By Antoinette Sendolo
Millions of US dollars were spent on building Ebola Treatment Units (ETUs) across Liberia and plans are underway to close down the structures, with the successful curbing of the virus down to zero. But concerns are being raised about what should happen to the ETUs amid the huge cost invested.
One of such ETUs is the Ganta ETU in Liberia’s northeastern Nimba County, 220 miles (354 Km) from Monrovia. In August 2014, the United States government gave the NGO, Project Concern International (PCI) US$5.6m to operate the ETU, with the management’s agreement expected to end in December of this year.
The Ganta ETU is one of 11 of such facilities built by the US Department of Defense originally intended to treat Ebola patients, but they are now serving other health needs of local communities. US President Barack Obama in 2014 mobilized up to 4,000 American troops to help in battling Ebola , which had been ravaging Liberia and two other Mano River Union countries—Guinea and Sierra Leone.
Located on the compound of the United Methodist Hospital, the Ganta ETU was completed in January 2015 during the dying days of the Ebola epidemic and it never handled a single confirmed Ebola case.
Officials of PCI say although this ETU has not treated a single confirmed Ebola case; it has handled about forty-one suspected Ebola cases and screened over 4,000 people across the county from January 2015 to present.
PCI’s Support to Ebola Treatment Unit Project (STEP) Chief of Party, Dr. TweldebrhamHailuAbrha said most of the suspected cases came down with malaria and meningitis. And over the past months, they have been providing health services to the locals and incurring other expenses.
He said due to the lack of ETUs in Ganta City, the money given the American NGO to run this facility was based on a projection of providing treatment for about twenty confirmed Ebola cases per day, as treating a single Ebola positive case was very expensive.
“It is very expensive to run an ETU, because you don’t use any material here for more than one time. Now that we don’t have cases coming in, we have our staff in the field carrying on awareness. We have three teams that go into the field twice a week,” Dr. Tweldebrham said.
Tweldebrham said with no confirmed case of EVD at this ETU, the American NGO shifted its focus to training more health workers, in order to prepare them for further outbreak. Out of 85 health workers hired, PCI is said to have trained 56 in different areas including emergency response and dealing with psychosocial issues.
Among them are 16 nurses, 3 Physician Assistants (PAs), one medical doctor, 25 hygienists, and the rest are support staff, who include private security officers and cooks.
With less than five months to the end of PCI’s management contract for the Ganta ETU, Tweldebrham was asked,” How much of this money was left?
“Not more than 60% of the US$5.6 million has been used but about 75 percent of the funds used went to program supplies. Sixty percent of that went to medical supplies including medicines and personal protective equipment (PPEs), thirty percent went to staff capacity building and ten percent was used on vehicles services,” PCI’s Chief of Party explained.
The PCI official said his NGO was wisely spending the money given to manage the Ganta ETU and maintain the facilities, which include two giant-size electric power generators.
Tweldebrham said that the 165kVA and 150KVA machines each consume about two gallons of fuel per hour. He said the machine runs eight hours interval when there is no patient at the ETU and it runs twenty-four hours when they have suspected cases.
“It would have caused us over eight hundred thousand United States Dollars to run this ETU per month if we were providing care for confirmed Ebola cases. But now that we don’t have any, we use between two hundred and fifty to three hundred thousand US dollars per month to run this place. Though there are no patients currently but this is a health facility so we still have to keep this place open in case of emergency,” the PCI official said.
“Now that Liberia is gradually winning the fight, it will be good enough if the government can maintain this facility to treat other diseases apart from the Ebola virus. We are aware that maintaining this place as an Ebola treatment Unit is cost intensive. I believe the government of Liberia can use it for other diseases, because demolishing this ETU will cost a lot of funds as well,” Tweldebrham added.
Managing the Ganta ETU has no doubt cost a fortune, even though it came online pretty late, a fact that PCI officials have acknowledged.
PCI’s Country Director in Liberia, Jolene Mullins admits that the ETU project came in late noting that if it had been around during the heat of the virus outbreak, many people wouldn’t have lost their lives.
“If the ETU was built during the heat of the virus, it would have had a greater impact because when we received the US$5.6million, we were in a better position to provide care for patients. Now that the project will be ending in December of this year, if we do not spend the entire 5.6million at the end of the project now that there is no active Ebola case, we will return the remaining funds to the American government because I am an American tax payer,” Mullins said.
Now that PCI’s Support to Ebola Project (STEP) phases out in less than five months, many locals in Nimba County have expressed concern over the future of this facility, which they believe can help improve the post-Ebola health sector.
Lilian Cooper 28, a mother of four who lives just near the Ganta ETU, believes that the center can be used to provide health care services for other none Ebola patients, with the very limited health centers in the area.
Lilian recalled that many people lost their lives during the virus outbreak in the county due to lack of health facilities. She said if the Ganta ETU is used to treat other sicknesses, people faced with health complications would have easy access to health care, rather than walking long distances to seek treatment.
“When they were building the ETU here, I was afraid that we will contract the virus because I have my children and my animals living here but now that we don’t have Ebola patients in the country, I want the ETU to remain opened to treat people with other health problems…but not Ebola because it is a deadly virus and we don’t want to experience it again,” Lilian explained.
Another Ganta resident, TarranceYeanay, 36, shares similar opinion that the Ganta ETU should not be closed, though he didn’t know it was so expensive to run just one ETU.
“Since that place was built, we only have been hearing about suspected cases and not a single confirmed case,” he said. Though Yeanay feels strongly about the huge cost to run the facility, he however wants the Ganta ETU to remain intact.
But for Yeanay, it should be used as a Tuberculosis (TB) center and for other infectious diseases instead of an ETU.
Nimba County health authorities also do not want the Ganta ETU to be demolished.
Dr. Collins Bowah, head of the Nimba County Health Team welcomes the idea that the ETU is used to treat people with other health problems, instead of it being destroyed like other ETUs around the country.
Bowah said the ETU should be renamed to deal with other health complications, stressing that Nimba is one of the Lassa fever belts in Liberia and other infectious diseases.
“We do not want to have the ETU demolished; this center can play a major role in helping to improve the health care system and also be used to treat patients in case of any other disease outbreak in the county. It will be important for the ETU to be used as a maternal health center in order to reduce the rate of maternal deaths in the county because it has become a major problem,” the head of the Nimba County Health team said.
Bowah thinks PCI’s operation has paid off, especially as regards training of health workers. He is confident that health workers in Nimba are able to work effectively at the ETU, now that they have been trained by PCI to respond to disease outbreak and other health problems.
“PCI has trained most of our health workers in the county. Since PCI started working in Nimba, our health workers have learned a lot of new things which put them in a better position to treat patients,” Bowah added.
What exactly will happen to the Ganta ETU when the PCI management project ends in December is yet not known. But PCI officials have told reporters that a plan on its future was being worked out with the Liberian government.
Many citizens are questioning the rationale of demolishing such structures that cost millions of US dollars, when they could be used to fill the big gap in the country’s health infrastructure.
But which ever way the decision goes, PCI’s Country Director, Jolene Mullins, has assured that whatever balance remains from the US5.6m given by the US government to manage the Ganta ETU will be returned to American tax payers when the project ends.
Liberia currently has zero Ebola cases and is on its second 42 days count-down to being declared Ebola free. On May 9, 2015 the World Health Organization certificated the country Ebola free but that there was a temporary relapse with the death of a 17-year old boy in Margibi County, outside Monrovia.