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Special Feature

Pres.Ellen Johnson-Sirleaf to Pres. Obama

H.E. Barack H. Obama
United States of America
Washington, DC

Mr. President:

I bring you greetings from the people of Liberia and in my own name. Let me first express our gratitude for the support you have given to us in the Mano River Union as we battle this unprecedented outbreak of the Ebola Virus Disease. Your announcement that further resources will be made available for the effort was welcome news for us.

Mr. President, as you know, the outbreak has overwhelmed the containment and treatment measures we have attempted thus far. Our already limited resources have been stretched to breaking point and up to now only a private charity, Medecins Sans Frontiers (MSF), has responded robustly in all the affected countries. But they too have reached their limits. Without more direct help from your government, we will lose this battle against Ebola. A WHO investigation conducted with other partners and our own Ministry of Health and Social Welfare projects thousands of cases over the next three weeks.

The virus spreading at an exponential rate and we have a limited time window to arrest it. Mr. President, well over 40% of total cases occurred in the last 18 days. Our message has gotten out and our citizens are self-reporting or bringing in their relatives. But our treatment centers are overwhelmed. MSF is now running a 160 bed-unit that will expand even further. This is the largest ever Ebola Treatment Unit in the history of the disease and even that is inadequate. To break the chain of transmission, we need to isolate the sick from their families and communities, but this is impossible because there is nowhere to take them. We are been forced to turn back the sick. We are sending them home where they are a risk to their families and the communities. I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us.

With blanket travel bans, border closures and interdictions on vessels berthing at our ports, this has become more than a humanitarian emergency. In a country that has barely emerged from a 30-year period of civil and political unrest, with the presence of a large youthful (mainly unemployed) population, some of whom were child soldiers  –  this health emergency threatens civil order. What is even more heartbreaking is that we are unable to reopen our basic and secondary health  facilities because terrified  health workers,   who have watched colleagues die, are afraid to return to work. To date, about 153 health workers have become infected and 79 have died. There is now a recurrence of children dying of malaria because mothers could not find a health facility that would admit them. Diseases that were treated with relative ease pre-Ebola now take lives because of the pall that Ebola has cast over our health system.

We need to provide up to 1500 beds in Ebola Treatment Units in Monrovia. We also need to create 10 additional sites in the outlying affected counties. This is beyond anything we are able to address on our own. Unless we significantly increase our capacity to isolate infected persons – their families and communities remain vulnerable and the transmission chain remains unbroken.  With our own resources, we can only support and manage one (1) one-hundred bed treatment facility. Medecins Sans Frontiers will scale up to 400 beds, leaving a very significant gap.

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Mr. President, Liberia’s peace and significant economic gains over the last 10 years have come at great cost. Throughout this process, the United States has been a steadfast friend a partner. As impressive as our gains have been, they remain fragile and this outbreak now threatens to undermine those gains and reverse our progress. In view of this, I am directly appealing to you and the American people for the following:

o A) That the US government sets up and operates at least one Ebola Treatment Unit (ETU) in Monrovia. Mr. President at the current rate of infections, only governments like yours have the resources and assets to deploy at the pace required to arrest the spread. Branches of your military and civilian institutions already have the expertise in dealing with biohazards, infectious diseases and chemical agents. They already understand appropriate infection control protocols and we saw these assets were deployed in Aceh after the tsunami and in Haiti after the earthquake. It is in appreciation of the difference in kind of disaster, that we requesting assistance from units with expertise in managing biohazards.

o B) That the US government assists in restoring regular basic and secondary health services at least 10 non-Ebola hospitals. We have been told by healthcare workers on the frontline that only 80% of patients presenting symptoms at ETUs are infected with the virus. The other 20% need to be treated at non-Ebola health facilities. However, we need appropriate infection control protocols and testing facilities to protect health care workers and non-Ebola patients in these facilities. Currently, in Monrovia there are 8 hospitals, ranging from 50 to 418 beds. Across the rest of the country we need to reopen at least one large public health facility to prevent deaths from treatable diseases and prevent maternal and infant mortality.

o Maintenance of air bridges during the course of the response. With airlines servicing the country down to two from a pre-Ebola total of 11, movement of personnel with expertise and equipment into the country is becoming increasingly difficult. Until private air service returns, we will require assistance with air bridges to respond to the crisis.

It is important to note, Mr. President, that since the beginning of the outbreak, MSF now has over 400 beds of Ebola patients in the region and not a single staff – medical or support- has ever gotten infected in those centers. MSF has made their protocols and template available to the CDC, Save the Children, International Rescue Committee and International Medical Corps. But none of these private charities will be able to deploy on the scale and at the speed required to arrest the spread of the Ebola virus diseases (EVD).

Once again, on behalf of the people of Liberia and in my own name, I want to express our sincerest gratitude for the long-standing friendship and partnership between our two countries and peoples.

Ellen Johnson Sirleaf

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