THE EBOLA FIGHTERS
Excerpt from ‘The Ebola Fighters’ by David von Drehle, with Aryn Baker
On the outskirts of Monrovia, the capital of Liberia, on grassy land among palm trees and tropical hardwoods, stands a cluster of one-story bungalows painted cheerful yellow with blue trim. This is the campus of Eternal Love Winning Africa, a nondenominational Christian mission, comprising a school, a radio station and a hospital. It was here that Dr. Jerry Brown, the hospital’s medical director, first heard in March that the fearsome Ebola virus had gained a toehold in his country. Patients with the rare and deadly disease were turning up at a clinic in Lofa County—part of the West African borderlands where Liberia meets Guinea and Sierra Leone. “It was then that we really started panicking,” says Brown.
Even in ordinary circumstances, the doctor’s workday was a constant buzz of people seeking answers: Can you help with this diagnosis? Would you have a look at this X-ray? What do you make of this rash? Inevitably, Brown would raise his eyebrows and crease his forehead as if surprised that anyone would think he might know the answer. Just as inevitably, he would have one. Ebola was different. On this subject, Brown had more questions than answers. He knew the virus was contagious and highly lethal—fatal in up to 90% of cases. But why was it in Liberia? Previous Ebola outbreaks had been primarily in remote Central Africa. Could the disease be contained in the rural north? The membrane between countryside and city in Liberia was highly porous; people flowed into Monrovia in pursuit of jobs or trade and flowed back to their villages, families and friends. “Sooner or later,” Brown remembers thinking, “it might reach us.” And what then? A poor nation still shaky after years of civil war, Liberia—population 4 million-plus—had just a handful of ambulances in operation. How could Liberia possibly deal with Ebola?
Because he couldn’t answer these imponderables, Brown focused on what he could do. At a staff meeting, he assigned Dr. Debbie Eisenhut, an American with Serving in Mission (SIM), to research the disease. By combing the Internet, Eisenhut found what little there was to know about Ebola virus—symptoms, modes of transmission, treatment options. In its early stages, Ebola looked like any number of human infections common in that part of the world, including malaria: fever, achiness, a general sense of malaise. By the time it produced more shocking symptoms—uncontrollable vomiting, torrential diarrhea, organ failure and sometimes bleeding—the patient’s chance of survival was small.
The best news Eisenhut found was that Ebola virus does not pass through the air; transmission requires direct contact with the body fluids of symptomatic patients. As for treatments, her findings were meager: fluids to stave off dehydration and Tylenol for pain. And to prevent its spread, chlorine bleach solution to disinfect skin, clothes, bedding and floors. There was no known cure. Eisenhut’s findings made it clear that Ebola patients must be separated from the rest of the hospital population and treated by staff wearing protective gear. And this posed further questions for Brown. The Eternal Love Winning Africa (ELWA) hospital didn’t have an isolation ward, nor was there time or money enough to build one. No hospital in Liberia had one. Looking around the compound for a solution, Brown’s eye settled on the modest chapel, bare but for a few battered wooden pews and a lectern that served as a pulpit. “Well, of course, turning the chapel into an Ebola unit was not welcomed by the staff of the institution. The bulk of them said, ‘Why should we turn the house of God into a place where we put people with such a deadly disease?’ And some said, ‘Where will you provide for us to worship in the morning?’” Brown recalls.
Dr. John Fankhauser, another volunteer, a family physician from Ventura, Calif., had a ready answer to those objections. Jesus himself treated patients in the house of God, Fankhauser noted. Still, the idea remained unpopular, so Brown tried a more personal brand of persuasion. One by one, or in small groups, he asked the upset hospital workers, “What if you get sick with Ebola, or a member of your family? If the ELWA facility is not prepared to treat patients, where will you go?” Eventually, as Brown recalls, “a couple of them saw reason.” Brown arranged for staff training and stockpiled bleach. Eisenhut took charge of the chapel conversion, assisted by Dr. Kent Brantly, a physician from Texas who had moved to Liberia with his family as part of the Christian relief group Samaritan’s Purse. The doctors found room for six beds, which seemed like plenty, because they assumed that Liberia’s Ministry of Health would eventually create a proper Ebola treatment facility. The chapel would be needed only as a safe place to hold infected patients while they awaited test results and transfers.
Vast and tragic questions lie behind that mistaken assumption. The Ministry of Health did virtually nothing. Why did it fail to take timely action? And why was the failure replayed in Guinea and Sierra Leone? Why weren’t these governments encouraged and supported by international watchdogs like the World Health Organization (WHO)? Why were so many officials from Washington to Geneva to Beijing unable to see what Brown could see, unable to prepare as he prepared? Why didn’t the news from the borderlands produce immediate official action in March, when the worst Ebola epidemic in history—by far—might have been contained and snuffed out?
Why, in short, was the battle against Ebola left for month after crucial month to a ragged army of volunteers and near volunteers: doctors who wouldn’t quit even as their colleagues fell ill and died; nurses comforting patients while standing in slurries of mud, vomit and feces; ambulance drivers facing down hostile crowds to transport passengers teeming with the virus; investigators tracing chains of infection through slums hot with disease; workers stoically zipping contagious corpses into body bags in the sun; patients meeting death in lonely isolation to protect others from infection?
According to official counts, more than 17,800 people have been infected with Ebola virus in this epidemic and more than 6,300 have died since this outbreak’s first known case in rural Guinea in December 2013. Many on the front lines believe the actual numbers are much higher—and in any event, they continue to rise steeply. The virus has traveled to Europe and North America, where the resulting fear exceeded any actual threat to public health. In West Africa, however, the impact has been catastrophic. The number of Liberians with jobs fell by nearly half as businesses and markets closed in fear of Ebola. Sierra Leone’s meager health care network simply collapsed: Ebola patients were told by the government to stay home rather than look for a hospital bed. In Guinea, the epidemic stoked distrust of government and aid workers. Medical missionaries were driven from villages by violence and threats.
Ebola should not have been a surprise. The steady expansion of human habitat brings people into contact with remote reservoirs of poorly understood diseases, and mobile populations allow pathogens to infect large numbers in a short time. The story of Ebola is the story of SARS, of MERS—and most of all, it is the story of HIV and its nearly 80 million victims, roughly half of whom have died. All are animal-borne viruses that crossed to humans; HIV and Ebola even come from the same region of Central Africa. But lessons are easily forgotten, it seems, in the face of feckless African governments and complacent Western powers, rival healers and turf-guarding bureaucrats. National and global health authorities would wait five months beyond March to acknowledge the unfolding disaster. Health ministries would ignore the warnings of doctors who were seeing the hot zone firsthand. WHO would initially rebuff efforts by the U.S. Centers for Disease Control and Prevention (CDC) to help. By the time the authorities woke up, the epidemic was galloping away from them. There will be time, when the still-raging epidemic is finally conquered, to dissect the failures. For now, consider the stories of individuals who stood up to Ebola and, by doing so, raised hopes that victory is possible. In the memorable words of an essay by one volunteer, Ella Watson-Stryker, they found themselves “fighting a forest fire with spray bottles.” They did not give up. …
In Monrovia, Jerry Brown found himself wondering if he had converted the hospital chapel in vain. April turned to May, and still Ebola had not reached the capital. There was one close call: an infected traveler from Lofa County commuted through the city on her way to the town of Harbel, where she died. But Dr. Mosoka Fallah, a Harvard-educated Liberian epidemiologist, rushed to the home of the taxi driver who had picked up the traveler and persuaded him to accept a 21-day quarantine. The three weeks passed—the full incubation period for Ebola—with no new signs of disease. Monrovia remained untouched.
Brown contacted the Ministry of Health in early June to ask if he should dismantle ELWA’s isolation unit. The official who took his call suggested waiting a few more days, just in case.
On June 12, after a late evening in surgery, Brown emerged from the operating room to find a string of missed calls on his cell phone. Ringing back, he reached the same official, who asked if the chapel facility was still ready. Two patients, visitors from Sierra Leone who were staying in New Kru Town, an area populated by immigrants, had turned up at the government-run Redemption Hospital in Monrovia with suspicious symptoms. Medical staff examined them without protective gear. “They most likely have Ebola,” the ministry official said, according to Brown. “And the only place I thought about that we could keep them until we have an investigation done is at your center.”
Brown dreaded the impact of welcoming Ebola into his hospital, but he felt he had no moral choice but to absorb it. He knew his fellow doctors would stand with him, but the nurses were another matter. They initially refused to mix disinfectant and don protective gear for the work unit. “If you want my resignation, I will give it to you,” one told Brown. “I would rather leave than attend to an Ebola patient.” Another nurse said she felt too sick to stay at work. “I developed a headache a couple of minutes ago,” she said.
With all their work thus far at stake, the doctors tried personal appeals to their favorite nurses. Brantly circled around to the nurse with the headache, and after a little cajoling, she agreed to work in the isolation unit—but not alone. The doctors continued to plead with staff until they found a nurse’s aide and an operating-room technician willing to suit up.
Covered head to toe in Tyvek gear, goggles and masks, this cobbled-together team was ready when the ambulance from Redemption pulled into the ELWA compound two hours after the official’s call. Brown was shocked to see the ambulance crew dressed in ordinary scrubs.
One of the patients lay dead inside the vehicle. Brantly rushed the other patient into the chapel; that patient died a couple of days later, according to Brown. A nurse from the ambulance was likewise doomed, along with a doctor who did the initial screening at Redemption. Ebola had reached the city.
