Dewey Defeats Truman

From the fishwrap of record:

MONROVIA, Liberia — More than a month after Liberia was declared free of Ebola, at least two new cases have emerged, the first discovered when the body of a 17-year-old boy tested positive for the virus, officials said Tuesday. 

The World Health Organization declared Liberia Ebola-free on May 9, a landmark moment in the country, which has suffered more deaths from the epidemic than any other.

But on Tuesday, Tolbert Nyenswah, Liberia’s deputy minister for health, announced at a news conference here in the capital that a new case had emerged.

It occurred in a small town just outside Monrovia. The family of Abraham Memaigar, 17, who died over the weekend, called a burial team that took swabs of the body and sent them to a laboratory. It confirmed that the boy had been infected by the virus.

On Tuesday, an Ebola response team exhumed the body and had blood drawn for a more precise swab test. That test also came back positive.

Dr. Moses Massaquoi, the case manager for the response team, said the blood test was necessary because investigators could not find the source of the infection and were trying to determine whether it was an “isolated outbreak or new strain of the virus.”

Late Tuesday, a person connected to Abraham tested positive for Ebola, and tests of two other people were inconclusive, Dr. Massaquoi said.

Thirty-three people who had contact with the teenager were isolated in their homes and were being monitored, he said. Three people will be sent to a treatment unit here Wednesday, he said.

“The Ebola fight is not over, but we must not lose hope,” said Dr. Bernice Dahn, Liberia’s newly appointed minister of health. She contended that the quick response to Abraham’s case, including the rapid testing and confirmation that the boy had the virus, demonstrated Liberia’s preparedness to deal with another outbreak.

Liberia has recorded close to 5,000 lives lost to the virus.

The country reactivated an Ebola treatment unit at a time when the facilities, built with the help of the United States military, had stood empty and Liberia was beginning to close them.

Mr. Nyenswah said it was not yet known whether the infection came from Guinea or Sierra Leone, West African neighbors that still have small numbers of new Ebola cases.

Abraham, who sold used clothes at a local market, fell ill at his mother’s house a week before his death, experiencing fever, diarrhea and vomiting.

Abraham’s father, James S. Memaigar, 49, a shoe salesman, said a local clinic had told him just three days before his son’s death that Abraham had malaria. The clinic had sent him home with a handful of tablets, Mr. Memaigar said.

Abraham died Sunday in his father’s home in a community known as Smell No Taste, a few miles from his mother’s home and a short distance from Liberia’s international airport and the Firestone rubber plantation.

Mr. Memaigar had contacted the burial team and dragged his son’s body out of his room on a mattress. Abraham was buried the same day by an Ebola burial team in an overgrown cemetery a short distance from the house.

Dr. Dahn said investigators were trying to determine how the boy had become infected.

Points of note:
1) In a country ravaged by Ebola, and desperate to convince everyone they're free of it, with purportedly only one case to deal with, the crack Liberia medical care system missed the initial diagnosis. Until it had doubled. Perhaps multiple times. Stop me if you've heard this one...
2) The virus, certainly not a new strain, but the same one that's been rampant since December 2013 in West Africa, has done its main thing: it has already spread to at least one other person, and perhaps a dozen symptomatic ones and/or a hundred unsymptomatic soon-to-be diagnosed ones. A month or more later. Stop me if you've heard this one...
3) Liberia has proven competent to confirm two cases, now that they don't have people dying by the hundreds this year. Yet. But as far as stamping out the disease at such a low level, they are about as competent as the Iraqi Army against ISIS.
4) We have no idea how many other cases they've missed/mis-diagnosed since outside attention has waned.
5) With the uninterrupted media blackout of most all Ebola-related news, we never will, either there, nor here. It's frankly almost a miracle that the NYT even chose to publish this piece.

Don't worry, though.
Ebola will never ever get here from there, so there's no need for flight quarantines, and our superior health care system and dedicated medical practitioners would stop it in its tracks if it ever...oh, wait, nevermind.

GSW OSh*t Contingencies, Everyday Variety

First, H/T to the always excellent blog of WeaponsMan , and in particular this post , for inspiring this follow-on riff. Read it first, or at your leisure.

A lot of us like to shoot.
Many of us realize that accidents can happen, even while shooting.
Some of us are even prepared for "B", if it happens during "A".

Please, try and make sure you and any club you patronize is in that last category.

Having a GSW OSK (O Sh*t Kit), for yourself, your friends and loved ones, or some random dumbass one lane/bay over is never a bad idea.
What to put into it is the subject of any number of posts and blogs. Visit them, do some thinking, and work it out for yourself. If you're smart enough to digest three or fourteen points of view, I'm not too worried about what you'll put inside it. If you aren't that smart, nothing else I write is really going to solve that.

But as important as what goes in the kit, is knowing WTF to do if you have to use it, including if/when you're doing so on yourself or a loved one.
So get properly trained - and no, just watching a couple of TCCC videos on YouTube isn't enough - to use whatever you decide to pack.
And because Two Is One, And One Is None, do your damnedest to make sure there are other people trained to standard and present as well, if more than one of you is going shooting. It's embarrassing when the Medic bleeds to death because he shot himself, and no one else knew WTF to do, right? It's also hard on their relatives.

And then, there needs to be a regularly updated Range Safety Plan.
Not some piece of CYA boilerplate BS known only to some insider Illuminati, but an actual explained plan known to the lowest schmuck above Raw Newbie Nevershotagunhbefore at that range on that day.

Oh, what's that, you say? Pre-paid annual range membership didn't get you that briefing, and you don't get an annual update in snail or e-mail? Then as good as your club is, it sucks balls in that respect. Bring it up with TPTB until they listen, or take your membership elsewhere. When they have an accident, you'll be able to buy them out for pennies on the dollar, sooner or later.

What it should comprise is knowing where you are, who and how to call 9-1-1, what to tell them, and how to direct them when they respond from the nearest paved road to where the bleeding body is actually located.

If that requires someone to be the "Follow Me" vehicle from the gate to Range B-23, so be it. If that requires 5 rodeo clowns to keep every other yahoo off the range road until the emergency is dealt with, so be it. Plan for the resources you have, to deal with what you might have to face.

And if possible, have/know a suitable nearby spot(s) where Lifeflight etc. could land and pick up the bleeding dumbass in a pinch, if this becomes necessary. That dumbass could be you, if some other dumbass shoots you.

DO ALL OF THIS WITH THE ADVICE AND INPUT OF THE FIRST, SECOND, AND THIRD LIKELIEST FIRST RESPONDERS TO YOUR VENUE, AFTER HAVING THEM VISIT SAME IN PERSON, AND LISTEN TO WHAT THEY TELL YOU TO DO WITH A PURPOSE.
And if you haven't consulted adequate legal counsel in depth about all this beforehand, you're STILL doing it wrong.

