DEADLY DISAPPOINTMENT AWAITS AT EBOLA CLINIC DUE TO LACK OF SPACE

Deadly Disappointment Awaits at Ebola Clinics Due to Lack of Space
Sick Patients Are Turned Away; At Least 1,515 Hospital Beds Needed in Liberia, Sierra Leone and Guinea
By
Drew Hinshaw in Monrovia, Liberia, and
Betsy McKay in Atlanta

Sept. 7, 2014 8:55 p.m. ET

A driver brings a sick woman to an Ebola clinic in Monrovia, Liberia. Kieran Kesner for The Wall Street Journal

Milton Mulbon arrived in a taxi at the gates of an Ebola clinic in Liberia's capital, Monrovia, with his 24-year-old daughter, Patience, bleeding in the back seat. Guards turned them away.

"They're telling me no space?" he protested, the taxi parked nearby. "She's lying down in there almost at the point of death!"

Taxis, ambulances, and even men pushing their sick in wheelbarrows are crisscrossing Monrovia, looking for an open bed in West Africa's overbooked Ebola clinics, health-care workers say. Sometimes they get in, through persistence and good timing. Mostly they don't.


Liberia, Sierra Leone, and Guinea—the three nations bearing the brunt of the outbreak—need at least 1,515 hospital beds for the more than 20,000 people who could be infected before the outbreak can be curtailed, according to World Health Organization estimates. At present, there are only a few hundred beds. International support has been slow to come and is just beginning to address this specific problem, with the U.S. promising 1,000 additional beds in a new aid package.

The shortage is so dire that ambulances have picked up people raging with the symptoms of Ebola, driven them around for hours, then dropped them back at home, medical workers say.

The odds of surviving Ebola at home, without intravenous hydration, are slim. Along the way, the sick often infect their families. That is creating ever more Ebola patients arriving at the gates of overcrowded clinics.

Some, like Mr. Mulbon, collect a bag of sanitary products and painkillers. His daughter, the mother of two boys, died within hours of receiving it. "She was helpless," Mr. Mulbon said.

Health workers complain they can't throw down mattresses fast enough. Some organizations, including Doctors Without Borders, are asking Europe and the U.S. to send disaster relief—even military personnel—to help West Africa get ahead of an Ebola epidemic that has been under way since December.

"Many months into an Ebola outbreak, we're in the position of turning away patients who look like they have Ebola," said Henry Grey, a Doctors Without Borders emergency coordinator. "That's an indication of the direct failure of the international community."

Ebola patients at the hospital. Agence France-Presse/Getty Images

A few foreign governments are beginning to respond. On Friday, the European Union said it would pledge €140 million ($181.3 million) to the three hardest-hit countries, €97.5 million of it going directly to their national budgets.

"The situation is going from bad to worse," said Kristalina Georgieva, the EU commissioner for international cooperation, humanitarian aid and crisis response.

On Thursday, the U.S. Agency for International Development said it would build 10 Ebola treatment centers with 100 beds each, part of a nearly $100 million aid package to the three nations. USAID Administrator Raj Shah said the agency is moving to fund and deliver beds and several hundred critical-care personnel "as quickly as possible."

The challenge isn't just delivering beds. It is training staff, said Jeremy Konyndyk, director of USAID's Office of U.S. Foreign Disaster Assistance, which is coordinating the U.S. government's response.

"We could get a bunch of tents and beds in here in no time," said Mr. Konyndyk. "The hard part is who staffs those beds."

It takes between 200 and 250 health workers to treat 80 Ebola patients, according to the World Health Organization. USAID and the U.S. Centers for Disease Control and Prevention are both looking to recruit and train health workers to take care of Ebola patients. The CDC program will begin in late September.

The trouble is finding doctors and nurses willing to treat a deadly disease—with no vaccine or formally approved treatment. In addition, the training is challenging, because they have to learn to care for patients while wearing cumbersome protective gear and meticulously guarding their safety.

Meanwhile, USAID is giving sick people who can't find a free bed a home treatment kit. It includes bleach and disposable gloves, Mr. Konyndyk said.

An estimated 3,685 people have been sickened by the latest outbreak, WHO says. About half have died.

But those numbers represent a small portion of the true toll, the organization says. Because most Ebola victims are suffering at home, their deaths or recoveries aren't noted in any official tally. Now, as clinics open, some of those who have been fighting the virus at home are beginning to show up.

A WHO clinic opened late last month in what had previously been a dental office. It was meant for 30 patients. But on a recent Tuesday, it was overbooked, with several patients sprawled out on the concrete floor, including children. The hospital's director was reviewing a list of patients in the car on her way to brief Liberia's Health Ministry.

Dr. Anne Deborah Omoruto Atai counted 44 patients. It was an improvement from a week prior when they had more than 70 people in the clinic with patients dying on the ground, she said.

Workers wearing protective gear stand inside the contaminated area at a hospital run by Doctors Without Borders in Monrovia, Liberia, on Sunday. Agence France-Presse/Getty Images

"It's difficult to give them adequate care when they're lying on the floor," she added. "We just leave it to natural selection."

Across town, workers at the Doctors Without Borders clinic were assembling a 400-bed tent hospital in the mud and rain. The field clinic they already have, with 125 beds, uses 350 head-to-toe body suits, 25,000 liters of water and 2,500 gallons of bleach—every day.

Taxis pull up here so frequently that both Doctors Without Borders and the CDC worry the taxis themselves have become conveyors of the virus. The disease spreads through bodily fluids and if a healthy person were to put his hands into the sweat left by previous passenger, it could spread—and in a way that would be impossible to trace.

"We're hearing stories of people taking four taxis across town," said Caitlin Ryan, communications officer for Doctors Without Borders.

Outside the clinic, two taxis pulled up at the same time. Once again, there wasn't any room for the sick. So a shouting match ensued.

"We are all Liberians," screamed a man who had brought a sick girl in his cab.

"They think we don't want to help," said Randy Tomanne, one of the guards. "Their child is ill. There's no other way you'd feel."

Later, a third taxi arrived. The driver said he had been paid $10 to take a family with a 6-year-old girl lying across their laps to a clinic. He had no idea it was an Ebola clinic.

"He just said the hospital," said the driver, Ibrahim Somir, while a man in a head-to-toe plastic suit sprayed down his taxi in bleach.

Before leaving to try his luck elsewhere, the girl's uncle shrugged off the risk he'd put the taxi driver in: "What else should we do?"

—Matina Stevis in Nairobi contributed to this article.

Write to Drew Hinshaw at drew.hinshaw@wsj.com and Betsy McKay at betsy.mckay@wsj.com