TUBMANBURG, Liberia—American and Liberian soldiers hammer, saw and sweat in the afternoon sun here in a frenetic campaign to build the county’s first Ebola-treatment unit. Soon, the soldiers will have floodlights to work round-the-clock shifts.
The unfolding epidemic has killed more than 4,400 people, mostly in West Africa. Everything in Liberia was needed weeks ago, and the Ebola-treatment centers are no exception. A month ago, President Barack Obama vowed to build 17 units. Soldiers have yet to complete one. (Further reading: Obama to name Ron Klain as Ebola czar.)
“My team has one speed, and that’s flat-out,” said Bill Berger, the leader of the U.S. government’s Ebola disaster-response team for West Africa.
Liberia’s health infrastructure was barely able to respond to the needs of its people before the outbreak. Ebola has since steamrolled it. As a result, the U.S. and other countries are essentially creating a health system from scratch on extreme deadlines.
The challenges are huge: Power outages and a lack of basic medical supplies are among them. Decrepit roads and heavy rains plague construction sites. Doctors and nurses were already in short supply because of years of low pay.
How fast the U.S. and international effort in West Africa comes together could determine whether the virus is largely contained in West Africa—or spreads more aggressively abroad. Cases have surfaced in the U.S., Spain and Germany. The World Health Organization said this week that there could be as many as 10,000 new cases a week in Guinea, Liberia and Sierra Leone by the end of 2014. That followed its criticism that the international community was too slow to respond.
Now the U.S. and others fighting Ebola are bringing to West Africa the sophisticated facilities these countries have lacked.
Before the outbreak, Liberia’s only lab capable of testing blood for highly infectious diseases was the Liberian Institute on Biomedical Research—a compound of World War II-era buildings and rusted cages that used to house chimpanzee test subjects. The bat-infested facility could only process 40 blood specimens a day and the electricity only worked intermittently.
The U.S. sent in workers to rewire the building, fix the plumbing, install Internet access and update testing equipment. The lab now can process 70 specimens a day and the Americans are hoping to boost that to 100. Meanwhile, the U.S. government has added three Ebola-testing labs in Liberia and Doctors Without Borders has added one.
Tolbert Nyenswah, the head of Liberia’s Ebola response, said the foreign support has been essential but way too tardy.
“Tell the international community that they have failed Liberia, Sierra Leone and Guinea, and they are still failing,” Mr. Nyenswah said. “They knew our health system did not have the capacity.”
At a meeting with international military leaders on Tuesday, Mr. Obama said “the world as a whole is not doing enough. There are a number of countries that have capacity that have not yet stepped up. Those that have stepped up, all of us are going to have to do more.” On Wednesday, he held a video conference with the leaders of France, Germany, Italy and the U.K. to discuss a more aggressive response.
Liberia is still recovering from years of civil war that ended in 2003, and the government has been running medical facilities on a shoestring budget. Bomi County, where the U.S. military is building the Ebola center, has two doctors for 89,000 people.
Bomi’s Liberia Government Hospital, next to the Ebola site, hasn’t had a working X-ray machine since the machine’s processor “blew up” two years ago, said Gabriel Gorbee Logan, the head of the county health department. The hospital had to shut for a month after its first Ebola case appeared in June.
Bomi County now has 66 confirmed cases of Ebola and about 70 more suspected, Dr. Logan said. About 15 people who have made it to the Tubmanburg hospital are being held in a temporary facility, but its maximum capacity is 27 people and it has less space to allow for isolation of suspected cases than a typical Ebola-treatment unit, said Neil Vora, a Centers for Disease Control and Prevention medical officer in the county.
Dr. Logan said they had been building an isolation unit but hadn’t finished it. He said he didn’t want to risk admitting to the general hospital Ebola patients who might infect staff and other patients.
To address shortages in its fight against Ebola, the U.S. has flown basic medical supplies into Liberia: hundreds of thousands of rubber gloves; hundreds of infrared thermometers; 5,000 body bags; and protective suits to treat patients. Meanwhile, U.S.-supplied generators are helping to power some Liberian treatment centers.
“We are writing the playbook as we go,” said Maj. Gen. Darryl Williams, the head of U.S. Army Africa, who is overseeing the military portion of the effort. He said the first thing he did on receiving his assignment was read reports of the earthquake response in Haiti—another disaster zone with devastated infrastructure. In a sign of the difficulty of responding in Liberia, a 25-bed field hospital for health workers in the capital is nearly complete but won’t be fully staffed and admitting patients until early November.
In more-remote areas, pockmarked roads make getting construction materials to sites even more difficult. The U.S. military is trying to speed up the process by using four Osprey aircraft—helicopter-plane hybrids—to transport materials and workers. It also plans to use a barge to float supplies down the West African coast from Dakar, Senegal, to avoid road transport. American contractors are patching potholes in the runway of Liberia’s international airport so large military planes can land without risking damage to aircraft.
Some Ebola-center materials are being bought locally, but many basics are hard to get. The U.S. has flown in 30 large tents, 4,400 cots, more than 12,000 yards of barrier fencing and more than 2,200 rolls of plastic sheeting for the construction effort, according to government figures. In addition, the U.S. has procured about 7,800 cubic yards of gravel in Liberia and trucked it to sites.
At the Tubmanburg Ebola unit site, the U.S. military has gone with tents instead of roofed structures to save time, and avoided laying foundations when possible, said Lt. Col. Scott Sendmeyer, the chief engineer overseeing construction. The Tubmanburg unit is expected to open in early November, and will be staffed by health workers who have undergone about two weeks of intensive training.
The infections abroad have driven home the need for extensive training for those treating patients while wearing cumbersome and complicated protective suits. But the one-on-one instruction that experts recommend means extra work for overtaxed health workers.
Dr. Logan said he and the staff of Tubmanburg hospital received brief training on how to use the protective gear near the beginning of the outbreak. He said he has about 70 people willing to do more extensive training, but said no one is ready to give it to them. “When they call they say they want only six persons, only seven persons,” he explained. “We want everyone to go.”
The U.S. Ebola-response effort in Liberia has involved some 7,800 cubic yards of locally sourced gravel. An earlier version of this article incorrectly said the gravel was among items the U.S. has flown in from abroad. (Oct. 17, 2014)
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