利比里亚内部管理混乱阻碍埃博拉应对
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.
高层会议的会议记录以及对参与者的采访显示，由于利比里亚官员、捐助国和抗击疫情的卫生机构之间协调欠佳，且存在严重分歧，国际社会应对利比里亚埃博拉病毒的行动受到了阻碍。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.
即便现在，在捐助国开始向利比里亚输送大量资源三个月后，仍有许多确诊病例没有上报；各国也拒绝改变计划，仍然在错误的地点设立现场医院；家属无法查明自己正在接受治疗的亲属是生是死；被派去查体温的医务人员有时缺少体温计；因为一个规模更大的墓地尚未开放，遗体都被火化了。
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.
《纽约时报》取得的对高层会议的详细叙述（最新的是周一的信息）揭示出，利比里亚疫情的大规模应对行动管理混乱，过程中充满分歧。目前有来自世界各地的100多个政府机构、慈善组织和捐助国参与其中。
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.
虽然存在种种问题，但是在捐助国的帮助下，利比里亚的新增病例从两个月前的每天约100例，下降到了约20例。利比里亚是疫情最严重的三个西非国家之一，也是死亡人数最高的国家。专家认为，这是因为感到害怕的利比里亚人减少了与他人的接触，遗体的掩埋也更安全，医护人员也得到了防护装备。然而，他们还是警告，尽管目前病例数量保持稳定，但仍有可能出现激增。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.”
突发事件管理系统(Incident Management System)取代了过去的国家埃博拉应变小组(National Ebola Task Force)。突发事件管理系统会议的参与者表示，不应该形容这个机构在利比里亚首都蒙罗维亚举行的会议混乱无序、因为争吵而陷入僵局，应该说会议是“合作”且“成功”的。尽管一人匿名表示，此次会议“充满了表演和政治作秀”。参与此次会议的美国疾病控制与预防中心(Centers for Disease Control and Prevention，简称CDC)高级官员弗兰克·J·马奥尼博士(Dr. Frank J. Mahoney)和凯文·M·德科克(Dr. Kevin M. De Cock)在一封电子邮件中称，会上存在“不同意见——同时，与会者也对相关问题进行了激烈讨论”。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.
德科克在周一的会议上指出，这里后勤问题严重，比如常规医院无法分隔埃博拉患者，有些县没有救护车，还有些测体温的人没有体温计。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号，联合国(United Nations)秘书长的代表抱怨道，已经提供了“数以百计”的车辆，但还是时常出现短缺。他在询问这些车辆在哪里时还说：“接收人也必须负起责任，就像捐助国一样。”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.
同时，这份会议记录的附属文件还表明，他们并没有针对埃博拉幸存者的全国性计划——不论是让他们与家人团聚，还是让他们去从事护理工作，因为据信这些人已经对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.”
关于此事的一篇报告称：“合作伙伴和政府针对幸存者当前开展和计划开展的工作，可谓零碎、缺乏远见、规模不足，不够全面、缺少证据支撑，也缺乏由幸存者主导的计划。”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.”
把医生运送到边远地区的美国军用飞机不仅被禁止运回患者，而且连血样也不能运回；人们不得不走路花四个小时，把最近从一个村庄采集的样本送到路上。前述会议记录显示，德科克在周一的会议上称这种情况“令人无法接受”，并表示，“本周必须做出改变。”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.
瑞典流行病学家、利比里亚卫生部(Health Ministry)顾问汉斯·罗斯林(Hans Rosling)表示，有关直升飞机的命令是从“美国的某个地方”发出的。他在接受采访时提到了会议记录中没有列出的问题：一个亚洲捐助国和两个欧洲捐助国，坚持要求在蒙罗维亚而不是在那些医院床位紧缺的偏远县城，建造新的埃博拉现场医院，蒙罗维亚的医院还有空床位。他表示，他们之所以如此坚持，是因为他们在两个月前就宣布了这些计划。最近两天没有全国病例的统计报告，因为负责汇编数据的政府工作人员没有拿到工资，于是停止了工作。一名专家提供了突发事件管理系统的会议记录、演示文稿，以及其他文件，这名专家表示，应该让公众知道埃博拉应对工作的混乱状态。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.
会议通常由卫生部副部长托尔伯特·尼耶斯瓦(Tolbert Nyenswah)主持召开，与会人员包括来自CDC、世界卫生组织(World Health Organization)、世界银行(World Bank)、联合国埃博拉应急特派团(United Nations Mission for Ebola Emergency Response)，各联合国机构及美国国际开发署(United States Agency for International Development)、无国界医生(Doctors Without Borders)的代表，以及来自很多其他国家的医疗、援助和军方代表。记者无法联系到尼耶斯瓦和其他卫生部官员置评；罗斯林从10月开始在利比里亚卫生部供职。The minutes make it clear that accuracy of the national case count is shaky.
会议记录明确提出，全国病例统计数据的准确度不可靠。On Nov. 5, Dr. Rosling said, “We are absolutely sure that we cannot be sure about the data.”
11月5日，罗斯林表示，“我们非常肯定，我们无法确信这些数据。”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.”
会议记录显示，利比里亚官员频频对捐助国提出抱怨，而捐助国则进行反驳。11月12日，工作组副主任詹姆斯·多尔博·贾拉(James Dorbor Jallah)说，“那些人在华盛顿或日内瓦坐着，还想要指挥这里的事情。”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.”
卫生部长沃尔特·T·戈维尼盖尔(Walter T. Gwenigale)同意他的说法。戈维尼盖尔抱怨称，“联合国和其他机构拿到的钱，都是刚印出来的，墨水都还没干”，但由一名利比里亚牧师牵头，向农村居民普及埃博拉知识的组织却“没有拿到一分钱”。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.”
周日，利比里亚总统埃伦·约翰逊·瑟利夫(Ellen Johnson Sirleaf)撤换了戈维尼盖尔，但没有给出原因，只是说他仍然担任顾问。约翰逊·瑟利夫的年轻顾问伊曼纽尔·T·多洛(Emmanuel T. Dolo)抱怨称，捐助国以“苛刻标准”和“西方标准”评判利比里亚的社区团体，这么做“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.”
在同一场会议上，卫生部副部长尼耶斯瓦指着本国政府的“小组领导”，向与会者警告，“这个房间里的合作伙伴们，没有与他们沟通，也没有让他们参与制定的策略——但你们必须要这么做。”A representative of the United Nations Children’s Fund replied that the local pastor needed to prove he could do the work.
联合国儿童基金会(United Nations Children’s Fund)的一名代表回应称，当地的那名牧师需要证明他有能力做这份工作。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.
两天后，世界银行的代表王世勇证实，联合国机构接收了几乎所有资金，利比里亚政府只收到了划拨给该国的2300万美元（约合1.4亿元人民币）拨款中的7%。但他表示，该国政府没有出具必要的文件，例如病逝的卫生工作者的名字，他们的家人正在等待补偿。他批评道，该国政府的“审批过程过于复杂、官僚化”，比如，一份文件需要三个签名。
