It's been a full year since the Ebola virus first caught fire and medical groups started ringing the alarm that this was no ordinary outbreak. Now, with more than 24,800 people infected and more than 10,200 killed by the virus, the end might be in sight—though complacency is still the enemy. In December, TIME named Ebola Fighters the Person of the Year for their courage and sacrifice. Here's how they—and others affected by the outbreak—say their lives have changed a year after the epidemic began.
Nurse and program director at the More Than Me Academy, a school for disadvantaged girls in Monrovia, Liberia
"Some things are just part of my life now. For me, there is no more shaking hands, no more hugging. I am not comfortable touching people. I still have it always in the back of my mind: If it’s not Ebola, tomorrow it could be something else. So I try to wash my hands as much as possible, and avoid direct contact. If someone touches me I feel bad. I think that has changed a lot of people. I think many Liberians will phase out shaking hands—which is very good hygiene."
Dr. Tom Frieden
Director of the U.S. Centers for Disease Control and Prevention (CDC)
"The Ebola outbreak in West Africa was unprecedented: ten times more patients than all prior Ebola outbreaks combined, spread among multiple countries, in an area not previously known to have had Ebola, and with explosive spread in large urban areas. I’ve always been very impatient—but Ebola showed me that even working as fast as CDC possibly could wasn’t fast enough. Now we need to work as quickly as possible in as many countries as possible to strengthen disease tracking and control though better laboratories, more trained disease detectives, emergency operations centers, and rapid response capacity. That’s what protects the people in these countries and protects Americans. We need to strengthen the World Health Organization (WHO) and global networks for disease control to work with national governments, CDC and others. Together, we save lives. When time is critical, when so much is at stake, we work as a world community to deliver effective, efficient results that protect all of us.
Personally, I have an even deeper appreciation and respect for the scientists and public health professionals at CDC. More than 800 of our staff have gone on more than 1,500 missions, working more than 40,000 person-days in West Africa. In each country, they have been pivotal in helping organize the response, improve patient detection and care, trace contacts, find and stop chains of transmission, and communicate effectively with patients, health care workers, policy-makers, and the public.
There is no doubt in my mind that without CDC professionals, there would have been many thousands more cases and deaths, and the outbreak in Nigeria may well not have been controlled at all. Everywhere I travel, and every interaction I have with partner organizations and host countries, people speak with true awe about the expertise, intelligence, creativity, and dedication of CDC’s professionals.
It’s our mission—and our commitment—to put the health, safety and security of America first. The way CDC does this is three-fold: find outbreaks as soon as they occur, stop them quickly, and prevent outbreaks wherever possible. Long before the West African Ebola outbreak, CDC and other U.S. government agencies had been working to bolster health security worldwide. It was the weak surveillance and overburdened public health systems in West Africa which delayed recognition of the current outbreak.
When emergencies like this arise, it is in our interest to support other countries with resources, technical experts and cooperation. If we fail to do that, it reduces safety everywhere else—including the United States. What has changed as a result of Ebola is a new urgency not only to expand global health security in countries around the world but also to ensure that we protect America by building capacity for a rapid, massive worldwide response to match the scale of emergencies that arise."
Dr. Kent Brantly
Samaritan’s Purse Medical Missions advisor and Ebola survivor
"This Ebola epidemic has been one of the greatest international tragedies of my lifetime. We have seen over 24,000 people contract the disease with more than 10,000 deaths reported so far. We have witnessed the devastation of three of the poorest countries in the world, whose health care infrastructures were already inadequate. And if we are honest with ourselves, we must acknowledge that the world as a whole was late in intervening and coming to the aid of these nations.
But in the midst of this tragedy, I have seen some very encouraging things: international governments and non-governmental organizations joining together to relieve the suffering of those in the greatest of need; government agencies in our own country working together to do things that had never before been done; scientists from competing institutions sharing their knowledge in an act of collaboration for the good of mankind; commercial businesses putting the well-being of societies ahead of their profit margin. I have seen people showing regard for their neighbors on the other side of the street and on the other side of the world. I have seen a broader understanding of the idea that we do, indeed, live in a global community. And we have seen people on many levels choosing compassion over fear.
