Department of Defense Press Briefing via Teleconference on Operation United Assistance

STAFF: Good afternoon, and welcome. One admin announcement before we get started. This is an on-the-record briefing. Because it's by phone only, we need to speak up. Say your name and who you're with before asking your question. None of our participants, it turns out, have any opening remarks. So I'll introduce our speakers and then we'll go right to questions.

With us today by telephone the ambassador to Liberia, Ambassador Deborah Malac, the USAID DART team leader, Mr. Bill Berger, and the Operation United Assistance Joint Force Commander, Major General Gary Volesky. Again, none have opening comments, so with that, let's just do a sound check. General Volesky, Ms. Ambassador, and Mr. Berger, can you hear us?

AMBASSADOR DEBORAH MALAC: Yes, we can.

MAJOR GENERAL GARY VOLESKY: I can hear you just fine.

STAFF: Okay, so we'll start, Bob, with you.

Q: Okay, this is Bob Burns with Associated Press. And I believe my question will be for General Volesky. In light of reports that, you know, Ebola appears to be declining in parts of Liberia, including in Monrovia, wondering whether this in some way changes your approach to your mission? Does it necessitate a smaller U.S. military presence in Liberia, that sort of thing?

MAJ. GEN. VOLESKY: Thanks for the question, Bob. It's good hearing you again. What I would tell you is, while there are some positive indications, there's new cases of Ebola every single day here in Liberia. And so we are supporting the lead federal agencies -- you know, that's USAID -- on building Ebola treatment units, training health care workers, and then sustaining these Ebola treatment units. And we see that, based on what is currently going on, that is something we will continue to do.

As far as the future of that, I'll turn that over to either the ambassador or Mr. Berger.

AMB. MALAC: Yeah, to -- just to follow on General Volesky's point, the numbers of cases continue to increase. We are not out of the woods by any stretch of the imagination. Clearly, the rate of increase is much lower than it has been over the last couple of months. But we need to continue with the plan -- following the government of Liberia's plan, adapting as necessary to -- as the epidemic itself also adapts and changes, and that's what we are doing.

But for the moment, we need more treatment units. We need more personnel to help treat patients. And so we still have a long way to go in this fight.

Q: Follow-up for General Volesky. How many U.S. troops are there now in Liberia? And is there a specific timetable for increasing it up to 4,000?

MAJ. GEN. VOLESKY: Yeah, Bob, we've got just under 2,200 right now. We will top out in the middle of December just short of 3,000, and that's the most we'll bring in the country.

Q: Is that -- the decision to limit it to -- did you say 3,000?

MAJ. GEN. VOLESKY: That's what -- that's what we've got. Now, when the original request for forces was created, it was larger than that. But what we found working with USAID and the government of Liberia was there's a lot of capacity here that we didn't know about before. And so that enabled us to reduce the forces that we thought we originally had to bring. And so right around 3,000 is what we're looking at, and that's really -- unlike what we normally deploy with the 101st, you know, it is heavy on engineers, it's heavy on medical providers and trainers, and then our sustainers to help sustain those Ebola treatment units.

Q: Thank you.

STAFF: Phil Stewart, next?

Q: Hi, Phil Stewart from Reuters. So just to confirm that your new target number is 3,000 as opposed to nearly 4,000, and could you answer whether there have been any members of the military or personnel, civilian personnel who have shown any symptoms that have warranted further examination so far? Thank you.

MAJ. GEN. VOLESKY: Yeah, no, we have had no military personnel showed symptoms. And I think that's a result of the pre-deployment training that we did before we got here. You know, we did a very deliberate training cycle, and no one was allowed to deploy to Liberia until they had completed that medical training.

We continue to sustain that training and talk about, you know, how to make sure you don't put yourself at risk. And our chain of command and our leadership is very, very involved making sure our soldiers, sailors, airmen and Marines are adhering to those standards.

And so you won't see soldiers roaming all over Liberia. We've got it very controlled. They go places where there's a mission, and we just make sure that we're following all those protocols.

Q: And so -- and 3,000 is the new target number, not 4,000? That's how I understood your comments before.