But it was even worse than that, as the Liberian epidemiologist Fallah quickly came to understand. He knew that an epidemic is not a simple matter of the sick people you can see. Even more important is the web of individuals who touch the sick or are touched by them. To control a contagion, it’s not enough to treat the visible patients; you must find and contain every strand and tendril of the web.
Fallah retraced the steps of the patient who died in ELWA’s chapel to a house in the Monrovia slum of New Kru Town, home to many Sierra Leonean immigrants, where he encountered “a strong feeling of denial” about the virus. One woman he approached gave a typical reply: “If anyone says they have Ebola in this house, I will give you a slap.” To acknowledge the disease was to invite social stigma and financial ruin.
“This was a six-bedroom house, but in New Kru Town, typically every room is a household,” Fallah says. “And we were counting between five to 10 or so in a room. So we’re looking at between 30 to 60 persons.”
Through dogged investigation, Fallah soon learned the identity of the person who drove the patients to Redemption Hospital and confirmed that the driver’s sister was dead of the disease. He learned that the driver had disappeared. And he determined that those contacts had other contacts—the strands of a web that Fallah followed until he discovered the identity of a contact who had been vomiting in the street. Yet other contacts (his heart fell when he realized this) had visited “a communal bathroom that all the houses use.”
This is a classic example of contact tracing, and it’s critical to fighting infectious disease. Watson-Stryker and others were doing much the same thing in Guinea and Sierra Leone. The network of contacts that Fallah unearthed revealed that Ebola had been simmering in Monrovia for some time. “Things were going on that we didn’t know about,” he says. “People visiting clinics. Some of them went to the church.” But none of it had been reported. Fear, shame and ignorance combined to keep Ebola shrouded. This was a terrible revelation, says Fallah. “It blew our minds.”
A Chain Reaction
Ebola’s lurking presence in the capital gave it a head start once it revealed itself in mid-June, and Monrovia’s fragile patchwork of health care providers was quickly overwhelmed.
The meltdown began in early July at Redemption, a single-story structure painted swimming-pool green and blazoned with murals that explain the importance of personal hygiene and antimalarial mosquito nets. Redemption Hospital’s lack of preparation ignited a chain reaction of infection and death: a nurse, a doctor, a medical aide. Frightened staff members vanished from their posts, forcing the hospital to close temporarily at a time of desperate need.
Other health workers at other clinics quickly followed. (Brown and his colleagues somehow managed to keep ELWA functioning.) Institutions that might have taken up some slack as clearinghouses for information to fight the epidemic—schools and government offices—also began shutting down, and many senior bureaucrats fled the country. President Ellen Johnson Sirleaf appeared stunned, frozen in place, unable to declare an emergency until seven weeks after the Redemption disaster. It was alarming how rapidly the yoked contagions of virus and fear unhinged Monrovia.
Within days of the June 12 call, ELWA’s six-bed chapel was overwhelmed. The Ministry of Health scrambled to create a rudimentary 20-bed Ebola treatment unit (ETU) at the state-run John F. Kennedy Hospital, and the new facility was beyond capacity almost as soon as it opened. At least two dozen people died in Monrovia in the early days after Ebola’s arrival.
More beds were needed. Brown decided to convert the brand-new kitchen and laundry building donated by Samaritan’s Purse. An emergency check from the organization, which was founded by the Rev. Franklin Graham—son of the evangelist Billy Graham—provided for building materials and more protective gear. Samaritan’s Purse also sent its director of disaster response, Dr. Lance Plyler, to join the battle. Hastily completed in July, ELWA 2, as the facility became known, had room for an additional 20 beds.
Still, it wasn’t enough. “Within a week it was filled,” Brown says. “People were now in the corridors, under the eaves of the building. Patients were just pouring in on a daily basis.”
Brown and Brantly had agreed early on that Brantly would handle the Ebola cases while Brown kept the rest of the hospital going. As July crept along one wretched day after another, matters became so chaotic at ELWA that Brown didn’t immediately notice when Brantly went missing from the treatment unit. When, late in the month, he noticed and asked for an explanation, Dr. Fankhauser broke the news that their colleague was feverish and had put himself in quarantine at home.
Evidently, Brantly had been exposed to the virus while performing triage in ELWA’s emergency room. During an overnight shift, a woman brought her suffering mother into the ER for help. Brantly wore a gown, gloves and face mask but not the full protective suit, because the suit “scares people, and they won’t necessarily tell you the truth,” he explains.
During the examination, the woman’s mother needed help from her daughter in making an urgent trip to the bathroom. Brantly suspected Ebola. He took the woman aside to explain why her mother needed to go to the ETU. “I had to counsel her extensively to reassure her that we were trying to do what was best for her mother—we were not abandoning her,” the doctor says. “I took off my mask, gloves and apron when I talked to her, and I probably held her hands or put my arm around her shoulder, as I often do.” Brantly doesn’t think he was infected by the mother. But the daughter had taken her to the toilet, and there’s a chance she hadn’t washed her hands afterward.
There was more bad news for Brown. On July 26, ELWA’s personnel coordinator, Nancy Writebol—a medical aide from North Carolina who worked with Serving in Mission—tested positive for Ebola. Within a few days, two other employees had been infected. Once again, Brown had to talk his way through a possible staff walkout.
It was late July now, and Ebola had pushed Jerry Brown and his hospital to its breaking point. On a personal level, he was now forced to do something he had promised his wife he would not do: suit up in Tyvek and go to work in the ETU. Every willing hand was needed, and the fearful staff must see that the boss had enough courage to do as much as he asked of them, he says.
Brown also made a painful decision to close the main hospital for a few days and limit some services after that. Though malaria season was coming on and expectant mothers counted on ELWA for childbirth, Brown felt he had no choice. Not after one of his own nurses, down with Ebola, was turned away for want of a bed.
Brushes With Death
What is it like to die of Ebola? Foday Gallah came close enough to know. A gregarious man with a level gaze, Gallah ran an ambulance in Monrovia, an exhausting and traumatizing service. Ebola has no power that he has not witnessed many times. His own infection came on the day that he saved a little boy’s life.
Gallah’s ambulance was summoned in early September to the home of a large family who had all been exposed to Ebola. He found the mother and two of her children wretchedly symptomatic. Gallah eased them into his vehicle but left the rest of the family behind. With beds in short supply, hospital staff would surely send away the ones without symptoms.
Soon, he was called back to that house. “When I got there, it was the grandmother, the father and the two sons. They were dehydrated. They were weak.” All four would die, just like the first three family members he transported. This left one small child all alone.
Gallah urged the neighbors to call him the moment the child showed symptoms. He remembers the ringing of his phone. “When I got there, the boy was lying in a pool of vomit,” he recalls. “He’s a 4, 5-year-old child, right? Very dehydrated and weak. He couldn’t move.” In a rush, Gallah donned his protective gear and scooped up the boy, who immediately vomited all over him. “Maybe there was an opening somewhere that I didn’t know,” he suggests. Thanks to Gallah’s efforts, the boy eventually recovered, but within days of the rescue, Gallah’s temperature rose. Then the pain hit. “I had headaches before, but the headaches of Ebola, they don’t break,” he says. “You take some ibuprofen to cool it down and it escalates.
“I have never experienced anything like I experienced with Ebola,” he continues. “Ebola pain, it don’t stop. It makes you want to give up. I used to be a strong man, and this just broke me down.”
Salome Karwah, then a trainee nurse at her parents’ modest medical clinic near Monrovia’s airport, suffered the same excruciating headaches when her whole family came down with Ebola after an infected uncle sought her father’s medical care in late August. But that was nothing compared with the agony of watching both parents die in front of her at the MSF-run Ebola treatment center. “I went out of my mind for about one week. I was going mad. I just felt that everything is over.” Karwah and her sister survived.
Soon after, MSF was looking to employ Ebola survivors in the treatment center. Scientists stop short of saying for certain that Ebola renders a person “immune” if he or she survives—but that’s their suspicion. There’s not one known case in the decades since Ebola was discovered of a person contracting the disease more than once. So when MSF asked, Karwah was one of the first to step forward.
“The first day I came here for an interview, I saw people carrying bodies. I started crying. I told my friend, ‘I can’t make it.’ But when I went the next day I said, ‘Sitting and crying won’t help me. So it’s better I go and work. The more I interact with people, the more I will forget about my sad story. So I decided to make myself very much busy to help others survive.”
For Kent Brantly, near death in late July, the worst part was the helplessness. “Ebola is a humiliating disease that strips you of your dignity,” he says. “You are removed from family and put into isolation where you cannot even see the faces of those caring for you due to the protective suits—you can only see their eyes. You have uncontrollable diarrhea, which is just embarrassing.” With his temperature high, his heart racing and fluid collecting in his lungs, Brantly lay in his room at the ELWA compound, just “trying to rest and not die” while awaiting transfer to Ribner’s unit in Atlanta. As his laptop played passages of Scripture set to music, words of the Apostle Paul settled on his ears: “For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God.” He clung to that hope like a lifeline. As he was waiting, word came of an experimental drug called ZMapp, developed by Canadian scientist Dr. Gary Kobinger. Like Geisbert’s TKM-Ebola, the drug showed promise in primates but had never been tested on humans and therefore hadn’t been approved for widespread use. Unfortunately, Dr. Plyler from Samaritan’s Purse was able to get his hands on only enough ZMapp—three doses—to treat one patient. Aware that Nancy Writebol was in even worse condition than he, Brantly asked that the first injection be given to her. But then Brantly grew sicker, and Plyler worried that he wouldn’t survive the transfer. He decided to split the doses: Brantly would receive one injection and travel first; Writebol would receive two and go on the next flight. The hope being, of course, that this would sustain them long enough to get them to Emory University Hospital in Atlanta…..
