利比里亞內部管理混亂阻礙埃博拉應對

The global response to the Ebola virus in Liberia is being hampered by poor coordination and serious disagreements between Liberian officials and the donors and health agencies fighting the epidemic, according to minutes of top-level meetings and interviews with participants.

高層會議的會議記錄以及對參與者的採訪顯示，由於利比里亞官員、捐助國和抗擊疫情的衛生機構之間協調欠佳，且存在嚴重分歧，國際社會應對利比里亞埃博拉病毒的行動受到了阻礙。

Even now, three months after donors began pouring resources into Liberia, many confirmed cases still go unreported, countries refuse to change plans to erect field hospitals in the wrong places, families cannot find out whether their relatives in treatment are alive or dead, health workers sent to take temperatures sometimes lack thermometers, and bodies have been cremated because a larger cemetery was not yet open.

即便現在，在捐助國開始向利比里亞輸送大量資源三個月後，仍有許多確診病例沒有上報；各國也拒絕改變計劃，仍然在錯誤的地點設立現場醫院；家屬無法查明自己正在接受治療的親屬是生是死；被派去查體溫的醫務人員有時缺少體溫計；因爲一個規模更大的墓地尚未開放，遺體都被火化了。

The detailed accounts of high-level meetings obtained by The New York Times, the most recent from Monday, lift the veil on the messy and contentious process of running the sprawling response to Liberia’s epidemic, one that now involves more than a hundred government agencies, charities and donors from around the world.

《紐約時報》取得的對高層會議的詳細敘述（最新的是週一的信息）揭示出，利比里亞疫情的大規模應對行動管理混亂，過程中充滿分歧。目前有來自世界各地的100多個政府機構、慈善組織和捐助國參與其中。

Despite these problems, with help from donors, Liberia, one of the three most afflicted West African countries, and the one with the highest death toll, has seen new cases drop to about 20 a day from about 100 a day two months ago. Experts attribute that to fearful Liberians touching one another less, more safe burials of bodies and distribution of protective gear to health care workers. But they also warn that cases are now holding steady and could explode again.

雖然存在種種問題，但是在捐助國的幫助下，利比里亞的新增病例從兩個月前的每天約100例，下降到了約20例。利比里亞是疫情最嚴重的三個西非國家之一，也是死亡人數最高的國家。專家認爲，這是因爲感到害怕的利比里亞人減少了與他人的接觸，遺體的掩埋也更安全，醫護人員也得到了防護裝備。然而，他們還是警告，儘管目前病例數量保持穩定，但仍有可能出現激增。

Participants in the meetings of the Incident Management System — which replaced the National Ebola Task Force — said the atmosphere in the meetings in the Liberian capital, Monrovia, should not be characterized as chaotic or bogged down in bickering, instead calling them “collegial” and “effective,” although one who spoke on condition of anonymity described “showmanship and political posturing.” Senior officials of the Centers for Disease Control and Prevention who attended — Dr. Frank J. Mahoney and Dr. Kevin M. De Cock — said in an email that there were “differences of opinion — accompanied by passionate discussions.”

突發事件管理系統(Incident Management System)取代了過去的國家埃博拉應變小組(National Ebola Task Force)。突發事件管理系統會議的參與者表示，不應該形容這個機構在利比里亞首都蒙羅維亞舉行的會議混亂無序、因爲爭吵而陷入僵局，應該說會議是“合作”且“成功”的。儘管一人匿名錶示，此次會議“充滿了表演和政治作秀”。參與此次會議的美國疾病控制與預防中心(Centers for Disease Control and Prevention，簡稱CDC)高級官員弗蘭克·J·馬奧尼博士(Dr. Frank J. Mahoney)和凱文·M·德科克(Dr. Kevin M. De Cock)在一封電子郵件中稱，會上存在“不同意見——同時，與會者也對相關問題進行了激烈討論”。

At the meeting on Monday, Dr. De Cock cited serious logistics problems, including regular hospitals that cannot separate out Ebola patients, counties with no ambulances and temperature takers with no thermometers.

