By Frank Bucholtz
Times Contributor
Ebola has been officially eradicated in Liberia, one of three West African countries hit hard by the deadly disease in 2014. And Langley residents played an important role in the fight.
Dr. Francis Kateh, deputy minister of health and chief medical officer for Liberia, was in Langley and other parts of B.C. for several days recently (June 21-24) to thank donors of medical supplies and other equipment, and to update them on what's now happening in Liberia and other affected countries.
The local donations were co-ordinated and shipped by the Korle-Bu Neuroscience Foundation, a Langley-based organization which already had connections with Liberia when the disease broke out.
The foundation, set up by Marj Ratel, a neuroscience nurse at Vancouver General Hospital and Walnut Grove resident, has as its mission improving health care in areas of Africa where local partners can undertake life-saving work with support from overseas donors. KBNF has specifically focused on brain and spinal injuries.
In Liberia, it partners with Jackson F. Doe Hospital in Tappitta, a rural area in Nimba County. It is located about 200 miles from Monrovia, the Liberian capital.
Kateh was named chief executive officer and medical director of the Tappitta hospital in 2010. It is the only hospital in the country with a CT scanner.
He grew up in Liberia and was able to pursue his medical studies in St. Lucia before returning to Liberia to work as a physician during the first Liberian civil war from 1989 to 1997. He went to the United States in 2000 and earned a master's degree in health administration. He became public health director in Anson County, North Carolina in 2004. In 2008, he furthered his education by obtaining a master of professional studies in homeland security leadership with emphasis in public health disaster preparedness.
This stood him in good stead in the Ebola crisis.
At first, the Liberian government was unsure of what to do about illness caused by the Ebola virus, as was the case in neighbouring Guinea and Sierra Leone. The disease had never before been seen in the three countries, all of which have minimal health infrastructure.
They weren't the only ones. The World Health Organization and other bodies also were unsure of how to respond, and the indecision allowed the disease to spread dramatically. A notable exception in responding was Medecins Sans Frontieres (Doctors Without Borders), which acted quickly and was not afraid to draw attention to the crisis.
"One of the key factors that helped in Liberia was when the leadership got involved," Kateh said, referring to president Ellen Johnson Sirleaf. "Within the African context, the president calls the shots. If the president says she wants it done, it is done."
With assistance from partner organizations and the U.S. Army, Liberia was able to develop a plan to reduce and eventually eradicate the disease.
Initial military measures did not solve the problem and, in fact, helped make it worse. In Liberia, when an area of Monrovia was quarantined and people were unable to leave, there were fears of starvation as most people do not have a stockpile of food, due to the heat and lack of storage ability.
"The community became engaged," he said. "We realized that a system of using the military to fight a public health crisis doesn't work."
In March, 2014, as Ebola was being identified in Nimba County, community engagement began. KBNF was just starting involvement in a neurosurgical mission and soon became involved in the Ebola crisis. With leadership from Kateh and the hospital, district chiefs (who play roles similar to mayors in Canada) began to get the message out to people about recognizing symptoms of the disease and who to deal with it.
People were asked to stay in their own areas to protect each other, and Kateh played an instrumental role in taking that approach to a national level.
"KBNF did not leave," he said. "Tappitta was the only hospital in the country that was open for a while."
KBNF shipped seven containers of medical equipment, including items as basic as examining tables, to Liberia. Ratel said a story in The Times was instrumental in helping gather funds and equipment to ship. More equipment has been gathered and will be shipped when funds have been gathered to pay shipping costs.
The good results in Tappitta came to the notice of the national government, and Kateh was asked to go to Margibi County, where there was a full-blown Ebola crisis. The death rate was 10 to 15 people a day and many health care workers were coming down with the disease — most of them dying.
"I was asked to go and help stabilize the area," he said. "Friends told me not to go, that it could be a set-up. But I remembered what Danny (Moe, a KBNF board member) had told me when I was in Canada last August. He had said to me 'You will have a major role to play in Liberia, and God will see you through.' So I went.
"Within three weeks, techniques we'd used in Tappitta began to take effect. It changed the trend of the disease in the county. We used the approaches of community engagement and taking ownership. I met with Tom Frieden (head of the Centre for Disease Control in Atlanta), and told him about our approach, and he met with the president and asked her to bring this approach to the national level."
He was then named deputy incident manager for Liberia in dealing with Ebola, and was charged with organizing the medical response and finding and placing resources.
A community care centre (CCC) strategy was implemented, with the premise that "the sooner we isolate a patient, the better it is." Another aspect was to work to keep Ebola patients sufficiently isolated from one another in the (mostly) makeshift health care areas where they were being treated.
Liberia also implemented a RITE strategy (rapid isolation in treatment of Ebola) which Kateh likened to a fire suppression crew using a helicopter to quickly respond to a report of a forest fire.
"A smaller unit can put out a small fire," he said.
Teams went to isolated areas of Liberia quickly when there were reports of Ebola cases. They isolated potential patients, obtained specimens and did testing — all in short order.
Gradually, the number of cases was reduced, at first in smaller numbers, and then dramatically. On May 9, Liberia was the first of the three countries to be declared Ebola-free. Kateh said it is sharing its techniques with Guinea and Sierra Leone, and there is much better co-ordination than was the case before. He is hopeful it will come to an end in the other two countries soon.
As a result of his efforts, he was recently named deputy minister of health and chief medical officer for Liberia.
He is ever watchful about Ebola and emphasizes that not enough is known about it to ensure that Liberia will remain Ebola-free. He also is very grateful to Canadians who were willing to help when his country was in the worst health crisis it had ever faced.
"Thank you for what you've done," he said.
Those interested in finding out more about KBNF can see their website kbnf.org.
West African Nations Devastated
Ebola has had a devastating effect on Liberia and two neighbouring West African countries, Guinea and Sierra Leone.
The first case is believed to have occurred in Guinea in December, 2013. As there was no history of the disease there, it took close to two months before Ebola was confirmed as the disease which was rapidly killing dozens of people. By then it had spread to Liberia and soon afterwards, Sierra Leone. The outbreak occurred in a remote area where the three countries are close together and there are few border controls.
On June 24 the World Health Organization stated that there had been 27,515 suspected cases and 11,232 deaths as a result of the outbreak.
Liberia had 71 practising physicians at the beginning of the outbreak, Kateh told The Times. They were responsible for health care for a population of more than four million. By contrast, B.C. has about 9,000 physicians to handle an almost-identical population.
In Liberia, 378 health care workers were infected with the disease while trying help others. Of these, 192 died. Five of them were physicians.
This outbreak of Ebola is by far the worst ever recorded. Outbreaks began in 1976 in the Democratic Republic of Congo near the Ebola River.
From 1976 until the outbreak in West Africa in 2013, a total of 1,176 cases had been confirmed in 25 previous outbreaks.
Editor's note: a new case of Ebola was been confirmed in Liberia, on June 30.