And do NOT, under 99% of circumstances, half-ass some home-concocted "designated ambolance" out of Fred's flat-bed and Aunt Martha's Chicken Soup and Bedsheet Doctoring Supplies" unless you want to be taking it in the heinie from some lifer named Bubba for the five to ten years you'll get for negligent manslaughter for trying to cobble this together on your own.

If you either like the buttsecks, or have two to five school-trained and certified paramedics, trauma RNs, and an emergency or trauma physician present for duty, with a state-certified medical transport vehicle fully stocked standing by, along with a lawyer on retainer and speed dial, and a $10M liability policy that covers deliberate personal stupidity, and all your personal assets are shielded by an LLC, and your job won't mind the months you'll spend in court or prison, and your family can get along without you for those years, then by all means ignore the previous suggestions at your whim.

Bonus points: When was the last time your club, in conjunction with the likeliest 9-1-1 responder agency(ies), did a no-shit live drill of same, from incident to arrival at a Trauma Center/Emergency Department, or from incident to Lifeflight (etc.) departure from scene?
If the answer is zero in recorded history, your club probably still sucks balls on this, whereas if you've gone to the point of volunteering to provide a real-world training opportunity to one or more agencies, the only way they won't take you up on it is if their training directorate sucks balls. This is why your local politicians (who pay for those agencies) have constituent assistance lines. Just saying.

I yell because I care.

Thoughts On Garland

No word on when Texas will be training the French police on how to respond to these sorts of incidents, but the difference in outcomes there vs. here argues for such a program to be instituted among them and our nominal EU allies, in haste.

My take is that this latest event is so full of Fail for both the perpetually offended adherents of the Religion Of Peace (tm) and for the hoplophobic would-be Overlords of Progressivism, and so chock-full of chocolatey frosted win for Those Of Us Who Like Guns, that this event will disappear from the mainstream news pages in about seven seconds, even if Bloombozo has to sponsor, at his own expense, two psychotic whackjobs to shoot up separate busloads of pre-schoolers to accomplish the feat.

Someone elsewhere called the recent incident wherein the final tally was Beat Cop 2, Jihadis 0, a "childish First Amendment stunt", and opined that they didn't much like it.

O, how I beg to differ.
And I put some extra Eloquence Wax in my morning coffee:

It's a free country, and you don't have to like it. ROWYBS.

And yes, it had a happy ending, and the cop is in fact a bona fide hero.
Except for us not subsequently JDAMing the Phoenix mosque wherein they festered, and that at sunset on a Friday, pour encourager les autres.

But it was also subsequently alleged that enticing lunatics to commit acts of violence and hoping someone else intervenes on your behalf is jackassical.

If one so believes, this is where the wheels depart one's Logic Wagon in haste.
1) Definitionally, lunatics' opinions are suspect, especially when those opinions are coupled with the utter lack of an impulse control filter leading them to commit violence, because they're gorram lunatics. This is why and for whom such helpful asylums as Guantanamo and Alcatraz were originally constructed.
2) Free speech and the First Amendment doesn't include the helpful phrase "unless it upsets anybody". You could look this point up if there's any doubt.
3) No one was "hoping someone else intervenes on" their behalf; the organizers laid on extra security, as did the authorities once their intel networks picked up the increased jihadi twitter chatter. And it's Texas: extra security is included in every CCW bite, at no charge to anyone. So that point goes away wholesale as well. The only thing jackassical may have been not advertising this as
"Security provided by the Second Amendment, and Bring Your Own Rifle LLC".

It was also alleged that staging stunts to prove your bravery and love of the first amendment, while counting on someone else to protect your hide is childish - to say the least.

As noted, that point is non-operative, so repeating it doesn't win any points.
Unless one is suggesting that it was Pam Geller's job, personally and single-handedly, to patrol the entire event perimeter, and/or the borders of Texas itself, outfitted like Paul Blart, tactical-tommy Mall Cop. Best wishes in making that argument.
We currently have 10,000 newspapers and magazines, 400M blogs, 357 cable channels, a few thousand TV and radio stations, and upwards of 300M citizens using everything from flyers and  handouts to bad breath, who are staging similar "stunts" every day from 1776-now, inclusive.
One who suggests that this event was a "stunt" take a looooooong healthy look at their position, shoot a back azimuth, and try that sentence again.
This was America. And it was (predictably) attacked by adherents of the Religion Of Peace(tm).
Once again, JDAMs, I say.
"Millions for JDAMs, and not one cent for dhimmitude" should in fact be one of the winning presidential campaign slogans this - or any - season. The sooner people stop finger-banging themselves in ignorance of that fact, things will get better for us, and worse for them, and things will approach rightness for the world to the exact degree we live this out.

Lastly, it was elsewhere noted that if this had been orchestated by anything other than two fucktards, it could have been much worse... and probably not at the actual venue where armed men were lying-in-wait; perhaps instead at a school or church a few days later.

Which rather argues for killing the bastards, both fucktards and professionals, root and branch down to the last semen stain in their underpants on seven seas and continents a-purpose and aforethought, on general principles, rather than staying home, cancelling an event, and shitting in one's pants lest some offense be found in their dhimmitude. Which is the gist of the "she was asking to be raped, walking down the street like that" argument at this point.
Which, it should be noted, is their argument for raping infidels since about 700 AD, which then requires a helpful stoning afterwards under the Religion Of Peace(tm), for being an infidel strumpet.

Thus a general rethink of any such twaddle is heartily suggested, coupled with some actual applied logic in consequential outcomes, and a healthy dose of "How the Constitution works in a free republic, e.g Texas".
So if anyone opining otherwise notices their dick bleeding afterwards, I have some band-aids. But housecalls are rare, and cost extra.

Someone noting, for example, that "the Pope wears a dress and a funny hat", or that "If God had not wanted us to eat pigs, he wouldn't have made them out of bacon" is not a sufficient provocation to anyone's religious beliefs to justify jihad and attempted mass murder, amongst civilized people.
Even if we note for the record that one's religion was founded by a mass-murdering pederast with delusions of grandeur, and is stuck in the backwards tribalism of illiterate pre-technological 6th century assholery to the extreme. Or put that on billboards.
Uncivilized people who miss this critical point are there primarily to provide target practice for the rest of us, pretty much since people learned how to write on clay tablets. (cf. Philistines, visigoths, and any number of natives on the African and both American continents, etc.).

If anyone wants to run around in a loincloth waving a spear, their so-called civilization is "quaint".
But when they roast peaceful missionaries for lunch, slaughter settlers on the frontier, or come to the town square and attempt to practice their curious cultural customs, like jihad, here, they have broken the social contract of tolerance for their peculiarities, and they need to be removed forcibly from the gene pool.
Probably in batch lots of several hundred thousand at a time, merely to politely drive the point home to their toothless bongo-playing kinfolk.
How much that improves the targeting skills of our military personnel, or how much fun and entertainment that provides to the rest of us, is merely a happy serendipity.

