[Congressional Record Volume 160, Number 142 (Wednesday, November 19, 2014)]
[Extensions of Remarks]
[Page E1632]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  FIGHTING EBOLA: A GROUND LEVEL VIEW

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                      Wednesday, November 19, 2014

  Mr. SMITH of New Jersey. Mr. Speaker, the world community has known 
of the Ebola Virus Disease, more commonly called just Ebola, since it 
first appeared in a remote region near the Democratic Republic of the 
Congo in 1976. In previous outbreaks, Ebola had been confined to remote 
areas in which there was little contact outside the villages or areas 
in which it appear. Unfortunately, this outbreak, now an epidemic, 
spread from a village to an international center for regional trade and 
spread into urban areas in Guinea, Liberia, and Sierra Leone that are 
crowded with limited medical services and limited resident trust of 
government. The unprecedented west African Ebola epidemic has not only 
killed more than 5,000 people, with more than 14,000 others known to be 
infected. This situation has skewed the planning for how to deal with 
this outbreak.
   In our two previous hearings on the Ebola epidemic, on August 7th 
and September 17th, we heard about the worsening rates of infection and 
challenges in responding to this from government agencies such as USAID 
and CDC and NGOs operating on the ground such as Samaritan's Purse and 
SIM. The hearing I held yesterday was intended to take testimony from 
non-governmental organizations providing services on the ground 
currently in the affected countries, especially Liberia, so we can 
better determine how proposed actions are being implemented.
   In its early stages, Ebola manifests the same symptoms as less 
immediately deadly diseases, such as malaria, which means initial 
health care workers have been unprepared for the deadly nature of the 
disease they have been asked to treat. This meant that too many health 
care workers--national and international--have been at risk in treating 
patients who themselves may not know they have Ebola. Hundreds of 
health care workers have been infected and many have died, including 
some of the top medical personnel in the three affected countries.
   What we found quite quickly was that the health care systems in 
these countries, despite heavy investment by the United States and 
other donors, are quite weak. As it happens, these are three countries 
either coming out of very divisive civil conflict or experiencing 
serious political divisions. Consequently, citizens have not been 
widely prepared to accept recommendations from their governments. For 
quite some time, many people in all three countries would not accept 
that the Ebola epidemic was real. Even now, it is believed that despite 
the prevalence of burial teams throughout Liberia, for example, some 
families are reluctant to identify their suffering and dead loved ones 
for safe burials, which places family members and their neighbors at 
heightened risk of contracting this often fatal disease when patients 
are most contagious.
   The porous borders of these three countries have allowed people to 
cross between countries at will. This may facilitate commerce, but it 
also allows for diseases to be transmitted regionally. As a result, the 
prevalence of Ebola in these three countries has ebbed and flowed with 
the migration of people from one country to another. Liberia remains 
the hardest hit of the three countries, with more than 6,500 Ebola 
cases officially recorded. The number of infected and dead from Ebola 
could be as much as three times higher than the official figure due to 
underreporting.
   Organizations operating on the ground have told us over the past few 
months that despite the increasing reach of international and national 
efforts to contact those infected with Ebola, there remain many remote 
areas where it is still difficult to find residents or gain sufficient 
trust to obtain their cooperation. Consequently, the ebb and flow in 
infections continues. Even when it looks like the battle is being won 
in one place, it increases in a neighboring country and then reignites 
in the areas that looked to be successes.
   The United States is focusing on Liberia, the United Kingdom is 
focusing on Sierra Leone, and France and the European Union are 
supposed to focus on Guinea. In both Sierra Leone and Guinea, the anti-
Ebola efforts are behind the pace of those in Liberia. This epidemic 
must brought under control in all three if our efforts are to be 
successful.
   Last week, I, along with Representatives Karen Bass and Mark Meadows 
of the Subcommittee on Africa, Global Health, Global Human Rights, and 
International Organizations, introduced H.R. 5710, the Ebola Emergency 
Response Act. This bill lays out the steps needed for the U.S. 
government to effectively help fight the west African Ebola epidemic, 
especially in Liberia--the worst-hit of the three affected countries. 
This includes recruiting and training health care personnel, 
establishing fully functional treatment centers, conducting education 
campaigns among populations in affected countries and developing 
diagnostics, treatments and vaccines.
   H.R. 5710 confirms U.S. policy in the anti-Ebola fight and provides 
necessary authorities for the Administration to continue or expand 
anticipated actions in this regard. The bill encourages U.S. 
collaboration with other donors to mitigate the risk of economic 
collapse and civil unrest in the three affected countries. Furthermore, 
this legislation authorizes funding of the International Disaster 
Assistance account at the higher FY2014 level to effectively support 
these anti-Ebola efforts.

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