Frozen pipelines of international action began to thaw. Dozing bureaucracies stirred. Within days after Brantly’s evacuation, the World Bank pledged $200 million and the CDC jolted awake its emergency-operations unit, and on Aug. 8, WHO declared an emergency of international importance.
But as West Africans—and eventually the whole world—would learn, there was a lot of slack in the international response. The ringing of alarm bells in early August would produce in September a promise of U.S. troops to build treatment units and an unprecedented U.N. mission to attack the contagion. These steps would produce scouting trips several weeks later, followed by initial deployments. (The first U.S.-built ETU went online in early November.) A shocking projection by the CDC warned that without immediate and effective action, as many as 1.4 million people could be infected by January. And still the response moved as if through mud. Joanne Liu of MSF grew so frustrated that she delivered a scathing attack at U.N. headquarters in early September, decrying the “coalition of inaction” that was permitting people to die by the hundreds in the streets of Sierra Leone. In response, Anthony Banbury was summoned to his boss’s office at the U.N. and ordered to lead the international Ebola mission.
A veteran of some of the largest famine-relief efforts in recent history, Banbury has a knack for both the logistics and the diplomacy involved in getting massive amounts of help to people with everything stacked against them: natural disasters, government corruption, nonexistent infrastructure. But he now says that nothing prepared him for the complexity of fighting Ebola. This was the first all-out international mission to fight an outbreak of infectious disease. There was no precedent.
Consider all that is needed: scores of small ETUs spread across thousands of square miles; trained doctors, nurses and support staff to operate them; diagnostic laboratories and the power sources to feed them; supplies to keep them going; food to replace the crops untended by dying farmers and farmers unwilling to work in groups to harvest; offices staffed by experienced diplomats to coordinate efforts among national governments, local governments, tribal leaders, NGOs and homegrown legions of Ebola fighters; and perhaps most of all, money—actual cash, not just pledges. Fighting a virus is not the same as responding to an earthquake or a tsunami. Instead of a defined and visible problem, there is a mutating, invisible problem. Disaster relief deals with aftermath; this battle was ongoing. Eventually, the humanitarian efforts would begin to get traction, but never as quickly as the humanitarians hoped.
When Dec. 1 arrived—Banbury’s target date for getting the upper hand on the epidemic—he would have to acknowledge that the target would not be met. There was progress, but the number of people infected and killed was inevitably going to grow further. The failures of the official institutions to deal with Ebola in a timely way had doomed the effort to a long slog. “I’m proud of what we’ve accomplished so far,” Banbury ventures, “but in retrospect, the whole world wishes we had done more and we had done it earlier.”…
Foday Gallah, the ambulance supervisor who saved a little boy’s life and nearly lost his own, recalled the fear he felt in choosing to stand up. But he says now that he really had no choice. “We have to do it. Nobody had come” to help, he says. “So we are the ones to pick up the cost. Fear was there, but it didn’t overtake us.”
Victory In Sight
The Ebola fighters have not yet won the battle. For every recorded infection, the CDC estimates that an additional 1.5 cases go unreported. And for every sign of progress against the epidemic, there is at least one sign that the crisis is not over. There are empty beds in ETUs around Monrovia today, with cases declining in Liberia as a whole. But Sierra Leone is failing to keep pace with its cases, and Guinea, scene of the original outbreak, isn’t in the clear yet either. But now Mali is scrambling to prevent the virus from running away. “I’m not that optimistic yet,” says Ella Watson-Stryker. “We still have cases coming in every day.”
Nevertheless, something significant has been accomplished in the fight against Ebola. The same Liberian clinics that were turning patients away in October, dooming them to die in misery on filthy plastic tarps, now have beds standing empty, unneeded. Two possible vaccines are on a fast track for widespread trials in the African hot zone. The time needed to test for Ebola is shrinking from days to minutes. The prospect of mass contagion moving into the U.S. and Europe has paled. In other words, victory appears possible, at the end of a clear, if difficult, path.
There is hope. And hope has proved to be the most potent weapon yet discovered against Ebola. With so much gruesome practice, doctors have learned a great deal about treating the disease, and survival rates are going up. Instead of visiting traditional healers, who became unwitting vectors of infection, more Africans are now going voluntarily into ETUs because they have seen survivors coming out. “Instead of saying, ‘If you get Ebola, you die,’ it became ‘If you report at the Ebola treatment unit early, you stand a chance,’” says Brown, the ELWA director. It is the faint light before dawn.
We are left with lessons to be learned, and the Ebola fighters can teach them. One has to do with readiness: there wasn’t any. Some of the poorest governments on earth weren’t ready for Ebola, and neither were the wealthiest. When a Liberian man named Thomas Eric Duncan arrived at a Dallas hospital with Ebola, he was sent home with antibiotics. When he returned, the hospital staff was inadequately protected.
Another lesson has to do with the importance of having promising medical interventions ready to attack a virus before it spreads. Scientists have been working on Ebola for more than 20 years, but none made it to the drug-approval process because there was no incentive for pharmaceutical companies to mass-produce therapies that we might only need “just in case.”
For instance, Nancy Sullivan and Gary Nebel, virologists at the U.S. National Institutes of Health, have worked for more than a decade on an Ebola vaccine that was rushed into human trials in August. Two other vaccines aren’t far behind. And the companies behind the drugs ZMapp and TKM-Ebola are scrambling to produce enough doses for further trials.
And always, there is the lesson of gratitude for those who willingly, even eagerly, do the jobs no one wishes to do. Jobs that involve risking a horrible death on behalf of strangers who repay you with hatred. Jobs that involve exposing your heart to unfathomable grief. Jobs that involve giving your all while knowing that you will never feel it was enough. Early in the epidemic, CDC director Frieden spoke of Ebola’s “fog of war.” Its shroud covers the battlefield. Eventually—though no one can say when—the Ebola fighters are going to be victorious. The fog will clear, leaving the hard truth in view: this won’t be the last epidemic. And when the next one comes, the world must learn the lessons of this one: Be better prepared, less fearful, less reactive. Run toward the fire and put it out together. Even more important, though, when the next one comes, remember the Ebola fighters and hope that we see their like again. —with reporting by Alexandra Sifferlin / Atlanta, Alice Park / New York City and Paul Moakley / Monrovia
Dr. Jerry Brown, 46
Medical director and general surgeon at the Eternal Love Winning Africa [ELWA] Hospital in Monrovia and director of the ELWA 2 Ebola treatment center
I first heard about Ebola in March, when I was listening to the radio. That was late March. We had patients with Ebola presenting in Lofa County. In the counties that border with Guinea. So it was then that we really started panicking and thinking, Now that one of our counties is involved, what next? Sooner or later it might reach us, we thought.
So from then on we started thinking about Ebola.
The very first challenge I had as medical director at that time was that if we started having Ebola patients show up in our emergency room, well, “Where do we keep them, doctor?”
The only place that came through my mind was our chapel, because we didn’t have the financial capability to construct something. Our intent was not to create a treatment unit but instead to transform the chapel into a holding unit such that whenever we had a patient in the emergency room and we had the suspicion of the person being a probable or suspected case, the person could be kept in the holding unit until the patient would be transported or transferred to the treatment unit. So that was our goal for having the chapel used initially.
It was June 12, in the late evening after surgery. I had just left the OR when I saw a series of missed calls on the phone [from the Deputy Minister of Health] and decided to call her back.
She said, “There are two patients that we have, they are Sierra Leoneans, and they visited one of the hospitals already, Redemption Hospital. A couple of their staff have already encountered them. But their presentation, their signs and symptoms, and from where they have traveled, tell me that they are probable cases and they most likely have Ebola. And the only place I thought about that we could keep them until we can have an investigation done is at your center.”
The very first thing I felt was, this is going to be challenging to have those patients brought here. We had not attended to such patients before, so in the back of my mind I kept thinking, What would it be like, to have those patients here?
From that day onward, I always had the fear of myself or one of my staff getting infected, and what would become of me thereafter.
The first two patients were brought in an ambulance, with two of their relatives, in the back of the ambulance, along with the patients. The front of the ambulance had the driver and two health workers; one nurse and one physician assistant. What was shocking was that the nurse and the physician assistant never had any personal protective equipment. The only thing they had was gloves, and dressed in their ordinary scrubs. That was frightening. The two patients in the back of the ambulance, one had died on the way. And the other was lying there. And then a boy about the age of 13 and his brother, maybe around his late 20s, were both in the back of the ambulance. We could tell that they were Sierra Leoneans by their accents and the way they spoke.
We were shocked. First question was why the health workers allowed the patients’ caregiver to ride in the ambulance with them. It all boils down to people not knowing what a disease Ebola actually was. So no one knew what was happening. And I tell you, if we had not done some training initially, and spoke about Ebola repeatedly during our regular devotions, it would have been a greater disaster in the ELWA hospital. Through the training a few persons had some knowledge of what Ebola was all about: the mode of transportation, the means of prevention and the signs and symptoms related to the disease. So the bulk of the workers at this institution knew a lot about it. So it was a pity to see those workers in the ambulance dressed as they were. One of them is said to have died of the disease later, the nurse.
So initially, that is the situation we had. Dr. Kent Brantly and Dr. Debbie Eisenhut were the first two who were willing to dress in full PPE and took the patient down to the unit. It was very challenging to get the nurses on board the first day, though they had been trained. The patient died a few days later.
