ARI SHAPIRO, HOST:
In Liberia, the total number of Ebola cases is down, but there are still flare-ups across the country. The original plan for the U.S. response was to send in thousands of troops to help build Ebola treatment units. Now, as the spread of the disease is changing, critics are pushing the U.S. to change its plan, too. NPR's Kelly McEvers reports from Liberia.
KELLY MCEVERS, BYLINE: This Ebola outbreak started in rural areas. But by June, it had reached Liberia's capital, Monrovia. By August, the number of people getting Ebola was doubling every week. The Liberian government and aid workers here begged for help. Enter the U.S. military. By mid-September, the plan was clear - build more Ebola treatment units, or ETUs - at least one in each of Liberia's 15 counties, one in each major town so sick people in the counties wouldn't bring more Ebola to the capital. Thing is, it's taken a long time to build these ETUs. Most of them won't be done 'til the end of the year.
LIEUTENANT ABRAHAM RICHARDSON: So right now we're leaving the triage building. This will be where all the patients initially arrive.
MCEVERS: Construction on this ETU, about two hours outside the capital, was finished last week by the Army's 36th engineer brigade out of Fort Hood, Texas. Lieutenant Abraham Richardson leads the tour.
RICHARDSON: On my right side - driven to the southern entrance and taken directly to the two rub halls - these two giant white tents down there. That's where all the confirmed cases will be.
MCEVERS: This is what the military is good at - landing in a place where they've never been and building stuff.
RICHARDSON: Our current plan is to house about 25 patients in each of these. So there's four of these large tents. That's a total capacity of a hundred patients for this particular ETU site.
MCEVERS: But some say this is a problem. Now that the spread of Ebola is changing, a huge treatment center in each county's main town might not make the most sense. Dr. Darin Portnoy is with Doctors Without Borders. It runs one of the original ETUs back in the capital. He just finished a shift caring for two very sick children. He says building all these ETUs across the country is a new solution to an old problem.
DARIN PORTNOY: ETUs were needed at one time. ETUs are not needed right now at the same level. Right now, the construction should scale down - fewer beds - and take the amazing capacities that have been brought to bear here and direct them elsewhere.
MCEVERS: Elsewhere meaning out to the remote rural areas where many of the new Ebola cases are popping up, where sometimes the only way to reach people is by walking for hours or taking a canoe. Portnoy says big international donors should support so-called rapid response teams that go out, find these people and set up treatment centers where they live, not big ETUs where they don't live.
PORTNOY: Just because you have a plan that you were going to do these things, doesn't mean that you have to continue on that plan because you have the awareness of what's taking place around you.
MCEVERS: The U.S. has started to scale down its plan. Some of the ETUs will now have 50 beds instead of 100. Major General Gary Volesky commands U.S. forces in Liberia. He says just last week one of his helicopters did give a team of epidemiologists a ride into a very remote village where people had Ebola. But he says he wants to know that the military has an exit plan - that someone else will take over jobs like this when he's gone.
MAJOR GENERAL GARY VOLESKY: You know, we've had experiences in other countries where we've built a capacity, and then we've left, and the local host station couldn't sustain it, and it just fell apart.
MCEVERS: Four Navy Medical Researchers built this lab a few hours north of the capital. Lieutenant Commander Vishwesh Mokashi shows us the results of an Ebola test on a laptop.
LIEUTENANT COMMANDER VISHWESH MOKASHI: So that's what you essentially see when you see a positive case.
MCEVERS: The lab is attached to one of the busiest ETUs in Liberia. Since it opened in September, it's admitted Ebola patients every day.
MCEVERS: How long have you guys been working here?
JOHN JAMESON: From September 16.
MCEVERS: Outside the ETU, John Jameson shows us the burial ground full of fresh mounds of dirt.
JAMESON: Every day is another three, four, five burials a day.
MCEVERS: Three, four, five burials a day. Thing is, these are the ones who could make it to the ETU. Health officials say there are many more people getting sick and dying in remote rural areas, and that means the disease will keep spreading. Kelly McEvers, NPR News, Monrovia.
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