MAJ. GEN. VOLESKY: That's our target number, yes, sir.

Q: Excuse me, Chris Carroll from Stars and Stripes. For General Volesky, could you give me an update on the progress on the construction of Ebola treatment units and a timeline? And for I suppose all three participants, talk a little bit, please, about this unexpected capacity in the country that you found.

MAJ. GEN. VOLESKY: Yeah, I'll talk to the second question first. What we found when we got here -- and, again, we followed USARAF with, you know, Major General Williams. They were on the ground for, you know, a number of weeks before we got here. And what they found was a good contracting capability here, working with USAID -- I mean, USAID had been here months before. So it wasn't the first Americans that found themselves in Liberia was military. USAID -- the lead federal agency -- had been here.

And so they developed a good kind of a common operating picture that enabled us to get, you know, contracted construction things going. So that, again, enabled us to reduce our forces that needed to flow here.

Could you repeat your first question again?

Q: There was a, I guess, timeline on the construction of the 17 Ebola treatment units?

MAJ. GEN. VOLESKY: Yeah, well, what we have gotten so far is the Monrovia medical unit opened just about a week ago. And as you know, that is the treatment center where we're going to -- any infected health care worker is with patients goes to, and that was, in my mind, a strategic treatment unit, because it -- it is hopefully getting the international community confidence that if they have people come to Liberia and if they get infected, there's a place for them.

We opened the Tubmanburg ETU a few days ago. And that was a joint venture with both the armed forces of Liberia, who really did the majority of the work, and we provided some oversight and electrical and plumbing for them. And so those were the first two.

We got some mobile labs. I mean, you talk ETUs, but the mobile labs have really been the thing that is -- what we'd call a game-changer. So when you take a blood sample, it used to take days to determine whether that individual had Ebola or not. Now that's determined in a few hours. And so that's good.

So we're looking at up to 17. They're all on a glide path, so we would expect to see three or four more done before the end of the month, and then I expect all of the treatment units -- again, weather-dependent and others -- to be done before December's over.

BILL BERGER: Could I also just say something? This is Bill Berger, the DART team leader, back to the question about the capacity on the ground. We also have NGO partners. More have been coming in. They're quite capable, and they're working with local NGOs, and that gives us great capacity. We have NGOs that are also willing to build ETUs and the community care centers, so we've been able to ramp up that capacity through grants from USAID to support the other efforts that are taking place that our DOD colleagues are working on.

AMB. MALAC: And if I may just jump in here and say that all of this is a result, of course, because of the announcement by President Obama back in September that the U.S. military was coming to help provide some additional heft to this logistics effort, because the presence of the U.S. military and the capacity that they bring to the table has been a real confidence-builder for all of these NGO partners who are now stepping forward in response to help us with this effort.

So we could not have done one without the other, so they very much are pieces of a whole picture, so we -- you know, we're much -- whatever the U.S. military brings to the table, we've been able to magnify and amplify with the -- by attracting these additional partners and to the picture, as well.

Q: This is Nancy Youssef from McClatchy Newspapers. And I had a couple questions about some of the things you've said earlier. You've talked about that there are new cases every day. Can you give us specifics on where those cases are popping up? Are they in urban areas? Are they in rural areas? And also, one of the things that we hear frequently is that people are hesitant to go and get treatment because they don't want to be stigmatized as having Ebola, that people are burying their dead very quickly and trying to deal with these cases privately. And so, to that end, can you give us a sense in terms of how much that's happening and how much traffic you're seeing come through the Monrovia treatment center?

AMB. MALAC: Well, the rate of infection obviously is down. I mean, back in September, we were getting -- you know, it was not unusual to have 100 or more new cases a day in Monrovia itself. Forget about elsewhere in the country. That number has significantly decreased in Monrovia itself, but we still have, for example, yesterday 45 new cases in the country. Some of those in Monrovia. Some of those now we're starting to see in greater numbers, small -- you know, hotspots popping up in other counties outside of Monrovia.