Before the end of June, the chapel, where we only had six beds, could no longer take additional patients because it was full to capacity. The initial intent of the unit in the chapel soon changed from a holding unit to a treatment unit. The chapel then became the first treatment unit in Monrovia.
So all the patients that were presenting with the symptoms [of Ebola] were all rushed here, to the chapel. [They] were dying every three, four, five days. Because of the rapid rate at which people were dying, you could easily find places to put someone else. By then the government in the middle of July created another ETU at JFK Hospital that became the second unit in Monserrado County, in Monrovia.
When the chapel became full and we could no longer take additional patients, and more people were getting ill and dying, the ELWA management decided to turn over our newly built kitchen and laundry for the new hospital under construction to be transformed into a treatment unit. Thus ELWA 2.
Within a week it was filled. We had 20 beds. Within one week we had more than 20 patients. Patients were now in the corridors and under the eaves of the building, and still patients kept pouring in daily. The outpatient department of the hospital was then turned over to be used as an extension of the unit, shutting down outpatient services to the public.
When it all started, and we had a unit set up, my wife did warn me not to enter the unit. So the first time I did enter I didn’t tell her I had entered. But she knew I had been trained. I went home and said nothing to her. And the very first time she had a suspicion of me going to the unit was when Dr. Abraham Borbor, who was one of my mentors, got ill. And I had to go in and attend to him. I had been in the unit for two weeks without her knowing. And I went home one evening and started discussing a few things about Dr. Borbor. Borbor was my role model, especially when I was in medical school. How he was now ill, and how I was feeling so sorry for him, and how his condition was not improving despite what we were doing. And she paused, and asked, “You are not working in the unit. How do you know these things?” and I caught myself. And tried to change the topic. It went to something else, and she never noticed.
But then she started having suspicions. I remember her saying, “I hope you are not being stubborn. I told you not to go to the ETU.” So I said, “Well, I will do my best.” I formed some excuse and we just abandoned the topic. A few days later she noticed changes in the color of my boxers from the bleach or chlorine solution used for disinfection when leaving the unit. And so she said, “Ah, what is this?” and so I had no option but to finally confess. It did not go down well with her. I apologized, and we kind of talked about it for some time, and then she accepted. What she said was, “I can’t stop you. I realize this is something you like, so I am not going to stop you. But just be careful. So when you are back home, change all your clothes in the garage before you enter the house. I do not want my children and I to get infected.”
But before she said this, I never took any of my outfits back home. I had special scrubs that I kept at the hospital. Once I got to the hospital I changed completely into my scrubs. At the end of each work day, I changed back to my ordinary wear and went back home. It was challenging to have her to accept this. She was afraid of me getting infected. She later realized that I was safe, and we kept trusting God to remain safe prayerfully. —as told to Aryn Baker
Salome Karwah, 26
Nurse’s assistant at the Doctors Without Borders/Médecins Sans Frontières (MSF) clinic in Monrovia and an Ebola survivor
We heard that there was a new sickness coming by the name of Ebola and it is in Guinea. And I was afraid, because Guinea is not far from Liberia. And most of our businesspeople go to Guinea to buy goods and bring them to Liberia. So I knew it was a possibility that they could bring it to our country.
I was working for our family clinic in the Smell No Taste area [near the airport, in Margibi County, an hour and a half from Monrovia by car]. I was a nurse. Both my mother and father, plus my elder sister and I, [were] medical personnel.
We got Ebola through a crisis that happened near our town. This lady, 26 years of age, she was pregnant, from [the city of] Kakata. And then she got sick. And then she died.
A lady from my community went to the funeral. And there she contracted the disease. My father’s brother, my uncle, was her pastor for the church. She got sick, and he went to help her as her pastor. He contracted it from her, and then she died. After a week, my uncle got sick.
[My uncle] drove to our house for my father to see what really was going on. That is when my father contracted it. And then he brought it into our house, with my mother taking care of him. He was a diabetes patient. When he got sick, I used to give him his medication, his injection, insulin. And then I contracted it.
My sister was pregnant six months. Helping my dad, she got it too. And then my mother did, because both of them used to sleep on the same bed. And then my niece who was 6 years of age. And then my fiancé. So everyone was infected.
They looked like normal symptoms. None of us really thought of Ebola. One of my brothers is an accountant at the clinic where they used to do the Ebola test. When my uncle died, he tried to find the cause of death. So he went there and took my uncle’s test. And it was positive.
[Then] he took my father’s blood, took his test, and my father was positive too. That way he knew that Ebola was in our house. So he took his personal vehicle and brought my father to the ETU [Ebola treatment unit], which was the 20th of August. My father died August 21st. He had just slept, and the next day he passed.
He brought my mother, my sister and me on the 21st, the day our father died. My mother died the 24th of August.
When I got sick, I was breast-feeding my 10-month-old baby. My brother took her blood to do her tests. She was negative. So my fiancé was taking care of her, because I was in the ETU. Since she was negative, they couldn’t bring her to me.
The 29th, [my fiancé] got sick. He left the baby with our next-door neighbor and came for the tests, and was positive.
Due to the death of my parents, I went out of my mind for about one week. I was going mad. I was very, very much distressed. I just felt that everything was over. But after a week, with encouragement from the nurses and a counselor—they helped me a lot—I become stable. I was taking my medication, I was eating. And always they were coming to encourage me.
To have Ebola is very, very horrible. It deals directly with the brain. It makes you—you can’t remember anything. The pain is very much severe. If you don’t have strong resistance, you can’t stand it. The headache of Ebola is extraordinary. It hurts like they are busting your head with an ax. And it gives you severe body pains, like you don’t even want to move your body from here to there.
The girl that [my fiancé] left my baby with, she used to bring her to the ETU, and I saw her every two days. She would stand across the fence and I would sing for my baby. I made a song for her on the day she was born. I used to sing it before she went to sleep. It goes like this: “Go to sleep, baby, go to sleep. Go to sleep, baby.” She knows it very well. So I sang this song when they brought her to the fence. She would be laughing, playing, and then they would carry her back.
I was in the treatment center for four weeks [and] four days. Really, what made me survive is the support from the nurses. The support from the psychosocial [team] also really helped me.
They were looking for survivors to come and work [at the MSF clinic]. I make it my duty to come. The more I interact with people, the more I will forget about my sad story. The more I share my story with people, the more I will get strong, strong, strong and stronger. So I decided to make myself very busy to help others survive. The day I came here for an interview, I saw people carrying bodies. I started crying. I told my friend, “I can’t make it.” But when I went the next day, I said, “Sitting and crying won’t help me. So it’s better I go and work. The more I see it, the more I will adjust myself to it.”
I go in [to the treatment wards] not saying I am a survivor. I ask [the patients], “Where do you live? What is your contact number?” And I tell them, “Just because you are here doesn’t mean that this is the end of your life. You have another life to live. I was a patient here. I managed to survive. So if I can survive—I’m not different from you—you can survive too.” And the person will say, “Ah, you are a survivor? How did you manage to survive?” And I tell them.
When I see my patients survive, it brings a great joy to me, because at least my efforts never went in vain. —as told to Aryn Baker
Foday Gallah, 37
Ambulance supervisor, Monrovia, and Ebola survivor
I am the supervisor on the Honorable Saa Joseph District No. 13 Ambulance. I go out in person. You are there to regulate the movement of the ambulance and sometimes supervise the cases that would come on board the ambulance. In April it [Ebola] began very severe, and people started calling us scared. People started calling us here and there. And we knew that this ambulance was important for the country. Using a regular car to get an Ebola victim to the hospital, No. 1, is going to be very slow. No. 2, it might cause a problem for the driver or other people on board the car.
So the ambulance, we just had it for Ebola cases; it’ll be faster and it will be safer. So it was very important for transporting Ebola victims. I was a little afraid because the first thing, Ebola, it is the first of its kind in the Republic of Liberia. Watching the impact and the devastation it caused in this -country—one had to be afraid. The first time I had to pick up an Ebola patient, you don’t want to hear it. I was very afraid. Before then we had gone through a training with the Ministry of Health, so we knew how to wear the PPEs [personal protective equipment]. Though the PPEs were on me, the fear was still there. Approaching the patient, I saw this patient lying in a pool of vomit and feces. Wow, it was something to see. I was very, very afraid.
Sometimes we carry up to 50, 60 patients a day, depending on the number of calls we have to receive. Because we have only got two ambulances with the government, so remember the Ebola is tracking everywhere in the neighborhood, everywhere in the country, everywhere in the capital city. You are driving one patient, and you are getting calls to pick up another at the same time. Sometimes 10 patients in the car at the same time.
I actually got sick trying to help a family, a family of eight. I first took the mother, the sister and the son—the first three—[to] an ETU [Ebola treatment unit]. After a week or so they died. After two, three days, I received this phone call. This time it was the father calling me. Because I knew the home I drove the ambulance. When I got there, it was the grandmother, the father and the two sons. They all were down. They were dehydrated. They were weak. I put them on the ambulance. There was only a little child [left] that did not have Ebola [symptoms]. If I take him to the ambulance, when he was still strong, he would’ve been tested negative. So I have to wait that he come down with either fever, a headache or diarrhea [before I could take him].
But before leaving that day I told the [neighbors], I said, this little child has been living with these people in this house. There is a likelihood that he might come down. But please, whenever he don’t have strength, when he come down with fever, call me and I’ll come and pick him up.
So that afternoon, I received this call. When I knew that it was from that house, and I had taken seven persons and they all had died, and that little child was the only one there at the time. So I hurried over there. When I got there, he was lying in a pool of vomit. Very helpless. And once you are losing a lot of fluid from diarrhea, you become very weak and dehydrated. He couldn’t move.
