By Sharon K. Gilbert

In an early release Tuesday of its Weekly Morbidity and Mortality Report, the Centers for Disease Control disclosed startling revelations from the frontlines of the West African Ebola crisis, finding four counties in southeastern Liberia were unable to respond to the outbreak as little as two months ago.

In August, a team of CDC evaluators headed by physician James D. Forrester spent nine days in Liberia assessing emergency preparedness in collaboration with the Liberian Ministry of Health and Social Welfare.

At the time of their visit to Grand Gedeh, Grand Kru, River Gee and Maryland counties Aug. 6-14, not one report of Ebola had been filed in the area.

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The team, however, discovered two cases of Ebola and found the Liberian counties unable to respond.

Each of the counties had just one hospital, with only about 100 to 150 beds each. The local health-care workers had no disposable gloves, no soap and no bleach or gel-based hand cleansers.

Washing stations, if they existed, consisted of a jug filled with water and a basin. Very basic isolation stations had been set up in only two of the four counties, and the stations lacked electricity and water. No waste disposal facilities had been set up.

Small towns and counties in the examined areas had spotty Internet connections at best, and communication relied on cell phones and radios. Only six of the 19 stations inspected had even rudimentary means of calling for aid or consultation. The other 13 depended on visits by the district health officer.

No air transport existed in the areas, and travel by road proved difficult if not impossible, which meant transport of specimens to CDC or WHO labs also was impeded.

Within the hospitals, very little to no training in how to handle Ebola patients had been provided. Training for use of personal protection equipment also was unavailable, and the supplies of the equipment were insufficient.

During their nine-day inspection, the CDC team made the first diagnoses of Ebola in the four-county area:

On August 3, a pregnant woman (patient 1) died during a spontaneous abortion after leaving Monrovia where she had contact with an infected person at a funeral; she was buried by the community in the week after her death. On August 24, 2014, Maryland County authorities identified a man hiding in a rice truck who had signs and symptoms of Ebola (patient 2). The truck had departed from Fish Town, River Gee County, and was destined for Pleebo, Maryland County. The man, who was reported to have participated in the burial of patient 1, was sent back to Fish Town, where he later was reported to have died of laboratory-confirmed Ebola. This was the first evidence of secondary transmission of Ebola in southeast Liberia.

There have been numerous improvements since the report. Ebola task forces have been set up with regular meetings and training in how to care for patients. Disinfection and new burial practices have been implemented, and there are plans to build Ebola treatment centers.

Until the new centers are built, however, the overall medical response to the outbreak is woefully inadequate, the report indicates.

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