So the -- it's shifting, because people are moving or people go to a funeral, they get infected, and they're still moving, they're going back to their home villages. So we continue to have to -- to adapt ourselves and how we are going to address and fight this disease. So we need to continue to keep a focus on Montserrado County, which is where Monrovia is. We do have excess bed capacity at the moment, and we hope we don't get to -- we hope we don't get those large numbers of beds filled up, but we are prepared if that number -- if those numbers begin to rise in Monrovia. But we continue to have new cases every single day even in Monrovia.

The rapid response to some of these outlying areas is a mechanism that is being developed in coordination with the government of Liberia, as well as with WHO and the other partners, particularly CDC is at the forefront of this effort, to be able to go in and respond very quickly in these outlying rural areas to ensure that we can get those little outbreaks under control before they become a broader problem.

We've done some surveys to determine whether or not some of the continuing transmission is because of secret burials. The evidence doesn't really bear that out, although it's possible that it's happening in small numbers in some places within Monrovia. That's not really an issue out in the outside counties, because there they've been burying -- there's been safe burial for all of those Ebola victims since the outset.

The only issue had been here in Monrovia, because they've been using cremation rather than burial, because of the numbers. But, again, the information at the moment doesn't bear out lots of secret burials going on.

As far as seeking treatment, I think the message is getting out. People understand now that they need to go, and the sooner they go, the better their chances are that they will survive this disease. So now that we have the beds available and we're starting to have more capacity available outside of Monrovia, as well, that should, we hope, encourage more people to seek treatment, and we would like -- we hope it will mean also that we'll see a larger number of survivors going forward. Thank you.

MR. BERGER: And I'd just like to add that, as the ambassador said, there's more awareness going on. That's part of the public outreach campaign and the public awareness campaign that was launched early on in this -- I think what the kinds of things you're citing were stories that we heard early on.

But as the -- we've been able to get the messages out to people, behaviors are changing. People are becoming aware as they see deaths happening in their communities that this is a very serious and deadly disease. So that's been a very effective part, I think, in why we're beginning -- we saw the number of cases reducing for a while. But as the ambassador said, we're not out of the woods yet. We continue to have new cases every day, and we have to stay vigilant.

Q: Can I follow up? A couple things. You mentioned that you had excess bed capacity. Is that in Monrovia only? And from what it sounds like, it seems that these mobile labs have become as important, if not more important than the ETUs themselves, because it seems that the focus is now shifting towards early detection. Is that a fair assessment of what you're seeing?

AMB. MALAC: I would say, on the labs issue, I don't think it's that they're more important than the ETUs. They're a critical piece of the treatment picture and case management picture, because the sooner you can -- you can screen someone out as not having Ebola who may otherwise be ill with some other febrile illness, can be sent off to a regular health care system, can receive treatment for whatever that is in a different environment, and you don't run the risk of somehow then transmitting Ebola to them because they have to sit around in an ETU and wait for days until those test results come back, which is what was happening, you know, several months ago.

The arrival of the lab reduces -- gives us greater capacity. We can test more quickly. We can get results in a few hours, and we can send people back home or we can send them to a regular health care facility to seek treatment. So you need the treatment options, so it's not more important, but they're of a piece. They have to be linked together, because otherwise you're going to treat everyone as if they're an Ebola patient and they're going to -- you know, potentially people who weren't sick when they arrived could become sick while they're there.

As far as excess bed capacity, it is true that at the moment we have empty beds in Monrovia, but it wasn't that long ago that we had not nearly enough beds and people were being turned away and only the very sickest were being taken into receive treatment, at a point whereby -- where at their -- their chances of survival are much less.

So the idea now is we have more than enough beds. We've been getting the word out that those beds are available and people should start seeking treatment. And we're starting to see that happen. But, again, we were building -- we built a large number of beds, looking at the numbers, you know, from several weeks ago, not knowing whether the disease was going to continue to escalate or whether it was going to flatten out or whether it was going to fall.

So, again, we need to have the treatment facility available, should it be necessary. We hope we don't get to the point where we have to fill every single bed.

The other piece is that these are scalable, so they can start out with a small number of beds for treatments and they could be added as needed if the patients present themselves.

