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Ebola at One Year: Cautious Africa Peeks Around a Corner

Fighting Ebola in West Africa

European Commission’s Humanitarian Aid and Civil Protection department

John Burger - published on 03/11/15

Liberia counting down days until disease-free declaration, but pain and precautions remain

It has been one very long year since the World Health Organization reported a major Ebola outbreak in Guinea, in western Africa. The disease spread rapidly to Sierra Leone and Liberia and other countries, threatening to become a worldwide crisis.

But the situation in Monrovia, Liberia’s capital, has improved to such an extent that Father Sony Pottenplackal feels it’s safe for him to return to India for a home visit.

“There are occasional reports of suspected cases here and there, on the outskirts of the city, but the total number of cases are very few,” he said in a telephone interview as he prepared to board a flight to his native Kerala. “People are doing their normal things, and you won’t find much fear. But we still take preventive measures: washing one’s hands [with a chlorine solution] and taking one’s temperature has become kind of a normal practice.”

The Salesian priest, who is principal of the Don Bosco Technical High School in Monrovia, said the adoption of such hygiene practices early on kept the death toll lower than it could have been—bad as it was.

The outbreak has taken almost 10,000 lives in the three countries. As of March 5, according to the WHO, Liberia has had a total of over 9300 cases in the 2014-2015 epidemic, with over 4100 deaths. Sierra Leone has had over 11,600 cases and over 3600 deaths, while Guinea has experienced almost 3300 cases and almost 2200 deaths.

There were a small number of cases reported in Nigeria and Mali and a single case reported in Senegal. Several cases, including one death, occurred in the United States.

It was the largest Ebola epidemic in history, but there is cautious optimism that the worst is past. Authorities in Liberia discharged the last Ebola patient in the country March 5, according to the New York Times. There were no other confirmed cases of Ebola in Liberia, and the country is anxiously counting the 42 days required by the WHO to be declared Ebola-free.

Liberia has reopened schools, and with children walking to classes, local merchants are making a living selling food and knick-knacks on the street, Father Pottenplackal said. But that makes only a dent in the devastating unemployment rate. Ebola took not only lives but wrecked Liberia’s economy.

The priest said that while the Salesian parish in Monrovia lost four parishioners to the disease, the school was spared. Nevertheless, as an educator, he was troubled by the forced idleness of students for months on end. The parish tried to provide books for them to study at home, since they could not assemble in school, and Father Pottenplackl took to the airwaves of a local Catholic radio station to give parents ideas on what they could do to keep their children active.

“I touched upon how parents can help children do self-study, how to motivate them to read, how even newspapers can be used as learning tools, writing a journal as a learning tool,” he said. “Writing [about one’s] experiences of Ebola and other daily events as a therapeutic means to overcome boredom and trauma healing.”

Ebola is also waning in other areas. U.N. experts said recently that the spread of the disease in Guinea, Liberia and Sierra Leone has dropped to almost 10 percent of what it was in September. But new cases continue to emerge in Sierra Leone.

An American nurse, Kelly Suter, spent four months in that country from October to January, as part of an emergency response team for International Medical Corps. working in a hospital on the grounds as a leper colony on land owned by the government and built by Save the Children.

She said one of the hardest parts of the assignment was seeing people—especially children
die alone, as the disease is so contagious that loved ones need to keep a safe distance. Medical personnel and others visiting need to be fully covered in space-suit-like “personal protective equipment.”

“You want to be with them when they take their last breath because they’re in there aloneno one can be in there with them,” she said in a telephone interview while on a home visit in Michigan. “You’re limited as to how long you can stay in PPE. It was really hard walking out knowing they were going to die shortly and they were going to die alone.”

Her first patient in the unit remains the most memorable. A young father named George had recovered and was about to go home the day she arrived. “As he was walking out of the unit, his five-year-old son was being checked in,” she said. “William was the first patient I met. I put an IV in him and sat with him because he was crying, he was alone.”

George was anxious to get out, but when he learned that his son was being checked in, he stayed to take care of him. “A lot of our kids had no adult with them because they risked getting sick,” she said. But patients who survive Ebola develop an immunity to it.

“William seemed to be getting better, but one night, after he seemed to be doing well, later on in the night his dad came out yelling for help,” she recounted. “We went in, and William was seizing. We gave him medication to stop the seizures and cleaned him up, but he died about 15 minutes later. It was really unexpected, especially since it seemed like he was doing better. It was really hard to watch, especially after everything that George did.”

Though the hospital was not a religious one, most of the staff were very spiritual and consistently began their work day with communal prayer and song, Suter said.

“We had a lot of survivors come back and work with us because they understood the disease and how hard it was, and they were appreciative that they survived and they wanted to come in to help,” she said. Among those survivors was a pastor, “so anytime something happened or someone was getting ready to pass or a family member was having a really hard time we were able to have someone who could support them spiritually or go into the unit and sit down with someone.”

Individuals such as Suter and many medical personnel from the countries themselves and from around the world were crucial in containing and fighting back the outbreak. International aid agencies also contributed greatly. To mention only two, Catholic Relief Services helped to support St. Joseph’s Catholic Hospital in Monrovia, which eventually closed because it lost 15 of its staffers to Ebola, and the Order of Malta sent $40,000 worth of protective gear and supplies to Monrovia.

“CRS was already working in the countries so it had relationships with local partners,” said John Service, Humanitarian Response Officer for the US bishops’ international relief agency. “We needed to send managers to work on several projects, including safe burial practices. We needed to find ways to help the local population compromise on long-held burial practices, which involved bathing of the body. That’s one of the times Ebola is most contagious.”

Service said the agency is now looking toward the post-Ebola, reconstruction phase, including helping families get back their livelihoods and finding a way to place orphans. “We’ll work with the Church on that and look to the model of the AIDS crisis of the past 15 years,” he said.

But those who know Ebola are not letting their guard down. “Now is the time to be careful. Just a few weeks ago, everyone was shouting victory, but, since then, there has been increase in cases in Guinea, including in the capital, Conakry,” said Dr. Patrick Guyon, who coordinates the Ebola efforts in West Africa for the Order of Malta and Malteser International. “We are encouraging increased surveillance, and are continuing our awareness campaigns to inform the local population about the risk of contagion, especially during funeral rites.”

According to Guyon, the key lesson to take away from this past year’s experience is that “the risk of an Ebola epidemic has been downplayed for a long time. The occurrence of cases in urban areas has completely altered the course of this epidemic: previous Ebola epidemics had only occurred in rural areas, where they could be quickly brought under control.”

Looking ahead, Guyon said, it’s important to address the weakened health structures in the countries that have gone through this ordeal, "restoring trust between people and health services, patients and caregivers, community actors and beneficiaries."

Said Guyon, "We need to improve the facilities of health centers, training staff, setting up an effective warning system for epidemic-prone diseases."

John Burger is news editor for Aleteia’s English edition.

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