I will forever remember the names and faces and stories of the patients I cared for. There are many things I will never forget: the bravery of our hospital staff at ELWA who stepped up to care for the first patients in Monrovia; the work of Samaritan’s Purse to fill the gap when no one else could; the compassion and care of the friends and colleagues who tended to me when I fell ill; the great efforts by so many people and organizations to bring me home when I was sick; the courage of the team at Emory who volunteered to care for the first Ebola patient in America. I will remember my friend, Nancy [Writebol], who walked that difficult road with me. And I will remember how thousands, maybe millions, around the world prayed for me when I was sick.
My prayer is that 2015 would see the end of Ebola; that the world would not forget the people of West Africa; that this experience, rather than thickening the callouses of fear and indifference, would soften us to a sense of compassion for the vulnerable among us. My prayer is that I would live a compassionate, meaningful life worthy of the second chance I have been given. Life will never be the same."
Health promoter with Doctors Without Borders/Médecins Sans Frontières
"My life feels divided between the time before Ebola and the time after. Over the past year I’ve struggled with the heavy sadness of watching death after death but also felt the incredible joy of taking a person home when no one thought they could live. I’ve seen entire villages perish, but I’ve also seen communities come together to protect themselves.
Ebola taught me how to look a dying mother in the eyes and convince her to trust me with her not-yet sick baby. It taught me how to tell a man that the last of his family had died. It taught me how to prepare a grieving son to identify his dead mother’s partially decomposed body. It taught me how to wade wide-eyed into a terrified crowd and how to listen as they found their way to calm. Ebola taught me the overwhelming strength of fear and the enduring strength of love.
I learned what it is like to work with the bravest, strongest, most inspiring people in the world, knowing that they are equally terrified, exhausted, and heartbroken. I learned what is like to be unwelcome in my own country because of my job. I learned how fiercely my family and friends will protect me. I learned what it’s like to lose again and again but to keep on going. I learned to keep speaking out because people are dying in the silent spaces. I experienced the utter loneliness of trying to push back against denial and apathy, but eventually also the empowering sensation of my words being echoed by far more powerful people.
Ebola taught me what it’s like to run a marathon at a sprinter’s pace. It taught me to take a break before I am broken. It taught me not to say, 'This is the last one' because there’s always more work to do. Ebola taught me that it is possible to balance on a fine line between pragmatic despair and stubborn hope."
Dr. Bruce Ribner
Director of the Emory University Hospital Serious Communicable Diseases Unit
"The past year has taught me that you need to follow your convictions. For 13 years I advocated to keep this program alive in the face of increasing budget constraints and questions regarding the need for the unit. I did it because I truly believed that this kind of unit and program were necessary as an insurance policy for emergency preparedness. I am glad that Emory supported this view and we were ready when the need arose.
It has been humbling and at the same time gratifying to realize how our team, our program and Emory have been thrust into the international spotlight. It is a position that the team and I are not accustomed to, but it has given us an opportunity to help support the heroes who are putting their lives on the line every day in West Africa. By caring for those who became ill we have supported their efforts while contributing to our knowledge about how to best care for those infected with the Ebola virus in both resource-rich and resource-poor healthcare systems.
In addition, by helping to lead the efforts to promote infectious disease preparedness in the U.S. we are doing our part to help prevent a similar tragedy here in our own country."
SIM USA missionary, Ebola survivor
"This last year has taught me two things. Since I have passed through this experience, God has given me a unique point of identification and sympathy with those undergoing the same suffering and recovery as I have. Therefore, to take on the risk of returning to Liberia to serve the people there is right.
Second, I have a greater awareness of what is happening in the world, and this has enlarged my biblical and world view. This past year has challenged me in so many ways to enter into the lives of people who are in crisis, to passionately speak to the world and share the gospel of Jesus, to help in sounding a wake-up call and plea for help for West Africa, and to become part of the solution rather than one who walks in fear.
