each household must be very supportive of this measure knowing that it is intended to help make the communities better by eradicating the Ebola disease from the country.

E. The search measure must be consistently applied every day for the period of four months. The searches should take place between 6pm to 10pm every night.

F. The search teams must be given digital thermometer to quickly check the body temperature of each member of the household. The search must be properly documented. If a sick person is identified, an ambulance must quickly be called in and the person taken to a designated testing center for proper diagnosis. If a dead person is found, the team should quickly order the Ebola burial team to quickly test the cause of death if applicable and dispose of the body if it is Ebola related.

G. If the search returns a severely ill person, a dead person, or someone showing significant symptoms of the virus, that person must be sent to the designated medical facility for proper testing and diagnosis, or removed for burial following the measures outlined above. Homes that fall within this category must immediately be evacuated, isolated, and disinfected if applicable. The remaining members of such households must be placed in isolation and tested and monitored for the Ebola incubation period of 21 days.

H. The team must thoroughly search each household within the community ensuring that every corner and around the house is searched since most infected and/or other ill people are hiding themselves from medical personnel so that they are not taken away for fear of being stigmatized, etc.

I. As indicated, this house-house strategy must be implemented every day for the entire plan period of four months. Failure to follow these measures as structured could lead to new cases of the virus which could prolong the timing of the eradication period.

 

7.5 Strategy #5: Recruit and Organize Community Structures

Recruitment-Healthcare Team: The government of Liberia and stakeholders must recruit and train as many personnel that could aid in the execution of the plan. These personnel will be given basic training in preventive measures, identification of patients, and assisting them to quickly seek medical treatment for Ebola or other ailments. Health workers that are not being utilized could potentially be suited for these assignments.

 

Recruitment-Community Based Vigilante Team: Since this plan is community based, the government should encourage the establishment of community based vigilante teams to assist with the house-to-house monitoring of patients, distribution and management of logistical support, and ensuring the timely and effective implementation of the plan. This segment is one of the most important aspects of the plan given that community members better understand their communities and activities that may be occurring there. Because of the size and nature of a particular community, the community members are well suited to effectively and efficiently implement the house-to-house search strategic approach at eradicating Ebola within the plan period.

 

It is also important here to call on the community members to also avail themselves to such a plan as a win-win strategy. Due to the resource constraints of the government and the enormity of the Ebola eradication efforts, community members that are expected to be recruited or those that are members of the community should place patriotism over financial or material rewards. Together, we must defeat this disease to reclaim our families, friends, community, country, and dignity as a people.

 

7.6 Strategy #6: Establish Zonal Managerial Structures

To ensure that the plan is effectively and efficiency executed in a timely manner, the country and/or severely affected areas must be divided into zones. Each zone must have its own personnel, logistics, treatment centers, and medical facilities that must report to the overall managerial team, which is National Ebola Taskforce.

 

7.7 Strategy #7: Restrict Movements, Isolate, and Quarantine

According to scientific research, Ebola can only spread through contacts. As infected people are allowed to freely move around, so does Ebola, thus culminating into the exponential spread of the disease in Liberia. Ebola can only be eradicated if infected as well as potentially infected areas are quickly identified, isolated or quarantine, and cured in a timely manner.

 

The government must ensure that the rights of people are respected and protected while ensuring that people or communities are only quarantined for the purposes of eradicating Ebola out of Liberia. Also, the people of Liberia must exercise due respect for the government and support it at this time to ensure that the deadly Ebola virus is eradicated from Liberia within the plan period.

 

As a result of the Ebola crisis, Liberia, as a country, is being directly and indirectly isolated and quarantined by its neighbors and other countries. Ivory Coast has closed its borders with Liberia. Liberia, Guinea, and Sierra Leone have closed their borders with each other. Many international flights as well as shipping fleets have been canceled for Liberia. Many people have canceled their plans for visiting or doing business in Liberia. Most domestic and international companies have halted their operations in Liberia. People that are leaving Liberia are facing scrutiny and are isolated and quarantined in foreign countries. All of these measures are intended to stop the spread of the disease and it has worked so far for many people and countries. Therefore, the point is, Liberians and the Liberian government must embrace the notion of being isolated or quarantined during the plan period as a prudent way of eradicating the disease out of Liberia.