This event was nothing more than one Texan well-schooled in common sense, of the sort one used to routinely find at the grade-school level, applying logic to that exact situation, one magazine-full at a time.
Had he used lit molotovs instead of a semi-auto pistol, it could have been no more eloquently put.
But had he chosen the former weapons, as observed by that noted tactician Col. Kilgore, it would have smelled like victory.

What Ebola? Where?

 

 

As noted yesterday, Ebola is not, in fact, gone from any of the three most heavily impacted countries in West Africa.
In fact, the weekly tallies right now are running at a fairly steady percentage of what they were during the apparent peak weeks last fall.
And without laboring yesterday's point, based purely on admittedly bogus numbers of dubious reliability, for any given point in this outbreak, including now.

In the past, outbreaks have burned out; usually by killing 90% of everyone in some remote village, and then going away because the other 10% survived/were immune.

We don't know how the Index Patient in this outbreak contracted it. Just like we don't know where any other Index Patient in any prior outbreak contracted it.

But this time, it hasn't gone away. Because this time, there's a near limitless pool of new victims, because it isn't confined to some remote little village. It's gotten loose across entire countries, and in the large cities thereof.

And it simply hasn't disappeared in any of them. It waxes and wanes, but it's still infecting people, and still killing them in droves. Despite everything we know (and don't know), and despite everything we've done and not done, it just keeps on keeping on.

It keeps infecting the careless, the stupid, the ignorant, and even those taking special precautions and wearing frickin' hazmat gear.

We did not duck this bullet, it just went over our heads last time.
There is absolutely NO reason to assume this will continue to be the case. In fact, rather the opposite: every day it doesn't spread just makes the day it does more inevitable. Like against terrorists, we have to get lucky every time, this virus just has to get lucky once. The calculus on that argues for preparation for what is clearly inevitable.

So how's that going over here?
No ban on flights here from there.

But why do that? No one has gotten here since they started the screenings.

Yeah. And signs prohibiting it are what keeps elephants out of the trees at the local park.

Which argues for several things:
* the screening measures, shoddy as they are, have been good enough to stop obviously infected people from travelling, in most cases (they wouldn't have stopped Duncan)
* it's harder to spread early on, and thus early infectees who are pre-symptomatic are the only ones who can make it past the screening
* we're dealing with a target population for whom taking an airplane flight is only slightly more likely than flying to space.

Unfortunately, that means that:
* those who do travel will have the means to go anywhere
* they won't raise suspicions until they're far from the minimal screenings that exist
* they'll then become symptomatic amidst their home populations, long after they're not under any sort of organized and mandated surveillance, and thus all reporting is completely on their honor and best behavior.

And as witnessed with Dr. Special Case, Dr. Special News Reporter, and Nurse Mimi Crybabypants, people, even trained medical professionals, are self-serving lying little shits who will endanger the public recklessly and repeatedly, left to their own devices, where Ebola and the horrors of quarantines (which latter have been instituted and accepted by all civilized people since medieval times) are concerned.

And that's just assuming the disease stays in West Africa, behind the current zone of interest.
If it gets out of that zone, like the Germans going around the end of the Maginot Line, there isn't anydamnthing to stop it or even slow it down.

And what about here?
We still have a treatment capacity of 11 beds, nationwide. And several of those are permanently reserved for military research casualties, so it's really only 7-8 beds.
I.e., the same number of Ebola cases in any of the three originally affected African countries by Week Two.

Then, it's back to local hospitals.
Which is to say, the Worst Of All Possible Worlds.

Dallas gave you a glimpse of what to expect.

As I've related, I've been flitting hither and yon locally in my professional capacity.
I'm here to tell you, having now seen multiple local hospitals, it's far worse than I could have imagined.

Most hospitals have no supply of protective gear for even a single outbreak case.
Many have no negative airflow room in which to place the victim(s).
None have more than a very few of them.
All of them require moving an infected patient through the entire ER, from lobby to treatment area, completely exposing not only visitors, but their entire staffs, to potentially infectious material.
None of the ERs I've worked at has any personal protective equipment rapidly available.
None of them has adequate PPE available for more than a few staff members.
None of them has conducted anything but cursory training in dealing with potential infectees; most have conducted none at all, and a few don't even address the possibility of it ever becoming necessary.
None of them has any capability to sort infected people before they enter the hospital, nor do most have any plans to do so.
The ones that do have plans are mainly limited to vague incantations about setting up some ad hoc magical whatsis. None have actual sorting facilities, decontamination abilities, nor have held any training or exercises to practice such implementation.
None of them has any capability to treat so much as one potential case, and still safely stay open to other patients, yet that is precisely what they have done and will continue to do, until it becomes apparent that they've already contaminated their entire staff, the entire ER, and recklessly and deliberately exposed dozens to hundreds of unprotected people to the disease.

Go back and read that last sentence again.

Bear in mind we're talking about busy ERs in a diverse, multi-lingual major metropolitan area, wherein reside approximately 10% of the entire US population, countless international tourist destinations, multiple international airports, three major seaports, and an international border within 1-2 hours' ground travel distance. Not the 2 bed ER in Podunk, Inner Wyoming.

Now let's talk about your ER, especially if you're within a tank of gas of those five major destination airports for flights from West Africa.

Then let's talk about your ER if you don't even have that going for you.

And now I'm not even on the home team in those ERs?
Potential Ebola Case walks in, I'm out. Period. Done. B'bye.

And the difference for me is, at least I'll know something there, because they'll come in with suspicious symptoms.
What are you going to do when someone coughs in the market, or is sitting next to you in the theatre or the bus with a fever? Wait until blood is shooting out of their eyes?

Best wishes with that plan.

I repeat, Dallas was a warning shot.

IIRC, Duncan was sick in hospital for a week or so before he died. I don't know how many nurses cared for him there; at 2/day it could have been as many as 14, plus ancillary staff, or as few as two. And with their inadequate protective measures (the same ones I've seen ready or not at most local hospitals) that means he successfully infected between 14% and 100% of his direct caregivers.

All of whom KNEW he had Ebola before they walked into his room.

His one case closed that entire ER for the duration-plus, and the ICU, and for all intents and purposes, a 400- or 500-something bed major acute hospital became a ghost town overnight. It may yet stave off financial ruin and bankruptcy.

Based on the early reports of the first nurse's lawsuit, I wouldn't hold my breath there, and despite the blow to the community, they probably don't deserve to stay open.

Then there was the disruption and expense to the city and county, from a grand total of three actual cases: Duncan himself, and the two nurses. (And both of them were evac'ed to two of those eleven beds mentioned earlier pretty rapidly.)

So the moral of the story is, the first eight or so people infected here have a shot.
Patient Number Nine and following will stand about the same chance as victims in Africa.
Which is somewhere between a 10 to a 40% chance of survival.
And, evidently from recent news, with a lifetime's major permanent disabilities and sequellae, including lifelong vision deficits up to and including permanent blindness in many cases.