So I hurried to put on my [protective suit] and went in for him because I didn’t want him to lose his life this time around. I ran hurriedly and picked him up. So I had him face up. I moved him toward the ambulance, and he regurgitated straight on me. But I didn’t take into consideration that something that happened, that vomit or something had seeped through, and I would have been [infected]. I wanted [to save] his life.
So I got him on the ambulance and hurried to the treatment unit. I had my full [protective gear] on. But maybe there was an opening somewhere that I didn’t know. I never had the feeling that this vomit have slipped through somewhere. Because I was only looking at him.
Two days later I started coming down with fever. The first day the headache was very severe. I was restless, so I said I have to go and do my test. Now the next thing came to my mind was that if I told a lot of people that I am going to do my test, there would be more fear and it wouldn’t be good. So I only told my mom and my brother and my boss. And my own very ambulance drove me off. The very ambulance that carried my patients drove me off. So when I went there [MSF Clinic], I was tested and it was positive.
I was attended to well. I was cared for. And thank God that I went there on time—I was fine. Other people, other folks say their treatment was not fine, but my treatment was fine. Everyone cared for me—the nurses, the doctors—because remember now I was always interacting with them, bringing in Ebola patients, and they were very friendly.
When I got there I was so loved by everybody. People were always talking to me. The people in [protective gear] were always talking to me: “Foday, how are you doing? You are going to be O.K.” Those words drove me on. And my family, my boss and everybody cared for me, so all those words gave me encouragement.
I have never experienced anything like I experienced with Ebola. Ebola pain, it don’t stop. When they started giving the medication, I found my pain doubled. I had a general body pain, joint aches pain, headache, stomach cramps. The pain became exceptional. For the headache, it was like someone taking a 100-lb. hammer and just pounding on your head. And at that moment you don’t want to hear any noise in your ears. You don’t want anybody calling your name. Someone calling your name is going to aggravate you. My phone rings—if it rings I shove it under my mattress because I don’t want nobody talking to me. Until after three days, four days, did the pain subside. And up till now as I am sitting talking to you I still have a slight headache. Not severe—it’s very mild—but I still have it.
I was trying to save a little boy, a little child. And he survived. He survived. He is alive and well and doing great. He is somewhere in Kakata. And that was my prayer. That was my wish. Even if I had died of Ebola, I still have family, right? But that little boy lost his family. His mother, his brother, his sister. Wiping away his entire family. But I kept him alive. So all my efforts did not go in vain. I survived, and he survived.
I saw him [in the treatment unit]. I got there two days before he was discharged. He was there. And I stayed there for two weeks. He was my son there. He was always around me. I was very happy to see him. I was very happy. Maybe he gave me the strength to live because all my efforts [to save him] did not go in vain with that child.
I don’t regret picking him up, because I prayed for his life, I wanted his life. And today he has his life. So I think I achieved something: his life. At least that can be a representation of his family. So there is one member of the family who survived.
I am going to go back in full swing. I am not going to be afraid. I am going to walk in to fight Ebola with all of my might. I would have died. A lot of people die. But in there I was treated, and cured, and automatically that is the work of God, and I have built immunity to it, so that is a gift. And I wish to share with a lot of people my blood. I want to give my blood so a lot of people can be saved. I am willing to do that.
I am going to get on that ambulance. I am going to every nook and cranny of the capital city, pick up whatsoever Ebola patient and take them to the [treatment unit], give them words of hope, of encouragement. I can do a lot. And try to educate people about Ebola. That Ebola is not a death sentence. —as told to Aryn Baker
Morris Kanneh, 45
Driver for the Liberian Red Cross dead-body-management team in Monrovia
I was working for the Red Cross. My boss man called said, “Morris, the administer want for you to go and drive for the Ebola team.” So I said, “What, Ebola? How could I go on the Ebola team? I’m not prepared.”
I went through the training, and they assigned me on a team. I become the first driver for [the] Ebola [body team]. We drove all over the country. I started in March, in Lofa [County].
On July 12 I picked up the first two bodies in Monrovia. The first was a lady. I was afraid from the beginning, but I was protected. She was on a bed. She looked dried up. Her eyes were red and there was blood in her nose. It was horrible.
Then it hit our nurses. We lost many nurses there. I had to pick up my friend, a nurse. I knew her well, I knew her husband. I was not expecting her to die, and I did not expect Ebola to take over Monrovia. —as told to Aryn Baker
Ella Watson-Stryker, 34
Health promoter with Doctors Without Borders/Médecins Sans Frontières (MSF)
I was at home in New York City, in March. And I got a phone call on a Thursday afternoon from MSF saying there’s a viral hemorrhagic fever outbreak in Guinea, and how quickly can you leave? So that was Thursday afternoon. By Saturday I was on the plane. I was changing planes in London, and I was in Heathrow airport with this massive influx of communications saying, “It’s Ebola. Come back.” I thought about it for a second. My first thought was very much the graphic movie version of Ebola, of people bleeding from their faces. I thought the mortality rate was something like 100%. Very briefly, I thought about getting back on the plane and going back to New York.
When I first got to Guinea, the outbreak at that point was just in Gueckedou, a two-day journey across bad roads. When we got there, the tiny crew of people who had been handling everything were very happy to see us. One of the women—she was in charge of the project—I don’t think anyone has looked that happy to see me ever in my life.
It was a typical West African town, and it was completely different at the same time. Everyone was terrified. You could see it in people’s eyes. That’s really what Ebola does—it scares people. It’s a disease that creates fear.
We had patients already in the ETU [Ebola treatment unit]. I remember we had two tents built, and they had put down extra slabs of cement. I asked, “What are those spaces for?” And they said, “Oh, we probably won’t need them. We have capacity for almost 20 beds right now. But it’s dry season, the weather’s great for pouring cement, so we put two extra slabs just in case we need extra tents.” Very quickly those two tents were put up, and even more quickly more cement was poured. So it was really the beginning of the cases coming in. It was obvious to me by the middle of April that we didn’t quite know exactly how bad it was, but that it was really bad.
My job is primarily focused on making sure that people have the information they need about Ebola to protect themselves, their families and their community. Often I—or my team—are the first persons seen by the community talking about Ebola. But it’s hard because people are afraid. Sometimes they think even just talking about it can bring the virus to them. When a village is infected, then they’re afraid to tell you because they don’t want you to take their family member away. It’s a virus that kills up to 90% of people who get it. We put people in ambulances, and they come home in a plastic bag.
Guinea broke my heart. I was not prepared for the level of mortality. I wasn’t prepared to watch entire families die. I wasn’t prepared to watch entire villages die. There was a village in Guinea where the entire left side of the road, the houses were empty. It was an entire extended family. And there was a graveyard in the village, and I knew all of the graves. There was one week that we went to nine funerals. They were people we knew before they were sick. We knew them when they were sick, and we took them home in a body bag. It’s emotionally devastating to go through that process. The lesson you learn in Ebola is don’t get attached to anyone except a survivor. Because everyone else is vulnerable.
The darkest day [was] probably in Guinea. The beginning of May. An important person had come back to the village. He had been at a funeral. And because he was very well known and very respected in the village, when he died everyone came to the funeral. I think it’s very normal for humans that we don’t want to bury someone covered in vomit and feces, we want to wash the body. So the first week all of his male relatives came in, and all of them died. Then all of his female members of the family came in, and all of them died. And then the children came in. We had three young children in the treatment center, completely alone. A 6-year-old, a 7-year-old and a 12-year-old. And the 12-year-old, she turned her face to the wall and she wouldn’t speak and she wouldn’t eat, she wouldn’t drink. She completely gave up. She wasn’t severely ill. We thought she had a really good chance. I still think if she had fought, she probably would have made it. But she was so devastated by the loss of her entire family that the only thing that she would say to us was “Just let me go join my mother.”
There was nothing we could do. We brought games, we brought sparkly barrettes, and we brought things that we thought might help her. We put a TV in the ward with children’s movies and films. But she just faced the wall and gave up. That was hard. That was one of the most helpless situations I’ve been in. Because we had a patient we thought had a good chance. But we couldn’t reach her.
I got to Sierra Leone in the middle of July. In Sierra Leone it was very clear the situation was completely out of control. It was really a desperate situation. We didn’t have enough staff. We didn’t have enough beds. We didn’t have enough of anything.
Tiwa was a young girl who came into our treatment center. She came in with her family. Her father had already died from Ebola. The family had traveled about three hours by ambulance to get there, and the road was bad and they were tired and they were hungry. So we came in with soft drinks and water and biscuits and snacks for them. We can’t touch the patients. As a result, we had to toss things across a 2-meter divide. And she’s catching them as I tossed them over. She was very shy at first, but then it became a game. She was about 9 years old, wearing a pink T-shirt. Her mother tested positive. Her aunt tested positive. But she was negative. So she was discharged the next day.
A week later I was going through the book, looking for who was going to be discharged the following day. And I saw her patient-ID number and I saw the word READMITTED. It was in all capital letters and red. And my heart dropped. I was just so disappointed that she had come back. That she had been negative, she had been safe, and now she was infected. She got sicker and sicker. She had vomiting, she had diarrhea. She was refusing to eat. And then she started to have hemorrhagic symptoms. She was bleeding from the nose and mouth. That’s the worst sign for us. Not many people will survive that. Ebola is unpredictable. I have seen patients come in who seemed fine, and 24 hours later they were dead. And I’ve seen patients like Tiwa, [for whom] we lost hope and then something happens, and they survived. She started to eat, and she started to drink. And the bleeding stopped. I was able to take her home. I would never make a bet on who’s going to live and who’s going to die. When it comes down to survival, I’ve seen too many miracles. And I’ve seen too many go in the opposite direction.
