Random Thoughts

     A few random thoughts from Liberia.  Tomorrow marks the 42nd day (as reckoned by the government of Liberia) since Ebola has been reported in Liberia.  The significance of this timeframe is that it is twice the maximum incubation period of Ebola Virus Disease. This is quite a landmark and marks an official definition of the absence of Ebola from Liberia.  It doesn't mean that the threat of Ebola is gone.  The virus persists in immune privileged tissues of the body in survivors for a prolonged period of time.  The last case of Ebola in Liberia resulted from sexual contact with a survivor whose semen contained virus 100 days after the virus had been cleared from his blood stream.  Indeed, an article in the New York Times reported the persistence of live virus inside of the eye of a US survivor, although in this case, he is not thought to be contagious.  There is also the risk of imported disease from Guinea or Sierra Leone but those countries seem to be getting the epidemic under much better control.  Of course, there is the risk from the natural reservoirs of the virus in the form of infected monkey and fruit bat meat.  That is what started the epidemic in the first place.  However, the procedures for recognizing and treating Ebola in Liberia are so much better than they were one year year ago.

     As we prepare to decommission the Ebola Treatment Unit, we work a lot with local medical providers and public health personnel.  It is a challenge to effect a seamless transition from a high tech solution like an ETU to a less revenue intense system.  You have to factor in how you are constrained by your contract, the preparations of the local health care system and pending (but not yet in place) facilities.  

     Liberia will retain several ETU's but the large majority will be decommissioned or repurposed.  We will close our ETU and it is a lot of work.  You have to decontaminate the equipment supplies, equipment and the structures at the site.  You have to figure out what to do with the supplies and equipment within the constraints of USAID and the Liberian Ministry of Health.  Factor in community engagement, local concerns about the loss of the economic stimulus that we provided and negotiating about a post Ebola role, it can get your head spinning trying to get it all straight.  So much is still undefined or awaiting other people's decisions that it becomes an exercise in patience (and sometimes frustration).  But we will get there.  I am reminded again of Henny Youngman's line that some people stay longer when they are leaving than they do when they are there.  I think it fits.