So yeah, Ebola has plateaued at a fraction of its peak, but refuses to burn out.
Which is merely that same exponential growth curve, on "Pause".

And given the current mutually-agreed-upon news blackout, your first clue it's rolling again will be when they announce on the news that someone is at County General, and came in shooting blood out both ends after they collapsed at the mall.

And then it's last September all over again.

Oh, BTW, for reference, at one of those ERs, in one week's time I've taken care of ten patients who came in with such routine symptoms as coughing blood, vomiting blood, and/or bleeding out their back end. We won't even talk about how many had fever, headache, and body or joint aches. So yeah, we'll get right on catching that Ebola patient the first time they come through the ER, because it's so easy to spot.

Just like they did in Dallas.

Sleep tight.

Welcome To The Party

Hi. Nice to be back. Fully and completely.

I was going to spend my day off tomorrow coming back to re-visit the entire (and ongoing) Ebola outbreak.

But today, on his blog, American Mercenary went there.

And I replied in comments.

Which occasioned his reply, and now this post, mainly because it's too frickin' big to fit there, it bogged down and choked his Disqus comment server, and I needed this excuse to kick me in the pants and drag me back to this whole thing eventually.

So, let's get to the rat killin':

AM wrote:

Aesop, I've always been a bit in awe of your ability to be so certain about the uncertain.

Why stop with "less than one third"? Why not say "Less than one tenth?" or "Less than one hundredth?" or "Less than one thousandth?"

What gives you any certainty for a bounding of the uncertainty?

It is an interesting question, isn't it?

The same question, asked a different way, is "how do you know even a fourth of cases were accurately reported?" Or "How do you know the population of any given country isn't complete and total bullshit?

And to go one step further, do you know if the rate of under reporting has been consistent or inconsistent? If it is consistent we can still use under reported numbers to track the progress of the epidemic. If the reporting has not been consistent, how would you know?

Here goes: 

I appreciate the snark, but unfortunately, WHO selected the "less than 1/3rd" Fudge Factor for those reports some months back, which has been noted on this blog over and over. In fact, it was revised to a higher Fudge Factor the worse things got, because it became crystal clear even to the doorknobs at UN/WHO that the locals were deliberately spinning numbers out their fourth points of contact as a matter of course, and the previous "1/2" Fudge Factor was No Longer Operative. Unless they've taken away the breadcrumbs, the memos to that effect from last July/August/September/October etc. are still available online, including on the Wikipedia page concerning the outbreak:

Note: the CDC currently estimates that actual cases in Liberia, Sierra Leone, and Guinea are two to three times higher than officially reported numbers[1][2][3].

(Nota bene that those Wiki links are to a CDC report, Science Magazine, and the LATimes' story on the subject, respectively. From last September and October. So as far as plucking that factor out of my back end, my hands are clean. I can still pull this out of recollection, and I haven't touched the issue since about last December, IIRC.)

And the exact point of the exercise has been that the reporting of the statistics by the involved countries was and is complete and utter bullshit, then, now, and ever shall be. The "1/3" Fudge Factor is the minimum of how much BS to ascribe to the stated numbers. The upper limit is bounded only by the actual population on the ground.

IIRC, I think I only made that exact point about 200 times amidst the height of the crisis.

Like here.
Here.
Or here.
Or probably any number of 200 other posts anytime after July/August.

The entire key to managing this outbreak, by all expert testimony of world-class epidemiologists, is having and effectively deploying sufficient resources, which requires accurate intelligence about where and how bad the outbreak is, and is progressing.
And actually having those resources.

Which has been and continues to be the exact things that have never existed anywhere in West Africa from 400 B.C. to date, inclusive, not least of which because you're dealing with people who have to wear open-toe sandals to count to 20, and have literacy and numeracy rates that make Appalachia look like Caltech and MIT, before we even get into the self-serving corruption problems endemic to the world's poorest former colonies, or the abysmal lack of response to this from outside until well past the date it would have mattered.

Has this spiraled along the exponential mathematical pathway it could have done by now?
Thankfully not. Huzzah.

Why didn't it?
No frickin' idea, anywhere, from anyone.
(Personally, I'm hoping it was the Invisible Hand of the Grim Reaper, selecting out hordes of Darwin Award Finalists with carefree abandon, particularly the 50% of people there who are sure Ebola is caused by witchcraft, and the 45% who are convinced it was cause by the United States practicing witchcraft, but that's just my mischievous nature breaking free for a moment in the sun.)

How bad was it then, and how bad is it now?
We know precisely two things: Jack, and sh*t.

So we don't know where it went, why, or how, and we don't know why it stopped or what was most effective, because we never had any accurate data to go by, not even roughly.
Which makes any official pronouncements about the outbreak from on high as relevant to actual medical science, as astrology forecasts are to actual astronomy.

PAY ATTENTION PLEASE:
This is exactly why the original pronouncements from CDC, like "This will never get to the US", and "We KNOW how to handle and contain this disease", turned out to be total horseshit too: they don't know what they're talking about, and they don't KNOW they don't know what they're talking about, because they're basing their announcements on prognostication based on happygas, NOT on actual scientific analysis or sober reflection on reality and facts on the ground. AND THEY NEVER HAVE.

In the West, it's even worse: the US effectively managed, what, eight or nine simultaneous cases?
And our max capacity is...eleven. Then, now, ever.
A number they had in any of those three countries last March or April, three months before anyone much cared.

The greater point was and is:
This disease will get out, again, and we'll fail to deal with it, again, and next time, once it gets to 12 cases, that city is f*cked.
Twelve cases apiece in two cities and that state is f*cked.
Twelve cases apiece in three cities, and we're Liberia, or Sierra Leone.

And if we're very very lucky then, you might contain it in just one time zone, or on one side or the other of the Mississippi, or the Rockies. At gunpoint.
If it gets to any African or Asian megalopolii, where the number of potentially infected people who can spring for a plane ticket is seven orders of magnitude more than all of the rural African continent, fuggedaboudit.

So how many MOPP suits does your unit have, and how long do they work saturated in infected blood?
And what happens if the factory where they make them is inside the Hot Zone next time?

This is a temporary pause, and we neither know why it paused, or when or where it will return.
We only know that unlike all previous outbreaks, it hasn't burned out and gone away, and now it probably never will.

And as long as we allow them to do so, it's a virtual certainty that people will continue to get on planes there, and bring the disease here and to Europe, in both of which where it won't be noticed immediately, and will thus propagate and spread, and that if it does so over the 21-day incubation period, it could infect enough people that, just like in Liberia, Sierra Leone, and Guinea, it will suddenly spread like wildfire, in cities where the Black Death isn't just hyperbole, but merely dimly recalled actual history. And then the Gods Of The Copybook Headings are going to have their due, in exponential hyperbolic glee, without any nod towards dismissive snark, nor any regard of officialdom's irrational exuberance.

And the bodies of the disbelieving and the slow to respond will be stacked like cordwood.