It’s really difficult when you’re working as hard as you can and you know it’s not enough. It’s really difficult when you can’t help but think if we could have done a little bit more, maybe that village could have been saved. We have spray bottles filled with chlorine water that we take in vehicles with us to disinfect [ourselves] in the villages. It felt often like that was the only tool we had. We worked desperately hard. We didn’t take off weekends. We put in 12-hour days seven days a week, and it wasn’t enough. It becomes very obvious that pushing that extra day isn’t what’s going to make a difference. Because you’re so small compared to how big the outbreak is.
I don’t know how much I help. A lot of the time it just seems like too little too late. But I’m doing it because if I wasn’t here on the ground doing my job, I would be in the U.S. reading newspapers and saying, “Someone needs to be doing something.” For me it’s better to be here trying than to have that sense of helplessness at home. In Liberia people say this is a man-made virus. And it’s not a man-made virus. But the disaster that the virus has created is man-made. It’s something we have chosen as humanity to allow to happen. —as told to Aryn Baker
Dr. Philip Ireland, 44
Liberian doctor at John F. Kennedy Medical Center in Monrovia, Liberia’s largest hospital
We had several cases of clinicians at the John F. Kennedy hospital who have come down with Ebola. Dr. [Samuel] Brisbane [and] physician’s assistant Stephen Vincent. And then I came down next.
It was in a meeting [on July 24] when I had this splitting headache. I saw flashes of lightning. I have never had a headache like this in my entire life. And I knew something was very, very wrong.
I did my temperature; it was 38.1 Centigrade [100.58 Fahrenheit]. And I said this sounds like, smells like Ebola. This can’t be malaria because I’ve had malaria a thousand times. And I know how it is. This is completely different.
I called the chief medical officer, told him I wasn’t feeling so well. I told him, “Doc, I think I have been exposed to Ebola, and I want to be tested.” And he was instrumental on the next day to have me tested. The guy came in the house dressed in the entire space suit, into my room. They did the test. The next day we found out that I was Ebola positive.
By day seven I could not feel my radial pulse. I was in early shock. I was really sick. Very, very ill. My colleagues said that if we don’t get him out of here [his home] today, he’s going to pass. And I felt that way for the first time on day seven. I felt I was in shock. If I didn’t get IV lines going I was probably going to die that day.
So my fellow doctors, a pediatric resident at the hospital, and an ob-gyn resident, and also my wife and her brother, all of them were calling to see if they could get an ambulance. But in Monrovia there were no ambulances [available] at the time. So they found this ambulance that was having some parts replaced at a garage. They were repairing the breaks. And [one of the doctors] literally sat there and waited until this ambulance was repaired and brought to the house.
Then we got to the hospital, to the Ebola treatment unit. I collapsed on the bed and passed out. I woke up and found out that they have given me three liters of IV fluids, saline. And I felt a little better.
That night was the worst night at ETU. I had 46 episodes of diarrhea and 26 episodes of vomiting. I was in a sea of mess. The next day there was this physician’s assistant—I will never forget him. His act of love towards me, to wash me, was so much so that I will never forget it in my entire life. He cleaned me totally. He dressed me, put me in a clean bed. And I felt that was so, so, so nice. I really appreciated that. I felt so relieved.
The very first night I woke up to some loud music. They had turned the SUV around and opened the doors and turned the music up very loud. Gospel music. And all the artists were singing, “You’re going to make it, you’re not going to die.”
At that time I already had headaches; I felt like a nightmare. Like you had the speakers right [next] to my windows and boom, boom, boom. And then they had a mixture of different kind of people, like some people were in there with fever or malaria. We weren’t all Ebola patients. Some people had strength, and those who had the strength will have prayer services of what we call vigils. And there was singing and praise God the entire night. They were singing and praying the entire night. And that was tiring. They would sing and pray the entire night. After one night of that, [two infected doctors] said, “No, no more praying to God. If you want to talk to God, do it silently in your heart.” So they stopped the vigils.
By day three, the morning of day three, I started to do some terrible, terrible hiccups [a symptom of advanced Ebola]. That was when the clinicians taking care of me thought I was going to die. And they communicated that with one another. In fact, at one time I was hiccupping with every breath. So they thought I wasn’t going make it. They were even discussing whether I would be cremated or buried. And the news circulated that selfsame day that I had passed. I was in bad shape at that time. But after that day, day four in the ETU, I started to get better. When they came in to check on me the next morning they met me standing. And they were very surprised.
I stayed there getting better, getting better. I was actually in the Ebola Treatment Unit for 14 days. And by day 10 in that place, which was like 17 days of illness, I was feeling much better. There was no more diarrhea, I didn’t have fever. Now I did have complications. I had pneumonia, I had hallucinations of all kinds of different things. Besides the acute renal failure.
So by day 17 I was much better. So the guy did another test and the test results came back negative. And then came day 14 [in the ETU]. I was told 20 minutes before I left the Ebola Center that I would leave the Ebola Center. They said, “Dr. Ireland, you have to take a chlorine bath.” And I said, “Is the water warm or hot?” And they said, “No, it’s cold.” And then I said, “I’m staying. I’m not going anywhere.”
Where I was, you have mosquitoes flying all over the place and cockroaches. So I said, man, let me get out of here. So in the evening I mustered up enough courage to do the cold chlorine water bath. They had me strip in front of all the nurses and the physician’s assistants. And the male physician’s assistant had to ask them to leave to give me some privacy.
I had two buckets of the chlorine water. Very cold, icy water. And then I put on this T-shirt, sweatpants. And I had to go to the spray where I got sprayed thoroughly. In my ears, in my face, with my clothes on. When I left I was so wet. I was drenched with chlorine water.
And I came outside. Now you have to bear in mind I am very, very fragile and weak. I’m still sick. I’m just glad I made it, that’s all. And I walk out and there are people singing all around me. The nurses were singing with their beautiful—they were singing and so happy. I was being released at the same time as a nurse. Nurse Barbara. And we had people from JFK there, my family, my elder brother was there, my wife was there. We had a lot of other doctors that were there. We had members of the press. A lot of people had turned out. And I felt like Nelson Mandela. I always use that description. It felt like the Long Walk to Freedom. And even though it was a short walk, for me, because the energy I had to expend because I was so weak, it was like a walk to freedom.
And I walk up and I raised my hands to heaven, thanking God for saving my life. And then I noticed something also. There were a lot of crying people, people happy to see me.
And when I got close to anybody, they actually backed away. —as told to Aryn Baker
Dr. Mosoka Fallah, 44
An American-educated Liberian infectious-disease expert who returned to his country last year to help establish a school of public health and now leads the effort to find, monitor and isolate the contacts of Ebola victims
As an infectious-disease student [at Harvard] I studied emerging and re-emerging infectious disease, and Ebola was always what we were talking about. At the time I had come back to Liberia to work on a USAID project. It was March. Ebola was the only thing on my mind. It was already in Guinea. I understood the interaction between the people on the border, between Guinea and Liberia. And I knew that there was definitely going to be Ebola coming to Liberia.
It was one thing reading about a disease and then being in a disease. Maybe I could have raised the alarm, but I didn’t. I regret that now. I regret that we didn’t stop it in Guinea. Then the cases came to Liberia from Guinea. It was March, the 24th or 25th. I called [Assistant Health Minister] Mr. Tolbert Nyenswah: “I’m hearing about this Ebola, how can I help?” Everyone was coming in and thinking about how to mount an effective response. It was a task force.
It became much more personal for me, because one of the relatives of the [first person to be killed in the outbreak] in Lofa County had taken a taxi to Monrovia. And she slept in the Chicken Soup Factory [neighborhood]. I grew up there. My mom is there, all of my relatives are there. I said, “We’ve got to get our boots on the ground. We’ve got to go to Chicken Soup Factory.” And they said to me, “This is the task force. We construct policies and strategy.” And I said, “O.K., I’m going to go down to the county [level] where we can discuss boots on the ground.” I led a team to Chicken Soup Factory. The index case had already left. But there were contacts like the taxi driver. I talked to him. He was frightened. He said, “I tried to help this old lady. If I do have the disease, I am going to spread it.” We told the townspeople to keep an eye on him. [We said], “Don’t stigmatize him. Don’t let him on the street.” Our contacts officer would go and take his temperature every day. And after 21 days, he did not come down with the disease.
That case had me running around recruiting and training people. And passing awareness. Then [in] April we saw the situation slow down, the number of cases drop. By the end of April, we weren’t getting any more cases. But I was a little bit worried. Given the fluid nature of our borders and the nature of Ebola, I was worried. I remember sending an email to a friend. “Very soon it will be in Liberia again,” I said, thinking of the increasing cases in Sierra Leone. Because when it hit Sierra Leone, it hit with so much force and ferocity. The cases mounted at an alarming rate. I didn’t know that was prophetic when I wrote that line to my friend. On June 27 we had a new case. I got a call from the Ministry of Health. And it was in New Kru Town [one of Monrovia’s most crowded slums]. The population density and the denial allowed the disease to escalate. A landlady we approached [to do contact tracing] said, “If anyone says they have Ebola in this house, I will give you a slap.” I just walked out. There was so much resistance, so much denial.