 

7.8 Strategy #8: Supply each Household with Food

The virus is spreading exponentially across the country because it is now very difficult and highly impossible to trace those infected and their contacts. The government has lost this aspect of the fight against the deadly virus. The ability to quickly identify, isolate, and treat infected individuals is one of the critical strategies for eradicating the virus out of the country in a timely manner. This strategy achieves the goal of managing the containment of the disease by managing the movements of infected individuals before they infect others. However, this strategy is vulnerable to failure due to the lack of adequate food supply available to most people, especially the impoverished people of the country.

 

To ensure the eradication of the virus from the country within the proposed plan period, the government must prudently utilize the imposition of the state of emergency to minimize the movement of people. This minimization strategy will quickly curtail the spread of the disease, thus eradicating the disease from the country. To ensure the effective, efficient, and successful application of this strategy, the government must adequately supply food to each individual within the country or within areas that are severely affected by the virus.

 

As costly as this strategy may seem, there seem to not be a better alternative due to the impossibility of tracing contacts and infected individuals. The virus has spread into many households of the country and has become entrenched due to the inadequate measures that were initially taken. Unfortunately, it has also become very difficult and highly impossible to determine which household has been infected or not until the victim shows up at a hospital, found severely sick or dead. Currently, most of the hospitals and treatment centers have run out of capacity to hold the exponential amount of persons being infected. As it stands, until the government can implement a house-to-house search strategy to identify, isolate, and treat infected individuals, the country will run out of spaces at the treatment centers to hold new cases of infected people.

 

Therefore, the government must manage the movement of people; provide adequate food supply to each household within the country or severely affected areas; and launch an effective and efficient house-to-house search strategy to eradicate the disease from the country within the proposed plan period.

 

7.9 Strategy #9: Supply each Household with PPEs

Because the virus has spread exponentially in the country, each individual is considered a prime suspect for spreading the disease. Therefore, the government of Liberia must supply each individual of each household with adequate supplies of portable hand sanitizers, Clorox, disposable gloves, face masks, etc. These supplies are expected to be used as frequently as possible during the plan period, with a frequency exceeding more than 30 usages per day. Therefore, the government must ensure that each person is adequately supplied with adequate portable PPEs during the four months period.

Although, the plan is encouraging the government to keep chlorinated buckets at public places for public use, it is highly recommended that the government provides each person with their individualized consignment of portable PPEs. Portable PPEs are effective at eradicating the disease because they are mobile and will travel with the individual, while the chlorinated buckets are ineffective because they are stationary and will remain stationary as the individual travels around. It is also important for people who receive these supplies to use them as recommended.

 

It is also important to note that the use of PPEs is the most important component to preventing and eradicating the disease. There is no alternative to this recommendation. Anything to the contrary is the prolongation of the disease in Liberia or anywhere.

 

7.1a Strategy #10: Subsidize the Operations of Key Medical Facilities

The spread of the disease is also being exacerbated by the closure of most medical facilities within the country. Because of the closure of these institutions that are deemed highly important to the eradication of the disease, most infected people are either choosing to stay at home, thus infecting others, or are going to seek some form of medical attention from ill-trained practitioners or “bush doctors”, thus infecting others and causing the disease to spread exponentially.

 

Additionally, due to the closure of these hospitals, many people are dying or suffering the effects of other non-Ebola related ailments due to misdiagnosis by medical and non-medical practitioners. The refusal to admit and the misdiagnosis of the late 16 years old Shaki Kamara, who was shot in the legs by the arm forces of Liberia and later bled to death, is a prime example of the misdiagnosis of patients that is resulting from the voluntary closure of medical facilities at this crucial time in the history of the country.

 

Due to the lack of resources and PPEs, most medical facilities have decided to voluntarily close down their operations unless the government of Liberia can subsidize their operations. The Ebola crisis has become a national security crisis of the country threatening its existence. Therefore, the government must immediately assess the criticality of some medical facilities to the Ebola eradication efforts and subsidize those facilities that are deemed necessary. Per the cost-benefit analysis performed earlier, the country faces enormous socio-economic and political disintegration if every effort is not made, including the subsidization of critical medical facilities, to eradicate the virus.

