Liberia and the Ebola Epidemic: A Dubious Distinction

This is the third article in a series of reports from Dr. Mardia Stone describing her thoughts and first-hand experiences with the Ebola epidemic and is effect on the Liberian people.

A family that says they had been waiting for two days at the Redemption ebola hospital holding unit wait for medical workers to take them to the new Island Clinic ebola treatment unit. [Photo credit - Carielle Doe, Producer on Ebola coverage in Liberia; http://instagram.com/cariyell]

Liberia has now surpassed Sierra Leone and Guinea in number of cases.  The situation is serious and people are terrified!
 
Today, the government of Liberia (GoL), upon the recommendation of the MoH and security forces, locked down West Point.  NO ONE IS ALLOWED IN OR OUT OF WEST POINT! Residents were teargased; the army formed a barrier around the entire area and placed Coast Guard at sea. This further exacerbates the catastrophe for the community because many of the residents engage in fishing as a livelihood.  It is unclear how long the community will be sequestered.
 
As I’m sure you’ve heard on the news, CDC infectious disease experts are now in Monrovia, and estimate a 12 month period before the epidemic will be under control in Liberia. There has been an increasing incidence of Ebola infection in West Point, underscored by recent confessions of residents that they’d buried up to 200 victims on the beach surrounding the area. 

 
In central Liberia’s Margibi County, Dolo's Town is another hotspot considered for lock down because of an increase in new infections.  A family of 12 from Dolo's Town, were arrested by security forces while they were attempting to escape to a neighboring county. They were brought back to Monrovia by police escort and taken to the treatment center. In that family, a 14 year old boy exhibited symptoms of Ebola and was admitted to the ETU. The others were tested, found to be negative (at present) and taken back to Dolo's Town for isolation, via police escort. 
 
Restriction of movement from one locale to the other is a critical factor in preventing Ebola transmission.  There is the perception that having Ebola or a family member with Ebola stigmatizes an individual. Given Liberia’s historical ethnic diversity (16 distinct ethnic groups in a population of 4.5M) and the fluidity of movement across its borders as individuals visit and/or trade with their tribesman, restriction of movement is a major challenge for the government. 
 
Many Liberians and Liberian political leadership believe that Liberian people respond best to force.   This belief is especially acute because of the high rate of illiteracy, with close to 80% of the population being illiterate or functionally illiterate.  The GoL’s show of military force in closing down West Point was a statement that the Government is serious and the people will be forced to respond more effectively to control measures in place.  Shows of military force have also worked in Guinea and Sierra Leone to stem the flow of internal movement in those countries. Observers believe imposition of restricted movement is a major source for why those countries now have fewer infections cases than Liberia.

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