I have had the privilege of learning how to trust God with my life here on earth, and with my eternal life. I have found that He is completely trustworthy and faithful. I want to keep on trusting my Lord, Jesus, and to bring more glory to Him by helping others find Him. I am also very grateful for the privilege of being involved in plasma studies, and for the opportunity to donate plasma for research. I'm thankful my husband David has been able to participate in an Ebola vaccine study, too.
There is so much to be done and our desire is to be involved in any way that is possible."
Dr. Joanne Liu
International president of Doctors Without Borders/Médecins Sans Frontières
"We are still learning, because we are still in it. We’ve started our reflection, but we know that the reflection is not finished, it’s just the beginning.
We never thought the outbreak would unfold as it did. We never thought it would last so long. We never thought it would be such a huge step for us a medical humanitarian organization. As we’ve said so many times, this was unprecedented. We are still not sure when this will be brought to an end.
In August we were saying that we were stretched and couldn’t do more, but we actually increased our deployment by five fold. We scaled up our response. But despite that, we never matched the magnitude of the needs. This is why we called upon other actors to intervene. We called for more deployment and the response came, but not at the speed we wanted. We can't overstate how much community awareness and leadership is necessary to bring this epidemic to an end. We've realized we should have invested possibly even more. When we look at one year after, we are still facing places where there is a difficult acceptance of Ebola and response teams not being welcome. The community is key to bringing a response to Ebola.
Even when we are going to reach zero Ebola patients, it’s going to take us years to rebuild the economy and the health care system because we still haven’t resumed fully. We are focused on the response to Ebola, but we've learned we need to make sure we keep offering adequate health care access throughout this epidemic. Making sure basic emergency access is there. We are dealing with a health care system that is weakened. Almost 850 health care providers were infected. This will take years to rebuild.We have nations in a state of mourning, and there needs to be a long-term commitment to get West Africa back to where it was."
Nurse with Doctors Without Borders/Médecins Sans Frontières
"Responding to the Ebola outbreak in West Africa taught me first hand about the damage caused by stigmatization, discrimination, and racism. In Sierra Leone, my colleagues told me that they could not buy things at the market because people said to them, 'Your money probably has Ebola on it because you work in the Ebola Treatment Unit.' Ebola patients met similar discrimination, like the 8 year-old Ebola survivor who was not accepted back into his village upon discharge because of fear that he might still infect others. As a healthcare worker, I have often fought against discrimination for my patients.
Now, for the first time, I experienced stigma myself upon returning to the U.S. I felt the fear, frustration, sadness, anger, and isolation that discrimination causes. I was reminded of similar reactions to those with HIV/AIDS in the mid-80s. I found myself caught advocating for my rights and the rights of my fellow healthcare workers and patients in West Africa.
The slow response to this outbreak by the global community reminded me that racism still exists and must be fought at an institutional level. Racism is not only highlighted in the needless deaths of Michael Brown or Eric Garner, but in our lackluster response to the Ebola outbreak in West Africa that has caused over 10,000 deaths. American politicians proclaim the U.S. is a strong and caring nation but when people were desperately in need and begging for our help we responded with fear and ignorance. Are we going to continue allowing racism to win? Do black lives actually matter?
My deplorable homecoming and subsequent battle against unnecessary and unscientific quarantines has heightened my awareness of the need for individuals, experts, and communities to hold politicians and leaders in the U.S. accountable for their actions. I have a new appreciation for what it means to take a stand against those in power and face those using fear and discrimination to manipulate the public for their own gain.
Although I experienced many difficult days, I was proud to see the response and support by colleagues, public health leaders, and civil rights advocates. Finally, I will carry with me the lesson that stigmatization and political posturing can be overcome using the civil liberties afforded us by the constitution. A Maine judge ruled in my favor stating that in-home-quarantines were not necessary. We must continue to stand together and fight for what is right, for equality in healthcare, and to overcome fear and misinformation. Obliterating these obstacles is the only way we can beat Ebola and the next infectious disease we face as a global community."