AM is, by any manner of measurement I can devise, a thoughtful and bright guy, a serving Army officer who evidently survived the recent purges, and in all likelihood, destined for field-grade and higher service.

So while we may occasionally disagree on finer points, I wish him nothing but the best, and hold his posts and comments in high regard, because he takes things apart and puts them together rationally, as a rule, if not entirely. If it were otherwise, he wouldn't be over there to the right on my Blog Roll.

But having noted that the figures we were being fed were pure crapola, pretty much for half a year, which was reported on, sourced, and fact-checked ad infinitum, I can't begin to understand when or why he ever thought it was otherwise, which is the kiss of death to ever understanding this disease or combating it scientifically and efficiently, let alone putting the slightest shred of faith in any official pronouncements regarding it.

My official policy remains: "Ebola: Run for your lives." because the signal to noise ratio is at best 1:10,000, and worse than that the higher up on the panjandrum scale any of TPTB reside.

I didn't think this was news anywhere, but evidently I haven't made the point frequently, forcefully, and cogently enough yet. My apologies for tiptoeing around that 800-pound gorilla.

Comments are wide open.

As the Tag Says, "Whatever Doesn't Kill Me..."

 

 

Greetings, visitors and any faithful readers.
Endless apologies for the continued delay in adding fresh content. Your patience will be repaid shortly. (Anyone betting you I'd shut up on the 'net very long, take the longest odds you can get, and retire early on your winnings.)

Work is work. To be more specific, it's five nights in a row/60-hour weeks, vs. my former 3 nights/36-hour weeks. And now at a new higher pay rate. It's amazing how hard you can work when the other choice is literal poverty. The paychecks are commensurately effing awesome. The only drawback is that my enforced unemployment came rather unexpectedly, and with my cash reserves on fumes, so I have a bit more catching up to do, but that's happening at 200% of the former speed it would have otherwise.

Cool things:
I now have direct experience with another dozen medium to large ERs locally.
I have met a lot of great folks, and am constructing a short list of places I'd consider making a full-time employment home.
Several of them started pitching me to sign on FT after seeing me for about two shifts.
While trying to keep my head from swelling about that, it's nice to
a) prove that you still have the chops to do the job, esp. serially in front of strangers, and
b) a little ego-stroking after the crotch-kick of getting shoved out the door at an employer isn't a bad thing.
If this is anything like what it's like to be a pretty girl from age 16-45 or so, I can at least understand some of the attitude that goes with it. Without the PMS complications.

That doesn't mean getting pushed into a pool of career icewater wasn't an effing PITA, but the end result will be that I'll probably make enough money this year to move into a higher tax bracket, and suffer the agony of being able to reach some lifelong financial goals in short order. Poor poor me.

A few other observations:
Keep a career back-up plan: a part-time job, small-potatoes self-employment, or whatever, but have a second gig. Something. Anything. Even if it's barely paying for itself, a small cash flow beats none at all, and your car doesn't run on a tankful of canned food or ammo reserves. Ask me how I know that.
While I likes me my firearms, I've always been a more well-rounded preparer than a gun nut, but if you've never visited the local collateral loan merchant (AKA pawn shop) you should be aware that any of Gaston Glock's tactical Tupperware is readily convertible to $250 cash money in most populated precincts, and that's without things nationwide being dire. So, for instance, three or four of them "extra" that you can part with for a few months equal your monthly readies. Again, ask me how I know.
Then imagine what their barter value might be under more dire circumstances. Esp. if you had a few spare magazines and a couple boxes of ammo apiece.
The same is most definitely not true of just about anything else you might think of.
Again, go visit the local hock shop, and chat them up, to get a no-BS idea of the actual value of things you might wish to convert to cash should the need arise. As someone who would formerly never have ventured into the pseudo Arab bazaar marketplace they represent until necessity forced my hand, you'll learn a few things, not only haggling, but you'll also get an idea of what's hot and what's not (e.g., any functional pistol is cash in the bank, whereas a brand new iPhone or high-end camera is nigh on worthless. Surprise.)

Free internet when money is tight is a gift from heaven (and Starbucks/Mickie D's/the local public library). With a laptop and the time, you can do for $0 what would otherwise be a couple of hundred $$ in cell/wifi bills. And if you haven't done a job search in awhile, the entire world is now online. Walking into an office with a resume these days is tantamount to telling an employer that you can take Morse code at 30 words a minute, or type at 80 words/minute, as if that should mean something to them.
(For those of you to whom Neil Armstrong and 8-track tapes are history as remote from you as the Thirty Years' War, Google "telegraph" and "typewriter". Those of us with underwear older than you are will quietly tolerate your confusion until you bone up on such arcana.)

OTOH, showing up on time (by which I mean early) with a good attitude, being flexible, and showing up, putting your head down, and getting the job done without any drama queenery once you get the job is timeless, in every career field since Thag and Og were making stylish saber-tooth cat skin leisure attire and chiseling wheels out of stone.
I save my sarcasm for here online, by and large. Believe me when I tell you it never wins you points at work, unless you own the joint.

Lest anyone think I'm going all Pollyanna, or selling out from financial necessity, let me assure you I've already collected a few choice bucketfuls of carefully distilled snark, soon to be shared here, and even more so over at Shepherd Of The Gurneys in upcoming installments. And then some. Suffice it to say that as much fun and pleasantness as I've discovered in my expanded work universe, the depths of Stupid out there are unplumbably bottomless, and probably incapable of measurement with existing instrumentation.

As an example I'll be explaining shortly, the level of emergency preparedeness even after the recent Ebola outbreak have proven inarguably that things are now not only far worse here than I predicted 6-8 months ago, they are worse than I could have imagined then or even now without the direct experience of seeing them again and again.

Which is a short tease of explaining that, No, Ebola Hasn't Gone Away, And It's Not Going To. Better effing believe there'll be more to come on that front in short order, just for one example. In fact, 2014 wasn't the problem, or even the wake-up call, it was more likely the last whistle stop before the missing bridge ahead. Stew on that, boys and girls.

So whatever you were doing to prepare for the vagaries of life before my hiatus, keep on knocking it out. Life is not going to get more predictable or happy for anyone any time soon, by any reasonable examination of the facts. Plan accordingly, and I'll be throwing out more details in coming days.

Promise.

Okay, That Was Annoying

 

Employment has resumed.
With roughly four times the amount of grief, annoyance, and general PITA fucktardery as I experienced filling out a Top Secret/SCI special background investigation back in the day.

Jeebus crispies!

My generic advice:
Keep your resume updated.
Including all your contacts and references.
Keep 7 copies of every bit of vital certification and testing information, including DNA swabs and urine samples of the personnel administering such testing and certification. It WILL be asked for. Demanded, actually.

Working 18 days straight may give me a heart attack, but at after running around like a headless chicken for a month with no income, in the feast-or-famine sweepstakes, I choose feast.
Especially when a 20% average pay raise is involved.