 

7.2a Strategy #11: Increase the Size of the Ebola Call Centers

To ensure that lives are quickly saved and the spread of the disease is contained by quickly removing dead bodies from the communities, the government must beef up the speed at which it is responding to calls from the communities. There are many complaints that people needing help are not getting through to the Ebola help lines. In some cases, dead bodies are being left in the street for about 3-6 days, thus prompting dogs to eat on them and later infect babies and others that are coming in contact with these dogs.

 

Therefore, I am recommending the government to increase the size of the Ebola Call Centers to about 2,000 to 5,000 telephone lines and help line representatives. I am appealing to all of the cell phone companies operating within the country, including Lone Star, Cellcom, Commium, etc., to donate the telephone lines and equipment to ensure that there is a rapid response to Ebola related calls for help. If these companies are not ready to make these donations, the government must finance the full cost of the operations of the call centers. As a reminder, given the national security threat to the existence of this country from the Ebola virus, the government must take full and swift responsibilities for the eradication of the virus from the country within a timely manner.

 

7.3a Strategy #12: Mandate the Prompt Reporting of all Deaths and Ailments

To contain and eradicate the exponential spread of the disease within a timely manner, the government must mandate the reporting of all deaths and ailments occurring within the country within this plan period. It is currently being observed that most people that are dying or that are experiencing severe ailments are not reporting these to the healthcare or requisite authorities. As a result, people that are infected with the virus are infecting others while been sick or when they pass. Additionally, some family members are still in the practice of burying their love ones, who may have died from the disease in some cases. According to medical experts, the probability of contracting the disease from anyone is higher during the late and terminal stages of the disease.

 

Therefore, to ensure that the disease is not being spread in this manner, the government of Liberia must mandate that all deaths and severe ailments must be reported to the government within 3 hours of the person dying, or the person being observed to be seriously ill. The mandate should also state that no one should touch the body of the dead person. Also, until otherwise applicable, anyone caring for a seriously ill person while the case is being reported must use PPE. Anyone failing to follow this mandate must be penalized appropriately according to the laws.

 

To ensure the successful application and compliance to this mandate, the government must designate a segment of the Ebola Call Center and must also set other logistical support aside, including ambulances or other vehicles to swiftly respond to these calls.

 

7.4a Strategy #13: Commit Some Government Vehicles to Pick up Bodies and Sick People

Due to the inadequacy of ambulances and the exponential rate at which the disease is spreading within the country, the government of Liberia must commit some of its fleet of vehicles to pick up dead bodies, sick people, as well as performing other duties that are relevant to the eradication of the disease from the country in a timely manner.

 

As indicated, this disease is threatening the national existence of the country so the government must do all it can to eradicate this disease within the plan period of four months.

 

Conclusion

Within just seven months since the Ebola virus emerged in Liberia on March 22, 2014, the disease is spreading unprecedentedly more than any other country that has been affected by the disease since it first emerged in 1976 in Zaire. More than 1,307 persons have died within the country. The WHO said the disease is spreading exponentially, why the government of Liberia has termed the disease as a serious threat to its national existence. The healthcare delivery system of the country has collapsed and the economy is severely shocked. Political challenges are emerging. The MSF has indicated that many of the Ebola Treatment Centers over capacity and infected people are being refused. The CDC has projected that unless something is done, the disease could infect more than 20,000 people in about 10 countries.

 

Therefore, to help eradicate this disease in a timely manner, I am proposing a community based Ebola eradication plan as a proactive strategy to eradicate the disease from Liberia and other affected countries within the next four months as of September 16, 2014. A key ingredient of the plan is for the government to mandate and enforce a house-to-house search strategy as a measure to identify, isolate, contain, and monitor any incidence of the virus at the community level before it reaches the hospitals. This plan is also calling on the government of the country or other affected countries to take full ownership as well as completely financing the full cost of the Ebola eradication efforts.

 

Rufus Darkortey is an Economist and President, Liberia Economic Development Initiative (LEDI). He can be reached at 216-577-3177 | rufusdarkortey@ledinow.org | www.ledinow.org

 

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