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| Pattern of Safety Lapses Where Group Worked to Battle Ebola Outbreak | Pattern of Safety Lapses Where Group Worked to Battle Ebola Outbreak |
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| Partners in Health, a Boston-based charity dedicated to improving health care for people in poor countries, signed on to the Ebola fight last fall with high ambitions. | Partners in Health, a Boston-based charity dedicated to improving health care for people in poor countries, signed on to the Ebola fight last fall with high ambitions. |
| Unlike Doctors Without Borders and other relief agencies that specialize in acute response to crises, Partners in Health pledged to support the deeply inadequate health systems in Sierra Leone and Liberia for the long haul. Its leaders also publicly criticized the low level of care provided to Ebola patients and promised that its treatment units would do better. | Unlike Doctors Without Borders and other relief agencies that specialize in acute response to crises, Partners in Health pledged to support the deeply inadequate health systems in Sierra Leone and Liberia for the long haul. Its leaders also publicly criticized the low level of care provided to Ebola patients and promised that its treatment units would do better. |
| “Let’s have a medical moon shot,” the group’s co-founder, Dr. Paul Farmer, said last October. | “Let’s have a medical moon shot,” the group’s co-founder, Dr. Paul Farmer, said last October. |
| But the medical group, which had never responded to an Ebola outbreak before and had rarely worked in emergencies, encountered serious challenges. | But the medical group, which had never responded to an Ebola outbreak before and had rarely worked in emergencies, encountered serious challenges. |
| Now, a previously undisclosed inquiry by international health officials and interviews with employees and managers of the aid group describe a pattern of safety lapses at a government-run treatment center in Port Loko, Sierra Leone, where Partners in Health worked. Staff members at the charity also cited a confusing leadership structure at the site. | Now, a previously undisclosed inquiry by international health officials and interviews with employees and managers of the aid group describe a pattern of safety lapses at a government-run treatment center in Port Loko, Sierra Leone, where Partners in Health worked. Staff members at the charity also cited a confusing leadership structure at the site. |
| The safety deficiencies, which included inadequate protective clothing, inconsistent protocols in using it and inappropriate disposal of contaminated waste products, led to the closing of the center in mid-March after an American and a Sierra Leonean clinician developed Ebola, and many of the aid group’s staff members were evacuated. | |
| Some staff members argued that the site should have closed last winter. Patient numbers had declined, and two newly built Ebola facilities run by other nonprofits had opened nearby, while Partners in Health worked at a converted vocational training center that was run by the Sierra Leone health ministry and was never ideal for patient treatment. | Some staff members argued that the site should have closed last winter. Patient numbers had declined, and two newly built Ebola facilities run by other nonprofits had opened nearby, while Partners in Health worked at a converted vocational training center that was run by the Sierra Leone health ministry and was never ideal for patient treatment. |
| But the medical group kept its American staff at the site despite the risks, deferring to government officials who wanted it to remain open and with whom the aid group needed to maintain good relations in order to work in coming years on strengthening health care there. | But the medical group kept its American staff at the site despite the risks, deferring to government officials who wanted it to remain open and with whom the aid group needed to maintain good relations in order to work in coming years on strengthening health care there. |
| “We knew there were gaps and places to improve,” said Sheila Davis, the head of Ebola response for Partners in Health. “Because it was a ministry facility, it really wasn’t our say whether it opened or closed.” She added, “We don’t tell the ministry what to do.” | “We knew there were gaps and places to improve,” said Sheila Davis, the head of Ebola response for Partners in Health. “Because it was a ministry facility, it really wasn’t our say whether it opened or closed.” She added, “We don’t tell the ministry what to do.” |
| The group’s leaders say they remain committed to working in tandem with governments, despite the risks and the difficulties that come with not having control. “We signed up for those challenges,” Dr. Farmer said in an interview. Achieving lasting change of the type that would prevent Ebola outbreaks in the future, he said, requires working with local ministries through thick and thin. | The group’s leaders say they remain committed to working in tandem with governments, despite the risks and the difficulties that come with not having control. “We signed up for those challenges,” Dr. Farmer said in an interview. Achieving lasting change of the type that would prevent Ebola outbreaks in the future, he said, requires working with local ministries through thick and thin. |