德科克在週一的會議上指出，這裏後勤問題嚴重，比如常規醫院無法分隔埃博拉患者，有些縣沒有救護車，還有些測體溫的人沒有體溫計。

On Nov. 12, the representative of the United Nations secretary general complained that “hundreds” of vehicles had been made available but there was always a shortage. Asking where they are, he added: “The recipient also has to be accountable, just as the donor.”

11月12號，聯合國(United Nations)祕書長的代表抱怨道，已經提供了“數以百計”的車輛，但還是時常出現短缺。他在詢問這些車輛在哪裏時還說：“接收人也必須負起責任，就像捐助國一樣。”

Also, the support documents with the minutes indicate that there is no national plan for Ebola survivors — either for reuniting them with their families or for using them to do nursing tasks because they are thought to be immune.

同時，這份會議記錄的附屬文件還表明，他們並沒有針對埃博拉倖存者的全國性計劃——不論是讓他們與家人團聚，還是讓他們去從事護理工作，因爲據信這些人已經對埃博拉病毒有了免疫力。

A report on the issue reads: “The current and planned work presented by the partners and government for survivors can be characterized as fragmented and lacking in scope, scale, comprehensiveness, evidence base and survivor-driven programming.”

關於此事的一篇報告稱：“合作伙伴和政府針對倖存者當前開展和計劃開展的工作，可謂零碎、缺乏遠見、規模不足，不夠全面、缺少證據支撐，也缺乏由倖存者主導的計劃。”

American military helicopters ferrying doctors to remote areas were forbidden to fly back not only patients but even blood samples; recently samples from a village had to be walked to a road four hours away. At Monday’s meeting, according to the minutes, Dr. De Cock called this “unacceptable,” adding, “This has to change this week.”

把醫生運送到邊遠地區的美國軍用飛機不僅被禁止運回患者，而且連血樣也不能運回；人們不得不走路花四個小時，把最近從一個村莊採集的樣本送到路上。前述會議記錄顯示，德科克在週一的會議上稱這種情況“令人無法接受”，並表示，“本週必須做出改變。”

Dr. Hans Rosling, a Swedish epidemiologist and consultant to Liberia’s Health Ministry, said that the helicopter order came “from somewhere in America.” In an interview, he cited problems not listed in the minutes: one Asian and two European donor countries are insisting on building new Ebola field hospitals in Monrovia, where hospitals have empty beds, rather than in remote counties where beds are desperately needed; they insisted because they announced those plans two months ago, he said. The national case count was not reported for two days recently because the government employee compiling it went unpaid and stopped working. The minutes of the Incident Management System were made available along with PowerPoint files and other documents by an expert who said the disorganization of the Ebola effort should be made public.

瑞典流行病學家、利比里亞衛生部(Health Ministry)顧問漢斯·羅斯林(Hans Rosling)表示，有關直升飛機的命令是從“美國的某個地方”發出的。他在接受採訪時提到了會議記錄中沒有列出的問題：一個亞洲捐助國和兩個歐洲捐助國，堅持要求在蒙羅維亞而不是在那些醫院牀位緊缺的偏遠縣城，建造新的埃博拉現場醫院，蒙羅維亞的醫院還有空牀位。他表示，他們之所以如此堅持，是因爲他們在兩個月前就宣佈了這些計劃。最近兩天沒有全國病例的統計報告，因爲負責彙編數據的政府工作人員沒有拿到工資，於是停止了工作。一名專家提供了突發事件管理系統的會議記錄、演示文稿，以及其他文件，這名專家表示，應該讓公衆知道埃博拉應對工作的混亂狀態。

The meetings are usually led by Tolbert Nyenswah, the deputy health minister, and include representatives from the Centers for Disease Control, the World Health Organization, the World Bank, the United Nations Mission for Ebola Emergency Response, numerous United Nations agencies, the United States Agency for International Development, the United States Army, Doctors Without Borders and medical, aid or military representatives from many other countries. Dr. Nyenswah and other ministry officials could not be reached for comment; Dr. Rosling has worked with the ministry since October.