Owner of Coming Attractions Bridal & Formal in Akron, Ohio
"The moment it became known that [Dallas nurse who was infected with and survived Ebola,] Amber Vinson, was in my bridal shop, two days before her Ebola diagnosis, my life was thrown into chaos. So much uncertainty about the Ebola virus caused extreme panic. I called the health department and the CDC. Both agencies assured me we were safe and not to worry. I believed them and figured everything would be fine since Amber did not show any symptoms when she was in my presence.
My staff and our families immediately were concerned, once it became public that Amber was in our store. Fears escalated in so many ways. Brides called wanting refunds for their merchandise that was already in-house. Most feared their dresses were “covered with Ebola.” If the bride didn’t have the fear, then her family, friends and relatives did. Brides who had bridesmaid orders also wanted a refund because they said they did not know what was going to happen with our business.
We realized we needed to do something to make our customers feel safe, so we brought in special equipment that hospitals use to kill bacteria and viruses. Once we did this we felt everyone should feel safe and we could reopen. That certainly wasn't the case. Phone calls of fears and concerns continued. We felt it was best to keep our store closed and stay quarantined for at least the 21 day period, so we did just that.
My husband and son were not quarantined; however, my son was not welcomed back to his school until the quarantine period was over because families were terrified. My husband was scrutinized by people when he was out. They feared that he could have potentially exposed them to the virus. After the quarantine period was over, my son was happy to return to school and we were excited to reopen our business.
What we didn’t expect was that the fear continued. Customers questioned if it really was safe to return to our store. Many continued to request refunds because they didn’t want to come back to our store. Some admitted they feared the uncertainty of our business being able to recover.
We had a big sale when we reopened. After the sale, the calls began. 'I can’t believe you are selling dresses that are covered with Ebola.' 'You need to take all those dresses and burn them in your parking lot.' 'Isn’t this the store where the man who had Ebola died?' Brides understood our dilemma. They told me they stopped telling people they bought their bridal gown from us because they are tired of hearing people say, 'You bought it from the Ebola store.'
Our revenues continued to drop. We were told by many that we needed to replace all of our merchandise, leave our building, relocate elsewhere and change the name of our business. Financially this was impossible to do. Our employees feared losing their jobs, but they knew business was bad when no customers were coming in. When we announced we were closing our store, we received an outpouring of support and kindness from the community. People we had never met started stopping in with a kind word or would drop off lunch for my staff. Unfortunately, kindness doesn't keep the business open.
The final blow came recently when our local bank, First Merit of Akron, Ohio, shut down our business line of credit and demanded payment in full within two weeks. We decided to refinance our home to pay this off, but the bank wouldn't wait. They seized the funds in both of our business and personal accounts for fear we would not fulfill our financial obligations. This came as a shock since we had never been late or missed a payment in the 20+ years we've had the business.
Our lives have been chaotic since this all took place, but we're trying to make the best of the situation."
Senior emergency health officer with the International Federation of Red Cross
"The last year has been challenging in every way. Besides the normal issues of being away from home in difficult circumstances, Ebola bought a whole new dimension and complexity to me personally and professionally. The lack of knowledge and understanding about Ebola at all levels—both internally and externally—as well as at the community level, meant that on top of planning and implementing a response to an ever-changing 'enemy' we were also fighting ignorance, fear and complacency. We needed to teach and explain the need for the response, the scale needed to be effective, the impact of the disease, and the need for a holistic and coordinated response. These needs extended from governments, donors and managers to medical personnel, communities and families.
The fear and stigma associated with the outbreak created unprecedented barriers to the response, and we know that speed saves lives. We don’t have to look back too far to see the effects of waiting to respond—for example, in the Horn of Africa famine that caused 260,000 deaths in just a few months. We promise never to make the same mistakes, but often we do.
As a practitioner—as a humanitarian—this takes its toll. You can see what’s coming and you know you have to do more. It is frustrating and disheartening. But the teaching, the discussions, the advocacy all pays off. The response kicks in and the support and the resources begin to have an impact.
