U.K. Criticized for Failing to Curb Ebola in Sierra Leone

The U.K. government and British charity Save the Children are under scrutiny for the management of an Ebola treatment center in Sierra Leone, the West African nation that has overtaken Liberia as the worst-affected country.

The epidemic is spreading in Sierra Leone at a pace that isn’t matched by containment efforts, Doctors Without Borders said on Dec. 2. Only 11 beds supplied by the U.K. were operational as of Nov. 27, the medical aid charity said. Save the Children said today that 40 beds are operational at its Kerry Town center, and the U.K. government said it is funding almost 700 available beds, including those at diagnostic holding centers built by others.

Britain is facing mounting criticism in Sierra Leone from local media and government officials, while foreign aid workers have also voiced concern about Save the Children’s capabilities. The U.K. has been taking the lead in its former colony, with the U.S. focusing on Liberia and France concentrating on former colony Guinea.

An 80-bed treatment center managed by Save the Children opened Nov. 5 in Kerry Town as part of the U.K.’s 230-million pound ($360 million) commitment to supply and support treatment beds that will total more than 1,000, fund burial teams and provide other health services in Sierra Leone. In addition, the British military has trained more than 4,000 local health workers, hygienists and other front-line staff.

More than 2,000 new cases were reported in Sierra Leone over the previous three weeks, compared with about 800 in Liberia and 270 in Guinea, according to figures compiled by the World Health Organization. With 7,798 total cases, more cumulative infections have now been detected in Sierra Leone than in Liberia, the WHO said today.

Lacking Expertise

“For Kerry Town, Save the Children do not have the expertise,” Paolo Conteh, chief executive officer of Sierra Leone’s National Ebola Response Center, told reporters last week. “That is something we must all accept and say we got it wrong or the Brits got it wrong in handing over that facility to Save the Children, which has never run an Ebola facility.”

The Kerry Town clinic will be running at full capacity in the next three weeks, Michael von Bertele, global humanitarian director of Save the Children, said at a press conference in Freetown today.

“At the start we had no experience,” said von Bertele, the former head of medical services for the British Army. “We had never done it before. Other NGOs with experience might have done it better.”

Known Limitations

Save the Children isn’t ready to run other clinics the U.K. is building, von Bertele said.

“The total capacity of the 80-bed facility will be phased in, as is accepted best practice, over the coming weeks, giving staff time to ensure a safe environment for patients and staff and reduce the risk of infection,” the charity said in an e-mailed statement. “We always knew, and said publicly, that the running and management of the Ebola treatment center in Sierra Leone would be complicated and challenging.”

A Cuban doctor became infected with Ebola at the Kerry Town clinic, near the capital of Freetown, soon after it was opened and was flown to Geneva to receive treatment. He has since recovered and has left Switzerland, the University Hospitals of Geneva said Dec. 6.

Under pressure to start operating the Kerry Town clinic as quickly as possible, Save the Children opened it just two days after construction was completed, with many systems and safety measures not yet in place, Leslie Roberts, an epidemiologist at Columbia University who visited the facility in mid-November to investigate how the Cuban doctor got infected, wrote on his blog.

Early ‘Chaos’

“By all accounts, the first couple of days were chaos,” Roberts wrote. He declined to comment beyond what he had posted online. “After two weeks of operation, the facility was little safer than it had been on the day the doctor was infected.”

Save the Children was “available and keen” to take on the management of the Kerry Town clinic at a time when other aid groups were stretched and unable to do so, a spokesman for the U.K. Department for International Development said by e-mail.

The agency is working with non-governmental organizations to run five other clinics it is building, including Ireland’s GOAL, International Medical Corps of the U.S., Spain’s Medicos del Mundo and France’s Solidarites International. Recruits from the U.K., Cuba, Norway, Australia, New Zealand and Denmark will staff them alongside local workers, according to DfID.

U.S. Assistance

The U.K. government and its partners should consider asking for technical assistance from the U.S. military, the Standard Times, Sierra Leone’s largest national daily, said in an editorial on Nov. 24.

While the U.S. Department of Defense forces in Liberia have no plans to expand its Ebola response mission outside of that country, it is sending two mobile blood labs to Sierra Leone to speed up testing of patients, spokesman Brian DeSantis said by e-mail.

Sierra Leone’s ministry of health “has agreed to totally provide the support in terms of nurses and other auxiliary staff to actually manage Kerry Town,” Chief Medical Officer Brima Kargbo said in an interview in Freetown on Dec. 5.

Doctors Without Borders has also provided some training and advice, though it declined a request to give in-depth support over a monthlong or two-month period, Monique Nagelkerke, head of mission in Sierra Leone for the aid group, said by phone.

Save the Children Chief Executive Officer Justin Forsyth built his career at the anti-poverty charity Oxfam before working for U.K. Prime Minister Tony Blair to lead efforts on poverty and climate change.

Helped by individual and institutional donations, Save the Children increased its income 21 percent to 343 million pounds in 2013, allowing it to extend its reach to 15.4 million children from 8 million a year earlier, according to its annual report.

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