fighting ebola at the source: destination...
TRANSCRIPT
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Fighting Ebola at the Source: Destination Liberia
CAPT Scott Lee Regional Emergency Coordinator ASPR Region VII
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Liberia
• Population: ~4 million people
• Capitol City: Monrovia
pop. ~ 1 million
• Land area: 43,000 mi² ~ size of Tennessee
• Few paved roads
• Health spending as percentage of GDP: Rank 1, US Ranks 3rd
• GDP Ranking: 170/183
• $88/person vs. US $9,000/person
• Weather: Two Seasons, Hot and Humid and Wet, Hot and Humid
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Liberia
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Health
• Average life expectancy: Males 56.56/Females: 59.9
• Degree of risk of Infectious disease: very high (food and waterborne bacterial and protozoal diarrhea, hepatitis A, and typhoid fever, malaria, dengue fever, and yellow fever, schistosomiasis, Lassa fever, rabies)
• Clean water and sanitation issues
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Medical
• Medical Infrastructure
largely destroyed during two civil wars
• 56 Doctors - 1 per 76,000 people
(Missouri: 254 per 100,000 people)
• Reliant on NGOs and
International community
for basic medical care
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“Ebola epidemic in W. Africa and the humanitarian crisis there is a top national security priority for the United States”
• Predicated on four key goals:
1. Controlling the epidemic at its source in West Africa;
2. Mitigating second-order impacts, including blunting the economic, social, and political tolls in the region;
3. Engaging and coordinating with a broader global audience; and
4. Fortifying global health security infrastructure in the region and beyond.
The Strategy
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Overall USG Response in partnership with Gov’t of Liberia (GoL)
Chief of Mission/
USAID-DART
United Nations
Mission for Emergency Ebola
Response (UNMEER)
DOD Operation United Assistance
Commissioned Corps Ebola Response
Technical Assistance, Contact Tracing, Lab Oversight, Training
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Chief of Mission/USAID
• Overall In-Charge of USG Mission and “mission” – the Ambassador
• USAID has enduring presence
• OFDA DART (USAID) has coordination/control from USG Interagency Response and is funding agent…….think FEMA
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CDC Tasks
• Provide Subject Matter Expertise to MoH
• Provide Training
• Contact Tracing
• Epidemiology Support
• Laboratory Support
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DoD Tasks
• Build Ebola Treatment Units (ETU) - 15
• Sustain Ebola Treatment Units
• Train Health Care Workers (1500)
– National Police Training Academy/Mobile Teams
• Laboratories (4-5 day down to 3-4 hours)
• Protect the Force
• Build and Support 25-bed Ebola Hospital
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USPHS Mission Specificity
The USPHS Commissioned Corps will be the only U.S. government asset in West Africa
providing direct patient care in 25-bed Ebola hospital.
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• CDC begins to respond (Dec 13 – May 14) • USAID requests additional HHS participation in
coordination effort. (June 2014)
• Proposal for USPHS to serve in multiple roles including direct patient care. Presented to National Security Council. (July/August 2014)
• Activation and Deployment memo of signed (Sep 2014)
• Includes broad language for multiple Corps roles.
• White House Principals Committee Conclusions: (Sep 2014)
HHS with USAID support, will deploy USPHS Commissioned Corps to Liberia to staff the DoD-provided 25-bed medical unit for Ebola care.
How it unfolded for PHS
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Potential Challenges
• USPHS has no “units” to send/owns nothing
• DoD facility staffed by Corps with a dangerous pathogen, in international environment with force health threats.
• Funding streams differ.
• High risk and high visibility
• In-country operational realities with communications , movement and logistics.
• Expectation management (politics v operations)
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Interagency Planning Within Dept of Health and Human Services and OGA
– Eligibility – Liability (SOFA, Bilats) for provision of direct care in Liberia – Level of care
With USAID – Overall roles and coordination – Fiscal resources
With DoD – Deployment requirements
• Force Protection, Life-support, Air Mobilization
– C2 integration
With CDC – Training requirements and in-country epidemiology
With International Partners – Additional in-country “hot-zone” training
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Monrovia Medical Unit
• Air Force Hospital
• Built by Navy Sea Bees
• Supported by the Army
• Run by USPHS Commissioned Corps
Truly a Joint Effort
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Monrovia Medical Unit
Hospital is available to health care
workers in the fight against Ebola in Liberia
Most advanced Ebola Care in West Africa Lab: Blood Analytics Pharmaceuticals Blood/Plasma
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Monrovia Medical Unit
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Monrovia Medical Unit
Admin Break Area
Rx Supply
Donning
Doffing Non Ebola
Suspected
Probable
Confirmed
Lab
Reception
Generators
Visiting Area
Laundry
Incinerators
Ambulance unloading
Storage Entry
Tanks
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LSA – Life Support Area
Conf. Rm
Gym
MWR
Laundry
Storage
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Admin Tent
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Supply Section
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Looking into the High-Risk Area
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Patient Wards
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Water/Chlorine Water Mix
• 3 Flavors: Plain Water, 0.05% and 0.5%
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Patient Intake
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Waste Incinerators
Wood Fired. NGO Partner Operated.
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Patient Showers and Latrines
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Family Visiting Area
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Life Support Area
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Our first two HCWs discharged
Today I am Healed; Tomorrow I Return to Heal Others
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Logistics O & M Engineering
Time and Distance
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Transition = Risk
• Teams swapping out
• Army/Contractor Transition
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Questions?