| However, after the two clinicians developed Ebola, Partners in Health pulled its staff out of the treatment unit and a nearby government hospital, workers said, and temporarily forbade them to speak with their Sierra Leonean colleagues with whom they had worked side by side. | |
| “This was unacceptable,” said Nick Sarchet, an American volunteer at the site, who said he had become a nurse because the philosophy of Partners in Health inspired him. | |
| Ms. Davis said the group intends to increase monitoring and adherence to safety protocols at other sites where it is still working to triage patients, train health workers and care for survivors. | |
| “We saved many, many lives,” Ms. Davis said in an interview. | “We saved many, many lives,” Ms. Davis said in an interview. |
| Responding to desperate calls for help last summer as people with Ebola died in the streets without care, a group of senior Partners in Health staff members, who jokingly referred to themselves as “the junta,” prevailed on the organization’s board of trustees to let the group go into Sierra Leone and Liberia. | Responding to desperate calls for help last summer as people with Ebola died in the streets without care, a group of senior Partners in Health staff members, who jokingly referred to themselves as “the junta,” prevailed on the organization’s board of trustees to let the group go into Sierra Leone and Liberia. |
| The nonprofit organization raised millions of dollars and advertised for medical professionals, not realizing at first that it would also need to recruit officers with expertise in logistics and running facilities to make the medical work possible and safe. | |
| Within weeks, the group was asked to support the overwhelmed Maforki treatment unit in the Port Loko district of Sierra Leone at the epidemic’s peak. “It was a complete mess,” Dr. Farmer said in an interview. “That’s why they sent us there. There were dead people in the courtyard.” | Within weeks, the group was asked to support the overwhelmed Maforki treatment unit in the Port Loko district of Sierra Leone at the epidemic’s peak. “It was a complete mess,” Dr. Farmer said in an interview. “That’s why they sent us there. There were dead people in the courtyard.” |
| Mr. Sarchet, who arrived in mid-November, said there were about 100 patients there. “It was crazy insane,” he said. A holding center for suspected Ebola patients at the nearby government hospital, where he also assisted, was even worse. “It was totally not safe to go in,” he said. Sharp needles were all over, the incinerator did not work and used gowns were piled up in the dirt, he said. | Mr. Sarchet, who arrived in mid-November, said there were about 100 patients there. “It was crazy insane,” he said. A holding center for suspected Ebola patients at the nearby government hospital, where he also assisted, was even worse. “It was totally not safe to go in,” he said. Sharp needles were all over, the incinerator did not work and used gowns were piled up in the dirt, he said. |
| Two government workers at the treatment unit developed Ebola in the early months, and one of them died, according to interviews with several staff members. “The conditions had been investigated several times,” Mr. Sarchet said. “The W.H.O. and C.D.C. always had a laundry list of things that were unsafe.” | Two government workers at the treatment unit developed Ebola in the early months, and one of them died, according to interviews with several staff members. “The conditions had been investigated several times,” Mr. Sarchet said. “The W.H.O. and C.D.C. always had a laundry list of things that were unsafe.” |
| Investigators from the World Health Organization and other experts who conducted the recent inquiry cited a lack of standardized procedures for donning protective equipment and no posters to remind workers of the proper sequence in which to remove pieces of their gear, according to an excerpt from the findings. The masks that workers wore over their noses and mouths were not tested to ensure they fit properly, the inquiry found. | Investigators from the World Health Organization and other experts who conducted the recent inquiry cited a lack of standardized procedures for donning protective equipment and no posters to remind workers of the proper sequence in which to remove pieces of their gear, according to an excerpt from the findings. The masks that workers wore over their noses and mouths were not tested to ensure they fit properly, the inquiry found. |
| Unlike Doctors Without Borders, which runs self-contained Ebola units supplied by its own warehouses, Partners in Health relied on the government’s supply chain for protective gear worn at Maforki. As a result, the equipment was ever-changing, said Tim Cunningham, an American nurse who worked at Maforki last winter. | Unlike Doctors Without Borders, which runs self-contained Ebola units supplied by its own warehouses, Partners in Health relied on the government’s supply chain for protective gear worn at Maforki. As a result, the equipment was ever-changing, said Tim Cunningham, an American nurse who worked at Maforki last winter. |