Once the frustration passes, there is an overwhelming sense of pride. I had the privilege to stand alongside thousands of Red Cross volunteers battling the fear and the stigma and representing the very best of their communities.
When I was deployed to Sierra Leone, I asked 150 volunteers to work in an Ebola treatment centre. Health care workers had left their posts in fear. And you can see why: 33 had already died in the district. On the first day of training most of the volunteers looked frightened, and I had to ask them to do a job that experienced medics with decades of training would refuse to do. I promised them they would be safe. I promised them that if they followed the rules they would not only survive, but would be heroes. They stood up. They completed the training and provided care and support for more than 700 people. So many survived because of this work, and those that died received a safe and dignified burial from people who cared.
The dedication of these volunteers is what will always stay with me. Because of them and the communities they represent, we must ensure we are never surprised by an outbreak again. We must do better, anticipating and responding, not just to Ebola, but for cholera and polio and measles and malnutrition.
We can educate, advocate, prepare and be ready to respond based on what we know and what we can predict. We may not always be right, but I would rather see us swing into action early and be wrong than be late again."
Dr. Anthony Fauci
Director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH)
"As Director of NIAID at the NIH, I am responsible for guiding and supporting research on essentially all infectious diseases, even those rarely seen outside the developing world. I have long viewed Ebola as a serious threat and have supported research on treatments, vaccines, and better diagnostics. However, nothing could have prepared me for the unique and challenging experience of caring for Ebola patients personally.
Since the beginning of the Ebola crisis in West Africa, I have been directly involved in the daily high-level policy discussions on handling this global health threat and the scientific challenges of developing safe and effective treatments and vaccines.
At first, my contact with Ebola patients and care providers was indirect, mostly through the media and colleagues who had volunteered to assist with the effort in West Africa. That changed when the NIH was designated to provide care for evacuated American health care workers. The NIH has a state-of-the-art facility with teams of clinicians and other health care providers able to provide care at all hours of the day and night, with ready access to laboratory testing and supportive care such as intravenous fluids and electrolytes, ventilatory support and renal replacement therapy. These capabilities markedly improve prospects for survival. Yet our ongoing experience treating a critically ill patient who arrived on March 13 has reminded me that the virus can challenge even the most skilled intensive care unit.
It is difficult for me to adequately convey the extraordinary tension and high adrenaline level you feel when you and your team are applying all of your considerable resources to save the life of your critically ill patient, and at the same time realizing the potential cost of a simple mistake, a breach that could endanger yourself or the colleagues in the same room with you. Such tension is exhausting, necessitating frequent rotations in and out of the unit.
It is humbling to realize what it must be like to have a ward full of such patients, without the resources available to us at the NIH. In this regard, these clinical experiences with Ebola patients strongly reinforced something I knew already: the individuals in West Africa caring for infected patients under such difficult conditions possess extraordinary strength and courage. They are the selfless heroes of this epidemic."
Dr. Rick Sacra
SIM Missionary Physician at the ELWA Hospital in Liberia, and an assistant professor at the University of Massachusetts Medical School
"When I returned to Liberia in January , just a little over four months after I’d been evacuated in an air ambulance, I was impressed by the resilience of the Liberian people. They have carried on with life despite the devastating Ebola epidemic. As I met with some of my colleagues, those who cared for me and who have carried on the good work at our hospital, we were lamenting that even after over 24,000 cases of Ebola and over 10,000 deaths, we still don’t have good data about what treatments work.
In a fast-moving epidemic situation like this, the process of getting clinical trials designed, funded, approved, publicized and underway is too cumbersome. Three different trials—one drug trial, a trial of convalescent plasma and a vaccine trial—have been initiated in Liberia. However, because of delays in initiating the studies and because of the small number of Ebola cases now, the drug trial has been completely stopped. Those who are running the other two trials are considering a move to Sierra Leone or Guinea where there are more Ebola cases, but those moves will involve more reviews and more delays.
