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   From: uy@libscum.com   
      
   When people started dying of Ebola in Liberia, Clarine Vaughn   
   faced a wrenching choice: Should she send home, for their own   
   health and safety, four American doctors working for Heartt, the   
   aid group she led there? Or should she keep them in the country   
   without proper supplies or training to fight the virulent,   
   contagious disease, which was already spreading panic?   
      
   After much agonizing, Ms. Vaughn, who lives in Liberia, pulled   
   the doctors out and canceled plans to bring in more. The African   
   physicians and nurses left behind told her they understood, but   
   felt abandoned. They said, “We need you guys here,” she recalled.   
      
   Since then, Ms. Vaughn has wondered if the American doctors   
   might have made a difference, and she asked the aid group   
   AmeriCares to help. It sent in a planeload of supplies that   
   landed in Monrovia, the Liberian capital, last Sunday.   
      
   The departure of many Western development workers from Guinea,   
   Liberia and Sierra Leone, the West African countries hit hardest   
   by Ebola, has further weakened the region’s decrepit,   
   understaffed health systems at the very moment they are facing   
   one of the gravest public health crises ever. Liberia,   
   population four million, has fewer than 250 doctors left in the   
   entire country, according to the Liberia Medical and Dental   
   Council. Seven doctors there have contracted Ebola, and two of   
   them have died.   
      
   “The locals’ seeing this mass exodus of expatriates has   
   contributed to the sense that there’s an apocalypse happening   
   and they’re in it on their own,” said Raphael Frankfurter,   
   executive director of the Wellbody Alliance, which provides   
   clinical services in a diamond-mining district of Sierra Leone   
   bordering Guinea, where the outbreak began.   
      
   Mr. Frankfurter, too, sent his four American volunteers home for   
   fear they might fall ill. They left behind 160 national staff.   
   “It’s certainly not in line with our values, because it’s just   
   such a glaring inequality,” he said. But “it’s a very scary   
   place to get sick right now.”   
      
   As an array of international organizations, wealthy countries   
   and charitable groups gear up to provide desperately needed   
   resources to fight the outbreak, the absent doctors and   
   volunteers are a reminder of the daunting practical obstacles.   
   Many African health workers battling Ebola are contracting it   
   themselves. At least 170 workers have gotten the disease,   
   according to the World Health Organization, and more than 80   
   have died.   
      
   Those sickened include Dr. Kent Brantly, an American now   
   recovering in an Atlanta hospital after receiving ZMapp, an   
   experimental drug. Three Liberian patients received ZMapp on   
   Friday, a senior Liberian health official confirmed. The   
   patients signed consent forms stating that they understood the   
   risks of the untested drug and waived liability for any adverse   
   effects.   
      
   The doses had been flown into Liberia with the agreement of the   
   drug’s San Diego-based producer and the United States   
   government, after appeals from President Ellen Johnson Sirleaf   
   of Liberia to President Obama and senior American officials. Its   
   arrival last week lifted morale and “raised the hope of   
   everybody,” Mrs. Johnson Sirleaf said in an interview.   
      
   Even as some leave, other international workers are arriving in   
   the affected areas. Still, fear is complicating the huge   
   increase in aid that is needed: food for people in areas that   
   have been cordoned off; laboratory supplies to test for the   
   disease; gloves, face masks and gowns to protect health workers;   
   body bags for the dead; bedsheets to replace those that must be   
   burned. Airlines have canceled flights that could have carried   
   in such supplies, despite assurances from the W.H.O. that   
   properly screened passengers pose little risk. Positions on aid   
   rosters remain unfilled.   
      
   Hundreds of workers for Doctors Without Borders have fought the   
   outbreak since March. The group’s president, Dr. Joanne Liu,   
   said there was an acute need for materials as well as for more   
   human resources on the ground — and not just experts and   
   bureaucrats, but also the kind of person who is ready to “roll   
   up his sleeves.”   
      
   “What we have to keep in mind is we are facing today the most   
   devastating and biggest Ebola epidemic of the modern times,” Dr.   
   Liu said. “There is fear, there is a front line, the epidemic is   
   advancing, and there is a collapse of infrastructure.”   
      
   A more muscular effort to fight the outbreak began lumbering to   
   life over the past week.   
      
   The newly appointed United Nations coordinator for Ebola, Dr.   
   David Nabarro, wrote in an email that he had his “head right   
   down working through some extremely challenging stuff under   
   tight time pressure.”   
      
   “All of us are going to have to perform in an outstanding way   
   over some months,” Dr. Nabarro added in a phone interview. “For   
   many, the image is fearful to a degree that it makes it very   
   hard indeed for them to do anything other than think about their   
   safety and the safety of those they love.”   
      
   The W.H.O.’s sole in-house Ebola specialist said he was   
   following his doctor’s advice to take the week off work. His   
   colleagues drew up plans to coordinate the international effort   
   and recruited employees from other agencies to help with data   
   management and field work.   
      
   With commercial flights dwindling, the United Nations’ World   
   Food Program began an air service for humanitarian workers on   
   Saturday. “The virus is spreading, and we’re all suddenly   
   realizing we need to do more,” said Denise Brown, the agency’s   
   emergency coordinator for the crisis.   
      
   The agency studied whether food stockpiled in the region for   
   refugees fleeing a military crisis in Central African Republic   
   could be moved to help people in what Ms. Brown called “hot   
   zones.” But planning was complicated by the refusal of some   
   countries to receive ships that had stopped at ports in Guinea,   
   Liberia and Sierra Leone, she said. And the movement of food   
   from domestic stocks into quarantined areas stalled as the World   
   Food Program and W.H.O. sought ways to keep transporters safe   
   and to ensure that deliveries did not cause people to   
   congregate, risking further transmission of the disease.   
      
   Dr. Marie-Paule Kieny, a W.H.O. assistant director general, said   
   that while it was “important to limit the movement in and out of   
   the hot spots,” there was an urgent need to provide food and   
   drinking water in communities cordoned off by the military to   
   “make sure we don’t add a humanitarian disaster on a difficult   
   health problem.”   
      
   Dr. Kieny has begun cataloging available doses of experimental   
   drugs and vaccines in preparation for a Sept. 4 meeting on their   
   possible use and testing in the outbreak.   
      
   Unicef staff at a supply depot in Copenhagen are working to   
   mobilize medical treatments, burial supplies, and millions of   
   bars of soap and disinfectants for use in homes and health   
   centers, many of which lack basic sanitary supplies. “This is   
   just the beginning of the intensification,” said Shanelle Hall,   
      
   [continued in next message]   
      
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