As we tracked case by case, we got to know that the first index patient who died had gone to Redemption Hospital. He had come into contact with all the nurses. So we had to consider every nurse and doctor at Redemption a possible contact. Actually, I followed about 45 people that were listed as contacts. This nurse, Esther, had touched him, and she became infected. And Dr. Sam [Samuel Muhumuza Mutooro] from Uganda—he treated him, and he became infected. And then the man who took the index patient in the back of his car died, and the sister died. What we knew was only the tip of the iceberg. Even before the ambulance had gone [to take the first case for treatment], six people had died. There is a communal bathroom that all the houses use. It just blew our minds. All of a sudden we have this situation in New Kru Town, of all places. We were worried that very soon it would spread to West Point [another congested slum].
I was working to mobilize tracers, to train tracers. And there were contacts that we could not find. Contacts were becoming symptomatic and moving and exposing other contacts. Twenty-six people got infected by one person. And then the cases hit us so hard. We had contacts everywhere becoming symptomatic and generating more contacts. That’s when the tension was on. Seven days a week, 10 hours a day. And we were getting from 50 to 200 phone calls. The phone calls would come until midnight and start at 5 a.m. I couldn’t afford to turn the phone off. All through Ebola, I think I turned it off once or twice, and only when a friend said to me, “Go and rest. You look like a dead body right now. We don’t want you around reminding us of death.” And I slept for two days.
Very soon I realized that the response is not a single piece. It has to be holistic. There has to be enough ambulances. There has to be enough case investigation teams. There has to be enough burial teams. The sick will be waiting for someone to die [in the Ebola treatment centers] so we can have space. Everything we did on Ebola was dependent on the ETUs [Ebola treatment units]. And we didn’t have enough.
August and July were quite tough for us. People would die, and we were helpless. We just couldn’t do anything. I would have a contact tracer follow a family. The mother died. The sister died. The maid died. The wife died. The father died. And she [the contact tracer] would go there every day to do contact tracing on the symptomatic people. She would encourage them, but every time she came back, there would be one more body. We were left alone. I have to say that. I always say that in July and August we lost a good window of opportunity. If they had come in with the ambulances and the tents, we could have averted a lot of death. If everyone had rushed in and built another [treatment unit]. They took such a long time to be built. Meanwhile, people were dying. The bodies would accumulate in the street. The burial teams would go someplace for burial and they would be chased out.
I was always afraid that Ebola would be in West Point. The unsanitary conditions. The population density. The fluid nature of the population. It was Aug. 12 that I got a call. [A volunteer] called me and said, “Mosoka, you better come to West Point.” He said, “There is one dead in the house with the door locked. And the other is sick and vomiting and toileting in the street.” I left everything and I ran to West Point.
Nobody wanted to talk, nobody wanted to explain what was happening. I called a couple of leaders [from West Point], and they began to reveal to us that for the past two weeks there had been massive secret burial going on. They would take [the bodies] to an island across the bay and they would bury them. There was no investigation or contact tracing. That night I called the WHO Country Representative. I said, “Our worst nightmare has happened. West Point has Ebola.”
The decision to open a [Ebola] holding center in West Point was a desperate decision. West Point is congested. There is no way you can walk in West Point without touching. You have the sick walking around, vomiting and toileting. I said, “The best we can do for West Point is to get the sick from the population.” The community didn’t understand.
And then it was Aug. 19, the worst day of my life. It was a rainy day. That day alone we took six dead bodies from West Point. I think there was a lot of misinformation. There was still a lot of denial. And then [rioters] broke into the West Point [Ebola] center. They took mattresses. Where were those contacts? Where did they take the mattresses? There was a very big panic. The government had to deal with people running around with infected mattresses. They also knew that they had the secret burials. So the government quarantined West Point. Later, the government lifted the quarantine. The lesson we have to learn is that the government, before taking action, should consult with the community.
I’m cautious about the declining number of cases because with Ebola, a single case is an epidemic. Before we were fighting a big war. Now it’s a guerrilla war and we’re fighting little pockets. If it comes back, it’s going to be even more intense. It only takes one case, and then all our achievements are reversed.
On Tuesday, Nov. 11, we got a call that a prayer leader had died from Ebola. Thursday morning, they brought a casket to carry the body. There were people there rubbing oil on her and praying for her. Forty people. Children as young as 3, 4. All of them under a tent. So as I speak to you, three of the people that were in that room are in the [treatment unit] today. This is in New Kru Town, where it all started. That’s what I am trying to say. It came back. —as told to Aryn Baker
Iris Martor, 32
Nurse at the More Than Me Academy, a school for vulnerable girls from the West Point slum of Monrovia
We have these big buses in Monrovia. On these buses you have, like, 200 passengers, and on my way to Monrovia from where I live is a long journey. So you have a lot of people from different walks of life and a lot of different conversations that come out. So it was in the buses I first heard about Ebola.
Initially two people will say the government is telling the truth about this new sickness we are hearing about. But 198 will say the government is lying. I was sitting next to some person when the argument came to hand. I decided to ask, “What is this sickness that the government says is coming?” He explained it to me. I became interested, and I started to follow up. So for me, I said, if the international community is putting their money in for this sickness, I want to believe it. But the majority in Liberia did not believe.
The incident that occurred that really brought fear into the minds of Monrovians was when the outbreak started in Redemption Hospital [in early June]. A nurse and a few other health workers at the hospital died of Ebola. This nurse treated a patient that came from Sierra Leone, and most of her colleagues attended to her, and eventually she died, and then this Ugandan expatriate [doctor] contracted Ebola and also died. And then everybody began to see the evidence of Ebola.
When Redemption got hit, people were really scared, and they stayed away. The other hospitals were scared too—when a staff member got infected and maybe died, then everyone got afraid. So that is how eventually all the health facilities and clinics started to shut down. Even private hospitals, at a certain point in time, closed down.
In the rainy season, you have a big increase in malaria cases and in diarrhea cases—you find a lot of sick people normally. Then we had this stranger called Ebola. So all the hospitals were closed, and the only places that were open were ETUs [Ebola Treatment Units]. So it meant that every person that was sick in the community needed to go to the ETU to be triaged from there. To be tested, to say O.K., this is positive, go [to the treatment center], or negative, so get some treatment and go home. And the ETUs didn’t have the capacity to take many people.
The point [when I realized I had to do something] was when we were finding out that people were dying from other sicknesses. It was August. We decided to bring in the home-care nurses because malaria was killing children and adults. Other sicknesses that could be treated were killing people because there were no facilities that they could go to. We go to the homes of the sick and do the assessment. If we see that the patient has signs that are related to Ebola, we link them to the ambulance service. And they take them to the ETU. Where there is no case [of Ebola], we do another investigation to see what is going on.
Before Ebola, I was already the school nurse. Then after Ebola started to escalate, we started to go into the community to look after our students, to really care for them. We didn’t want any of them to get sick, and praise be to God none of them had gotten sick of Ebola. So I and my team, we would go house to house where our students lived in West Point. And we sensitized them and we gave them materials to help. [But] what could the aid do, if I only sensitized my student, and I see this neighbor and that neighbor have Ebola? I leave that neighbor alone, and the neighbor contracts the virus, there is a possibility that my student can contract the virus. So when the number of sick people began to increase, More Than Me saw the need that they should do a bigger intervention than just limiting to their students. Now we visit every house where there is a sick person.
Home care is dangerous because you don’t know the environment. If it is in a hospital setting, you are sure of your environment because that is where you work. And you know that this is an ETU, and everyone has Ebola, so you know how to act. But going into a home where it is not confirmed whether the patient has Ebola or not, that makes it dangerous. Whatever way you do it, it is a risk. So we did it in a way to reduce the risk. The only way you can get Ebola is through direct contact with the body fluids of an infected person. So whether a person shows signs of Ebola or not, consider a sick person as a suspect. That is clear. So don’t touch. Don’t even sit. Now you talk to the patient at least one meter apart. Based on what the patient says, based on what you have seen—if you are a professional nurse, if you see these signs, it suggests this. Sometimes it might suggest two things, but if you probe and ask follow-up questions, then you rule out one and it points to one. So based on that, you treat.
As a nurse, when you are graduating, you swear an oath to take care of life. Initially I was afraid. I should admit that. I don’t want to die. I have my family, I have my children. But if I don’t help, I will still not be free. I might be more exposed, and this time around my entire family could be wiped away. God forbid, if I died in the fight maybe my children and my parents could live. So I decided to take that courage and to go out there and help my fellow Liberians. Because that is the oath that I swore. If someone from America comes to help my people, then why can’t I? This is my country. I should take the first step, and someone can walk in my footsteps.
The cases are going down, yes, but in my opinion, it is not time to celebrate. It is time to be more cautious. Ebola has not been completely eradicated. It is still around. The more we start to get complacent and become careless, there is a possibility that it may shoot up again. As long as Ebola is still in Guinea and Sierra Leone, I can tell you that Liberia will not be free. If I become a decisionmaker in this country, I would like for this country to always have a contingency plan. If we had had a contingency plan, [Ebola] wouldn’t have spread as it did. So there should be a lesson learned for any Liberian who lives after Ebola is gone. Policymakers should be able to look at this experience and really plan for the future. Because tomorrow it may not be Ebola, it may be some other things. —as told to Aryn Baker
Katie Meyler, 32
Founder of More Than Me, a school for vulnerable girls from the West Point slum in Monrovia
More Than Me, before Ebola, was an organization that would help young girls get off the street and into school from a community called West Point. We specifically targeted young girls who were highly at risk of being sexually exploited. Poverty is so extreme in Liberia that it’s not uncommon for young girls to get forced into sex just to have their basic needs met, such as a glass of drinking water. There was not even a chance that you could go to school unless you had money in Liberia. So I started paying kids’ school fees, and that’s how we began. The school opened this year. It was the first all-girls tuition-free school in Liberia. Our mission for the school was, when girls graduated they got to choose what came next for their own lives.