Oh, and a hearty FU Very Much/ESAD to my former employer, Callous Bastard Hospital.
The last three places I've worked this month are already asking me to fill out permanent status employment apps after seeing me work as temp registry for them for a couple of shifts. It's nice to be popular.

But clearly, you have to run away from home (or be booted out the door in my case) to get any respect.

Normal posting will resume in a week or two.

Shameless Plug

Over there someplace --->>>
there should be a new addition to the blogroll:

Hogwarts' School of Grid-Down Medicine.

AKA providing medical help for you and yours, when you're all there is, or is likely going to be, for any number of reasons.

Doc Grouch, Ivymike, and myself had it suggested upon us courtesy of Concerned American over at WRSA.
We promptly all fell all over ourselves thinking what a great idea it was. Doc Grouch and Mike did just about all the work of launching it.
My input was some tinkering, and then I got a vacation, and then my return to reality, as previously noted, has been a bit...bumpy lately.
Thus any credit due to me for it so far is right about nil, so I'm not being immodest to tell you the site looks great, and there's stuff there you should read, learn, and pay attention to, if you think big shiny white hospitals and endless streams of Government Bux to pay for visits there will not last forever, in all places and times, for the rest of your life.
In other words, if you have any grasp on medical and sociological realities, let alone an awareness of the frequency of life's normal allotment of natural disasters.

Doc and Ivymike have done great things there thus far.

As my situation stabilizes, and I get back to regular posting, I'll have more of a share carrying my end of the log, along with Doc Grouch, IvyMike, and anyone else we can cobble together to keep it a going concern, and improve it.

Start at the beginning, read the posts, do the homework.

Our goal is not online medical school. (There are probably laws against that anyways.)
It is that everyone with the time and inclination be provided with the guidance, resources, and gentling prodding (of a solid boot in the ass, metaphorically) to be as prepared as they may choose to be to deal with medical emergencies anywhere, with what's in your pockets, or even better, with the prudently-stocked contents of your home version of Somewhere General Hospital. And anyplace on that spectrum between those two. Guided by what we have invested and reaped from a combined goodly number of decades each and all trudging through the corridors practicing our medical arts.

Go.
Pay attention.
Learn stuff.
Practice it.
Save Lives.

Potentially even those that mean the most to you personally, at a time when you may be their best, or only, chance.

West Point Ranger Studs - STILL not faster than a speeding locomotive

Today's Lesson: Watch Your Step

Fitness model, actor and reality TV star Greg Plitt was fatally struck by a Metrolink train in Burbank Saturday afternoon. Police say Plitt was filming on the train tracks.

People who knew Plitt and fans who wished to honor the fitness guru stopped by the train tracks Sunday to pay their respects. A bouquet of roses was left at the scene.

Plitt, 37, was a top fitness model and actor. He appeared on TV shows and movies, and was on the cover of more than 250 fitness magazines just in the last eight years.

Burbank police say Plitt was filming with two other people on the train tracks, just north of the Burbank Metrolink Station, when he was struck and killed by a Metrolink train.

Witnesses say Plitt was holding a video camera when the accident happened.

"He had on all black. The train went by. I saw him stumble over the tracks. He had a camcorder in his hand," said Metrolink passenger Victor Crowell.

Y'see, train yards are generally gravel and hardscrabble, with not just tracks, but large ties ("sleepers") sticking out, along with the anchor spikes, and all matter of other detritus afoot.
So when you stumble right in front of a moving train, that's it for you.

This is why on real productions (as opposed to someone half-assing it with a couple of buddies "on-the-cheap" with a handicam) there are whole departments of people who make sure that the person with the camera is safe from such things. Now you know what a grip does.

Tragic for Plitt and his family, and no doubt rather inconvenient for the train crew and passengers. But I daresay his DayPlanner has opened up quite a bit, and 200 other would-be fitness cover boys are shedding crocodile tears.

But even if you're rough, tough, and buff, with an Academy ring, a black-and-gold tab, a five years with the Regiment, your chances against a moving Metroliner in your gym shorts and tennis shoes are about the same as if you wore a meat suit to swim with Great White Sharks.

For Mr. Plitt, lesson learned, albeit about 5 seconds too late to deliver any helpful behavioral changes. Some stuff may look easy, and making videos is: right up until you find out the parts where it's not so much the case. Like from the undercarriage of the train.

Oh well. 

And the other shoe drops...

My vacay was lovely. As will become apparent, I should have stayed there.
(If you have the chance for two weeks on Maui, I highly recommend it. Anytime.)

Upon my return, I found out the reason they were so cheerful about letting me have time off for the holidays, was that in their ceaseless efforts to not go broke implementing ObamaCare, my facility will be "re-organizing", and wished me their best in securing another position. Just. Like. That.
The fact that I'm experienced, at the top pay tier, and recently passed the half-century milestone were all purely coincidental, they assured me. And I have a bridge for sale too, right next to some beachfront property in Kansas.

Step Two was dusting off the resume, and getting a gig with any number of nursing registry agencies hereabouts that are swamped with the need for ED nurses locally, because for some reason, there are a ton of facilities with openings for non-permanent personnel on all shifts. Everywhere.
Doubtless this is just another purely random coincidence, I'm sure.

The sweetener is that they pay on average 10-20% more than my former employer, for doing the same job, and (after a few months not there), even including my former hospital home. So they laid me off to get me a raise, and set my own days and hours forever, including no more holidays at my discretion, and all it cost them was any shred of loyalty or concern for their best interests I might have had after the last ten-plus years in their trenches.

Such a deal.
The other bummer was instantly being ripped from amongst the greatest bunch of people, doctors, nurses, and staff, I've ever worked with. $#!^ happens.

The fly in the ointment was that I needed to do all the pre-employment hoops I haven't jumped through since Clinton was president, and dig up paperwork from the late Pleistocene, as well as document my decades of competencies in everything, from scratch. (Satisfying my inner hyper-anal control freak, I have so far aced everything they've thrown at me. And thank the Flying Spaghetti Monster I can do this stuff online, at home, in my pajamas, whenever I feel the urge. Yay, 21st century technology.)

During which, it turns out that between eating like a teenager, no small amount of it grazing on craft service, and the very same two decades of dealing with nightshift ED work and the lovely people deposited on my gurneys, my blood pressure seems to have decided to translate into flight data from a space launch liftoff, after being textbook normal up to at least six months ago.

Oh goody. After a quarter-century in healthcare, I always wondered what it'd be like to be the patient. (Not.)

I have consequently been just a wee bit pre-occupied with securing gainful employment, and not having my head explode, while finding a regular physician for the first time since I was a teenager, managing new meds, and embarking on a new quest to burn off at least a decade of crap daily diet and not enough cross training. With my former health insurance a distant memory.