Q: And I'm sorry. Could you tell me how many mobile labs there are in country?

MAJ. GEN. VOLESKY: We have three, but there are four more that just -- that will arrive and be set by the end of November.

MR. BERGER: There will be a total of nine in the country.

AMB. MALAC: But we should just clarify that one of those is a CDC-NIH mobile lab and one of them is an E.U.-donated (inaudible) mobile labs are all U.S. military provided, and then there's a national reference laboratory here in Liberia, which is a permanent facility, which DOD through various entities has been supporting, along with the NIH, to help build their testing capacity, as well.

Q: (off mic) DOD provided nine total? Is that right?

AMB. MALAC: Yes.

Q: Thank you.

Q: Hi, I'm Carl Osgood. I write for Executive Intelligence Review. Could you talk a little bit about your engagement with the Liberian medical system? I know you're talking about training health care workers, but I'm wondering also, in terms of capacity and capability, of what the Liberians are able to do and the ways that you're able to help them increase those capacity -- capacity and capability?

MAJ. GEN. VOLESKY: Well, I can tell you from our perspective, what we're doing -- and then I'll pass it over to either the ambassador or Mr. Berger -- what we are doing is we've got members of the 86th CSH out of Fort Campbell that have come, and they've developed a cadre that train through the WHO criteria -- their curriculum on, you know, training these health care workers to work inside the ETUs. So that's our piece.

So out of the national police training center, we can train up to 200 a week of those students to go out into the ETUs. Next week, we start our mobile training teams that will actually go out into the counties and train health care workers in their own locales, so that we can expand that reach. But I'll turn it over to the ambassador to talk about the others.

AMB. MALAC: As far as the broader health care system is concerned, obviously what you have -- we have sort of a two-tiered process at the moment, because you have these Ebola treatment units which have in some cases foreign medical workers who are providing some of the clinical care.

But the vast majority of the staffing at all of those are local -- are Libyan health care workers, many of whom come from the regular health care system, others who are people who have -- who stepped forward to take on these jobs and have been trained to perform specific tasks in the treatment units.

Separately from that, we have obviously what we need to help the government start to do is restore confidence and capacity of that regular health care system. And they need to happen together, because we can't just address -- we will never get to zero on Ebola if the chance -- the risk of transmission in the regular health care system still exists.

So one of the lines of effort that we are doing through the DART with some of their funding is to help -- and working very closely with the Centers for Disease Control, who have helped develop a curriculum. They are going around -- we are training regular health care facility staff in infection prevention and control, how you triage patients appropriately, how you identify who needs to go into the regular health care system or who needs to go to an ETU, because they potentially are an Ebola case.

So it's -- these things are happening hand in hand, and it's an ongoing effort. The U.S. government through USAID more regularly has been a large partner to the government of Liberia over the last -- since the end of the civil war to help rebuild the health care system here. So we remain invested in that process and we'll continue to work with the government on developing the capacity of the system.

Q: Yeah, do you find that the Ebola -- the Ebola epidemic is having an impact on the Liberians' ability to treat people, patients with other kinds of illnesses?

AMB. MALAC: Definitely. The system collapsed under the weight of this epidemic, which was much broader and faster than anybody could have anticipated, partly out of fear. People were afraid -- people went to hospitals, health care workers got infected. As a result, a number of health care facilities around the country, you know, shut their doors in order to -- and sent people away.

So we are seeing, you know, increases in death and -- from treatable conditions. We're also seeing an increase in maternal mortality, child mortality, for babies, because it's -- in some parts of the country, it's difficult to even -- you know, hospitals and clinics won't even take pregnant women who are in labor.

So it's definitely having an impact. You know, immunizations are down. Again, people -- a lot of this is, you know, taking grassroots education, working door to door, street to street, village to village to help people understand what and how you protect yourself from Ebola and what you need to do to keep that from -- you know, from transmitting it to other people.

We have to do the same kind of education with the health care system to ensure that we can restore basic services, so that we can vaccinate children against measles, we can treat people who have just malaria and not -- and not Ebola, and we can, you know, safely deliver mothers deliver babies when women go into labor.