And then Ebola hit, and our whole mission shifted. The President closed schools indefinitely. As long as Ebola existed in Liberia, it’s a threat to the lives of our children. And we have to do whatever it takes to make sure that we can do our best at ending Ebola. So our mission changed from helping these young girls go to school and making sure they have real choices when they graduate to keeping these children alive.
One of the first things we did with fighting Ebola was realizing who’s working in West Point and who’s not. Then we started a meeting with all the people who worked in West Point. The awareness–team guys hadn’t been paid yet by the Ministry of Health. So we paid them. The active-case finders—the people who go door to door looking for the sick—didn’t have boots. So we bought them boots, 300 pairs of boots. All that kind of stuff. They wanted T-shirts.
And then they were like, “We call for an ambulance and the ambulance comes in four or five days. We need an ambulance.” So one of my donors sent me money. We bought an ambulance.
So we got this ambulance [team] trained—WHO trained them. Doctors Without Borders did a second training. We did training after training after training so these guys wouldn’t get hurt. And I started following the ambulance to make sure that they were protecting themselves the right way.
And so this was at the time when there were no more beds [in the Ebola treatment units], so the ambulance shows up to Redemption Hospital. It’s a building where you put sick people until there’s a space for them to be transferred.
The conditions there were—I mean, there wasn’t any water when we showed up. That’s the main way to help people stay alive. Inside, there’s dead people lying next to children who are still alive. There’s feces and blood and vomit mixed in with bleach, and it’s like a swamp on the ground when you walk around.
Because it was a holding center and not a treatment unit, there wasn’t much the workers could do to help the people who were sick. So the people that are sick are just kind of lying there without any communication with their friends or family. No support. I mean, children by themselves were with dead people—literally, dead people outside of the hospital, dead people inside the hospital, mixed with people who were alive. It was chaos.
People were all around, crying and screaming that their family members had died or looking for family members that they couldn’t find. There’s no tracking system, so no one—when someone dies, there’s no bracelet to say, “Call Charlie’s parents.” It was horror. It was hell on earth. So we’re there, and I watched a woman die in front of me in a taxi waiting to go into the hospital. In the meantime, a truck pulls up. The truck is Red Cross, and they’re coming to collect dead bodies. They opened up the gates in the hospital, and they’re taking one dead body after the next dead body and putting them in the truck.
Everyone’s screaming and crying around. I was crying, and then I started laughing, just because it was, like, so overwhelming. I was, like, breaking, in a way.
And then up pulls this other ambulance, and they open the doors and they take out this lady who was dead. She died in the ambulance.
And sitting on the steps of the ambulance was this 3- or 4-year-old girl in a pink party dress. It was almost like fiction. It didn’t feel real. In this crazy scene of death and dying and dead bodies and screaming and crying and mourning is this cute little girl with her pink party dress just sitting on the steps of this ambulance, with no symptoms of Ebola. She told me her name was Pearlina. Later I saw her paperwork and I realized that her real name was Berlinda. But by then she was just our little pearl, and the name stuck.
And so I ask the ambulance, “Who’s this little girl? What’s her story?” And they said the community didn’t want her there because her little sister had died, and now the mom. Everyone was afraid, no one wanted to take her in. And there was nowhere for her to go. I heard this was going on all over the place. And I was like, “She cannot stay at Redemption Hospital.” Because this girl, she might have Ebola. She might not. If she doesn’t have it, she’s definitely going to get it, and most likely she’ll die because there’s no help here at Redemption.
So I told the hospital that if they needed a place for the girl, I had this guesthouse. And we would hire people to watch her and we would take awesome care of her. And they’re like, “Amazing,” like, “Get her out of here.”
We hired our kindergarten teacher and a social worker and just said, “No touching this child. Let’s treat her as if she had it.” We quarantined her with Disney movies and ice cream. So she was the first child to be there, and we were all just hoping and praying with everything we had, falling in love with this child, that she wouldn’t get sick. And she didn’t.
So that was the first child, and more and more started. Another woman in the community was going into the ETU, but her daughter wasn’t showing signs at the time. So she’s like, “My family has turned their back on me. I don’t have anywhere for my daughter to go. You’re the only person I know that would take her.” There were these twin babies that didn’t have anywhere to go. There’s kids who are just literally homeless—like, home by themselves at 4 years old. There’s nowhere for them to go. So I kept running into that over and over again.
So our house became an emergency-care center for children. It’s called HOPE 21 [Housing Observation and Pediatric Evaluation for 21 Days]. Kids are kept safe for 21 days. They are quarantined with love and movies and their favorite foods.
And when they graduate from their 21 days, they make a wish list. Basically everything they wanted on their wish list we’ve been able to buy them. They all want bicycles. They all say they want laughter. New clothes, cell phones—almost like a Dear Santa list. I think right now there’s 11. I could fill that place up easily with a hundred children. There’s sleep room probably for 40. But what we’re doing is only taking children that literally have nowhere to go.
[On Sept. 24] I went to Jerry Brown’s ETU. I was so excited to meet him because I had heard all this great stuff about him. He was having one of these graduation ceremonies that he often has of survivors. There’s all these family members waiting to receive their survivors. People are singing and praying and celebrating that they had lived. And there’s this little girl with her face down, and she’s just bawling and a wreck. And I was like, “What’s wrong with this girl? She survived Ebola. Why isn’t she happy?” The other survivors explained to me. She woke up from a coma, and her whole family was dead. No one to pick her up. Her name was Esther.
I told the social worker from the Ministry of Health, “We have this home, and until you can figure out where her family is, please let us take care of her.”
And there were, you know, nights where she couldn’t sleep. I would talk to her and breathe with her to help her calm down. And through that experience we bonded. When you say Ebola, I know that the world will think numbers or moon suits or something. But when you say Ebola to me, I think about Esther and Pearlina. —as told to Aryn Baker
Nelson Sayon, 29
Worker with the Liberian Red Cross body-management team, Monrovia
We pick up the bodies, the dead bodies, dead Ebola bodies in the street, from the communities, from the homes, and take them to the crematorium.
Normally we used to bury. But then the community members got upset, saying that we cannot bury. Because whenever we went to bury in the community, they would take rocks and begin to stone our vehicles. Some were afraid that if we do bury, the body will resurface and they will contract Ebola. So the government of Liberia made a decision to cremate all bodies. So from that point in time we start picking bodies from the street and start taking them to the crematorium.
I volunteered myself to help my country, Liberia, because there were dead bodies in the houses and in the community. It would infect people. I started the job Aug. 2, 2014. Before the Red Cross, I was riding a motorbike transporting people from one point to another.
We started training with the Liberian Red Cross. They gave us personal protective equipment, the good ones. Good PPE, dressed from the head to the toe. The entire body is covered up.
My first day on the job I was afraid. Because when you start something, the very first day you will be afraid, a little bit afraid. And the job was so hectic the first day. My first day I was picking up 10, 15, 20 dead bodies. So I would really be afraid.
The first body, it was decomposed. I was afraid. Most of the bodies we pick up are all rotting bodies—some since five or six days. Really I never felt sick. But I was definitely miserable. Yeah. I almost felt like throwing up. It was my first day to see dead bodies—more especially, rotting bodies. Yeah, the first body we went for that day, we pulled the body by the arm. The feet. The flesh almost came off on the hands. Some bodies are very, very heavy. Normally we send down four persons to pick up a body. But some bodies need six persons to pick up.
We spray the body, disinfect the body. And then when the body has been disinfected we take the body—wearing our protective gears—we take the body and put the body into the body bag. Spray it and then seal it and take it into the pickup truck. From the car to the crematorium.
You really sweat in the PPE. Sometimes my head aches, a severe headache. But in Liberia, as soon as you say you are suffering from a severe headache, people will move far away from you. Sometimes what I do is that when I get home, I take my ORS [oral rehydration salts], glucose and water and some antibiotics to keep me strong for the next day.
Sometimes I worried I might contract this virus. But what I would do is in the morning when I wake up, I pray to God to help me out. Because it is only God who can help you out in this process. And more especially for me, the work I do is very dangerous. Because I deal with positive cases on a daily basis.
Thank God for Liberia, none of the DBM—the dead-body team, the safe-body-removal team—none of us has ever contracted the virus. Because God is with us, and we are going through our preventive measures. We wear our protective gears.
I felt so bad to burn the bodies. You know, we have a decoration day in Liberia, where people go to decorate their lost ones’ graves. So then, it is so frustrating to see—a brother dies, you have no grave for him. A sister, mother dies—you have no grave for her.
In the community where I live, I don’t really tell people that I am working on the dead-body-burial team. I don’t tell them because when I tell them, they are, “Oh, walk far away from him.” So they think I work for the Red Cross, that’s all. Liberians realize to go by the preventive measures, by washing your hands, do not touch people, do not go to an area that is populated, do not go on the beach [with crowds]. Liberians already understand that.
For a while we thought they were reducing, the Ebola cases. [In November] we were picking up one, two bodies a day. But in recent weeks, we are picking up seven, eight, nine in a day. It is frustrating.
I really want for Ebola to be eradicated. If I can hear from WHO that Liberia is free from Ebola today, I will be very happy. I’m tired. I’m tired to see Liberians going to the crematorium to be burned. —as told to Aryn Baker