Originally published October 10, 2014 at 9:33 PM | Page modified October 10, 2014 at 10:31 PM
FREETOWN, Sierra Leone - International health officials battling the Ebola epidemic in Sierra Leone, recognizing they are overwhelmed and have little chance of getting enough treatment beds in place quickly to meet the growing need, approved plans Friday to help families treat patients at home.
The decision signifies a significant shift in the struggle against the disease. Officials said they would begin distributing painkillers, rehydrating solution and gloves to hundreds of Ebola-afflicted households in Sierra Leone, contending that the arriving aid was not fast or extensive enough to keep up with an outbreak that doubles in size every month or so.
'It's basically admitting defeat,' said Dr. Peter Kilmarx, the leader of the U.S. Centers for Disease Control and Prevention's (CDC) team in Sierra Leone, adding that it was 'now national policy that we should take care of these people at home.'
'For the clinicians, it's admitting failure, but we are responding to the need,' Kilmarx said. 'There are hundreds of people with Ebola that we are not able to bring into a facility.'
The effort to prop up a family's attempts to care for ailing relatives at home does not mean officials have abandoned plans to increase the number of beds in hospitals and clinics. But before the beds can be added and doctors can be trained, experts warn, the epidemic will continue to grow.
CDC officials acknowledged the risks of dying from the disease and passing it to loved ones at home were serious under the new policy: 'You push some Tylenol to them and back away,' Kilmarx said, describing its limits.
But many patients with Ebola are already dying slowly at home, untreated and with no place to go. So officials said there was little choice but to try the new approach.
'For the first time, the nation is accepting the possibility of home care, out of necessity,' said Jonathan Mermin, another CDC official and physician in Freetown. 'It is a policy out of necessity.'
The vote on the new policy came on a day international officials said the death toll from the epidemic in West Africa had surpassed 4,000, including 233 health-care workers. Faced with similar circumstances in neighboring Liberia, where even more people are dying from the disease, the U.S. government said last month that it would ship 400,000 kits containing gloves and disinfectant.
'The home kits are no substitute for getting people' to a treatment facility, said Sheldon Yett, the UNICEF director for Liberia. 'But the idea is to ensure that if somebody has to take care of somebody at home, they're able to do so.'
Eight months after the Ebola outbreak was identified in West Africa, the U.N. funding appeal remains woefully short, with countries pledging only one-fourth of the $1 billion that the world body says it needs to contain Ebola, the U.N. deputy secretary-general, Jan Eliasson, told the General Assembly on Friday.
Britain has pledged to get an additional 400 beds into urban areas around Sierra Leone in November. More rudimentary holding centers for patients awaiting space in hospitals are planned by the government.
Promises of international aid have increased substantially since the outbreak was first identified in Guinea in March. Indeed, Cuba sent 165 doctors and nurses last week and China has expanded a medical team deployed in the country.
But Friday, Sory Sesay, 2, lay face down on a bench at home, an arm dangling, his eyes open, listless and apathetic.
What remained of his family was sitting immobilized on the front porch with him at their house in Waterloo, just outside Freetown, Sierra Leone's capital.
All were sick: his father, who had already lost his wife and daughter; his 11-year-old brother; and a 16-year-old neighbor, whose mother had already died.
They had no painkillers, no rehydrating solution, and only a sack of rice to eat, placed at the edge of the house by someone.
'The government has not yet come in to assist us,' said Sheka Dumbuya, a community leader. 'Mr. Sesay is actually traumatized. We took them the day before yesterday to the health center, but there is no space for them.'
In a sign of the difficulties confronting the growing epidemic, Stephen Gaojia, the head of the government agency overseeing Sierra Leone's Ebola response, angrily denied that the policy to help patients at home had been adopted. 'We are not so desperate as to go to that level right now,' Gaojia said.
CDC officials said he left the meeting before the vote took place.
An official with the World Health Organization (WHO) in Sierra Leone, Dr. Zabulon Yoti, said the decision Friday would help people with no other options. 'We support the families,' he said. 'They should have some basic things as they are struggling' to take care of their families.
Nobody knows exactly how many have died from Ebola in Sierra Leone.
The government figure of 900 to 1,000 is thought by international health officials to be a serious underestimation. Even some senior figures in the government have suggested it is untruthful, and the situation in holding centers and cemeteries suggests the government number is far from reality.
A man arrived at the Waterloo health center Friday, clutching his seriously ill 4-year-old daughter. He had ridden from a town more than 100 miles away in a taxi shared with others - possibly exposing them to the virus - and he was already exhibiting Ebola symptoms. The girl, her eyes open, was rigid in his arms. She had high fever and diarrhea and had vomited, classic Ebola symptoms.
A nurse shouted angrily at the man from a few feet away: 'Are you trying to spread the virus?'
He was too ill to respond.
On the porch of the center lay a man's corpse. Perpendicular to him lay a patient, still alive but rigid. Inside the center, a few yards away and unprotected from them, dozens of patients had crowded in, seeking treatment for other illnesses.
