When the news broke out that a man in Dallas had developed Ebola, the pandemic ceased to be a news story about a far-away place.
The predictions of Ebola cases suddenly seemed more relevant to the daily lives of Americans: 1.4 million in West Africa by the end of January according to the Centers for Disease Control and Prevention (CDC), and 20,000 by the beginning of November according to the World Health Organization (WHO).
“The CDC report and the WHO report are based on the same projections,” said Dr. Adam Levine, an associate professor of emergency medicine at Brown University who recently spent five weeks in Liberia setting up an Ebola Treatment Unit or ETU.
“The CDC is assuming that cases could grow to 1.4 million based on non-recorded cases by a factor of 2.5. In order to have a recorded case, a person has to be admitted and tested, and then the blood test results must be sent to a lab. There have been more than 6,000 confirmed cases in West Africa – but it is probably twice that number. If we dramatically increase the response to Ebola, then these numbers will decrease,” said Dr. Levine.
The CDC believes that if 70% of Ebola patients are treated and isolated, then the epidemic will end.
“But this means that they need to train staff and create protocols. It will require a great deal of money, supplies, health care workers, logistical support and training,” said Levine.
On September 16, the US government announced that it would send 3,000 military personnel and $750 million to West Africa. They already have 230 people on the ground, but it will take time to mobilize the rest. This group’s mission will be solely to build ETUs. None of them will be treating Ebola patients.
The people who are on the ground now fighting Ebola – members of the CDC, WHO, Doctors without Borders and a myriad of Christian groups – are struggling. In Nigeria and Senegal, the epidemic has been contained and stopped. But in Sierra Leone, Liberia and Guinea –the battle is far from over. The number of deaths and confirmed infections increase dramatically in these three countries every day.
Daniel Epstein, a spokesman for the World Health Organization, said the situation is dire.
“Ebola is one of the most serious humanitarian crises in the world today. Our WHO staff on the ground are overwhelmed,” said Epstein. “The Ebola Treatment Units, clinics and hospitals fill up right away with patients. There are literally patients dying outside the gates. We need more community care.”
One of the worst side effects of Ebola is that people affected by other treatable diseases – like malaria, diarrhea or even normal situations of women going into labor – have nowhere to go because health care facilities in these countries are trying to deal with Ebola.
Catholic Relief Services has been on the ground in West Africa for 50 years. They run operations in Sierra Leone, Guinea, Senegal, Nigeria and Liberia. CRS had been running malaria prevention programs in Sierra Leone and Guinea.
“In Guinea, Ebola has had a hugely negative impact,” said Dorothy Madison-Seck, regional officer for CRS in West Africa. “So CRS is now working on an Ebola response. Our regular malaria-prevention activities have been halted. The funds for malaria were reprogrammed to Ebola.”
CRS has committed $1.6 million to an emergency response to the Ebola outbreak. They are focusing on a public education campaign through partners in the Catholic Church, religious leaders and ministries of health in all three countries. Right now, CRS staff is using the airwaves to educate, as well as a door-to-door campaign which hands out flyers and fact sheets.
“We talk about how Ebola is transmitted and how you take care of yourself,” said Madison-Seck.
One of the biggest changes in the region, noted Madison-Seck, concerns the human touch.
“Human touch is very important to Africans. They are very affectionate people. Cultural norms have now changed. People are not shaking hands or kissing anymore,” she said.
When Dr. Timothy Flanigan arrived in Liberia to deal with the Ebola virus as an infectious disease specialist from Brown University, he knew what to expect on some level. He knew about how the disease was transmitted, and he knew how to keep himself safe.
However, this is the first time that Ebola has ever become an epidemic in a large, urban setting.
“No one has ever seen this before. In that sense, it’s new for everyone,” said Dr. Flanigan.
When the Ebola virus struck Liberia, many of the country’s few hospitals closed down. Liberia, Sierra Leone and Guinea already had one of the poorest health care infrastructures of anywhere in Africa, with the lowest amount of doctors per population.
Dr. Flanigan, who is a Catholic deacon, is now working with Liberia’s Catholic health care system, training local health care workers on how to care for Ebola patients. He is also teaching them about protective personal gear – gloves and masks. “We just had containers arrive with supplies. Some of these were donated by my parishioners from St. Theresa and St. Christopher parishes in Tiverton, Rhode Island,” he said.
As a doctor, Flanigan is seeing heroic courage every day.
“I am so moved by the health care workers here. They are fearful, yet they are committed to keeping their centers open. It’s humbling because these people are making very little money,” said Flanigan.
Dr. Flanigan also notes the losses to the local Catholic Church, especially the Brothers of St. John of God and the missionary Sisters of the Immaculate Conception who were working at St. Joseph’s Catholic Hospital in Monrovia. Four of the brothers recently died from Ebola, as did one of the sisters.
“The pain and sacrifice of the Brothers of St. John of God is overwhelming. They were willing to be present. This is not unlike the Church being present in the Middle Ages with the plague in Europe, or St. Damian to the lepers in Molokai. It’s the presence of Christ to those most in need, even when there is risk,” said Dr. Flanigan.
The positive stories coming out of Liberia are few, but they represent a start against a massive, heart-breaking situation.
Levine said he helped set up an Ebola Treatment Unit, the first ETU built by International Medical Corps in Bong County, Liberia. During the weeks it was being built, Levine said he slept less than he had ever slept in his life. “We had a number of patients who died, but we also had a number of patients who pulled through. So it was not completely depressing,” he said.
Dr. Flanigan is staying for two months in and around Monrovia.
“In some communities, Ebola appears to be decreasing. People are drawing a circle around their house when someone has it. Others are providing them with food and care,” said Dr. Flanigan.
He noted how important religious faith can be at a moment like this. “Liberians have a very strong faith and prayer life. It is something very concrete. Before we train, we always stop to pray together. We ask our Lord to be with us, to help people dealing with this tragedy, the pain and suffering.”
One of the worst things about Ebola is that people stop touching patients. “You feel totally abandoned. You feel that the Lord has abandoned you, but he never does. We have been training the locals to touch patients with protective gear on – but also to be supportive emotionally, to smile with their eyes.”
There does not seem to be enough health care workers, supplies, and protocols to deal with the situation on the ground in Liberia, Sierra Leone and Guinea. Everything is an open question.
All that doctors and health care workers hope for is trying to save one life at a time.
Sabrina Arena Ferrisi is senior staff writer for Legatus magazine.
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