Three-year-old Matu Buema lies wheezing in her hospital bed, a tiny, listless bundle in her mother Fatu's arms. The normally bouncy toddler is suffering from a bout of malaria that could easily kill her - yet right now, she is far and away the luckiest of the patients to have sought help at Phebe Hospital in central Liberia.
The only case that get past the checkpoint are those where a child's life is in imminent danger, such as young Fatu, or mothers with complications during childbirth. Who gets in and who doesn’t is down to the discretion of the two doctors still working at the hospital, but even then there is a limit to their charity.
With most of the hospital technicians and specialists absent, many operations cannot be carried out all, and when The Telegraph visited Phebe last week, malaria-stricken Matu was the sole patient in a facility with 200 beds.
"At the moment we can look after only the most critical cases because of the lack of staff," said Kerson Saykor, the administrator of Phebe, standing next to a memorial picture of one of the dead nurses posted to a wall.
"We want the nurses to come back, but they are saying they want protective equipment in case any other patients come in with Ebola, and we do have enough of that to give them yet."
The problems at Phebe are repeated across Liberia, with scores of clinics and hospitals now shut because of the Ebola outbreak. Such has been the chaos that no hard figures on the numbers of closures are available, but with around 80 of the country's 6,000 health workers infected with the virus, including some senior physicians, the impact on the health service has been devastating.
Earlier this month, three hospitals in the capital, Monrovia, were shut, including St Joseph's Catholic Hospital, where an elderly Spanish missionary, Miguel Pajares, died from Ebola last week after being flown back to Spain for treatment. The two other hospitals in Monrovia since reopened, but are now so overstretched that people in Bong County know there is little point in making the four-hour long journey to go there.
The result is that any adult who falls acutely ill in Bong County right now can expect to die. In the township next to Phoebe hospital, a collection of shacks and breeze-block homes amid palms and dense bush, locals said that two residents had passed away in the last week alone because of lack of treatment.
One of them, Yanduay Forkpah, 69, was actually being treated in Phebe when the outbreak began, and was simply ordered to leave, according to his sister Younger Franklin, 62, who had buried him the day before The Telegraph visited.
"My brother developed pains in his neck about three weeks ago, and he spent two nights in the hospital," said Ms Franklin, as she walked down a bush trail to the clearing where his grave now lay, a mound of earth adorned with a cross made of two twigs.
"We didn't know what was wrong with him. But just as they were about to give him an X-ray, they told him the hospital was closing because the staff were dying of Ebola. Since so many other hospitals were shutting too, we had no choice but to bring him home, where he died."
Another case was that of Qweta Karba, 45, a mother-of-nine who was diagnosed two years with a chronic stomach ulcer. It suddenly grew worse again in late July, and despite agonising abdominal pain, all her husband Danny M Karba Senior could do was give her paracetamol.
"She died three days ago, by which time the pain was getting really bad for her," said Mr Karba, 62. "I am very sad that nobody was able to treat my wife – they could at least have done an ultrasound for her. The children are terribly sad."
Ironically, Mr Karbah is himself one of the health workers who deserted the hospital: he works at Phebe as a nurse and counsellor treating HIV cases. But while HIV is now a known quantity, Ebola is entirely new to the region, and its horrific symptoms, which include bleeding from the eyes, inspire terror even in health workers.
"I was working there when the outbreak killed some of the nurses, and everyone just ran away," he said. "We cannot go back there until they give us protective gloves to work with people."
Right now, nobody knows quite how many people have died in Bong County and elsewhere as a result of not being able to get emergency medical treatment.
But with the outbreak engulfing not just Liberia but Sierra Leone, Guinea and Nigeria, aid agencies fear it could get worse before it gets better. Even if they can provide health workers with the necessary protective equipment, many may still be scared to come back to work.
In an assessment paper earlier this week, UNICEF warned of an "overwhelming gap in the delivery of critical life-saving interventions" caused by the Ebola break. The report said it also risked driving patients to seek the care of bush midwives and traditional healers, many of whom do not observe proper hygienic practices.
More seriously, the absence of health workers is undermining basic vaccination programmes for the likes of measles and polio collapsing.
Immunisation rates are barely at 50 per cent at best, and the report warned that "with mothers afraid to take their children to health facilities, immunisation is expected to drop significantly by up to half the current coverage rate."
Sheldon Yett, the Liberia representative for UNICEF, told The Telegraph: "We are all now focusing on the Ebola epidemic, but we are facing other impacts just down the road because of the huge impact on the health system. There is potentially a much bigger disaster on our hands."
http://www.telegraph.co.uk/news/worldnews/ebola/11037365/One-patient-in-a-200-bed-hospital-how-Ebola-has-devastated-Liberias-health-system.html
TRANSLATE
President
Ellen Johnson Sirleaf has imposed a curfew beginning Wednesday, August
20, 2014 from 9PM to 6AM daily as part of additional measures under the
state of emergency to curb the spread of the deadly Ebola virus.
At
least nine suspected Ebola dead bodies are left uncollected in several
towns of Nimba County, as county health teams there reportedly struggled
with a single vehicle for Ebola response, the 
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