So it's having a very detrimental impact on ability to treat to these things, both -- you know, both the health care workers are afraid, because they have patients who may come in who won't be honest about their symptoms, and vice versa, patients are afraid to go in because they're afraid that they will have been in some place where the health care workers haven't taken proper precaution.

So it's -- we have -- you know, so as we address the epidemic itself, in terms of getting case numbers down, we have to do this kind of an education process to help rebuild the capacity of the regular system.

STAFF: Final question, ma'am?

Q: Hi, Cheryl Pellerin from DOD News. I wanted to ask Mr. Berger if the composition -- the number and composition of the DART team and how your mission has changed since you first got there to today?

MR. BERGER: Thank you for that question. The size of our team varies by a couple -- numbers of a couple of people, depending on which technical specialists we need, but we're at a round of 30 people directly on the team. We have two CDC folks that are on the team, but CDC itself has over 60 people in country working out in all of the communities.

So I guess that I would say, when I arrived here a while back, we were pushing everything we could to move everything -- every effort that was happening on the ground and initiating new efforts to move the process forward. At that time, the curve was going up and nobody was sure if we were going to be able to break that.

So we did everything we could. We hit the ground running when we got here, started finding out where there were bottlenecks in the response process, got those taken care of. We helped set up an EOC so the government could do the kind of coordination that it needed to do within itself and with the international community. We helped get safe burial teams out on the ground. We've started working on supporting the LIBR Lab and getting that back into shape. And when ETUs were coming online, if they needed anything, a generator, we went to Power Africa and got that. If they needed gravel, we got those kinds of things.

So we were just working flat out. Now we're working more with our partners, working on the community care strategy, working with partners that are building ETUs, getting the public messaging out there to change behaviors, and finding more NGOs and international partners to help do the clinical and management care of the ETUs.

Q: (off mic) so you have DOD, CDC, USAID people in your team?

MR. BERGER: Public Health Service, U.S. Forest Service, we can draw on almost any agency within the U.S. government as needed to augment the capacity of the USAID mission and the embassy here to fight this battle with Ebola. That's what we do. We're here to augment that capacity.

Q: Thank you.

STAFF: Well, Ambassador Malac or Mr. Berger or General Volesky, do you have any closing comments?

AMB. MALAC: If I may, I would just like to say, we appreciate the continuing interest in what's going on out here on the ground. We know that there's been promising news from Liberia (inaudible) promising news from our neighbors in Guinea and Sierra Leone. They still have -- they still have some work to do, as well. But I think I need to stress -- I would like to stress that we have a lot more work to do here.

We really are still very much at the beginning of this effort, although we've been all working very, very hard for many weeks, some of us for many months, on this issue. But we are -- it's nice to know that we have -- we have been able to make -- have some impact on the curve, but until we have everything down to zero and we haven't had a case for a couple of months, none of us will be able to rest easily at night.

So we know it's some -- it will be easy to forget about what's going on here in the wake of what seems to be positive news. But we are all not letting up and continuing our work. But thank you for having us today.

MR. BERGER: And I would just say that this response is -- is what it was meant to be, truly a whole-of-government response. And we've brought every asset to bear of the U.S. government to fight this disease, and there's been tremendous cooperation among all of the agencies and the coordination has been outstanding.

And our -- that support we've received from the embassy and the USAID mission has been extraordinary. They're running with their same staff that they had when this thing started, and yet they're helping to support all of us, so their people are working in the embassy just as hard as everybody else on the DART team or in DOD and working out in the field. Over.

MAJ. GEN. VOLESKY: And what I'd like to say is, there was a lot of discussion when we came with our force. And, you know, it consists of all of the services who are here. In fact, I saw our coast guardsmen a week ago. They're all representative. I can tell you without a doubt, they are all very proud to be here. They feel like they're making a difference. Everywhere I go, soldiers, sailors, airmen and Marines are telling me they're happy to be here. They can see it in the people's eyes here the confidence-building. And so this is great mission for all of our servicemen and women.

STAFF: Okay, thank you very much, sir. And we look forward to the next opportunity.