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Last Mile Halth

Coalition Fights Ebola at the Outbreak’s Invisible Frontline in Remote African Rainforest

October 14, 2014
Rural Grand Gedeh County covers thousands of square miles of lush Liberian rainforest far from epicenter of the Ebola outbreak in the capital of Monrovia. But that doesn’t mean it’s been spared. “Right now the burden of the disease is the worst in the capital,” says Rebecca Rollins, interim chief communications officer for the Boston-based health NGO Partners in Health (PIH), one of the groups helping to fight the disease. “But we believe the rural areas will be the hardest hit next.”
Rollins returned from Grand Gedeh last week. She said that Ebola has paralyzed the region’s already weak healthcare systems. People with symptoms make the 10-hour trip along a rutted road to the capital and others decide to stay away from doctors altogether, setting the stage for a larger healthcare crisis. “People are afraid,” she says. “They are not getting any routine vaccination, prenatal care and other treatment. This is an area with malaria and measles. When we arrived at the local hospital, it was dark and empty of patients and medical supplies.”


Grand Gedeh is 10 hours away from the capital of Monrovia. The roads can be tricky. Top image: The Partners In Health Advance Ebola Response Team visits the Martha Tubman Memorial Hospital in Zwedru, Liberia, in the southeastern region of the country. Photo by Rebecca E. Rollins / Partners In Health

According to World Bank estimates, there are fewer than two doctors for every 100,000 people in Liberia and Sierra Leone. (There are about 2.5 doctors per 1,000 people in the U.S.) Even staffed Ebola treatment centers can’t provide enough care and lack properly trained healthcare workers. In rural areas like Grand Gedeh, the situation is even worse.

That’s why PIH recently joined the local non-profit Last Mile Health to fight the crisis. Last week, the two groups received $2 million from the GE Foundation to help fund the effort, whose budget could reach $100 million over the next year.


A rural clinic in Grand Gedeh. Image credit: Last Mile Health

The coalition plans to use the money to build a force of 500 health workers to staff 47 health centers in Liberia and Sierra Leone. They will also train an additional corps of 800 community health workers who will work in villages and focus on education, surveillance and monitoring.

In the future, the coalition will help the local Ministries of Health transition from the Ebola response to a more robust health system. “We need a clear and comprehensive strategy to fight Ebola and improve healthcare in the villages,” says Dr. Raj Panjabi, Last Mile Health’s founder. “Ebola started in the rainforest and it could have stopped there if we had a health care system in place.”

Panjabi is a protégé of Paul Farmer, PIH’s founder. Farmer started his organization in 1987 to bring healthcare to residents living on Haiti’s mountainous Central Plateau. PIH has since become one of the leading NGOs fighting disease around the world, from tuberculosis to HIV.


A team from Partners in Health including Paul Farmer, in the middle with a tie, visited Grand Gedeh last week. Image credit: Rebecca Rollins, Partners in Health

Panjabi was born and raised in Monrovia. His parents immigrated to Liberia in the 1970s, but the family moved again after civil war broke out two decades later. “We were lucky and got on a cargo plane,” he says. “I’ve never forgotten the people we left on the tarmac.”

He attended medical school in the U.S. and returned back to Liberia after graduation. “There was devastation everywhere,” he says. “In the rural areas, people lost their lives when they got sick just because the closest care was two days away.”


Last month, the Partners In Health Advance Ebola Response Team visited frontline health workers from Last Mile Health in Grand Gedeh. Image credit: Rebecca Rollins, Partners In Health

Taking a page from Farmer, he started Last Mile Health to bring basic care to remote villages in the country. His network could now serve as an important bulwark in the fight against Ebola.

PIH and Last Mile Health will use the money from the GE Foundation to mobilize Last Mile’s network of rural health workers and build local treatment units. “We started out by training village health workers, providing them with equipment so they could become professional healthcare practitioners and handle medical conditions ranging from malaria to hypertension,” Panjabi says. “We are now teaching them to recognize Ebola, and isolate and care for those who got sick.”

Rollins says that doctors have to start treating patients where they get infected. “An important part of managing the crisis is tracing the patient’s contacts,” Rollins says. “You cannot do that with patients who traveled many hours to reach you.”


A natural bridge in Grand Gedeh. Photo credit: Last Mile Health

The Ebola outbreak appears to be far from over. The U.S. Centers for Disease Control together with World Health Organization reported that as of September 23, there were 6,574 cases of the hemorrhagic fever caused by the Ebola virus in Liberia, Guinea, Sierra Leone, Nigeria and Senegal. Those cases, which are almost certainly an undercount, resulted in 3,091 deaths.

“The reports we are hearing in the US is that people in West Africa are dying of a powerful disease that can’t be cured,” Rollins says. “The truth is that people are dying because of inadequate health care. We can help.”


Best friends in Grand Gedeh. Photo credit: Last Mile Health