Love in a time of Ebola

A spotlight on Liberia’s fight against the virus

One ambulance. One Toyota Land Cruiser. Two laptops. Personal Protective Equipment (PPE). Risk allowance for health workers.

Patricia Kamara, Executive Director of the Christian Health Association of Liberia (CHAL), knows exactly what her organization needs to fight the raging Ebola epidemic which, by the end of August, had already killed 694 in Liberia alone, 1,546 throughout the West Africa region.

She knows the need. She just doesn’t know how to fill it.

CHAL, a partner of the Christian Reformed Church’s World Renew, has 45 member units that include seven major hospitals and 38 primary health care facilities situated in 12 of the 15 counties of Liberia. Its health workers are trying to halt the speedy spread of the contagious disease but are stymied at each stage by a lack of supplies, especially vehicles and PPE’s.

And the need is dire.

Without vehicles, Kamara told Christian Courier, the health workers cannot reach the infected Liberians in rural areas. A national radio broadcast implores Liberians to immediately contact a medical call centre if they notice symptoms of the deadly and contagious disease. However, it can sometimes take two or three days before the response team arrives. Even then, “sometimes the team does not arrive on time,” Kamara said. Infected bodies are often transported in wheelbarrows, without even the guard of PPE’s – the garb that keeps workers from contact with the contagious bodily fluids.

And without PPE’s, many workers are afraid to treat the victims once they arrive at the hospital. CHAL alone has lost 24 health personnel to the disease. The workers have learned, lived and worked together for years, but are now confronting a disease that they have never seen before, that they are not trained to treat, and that is killing their coworkers. According to Kamara, showing up at the hospital takes immense courage. Some make any excuse not to come for fear of being infected.

“That fear is there. That fear is there,” Kamara emphasized.

The workers, who are mostly unpaid volunteers, are asking not just for enough PPE’s to reduce the risk, but also for “risk allowance,” a stipend paid to family if the worker dies. They are worried about providing for their families.

The World Health Organization (WHO) reported an unprecedented number of health workers dying from the disease, which it attributes to three factors: a shortage of PPE’s, a shortage of staff and the compassion that keeps the workers at the hospital for far more hours than is advisable for their own safety.

As more and more workers succumb to the disease or quit out of fear, the hospitals simply cannot provide care – whether to Ebola victims or any other patient. Patients are dying from treatable illnesses because there is no room in the hospitals.

“All around us the hospitals are closed,” Kamara explained. “So where will the people go for treatment?”

Even when the hospitals are open, it can be difficult to convince patients to be treated. Families are unwilling to bring Ebola patients to the hospital because they fear stigma and isolation from their neighbors, Kamara said. “Some families desire to keep it quiet, to keep that patient indoors. They don’t want to talk much about it. They don’t want the public to know.”

About Ebola
Because so many Ebola victims keep it quiet or cannot access help, the actual number of deaths from the virus could be two or three times the official count. And it may only get worse: WHO estimates 20,000 may die before the virus loosens its hold. The Ebola virus, which Kamara called the “worst in human existence,” is sweeping through both rural and urban areas of Liberia, Guinea and Sierra Leone. A few confirmed cases have also been reported in Nigeria and Senegal.

Ebola’s early symptoms are similar to many other diseases: fever, sore throat, muscle pain, headaches. Soon, however, the disease causes a viral hemorrhagic fever with bleeding possible both inside and outside the body. If the infected patient does not recover, death usually occurs within 7-16 days of first showing symptoms. According to the WHO, Ebola has a mortality rate of 90 percent, if untreated. If treated, the survival rate of this outbreak is 47 percent, higher than previous outbreaks.

The incubation period from the time of infection to showing symptoms is 2-21 days. Ebola is spread by human-to-human contact with bodily fluid and is not airborne, contrary to what many fear. It can feasibly be contained by use of protective equipment. The chance of it spreading to the western world, where the medical infrastructure is in place to treat it and contain it, is negligible, according to the WHO.

Food shortages likely
In West Africa, however, where the hospitals are well beyond full capacity and supplies are slim, the effect has been devastating. Schools, businesses and markets are closed. The Liberian government has also authorized a national curfew from 9 p.m. to 6 a.m. and established quarantine zones in heavily affected areas. Sierra Leone and Guinea have taken similar measures.

And even as these countries quarantine their citizens, their neighbours are quarantining them. The more affluent Africa countries are increasingly banning travel between their borders and countries inside the Ebola zone.

Unfortunately, these measures have had unintended consequences that will further hurt Liberia, Sierra Leone and Guinea. The United Nations’ Food and Agricultural Organization (FAO) issued a special alert on September 2 to report that “although necessary, these restrictions [for containing Ebola] have resulted in food security concerns that curtailed the movement of goods and services, including food items, leading to panic buying, food shortages and significant price hikes.”

That’s not news to the Reverend Milton Marah, a pastor in Sierra Leone, who, due to a ban on public gatherings, has an empty church but still-needy congregants: “Local food production has been curtailed,” he wrote. “Demand for imported food stuff is high but the cost is not affordable. Some of our church families have started coming to our headquarters for food assistance. Such supply baskets are soon getting dry.”

This, too, will probably soon get worse. The 2014 harvest season is about to begin in West Africa, and the likely labour shortages resulting from the movement restrictions due to Ebola would mean fewer crops harvested and more expensive food in an area where many already spend more than 80 percent of their income on food, according to the FAO.

The miracle drug
There are no vaccines or proven cures for the disease. However, when in July two Americans, medical missionaries in Liberia who contracted the disease, were treated with the drug Z-Mapp and lived, there was hope that it could be the miracle drug. Z-Mapp, unfortunately, is only in its experimental stages of testing and cannot yet be produced in mass quantities. So far, its effectiveness in curing Ebola in humans has been inconclusive.

But waiting for a drug may not be the best strategy. Kamara urged Christians in the western world to help provide the supplies that Liberian hospitals desperately need – to be active and show compassion on both the sick and those who risk their lives daily to treat the sick. “If you sit and watch us go through this, it will [get] worse,” Kamara pleaded, comparing their crisis to the devastating Civil War that ravaged Liberia for 14 years, eventually ending in 2003 with an estimated 250,000 casualties (BBC).

The international community turned a blind eye then. Kamara never wants to see that again.

On the front lines now of a very different battle, Kamara added one more thing to her list of CHAL’s needs.

“We need assistance from you all,” she insisted.


  • Judith Dinsmore is a freelance writer living in Pittsburgh, Pa.

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