So the 20 extra pounds around my gut are my fault, and the ED is the ED, but a hearty "Fuck You" to president for-life? HopeyDopey, and his ceaseless efforts to destroy the 17% of the American economy that has been my career, by mucking up the revenue stream for all hospitals. The only silver linings are that having discovered my new health situation, I won't be stroking out from his upcoming State Of The Union, 'cuz I've got meds to fix that now, and because of totally screwing the pooch for the medical industry, there are suddenly no shortage of doctors happy to see me for cash-for-service, indefinitely.

Regular blogging will resume when the recent roller coaster comes in for a landing.

The fivefold teaching moments are thus:

The government is not here to help you. Ever.
Neither is your employer. Loyalty is for dogs. Their end of the contract comes when the paycheck clears. Anything else is icing on the cake, but don't count on it.
Keep your resume current and updated.
More veggies, less pizza.
More PT, sergeant, more PT. Because I miss the Daily Seven like BUDS candidates miss getting wet and sandy in January.

And if you thought I was a non-cheery cranky caustic SOB before all this needless personal drama,

GET OFF MY LAWN.

 

 

Back regularly as soon as I can. The medical chances of me shutting up on the internet are about 8 billion to 1, against.

Paradise, Bitchez

For the first time in two decades, I got the holidays off for personal vacation. (Seniority, or the gods of random fortune, thank you).

Consequently, by the time this goes up, I'm sitting on a beach much like this one.
Just because.

Happy Holidays, &c.

Back after New Year's.

@$$Clown Of The Ides: Chuck U Very Much, Senator...

The real motivation for all that Ebola preparedness comes out:

(PORKVILLE) - Senator Chuck Schumer on Monday called on U.S. secretary of health and human services Sylvia Mathews Burwell to recognize the enormous amount New York hospitals have spent preparing for and treating the Ebola virus, and use some of the money she was given by Congress to reimburse hospitals for their expenses.
Burwell has 30 days to come up with a spending plan for the $733 million her agency received from the latest continuing resolution, a $1.1 trillion spending package that allotted a total of $5.4 billion to combat Ebola.
Most of that money is headed to West Africa, where the epidemic continues to claim thousands of lives, but some can be used domestically.
Schumer said he would like New York hospitals to receive roughly $50 million
         “I am urging secretary Burwell to make sure all of New York's institutions are completely reimbursed for their funding,” Schumer said at a press conference today outside Bellevue Hospital. “That was the purpose of the fund when we push for it and created it.”
Mayor Bill de Blasio has already reimbursed Bellevue, a part of the city's Health and Hospitals Corporation, $20 million for the expenses it incurred when treating Dr. Craig Spencer, the physician who contracted Ebola while working with Doctors Without Borders in West Africa.
But other hospitals have spent tens of millions of dollars preparing for the virus, Schumer said.
Montefiore has spent approximately $7.5 million building a biocontainment unit and training staff, Mount Sinai has spent between $7 and $8 million, and New York Presbyterian has spent roughly $3.3 million, according to Schumer's office.
Ken Raske, president of the Greater New York Hospital Association, estimated the ten Ebola-designated hospitals in New York have collectively spent between $50 million and $75 million on capital construction, the purchase of protective gear and training.

Try and look surprised at the prospect of a Democrat senator trying to shove both arms armpit deep into the taxpayers' pockets and keep everything he can get his hands on.

Webster's Dictionary could save space by consolidating the entry for Chuck and the entry for chutzpah. Or at least using the same picture.

Like Getting Ebola Wasn't Bad Enough

Kenema, Sierra Leone (Al Jazeera )- Massah Kamara sat patiently with her brother Momoh, her haunted eyes focused somewhere in the middle distance beyond the walls of the post-Ebola clinic.
Three months earlier, doctors gave her the good news - after weeks of fighting the disease, she had finally beaten Ebola. She would live.

Back in her home neighbourhood of Nyandeyama, a quiet suburb of sandy streets and mango trees, she found out 22 members of her family were dead, including her parents. She had no money, so was unable to go back to her tailoring business, and many of her possessions had been burned by terrified neighbours.

Then, just when she thought things couldn't get worse, she began to lose her eyesight.

"My eyes are dark," she said sadly. "Even when the sun is shining, my eyes are dark." Kamara said she was happy to have survived Ebola, but fear and misery were etched onto her face.
Kamara is one of 40 percent of Ebola survivors to have gone on to develop eye problems, according to a recent study carried out by the World Health Organisation and Kenema's District Health Management Team. It has been more than a month since the district saw it's last case of Ebola, and attention is turning to the plight of survivors.
The results of the survey, a copy of which was seen by Al Jazeera, outline a raft of physical, social and psychological problems the survivors are experiencing.
Seventy-nine percent, for example, now suffer from joint pain; 42 percent have problems sleeping, while more than one-third of those surveyed experienced peeling of the skin. Many others reported problems with their reproductive system.
Post-survival effects 
"There is so little written about post-Ebola problems," said Maggie Nanyonga, a WHO consultant working with Ebola survivors in Kenema district. "We don't know if it's the drugs that are causing it, or the disease, or just stress."
In a small room at the government hospital in Kenema, now known simply as "Psychosocial", volunteers busily transcribed forms with survivors' complaints. "Serious backbone pain. Difficulty breathing. Properties burned but not replaced," reads one.

"Ear and joint pains. Poor health with red eyes," reads another. 

 "Tired legs and weakness. Cannot see clearly," reads a third.Health education officer Michael Vandi said the eye problems are of particular concern. "We just weren't expecting this. A lot of them are experiencing it, often combined with headaches," he said.The head of the hospital's eye department, Ernest Challey, said he believes he has found the cause - a condition called Uveitis that occurs when the innermost coating of the eye becomes inflamed.
It is triggered by problems with the immune system, a viral infection, and sometimes trauma, he explained. It leaves patients with dim and blurred vision, and pain when they're in bright light. If left untreated, said Challey, it can lead to blindness.

But the physical symptoms are just a part of the immense challenge many Ebola survivors face. "Sometimes I cry when they tell me their stories," said one nurse after writing down Kamara's details in the post-Ebola clinic, the first of its kind.

And it gets worse, according to the rest of the story: the locals treat survivors like pariahs, having burned their few belongings, and shun them afterwards, so they're left with no place to live and no job, as all the health problems pile on.

There's never been a post-Ebola clinic, because historically, the Ebola Survivors Clubs have usually been able to meet in a phone booth.

But with a few thousand survivors this time out of at least 20,000 victims, medical science is getting a new chapter in Ebola treatment: follow-up prognosis for survivors. And it isn't pretty.

Not least of which because what little assistance is going there is aimed at trying to curb the actual outbreak, not deal with the aftermath.

We never had to do much of that before...

Some People Don't Know When The Music Is Over

"Can I just get five more seconds in the spotlight? How about four? Okay then...three...?