| The type of masks available frequently varied, as did other materials, he said. One batch of gowns ripped apart during doffing and were quickly set aside. Others were too restrictive. The head clinician kept a log of breaches, Mr. Cunningham said. | The type of masks available frequently varied, as did other materials, he said. One batch of gowns ripped apart during doffing and were quickly set aside. Others were too restrictive. The head clinician kept a log of breaches, Mr. Cunningham said. |
| The lack of consistency stemmed in part from the lack of unified leadership, given that both the health ministry and Partners in Health leaders were running operations. “From Day 1 there wasn’t somebody in charge of the whole scene,” said Mr. Sarchet. “You were constantly trying to work within two different systems. That was a huge hardship.” | The lack of consistency stemmed in part from the lack of unified leadership, given that both the health ministry and Partners in Health leaders were running operations. “From Day 1 there wasn’t somebody in charge of the whole scene,” said Mr. Sarchet. “You were constantly trying to work within two different systems. That was a huge hardship.” |
| The investigators noted in the report that gowns and other materials were not regularly checked for holes or other problems before being worn. They found contaminated waste strewn in the open in an area used for burning garbage. | The investigators noted in the report that gowns and other materials were not regularly checked for holes or other problems before being worn. They found contaminated waste strewn in the open in an area used for burning garbage. |
| “When somebody was tired, sometimes they did not put it right inside the pit,” said Usman Mohamed Koroma, a ministry employee who helped oversee infection prevention and control at the site. He contracted Ebola in March, the same week as the American. | “When somebody was tired, sometimes they did not put it right inside the pit,” said Usman Mohamed Koroma, a ministry employee who helped oversee infection prevention and control at the site. He contracted Ebola in March, the same week as the American. |
| After being critically ill, the American patient, who the charity said has not been identified because he requested privacy, was released last week from the National Institutes of Health in Bethesda, Md. | After being critically ill, the American patient, who the charity said has not been identified because he requested privacy, was released last week from the National Institutes of Health in Bethesda, Md. |
| Mr. Koroma said he briefly wondered whether he, too, would be evacuated to the United States. “I gave that idea just a casual thought. I said, ‘because I’m not a white folk, I’m not from America. I’m an indigenous Sierra Leonean. I’m an African Sierra Leonean. They are not going to move me.’ ” | Mr. Koroma said he briefly wondered whether he, too, would be evacuated to the United States. “I gave that idea just a casual thought. I said, ‘because I’m not a white folk, I’m not from America. I’m an indigenous Sierra Leonean. I’m an African Sierra Leonean. They are not going to move me.’ ” |
| It took two days, and daily calls from a Partners in Health staff member for him to be admitted to a British-run treatment unit set up for sick health workers in Freetown, Sierra Leone’s capital. | It took two days, and daily calls from a Partners in Health staff member for him to be admitted to a British-run treatment unit set up for sick health workers in Freetown, Sierra Leone’s capital. |
| The Maforki treatment unit never reopened. More than 350 confirmed Ebola patients were treated at the site, according to the district’s medical officer, Dr. Adikali Kamara. | The Maforki treatment unit never reopened. More than 350 confirmed Ebola patients were treated at the site, according to the district’s medical officer, Dr. Adikali Kamara. |
| “They were doing their best to make sure to protect the health care workers,” he said of Partners in Health. Maforki was not the only treatment unit with infection problems, and even Doctors Without Borders, with long experience treating Ebola, had health workers who became infected. | “They were doing their best to make sure to protect the health care workers,” he said of Partners in Health. Maforki was not the only treatment unit with infection problems, and even Doctors Without Borders, with long experience treating Ebola, had health workers who became infected. |
| Leaders of Partners in Health have reiterated their commitment to staying in Sierra Leone and Liberia. “We’re there to build the system. We’re not going anywhere,” Dr. Farmer said. “Let’s have the highest aspirations we can, and if we fail then just say we fail and keep on trying.” | Leaders of Partners in Health have reiterated their commitment to staying in Sierra Leone and Liberia. “We’re there to build the system. We’re not going anywhere,” Dr. Farmer said. “Let’s have the highest aspirations we can, and if we fail then just say we fail and keep on trying.” |