會議通常由衛生部副部長托爾伯特·尼耶斯瓦(Tolbert Nyenswah)主持召開，與會人員包括來自CDC、世界衛生組織(World Health Organization)、世界銀行(World Bank)、聯合國埃博拉應急特派團(United Nations Mission for Ebola Emergency Response)，各聯合國機構及美國國際開發署(United States Agency for International Development)、無國界醫生(Doctors Without Borders)的代表，以及來自很多其他國家的醫療、援助和軍方代表。記者無法聯繫到尼耶斯瓦和其他衛生部官員置評；羅斯林從10月開始在利比里亞衛生部供職。

The minutes make it clear that accuracy of the national case count is shaky.

會議記錄明確提出，全國病例統計數據的準確度不可靠。

On Nov. 5, Dr. Rosling said, “We are absolutely sure that we cannot be sure about the data.”

11月5日，羅斯林表示，“我們非常肯定，我們無法確信這些數據。”

In the minutes, Liberian officials regularly complain about the donors, and the donors argue back. On Nov. 12, James Dorbor Jallah, the task force’s deputy manager, said: “People will sit in D.C. or Geneva and want to direct what is happening here.”

會議記錄顯示，利比里亞官員頻頻對捐助國提出抱怨，而捐助國則進行反駁。11月12日，工作組副主任詹姆斯·多爾博·賈拉(James Dorbor Jallah)說，“那些人在華盛頓或日內瓦坐着，還想要指揮這裏的事情。”

The health minister, Dr. Walter T. Gwenigale, backed him up, complaining that “the U.N. and other agencies got their money before the ink was even dry,” while, he said, a group run by a Liberian pastor to teach rural people about Ebola “has not gotten one cent.”

衛生部長沃爾特·T·戈維尼蓋爾(Walter T. Gwenigale)同意他的說法。戈維尼蓋爾抱怨稱，“聯合國和其他機構拿到的錢，都是剛印出來的，墨水都還沒幹”，但由一名利比里亞牧師牽頭，向農村居民普及埃博拉知識的組織卻“沒有拿到一分錢”。

On Sunday, President Ellen Johnson Sirleaf replaced Dr. Gwenigale without explaining why, but said he would remain an adviser. Dr. Emmanuel T. Dolo, Ms. Johnson Sirleaf’s youth adviser, complained that the donors were “showing a level of disrespect” by judging Liberian community groups by “harsh standards” and “Western standards.”

週日，利比里亞總統埃倫·約翰遜·瑟利夫(Ellen Johnson Sirleaf)撤換了戈維尼蓋爾，但沒有給出原因，只是說他仍然擔任顧問。約翰遜·瑟利夫的年輕顧問伊曼紐爾·T·多洛(Emmanuel T. Dolo)抱怨稱，捐助國以“苛刻標準”和“西方標準”評判利比里亞的社區團體，這麼做“有些不尊重”。

At the same meeting, Mr. Nyenswah, the deputy health minister, pointed to his government’s “team leaders” and warned, “Partners in the room have not been engaging them and involving them in strategy — but you have to.”

在同一場會議上，衛生部副部長尼耶斯瓦指着本國政府的“小組領導”，向與會者警告，“這個房間裏的合作伙伴們，沒有與他們溝通，也沒有讓他們參與制定的策略——但你們必須要這麼做。”

A representative of the United Nations Children’s Fund replied that the local pastor needed to prove he could do the work.

聯合國兒童基金會(United Nations Children’s Fund)的一名代表迴應稱，當地的那名牧師需要證明他有能力做這份工作。

Two days later, Shiyong Wang, the World Bank representative, confirmed that United Nations agencies had received nearly all their money and that the Liberian government had received only 7 percent of the $23 million allotted to it. But, he said, the government had not produced required documentation — not even, for example, names of dead health workers whose families awaited compensation. He criticized the government’s “overly complex and bureaucratic approval process,” including three signatures on each document.

兩天後，世界銀行的代表王世勇證實，聯合國機構接收了幾乎所有資金，利比里亞政府只收到了劃撥給該國的2300萬美元（約合1.4億元人民幣）撥款中的7%。但他表示，該國政府沒有出具必要的文件，例如病逝的衛生工作者的名字，他們的家人正在等待補償。他批評道，該國政府的“審批過程過於複雜、官僚化”，比如，一份文件需要三個簽名。