What It’s Like Treating Ebola In Liberia

Until last Friday, I was in Monrovia, the capital of Liberia, and Grand Gedeh, in the southeast, with an organization called Last Mile Health. We were training Liberian healthcare workers on the basics of treating ebola: triage, patient management, how to set up isolation units.

When I got back to the U.S., the first thing I noticed was all the fear. There are people here who are afraid to see me. I don’t have a fever; I have zero chance of giving you ebola. It reminds me of the stuff you’d read about the early days of the HIV and AIDs crisis.

If someone like me did get ebola, in the United States or Europe, there’s a high chance we can support you through it with blood, IV fluids, electrolyte replacements. We know how to do it. We can even put you on a temporary kidney machine for dialysis. I believe Thomas Duncan, the man in Texas, just came too late. Otherwise, people have a good chance of surviving in Texas. That percentage is much smaller in Liberia.

That’s especially sad, because Liberia was a U.S. colony. Monrovia, the capital, is named after one of our presidents. The whole place feels Americanized; they say a Pledge of Allegiance that’s nearly the same as ours, with "Liberia" in place of "United States."

It’s sad that we didn’t go right away. It would be so much cheaper and so much easier to have built health systems in the first place, but Liberia is an African country with no resources we are interested in — so we didn't act, until it becomes this global thing and starts threatening our borders. This was preventable.

Into that void stepped Doctors Without Borders. They were great, there right at the beginning, and they’ve been expanding like crazy. But, they were so overstretched. You saw treatment units built for 100 serving 150 patients, more, and then you’re just asking for trouble. It increases the risk to your staff because, at some point, an accident happens.

The rest of the international response was painfully slow. The WHO and the international community was super slow in providing the funds to respond to the crisis. Training healthcare workers, providing equipment to be able to safely take care of the sick, all of these things came way too late.

One of the most important parts of the response is infection prevention — teaching Liberian health workers how to correctly put on and take off personal protective equipment, which is the whole suit and gown and gloves, and then hand-washing practices and all of that.

There’s still a huge amount of work to do. In Liberia, and this is just a personal opinion, but we are still not treating the sick. We don’t know how to cure the disease, but we do know how to support someone through their illness. People with ebola die of hypovolemic shock or septic shock because you have very low blood pressure, you’re vomiting or hemorrhaging everything up. This loss of fluids can eventually kill you.

In Liberia, we are taking the sick out of the community to a place where they can die. We’re not giving them IVs, only fluids by mouth — doing whatever we can to minimize risk. So, people are dying of dehydration.

We’re not offering any good solutions. If we tell someone “Okay, you’re sick, you need to go to the ebola treatment unit,” they know they’re going to die there. Why would you send your kid to die alone in the hospital when you could take care of him at home?

It’s easy to judge people who may have been exposed for not coming forward, for not leaving their community and going to the treatment centers. But, if you think about it on a human scale it makes more sense. We’re not providing them with any hope of getting out of the situation.

And, I think more largely, in Liberia, they have a different sense of their lives and mortality. We have one case of ebola, one person dies, and we freak out. Over there, it’s sad to say, but I think tragedy comes with a greater sense of inevitability. This is not Liberia’s first catastrophe — they’ve had two civil wars in the last 25 years — and their daily lives have been more impacted by early death.

A number of hospital workers have gotten infected. That’s troubling because no one is going to want to come and work — and then what do you do?

You always worry about your own safety a bit — and I think that’s good. It’s healthy to be cautious. This time, I was mostly training. When I return at the end of the month, I will be working directly with ebola patients in the treatment center, and my concern level will go up, of course. But, it’s good to be scared; it forces you to be careful.