Seeing Ebola from the Epicenter of the Outbreak in Monrovia, Liberia

When traveling to areas devastated by earthquakes and violent storms, the physical damage is often apparent even before you step off the plane. But here in Liberia where the death toll has surpassed 2,000 and continues to climb, there are no flattened buildings or tent camps filled with survivors. Signs of the crisis are more understated. In front of every building, hand washing stations spill out a diluted chlorine solution. Police at checkpoints stop vehicles so they can check temperatures. And murals graphically depicting Ebola’s symptoms scroll along sidewalks and roads.

The virus has the whole country on edge and everyone is more guarded. It is a matter of survival. There is no shaking hands, no hugging, and no kissing. All the schools in the country are closed as it’s believed that having all those children together would create too high a risk of infection. Parents are telling their children not to play with their friends, to stay home. Many foreign-owned businesses have closed their doors, laying off workers, while other Liberian families suffer as the breadwinners become ill, and customers stay home out of fear.

Traumatized by watching their co-workers succumb to the virus, many health workers are staying home, too. Without them, many hospitals have closed or scaled back services. As I walk through empty hospital wards here, it’s clear the lack of health workers has brought medical care to a virtual standstill for a population of 4 million. Patients still need care for malaria, typhoid and complicated childbirth — conditions that can prove deadly, too — but the degradation of an already weak health care system has left many of those conditions unattended. While good data is not available, many speculate that the increase in deaths from treatable diseases due to the breakdown of the health system has been more devastating than Ebola itself.

The Ebola treatment units (ETUs) are the cornerstones of the Ebola response strategy in Liberia. I recently visited one ETU in a rural part of the country, constructed on the grounds of a former leper colony. There are 200 staff including doctors, nurses, cooks, decontamination crews, sanitation workers and ambulance drivers. There are workers to maintain the latrines, hand-washing stations, the incinerator that burns used safety equipment and the morgue for burying the dead. There are visitors, too: Families come to see their loved ones stricken with Ebola, talking to them through a mesh screen. Almost everything you need is right there on site, or at a nearby university campus that’s serving as a dormitory for the medical crews. Workers shuttle blood samples to Monrovia for testing — an agonizing wait for patients who get the diagnosis two or three days later.

Friends back home in the U.S. are surprised to hear I am not wearing the full protective gear shown on news reports. Those are only required for the medical professionals treating high-risk patients, who are carefully separated from the rest of the unit. When their shift is over, those doctors and nurses are sprayed with a chlorine solution before and after they remove their layers of protective equipment. The equipment is then incinerated, except for certain re-usable items, such the goggles and boots, which are disinfected and re-used. This laborious process goes on around the clock. With 17 more Ebola treatment centers planned, the need for trained health workers — and personal protective equipment — is going to increase dramatically.

Liberians were already struggling with the everyday grind of poverty and the devastation of the recent civil war when the Ebola epidemic struck. They are reacting with a mix of fear and a sort of weary determination that this is yet another crisis to overcome. Liberia alone won’t be able to stop the outbreak from spiraling out of control. It is going to take a combined effort of governments, non-governmental organizations, multilateral organizations, and the private sector coming together to support Liberians and halt this epidemic. And once that is accomplished, it is going to take an even greater — and much more sustained effort — to restore and improve the health system of Liberia so that it doesn’t happen again. (Read more about AmeriCares Ebola response)

Published originally by The Huffington Post on  10/09/2014 10:45 am EDT