Speaking of Slow Learners, today's NPR blast of woulda-coulda-shoulda:

Speed. That's key to ending the Ebola epidemic, says the director of the U.S. Centers for Disease Control and Prevention.
Dr. Thomas Frieden is visiting West Africa this week to figure out how to reduce the time it takes to find new Ebola cases and isolate them.
Otherwise, Ebola could become a permanent disease in West Africa.
               "That's exactly the risk we face now. That Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come," Frieden tells NPR. "That is what I fear most."
Frieden plans to spend several days in each country where the virus is still out of control — Guinea, Liberia and Sierra Leone.
The biggest challenge right now is in Sierra Leone, he says, where the epidemic shows no signs of slowing down. New cases continue to rise exponentially. Last week, the country reported nearly 400 cases, or more than three times the number of cases reported by Guinea and Liberia combined.
Since February, there have been nearly 18,000 reported Ebola cases globally, the World Health Organization says, with more than 6,000 deaths.
               But Frieden is still confident that the three countries can eventually reach zero new cases and end the epidemic.
Why?
Because the world has stopped every Ebola outbreak before, Frieden says. "Even in this epidemic, we are stopping individual outbreaks. The challenge is doing it at a scale and with a speed that we've never done before."
When Frieden visited West Africa last time, in August and September, the disease was "raging out of control in Monrovia," he says.
Since then, the epidemic has slowed down in Liberia. "But we haven't been able to get it under control," he says.
               "As the weeks have gone by, we have been able to intervene faster [in Liberia]," Frieden says. "We've found that we can stop outbreaks in weeks instead of months."
So a hot spot in one town or county ends up having only a handful of cases instead of hundreds, he says.
Now the CDC and international aid groups need to figure out how to do that in Sierra Leone.
But even then, the response may not be fast enough. All it takes is one sick person to travel to a vulnerable town and ignite a new hot spot. That's been happening in Guinea for months.
"It's not like a forest fire, so much," Frieden says, "as a country full of bush fires in different places."

Tom, check your spam filter: President Obola sh*t-canned you back in October, when he appointed Flounder to be the new Invisible Disinformation On Ebola Czar. The memo you missed is probably in there.
So, a few pointers:

* If you've noticed a lot of space on your Day Planner lately, it's because you're officially dead in D.C.
* The first hurdle to tracking Ebola contacts in West Africa, is getting the countries involved to admit that they have them. When everybody admits that there's a "fudge factor" of between 2 and 200 to multiply official reports by, going back to, oh...forever in this outbreak, that's how many cases you'll never track, times the 10-100 contacts they create.
* The second hurdle would be teaching 20,000,000 people there how to count. If the illiteracy rate there was the growth rate of GDP, they'd all be driving Beemers and flying in Gulfstreams. As it is, they wear sandals in case they have to make change for a quarter.
* Ain't nothing happening there on a Western "right now" time frame. They make "island time" look like a FedEx Distribution Hub. "Just in time" in West Africa means "order three years in advance, double the needed amount, and keep a slush fund handy for last minute bribes, and there's a 60% chance we'll have this no later than a month after you need it."
Seriously, dude, try talking to any of your own people there about this.
* Once you tackle those paltry problems, you only have to get past two or three other minor details:
The cultural hurdles of a grabby/touchy/feely society
The religious hurdles of inshallah and the associated local burial rites and customs
The scientific hurdles of taking a country to accepting scientific germ theory accepted here since Pasteur, in one where this month 50-75% of the peoples there are more likely to believe that what's killing people is curses and witchcraft than "Ebola".

If you look closely Tommy, you might notice how curiously similar all that sounds to the phrase "nation-building". Something Britain and France couldn't do there in centuries. Maybe there's no TV in your lab or office, or you're more of a theatres-and-symphony kind of guy, but that phrase doesn't have quite the cachet now that it might have had in, say, 2003.

So why don't you respond to one of the 47 e-mails that career recruiter has been sending you for the last 8-10 weeks, and see about updating your resume.

You've "solved" quite enough geo-political epidemics for one lifetime, I think, and maybe you should get a new hobby to fill your golden years.

Oh, and nota bene, careful readers, that NPR and Frieden himself are still describing this outbreak as "out-of-control" in no uncertain terms, in all three countries.

Slow Learners Pay The Price

GENEVA (Reuters) - The failure of Sierra Leone's strategy for fighting Ebola may be down to a missing ingredient: a big shock that could change people's behaviour and finally prevent further infection.
Bruce Aylward, the head of Ebola response at the World Health Organisation, said Sierra Leone was well placed to contain the disease -- its worst outbreak on record -- with infrastructure, organisation and aid. The problem is that its people have yet to be shocked out of behaviour that is helping the disease to spread, still keeping infected loved ones close and touching the bodies of the dead. "Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die ... before those behaviours start to change," Aylward told Reuters.The WHO's death toll from outbreak has climbed to 6,583 but the actual figure is likely to be far higher due to under-reporting of cases. The flare-up in Sierra Leone's capital Freetown and the country's more heavily populated western areas resemble the massive infections suffered in August by Liberia's capital Monrovia. "In Monrovia you had bodies on the streets, you had a riot, you had someone shot - awareness went through the roof in a very, very short time as a result," said Aylward.             "You don’t want to see that kind of thing drive public awareness but it has an impact very, very fast. People changed behaviours in Monrovia - bang! Like that." Mali also learned through a shock. Just as it seemed nobody had been infected by its first Ebola patient in October, another cluster of deaths sprang up the following month. Aylward said he told Malian officials that the only way to stop the outbreak was to trace anyone who may be at risk. "That’s when the contact tracing... took a jump from around 60-70 percent completion to 98 percent," he said.Denial and ignorance are part of the problem but a weak healthcare system and logistics also play a part. Officials in Kono - where an explosion of infections was discovered this week - said the eastern district of 350,000 inhabitants had only one ambulance and no Ebola treatment centre."The forest area of these three countries has got some really special and concerning practices, where they share meals with the corpse, where they sleep with the corpse," he said.Some areas of eastern Sierra Leone that were hit hardest early in the epidemic -- around the towns of Kenema and Kailahun -- have seen a massive reduction in case numbers as people change behaviour. "The areas that are now doing badly are the areas that were affected last. They are still on the learning curve."

Amazing to hear the UN official in charge of the entire WHO response wistfully longing for the more resposible parties to shoot few stupid people to get their attention, but there it is, and in print.

And short of that or massive die-offs, currently in progress, about the only thing likely to wake them up.

And as noted by commentor geoffb, the lesson fades from view overnight:

ABUJA Nigeria (Leadership) -The declaration of Nigeria as an Ebola-free country by the World Health Organisation (WHO) in October has prompted many Nigerians to discontinue the practice of maintaining a good level of hygiene as a measure of containing the Ebola Virus Disease.
From schools to banks and other public places, the strict measures of screening for signs of the disease put in place while the outbreak lasted between July and October, have fizzled out in most places. Most Nigerians are now living a care-free life because, according to them, Nigeria has been certified Ebola-free by the WHO, which means there is no cause for alarm.

Hopefully Ebola got the same memo, or the remedial course is going to be a bitch there.