Fight against Ebola 'bungled'

A case of hiccups alerted Médecins Sans Frontières to Ebola in Guinea. Since then the organisation has dealt with thousands of cases of the deadly disease there and in other West African countries.

Within days of the report of the patient with hiccups - a symptom of Ebola - MSF dispatched three medical teams.

Ten days after their arrival came confirmation that the patient had Ebola.

MSF called the outbreak "unprecedented" because the cases, though few, were widespread in West Africa.

All previous outbreaks had been confined to small rural areas and were self-limiting.

But it took thousands of deaths and several months before the World Health Organisation declared the outbreak an emergency, in August.

Sounding the alarm was "like shouting into the desert", said MSF director of operations Bart Janssens.

Today Médecins Sans Frontières releases its report, One Year On, which relates how the disease spread, killed more than 10000, including 500 health workers, and continues to infect people in Sierra Leone, Guinea and Liberia.

The report points fingers at a Sierra Leone hospital and its US partner, the Tulane Medical Centre, and at US biotech company Metabiota for missing the first cases in Sierra Leone.

MSF says the hospital in Sierra Leone and its US partner refused to give the organisation data on people who had been in contact with patients so that they could trace and isolate the contacts to prevent further infections.

According to the report, in a single year:

• MSF lost 2547 patients - a huge number even for MSF, which works in the world's worst war zones.
• Fourteen MSF health workers died;
• Local workers were kicked out of their homes and their children ostracised;
• More than 214 MSF staff were pulled from war and other crisis zones to help in West Africa;
• Doctors would turn away the sick to die;
• MSF distributed 70,000 home-care kits in Monrovia, Liberia, to help keep people safe while they cared for sick relatives who could not be treated in hospitals because there were not enough beds; and
• The organisation imported incinerators into Monrovia because burial teams could not safely bury the dead quickly enough.

As a result of the epidemic, Sierra Leone, Guinea and Liberia have ravaged economies, their health systems are in tatters, children have missed vaccinations and many adults have had no medication.

But more than 2,300 of the patients admitted to MSF facilities were cured.

"This outbreak has often been described as 'a perfect storm': a cross-border epidemic in countries with weak public health systems that had never seen Ebola before," said Christopher Stokes, MSF's general director.

"But this is too convenient an explanation. For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences."

• Liberia on Friday confirmed its first new Ebola case in more than a month, dashing hopes that the country could soon be declared free of the deadly disease.

RESOLUTE AMONG THE PLAGUED - KATHARINE CHILD

"Satisfying" - that is how volunteer doctor Gilles van Cutsem describes his time fighting Ebola in Liberia in November and December.

Speaking to The Times yesterday ahead of the release of the Médecins Sans Frontières reportOne Year On, Van Cutsem, the organisation's medical director for South Africa, said he was with 60 experienced doctors and 1000 locals on the front line in Liberia. And they were making progress.

But their work is fraught with danger. In the past year, 28 Doctors Without Borders workers contracted Ebola - and half of them did not survive.

"It is a terrible disease because it kills those trying to care for the sick," said Van Cutsem.

But "there was a tremendous need and we [at Doctors Without Borders] were among the very few to respond. You feel useful."

The commitment of the workers risking their lives inspired him.

Van Cutsem said doctors and other workers would visit villages deep in the forests to train residents on safe burial, infection control and transporting the sick safely.

"Within 30 minutes of a team's arrival, most of the villagers would come out to hear the doctors because they had seen 10% of their village die and they wanted Ebola to stop," he said.

"We were not only treating patients, we were trying to stem the disease."

The number of Ebola cases in Liberia has decreased, with no new ones reported between February 19 and mid-March. But more were detected last week.

Van Cutsem explained that from the time someone arrived at the airport in Monrovia he could not safely make physical contact with anyone. Soon the pressure of avoiding touching another human being changed behaviour.

The protective suit, with two masks and goggles, worn when treating infected people caused profuse sweating and could be worn for only an hour.