The ethics and standards of the randomized controlled trial have also been a sticking point—the idea of enrolling Ebola patients in a trial in which half of them are receiving a placebo has just not gone over well with physicians in West Africa. And let’s be honest: If we go back to where we were in the West not so long ago, the initial proof of effectiveness of vaccines and antibiotics was not carried out in rigorous placebo controlled double blind studies. The WHO should be given broader authority to negotiate in advance with developing countries about standards and guidelines so that when a trial is needed it can be initiated quickly.
While not letting up on our efforts to eradicate Ebola, we also need to turn our attention to the future and ask ourselves the question: What will prevent the next disease outbreak from becoming another humanitarian disaster? The fact is there were simply not enough doctors and nurses in these three countries to handle such an outbreak. The international aid community needs to support major expansion of medical education, nurses’ training and especially residency programs for both primary care and specialist physicians in Liberia, Guinea and Sierra Leone."
Founder of More Than Me, a school for vulnerable girls from the West Point slum in Monrovia
"There is not a day that goes by that I don't think about Charlie, age 8, or Sarah, age 10, who both were murdered by Ebola. There is no grave, ceremony, or memorial in their name so I want my life to be a memorial to them. To let their families and the world to know their little lives mattered and they are not forgotten.
After seeing how our world failed Sarah and Charlie and thousands of others I will never ever be the same person again and I'm glad. I am more confident. I'm bolder. I am more demanding that we can and must do more. It's embarrassing, devastating, and frankly not OK that the majority of people live in such a vulnerable state, especially considering the amount of resources and technology that are available.
I know for a fact that we cannot fix healthcare or any other problem in Liberia without at least basic education for all. More Than Me is on a mission to use our Academy to make sure that we play our part in rebuilding the education infrastructure in Liberia. It's not as sexy as Ebola, but it's a long hard road and nothing else will change until the world's most vulnerable have the basic tools necessary to fight for their own lives.
Other things I've learned:
1. I am who I thought I was. My whole life I thought I would die for what I believed in; during Ebola I proved to myself that I actually believed that. When I thought I had Ebola, that was it, I knew I did the right thing.
2. I am an expert. I don't have any big fancy degree from any fancy place but I know Liberian people. I am an expert at standing with them and fighting for them to be heard and for action to be taken immediately.
3. The organizations and people that the world looks up to as heroes were not. The real heroes were the unlikely. They were often unnamed and many of them died fighting for their families and their communities.
4. The number one reason that Ebola had the toll it did was because the lack of human capital. We cannot fix the healthcare system or any other system in Liberia until we first rebuild education. We don't have time to do this slowly. We have to leapfrog. Education injustice is an emergency in Liberia, and if not fixed, it poses a very large threat not only to Liberian people but to our world.
5. I feel like after five months on the front lines of the Ebola war zone I have an idea of what war is like and how 14 years of it devastated Liberia so badly.
6. Ebola was a major spotlight on what does and doesn't work in international aid—mostly on what doesn't work. I'm not a pessimist but I am honest, and thousands died because of bureaucracy, corruption and ego. I never ever want my organization to "grow" to become that in a zillion years. May we always reflect the heartbeat of the people.
7. I got addicted to working in an emergency. The amount of purpose and immediate results of saving lives was the best feeling in the world.
This hell on earth has changed me in ways I’m not even sure of. Somehow it made me stronger, less concerned about what others think, more focused on what matters. I think about the little girl I saw just dead on a bench, or Sarah, or her mother’s face when she found out her daughter was dead. Sometimes before I sleep I weep thinking about what a lonely inhumane death small Charlie had. It's sad and dark, but then I think about the survivors and all they have lost, but they have life. I have life. And I must use it to the max. I thank God for Esther, who survived, and the honor it is to know her and be a part of her future. When you knock her down, she gets stronger. Joy to the world for her and the rest of us who have beaten this demon."
Clay Lewis Jenkins
Dallas County Judge
"Ebola blessed our team and the Greater Dallas community in ways we are just beginning to and may never fully appreciate. For one, it brought us closer together and gave us a confidence that together we could overcome great challenges. The Ebola response reinforced the importance of treating others as we would want ourselves and our families treated."