Issue link: https://www.epageflip.net/i/574309
ByMariaChengand Raphael Satter and Krista Larson TheAssociatedPress KENEMA,SIERRALEONE The chlorine was expired. The protective gear was missing. Andtheredtapewassothick that responders fighting last year's Ebola outbreak in West Africa had trouble get- ting approval for boots and buckets. The 2014 Ebola epidemic pitted a lethal virus against barely-there health systems, and it was always going to be deadly. But an Associated Pressinvestigationhasfound that a string of avoidable er- rors badly undermined the work of international aid workers. The World Health Orga- nization, charged with lead- ing the fight against global outbreaks, already has been criticized over its manage- ment of its efforts to stop Ebola. Earlier this year, an AP investigation found that WHO delayed declaring an international emergency — similar to an SOS signal — on political and economic grounds. Newly obtained emails, documents and interviews show that WHO and other respondersfailedtoorganize a strong response even after the signal was issued. Experts say the bungling ultimately cost lives across West Africa. "We would like to think that WHO comes in as the cavalry, but they were bun- gling the response as they came in to try to rescue peo- ple," said Dr. Irwin Redle- ner, director of the National CenterforDisasterPrepared- ness at Columbia Univer- sity. He described the WHO problemsuncoveredbyAPas "horrifying." To date, Ebola has killed morethan11,000peopleand officials estimate the epi- demic won't be stopped be- fore the end of the year. Kenema, a diamond town in Sierra Leone whose pot- holed roads turn to red sludge in the rainy season, was a microcosm of the Eb- ola-fighting efforts across West Africa as the disease spiraled out of control. As Ebola cases climbed in July 2014, WHO's Director- General Dr. Margaret Chan identified Kenema as one of two priority areas. "Trans- portation,PPE(personalpro- tectiveequipment)andother equipment must (be) pro- vided," she wrote on July 24. But staffers regularly re- ceived expired or question- able chlorine, incidents that spooked an already rattled staff. Nurse Donnell Tholley said workers sometimes re- sorted to donning ill-fitting glovesfortheirhandsandus- ing stray plastic packaging on their feet instead of the tall protective rubber boots they needed. More than 40 healthworkersdiedandoth- ers abandoned the hospital out of fear. Joseph Fair, a U.S. disease expert in Freetown advis- ing the Sierra Leonean gov- ernment, described WHO as "paralyzed," recalling inter- minable conference calls de- bating things like the color of body bags — even as sup- plies ran out. "Where was the sense of urgency that would have al- lowed professionals to make these decisions quickly?" asked Suerie Moon of Har- vard University, who is co- chairing a panel evaluating WHO's response. The situation at Kenema Government Hospital was horrific — blood-drenched patients lay in agony in un- derstaffed wards and WHO staffers made repeated re- quests for support that went unanswered.Otheraidwork- ers declined to work there, citing the dangerous con- ditions; there was virtually no triage and patients of- ten were shuffled to the Eb- ola ward with incomprehen- sible slips of paper. When the Red Cross of- fered to build an Ebola treatment center to allevi- ate the pressure on the hos- pital, it was held up because no one in Sierra Leone's gov- ernment or WHO could tell them where to build it. "We are at risk of very poorperceptionbythepublic when we send in IFRC (Red Cross)thenblocktheirability to care for patients," WHO's Ian Norton wrote in a note to his colleagues. By the time the clinic was finally built, the peak of the outbreak in Kenema had passed. Twenty health work- ers had been infected in the interim. Many patients who suc- cumbed to the virus were buried in a cemetery be- hind the clinic, their graves marked with numbers in- stead of names. Dr.BruceAylward,WHO's top Ebola official, said it was commonforEbolatreatment centerstobecaughtupinpo- litical wrangling. "Undoubt- edly in some cases there was bureaucracy," he said. But he argued it was wrong to lay the blame at WHO's door. "These were government decisions at the end of the day," he said. Complaints about WHO leadership focused in part onJacobMufunda,theagen- cy's top representative in Si- erra Leone. Requests to fix critical problems like the hospital's shaky generator regularly went unfulfilled by Mufun- da's office, leaving staffers to cover thousands of dol- lars' worth of expenses out oftheirownpockets,accord- ingtotwopeoplethereatthe time. They spoke on condi- tion of anonymity because they were not authorized to talk to the press. An email from Chan, WHO's top leader, which AP obtained, corroborates allegations of tight-fisted- ness, not just in Kenema but across West Africa. Chan told Mufunda and other se- nior officials that only a tiny fraction of needed cash was being released and that the problemhadfesteredforfour months. "Iexpectallourcolleagues ... to facilitate experts and staff to do their field work and not to post barriers be- cause business as usual does not work during crisis," she wrote. Mufunda, who was reas- signedtorunWHO'sofficein Mozambiqueshortlythereaf- ter, did not return messages seeking comment. The problems that ham- strung the Ebola response have prompted soul-search- ing at WHO and across the world's public health com- munity. Two months ago, a WHO- commissioned panel criti- cized the organization's lack of leadership but did not mention the logistical prob- lems uncovered by AP. All of the top leaders at WHO dur- ing the Ebola outbreak re- main,exceptforitsAfricadi- rector,whoretiredafterserv- ing out his term. Thathasleftoutsidersdis- mayed. "Somebody did things to the chlorine powder, some- one delayed the shipment of the body bags, there was clearly someone be- hind these bad decisions," said Redlener, the disas- ter prevention expert. "If I was running the shop there, there would have been a lot of heads rolling." AP INVESTIGATION Bu ng li ng b y UN a ge nc y hu rt E bo la r es po ns e ASSOCIATEDPRESSFILEPHOTOS Women sell food at a market in Kenema, eastern Sierra Leone, a town where more than 40health workers at the government hospital died of Ebola. An Associated Press investigation has found a toxic mix of avoidable problems faced by Ebola responders, including weak leadership, shoddy supplies and infighting, exacerbated a chaotic situation at a critical front in the battle against the virus. Nurse Donnell Tholley, 26, who worked at the Kenema Government Hospital during the Ebola outbreak, holds Donnell Junior, who he adopted as his son a er the baby's mother died from the virus, at their apartment in Freetown, Sierra Leone. World Health Organization Director-General Dr. Margaret Chan, le , and Assistant Director-General of Health Security Keiji Fukuda confer during a news conference a er an emergency meeting at the WHO headquarters in Geneva, Switzerland, in 2014. Maxon Kobba, right, a nurse who works at the government hospital in Kenema, eastern Sierra Leone, stands next to colleagues at the facility. Kobba says as many as 20Ebola patients could die in one night at the facility. A health worker sprays a colleague with disinfectant a er working inside a morgue with people suspected of dying from the Ebola virus, in Kenema, eastern Sierra Leone. RANDAL S. ELLOWAY DDS IMPLANT DENTISTRY 2426 SO. 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