Every time Foday Gallah slings himself into the passenger seat of his ambulance, he gives a small prayer of thanks that he is still alive. Eight months ago the Monrovia-based ambulance supervisor caught Ebola from a patient as the virus rampaged through Liberia’s capital city. But even in the throes of agonizing joint pain that is characteristic of the deadly disease, he wanted nothing more than to be back in his ambulance again, helping his fellow Liberians. He got his wish. Speaking to TIME on his mobile phone as his ambulance makes its daily rounds — so far two women in labor and a man with severe breathing problems — he describes his recovery and plans for his upcoming wedding. Aside from increased eye sensitivity, a common Ebola-survivor complaint, “I’m doing just great, thanks be to God. But others, man, they aren’t doing so well.” And Gallah isn’t just talking about side effects.
On Sept. 26, 2014, the U.S. Centers for Disease Control and Prevention (CDC) released an alarming report that suggested that as many as 1.4 million Liberians and Sierra Leoneans could be infected with Ebola by January if adequate precautions were not taken. That worst-case scenario garnered international attention and galvanized local action, helping scale down the exponential spread of the disease over the course of several months. Now, one year since the declaration of what went on to become the largest outbreak of Ebola in history, the total number of confirmed cases in West Africa, or coming from West Africa, stands at 24,701, with more than 10,194 dead. Though those numbers continue to rise, it’s a far cry from how bad it could have been. Still, the impact of Ebola on the societies and the economies of the three West African nations most affected — Guinea, Sierra Leone and Liberia — has been devastating.
After a four-month convalescence, Gallah was able to get his job back with the ambulance service. Not all survivors were so lucky, he says. Most still struggle to find jobs, from friends at the clinic where he was treated, to Ebola patients he picked up and others he met through a newly formed survivors group. Many have been kicked out by landlords for failure to pay rent on time, or because fear of the disease is still strong in Liberia. But the worst, he says, are the Ebola orphans, the children who lost one or both parents to the disease and now must rely on extended family members for food, clothing, support and school fees. In a country where 84% of the population lives on less than $2 a day, an extra mouth to feed can be an insurmountable burden. The government has stepped in with foster care and orphanages, but that only helps the most extreme cases — children whose entire families have been wiped out. The others fall through the cracks. In his neighborhood alone Gallah knows of at least seven children who are now living with aunts, uncles and cousins who can barely get by. Many are survivors themselves. “It’s pathetic. These orphans are the worst side effect of Ebola, and no one is doing anything to help them.” Gallah, along with other members of his survivors group, now puts aside 100 Liberian dollars ($1) per month for an Ebola-orphans’ fund to help pay for school fees. If nothing is done soon to help in the aftermath of Ebola, he says, “worse than having Ebola will be the life of those who survived it.”
Iris Martor, a nurse and program director at the More Than Me Academy, a free school for disadvantaged girls in Monrovia that was forced to shut its doors when Ebola tore through Liberia’s capital city in August, wants to see the organization expand its mission to educate Ebola orphans. For the moment though, she wants to make sure that the national focus on eradicating Ebola doesn’t waver. At the peak of the epidemic, Martor helped organize a team of nurses to monitor health conditions in some of Monrovia’s most affected slums, and knows all too well how the virus can leap from person to person in crowded quarters. To this day she still cannot bring herself to hug or shake hands with friends. Her caution is warranted. After a hopeful three-week lull since the last reported case of Ebola in Liberia, the World Health Organization announced a new case on Friday. Noting that both of Liberia’s neighbors have seen worrying upticks in case counts, Martor says vigilance is a must. “As long as Guinea and Sierra Leone still have problems, Liberia will be at risk. Only when all three countries are free from Ebola can we put it all in the past. Only then can we really start thinking about the future.”
Inside the Ebola Crisis: The Images that Moved them Most
Pete Muller, Aug. 26, 2014. Sengema, Sierra Leone."The rain started shortly after a small team of Red Cross burial workers approached the body. The deceased man, reportedly in his mid-sixties, collapsed and died outside his remote home more than a day before the burial team arrived. Having received instructions from officials that bodies of Ebola victims are extremely contagious, his family members placed a sheet over his body, marked a cordon in the sand, and called the Red Cross. With approximately 20 burial workers serving all of Kailahun district, an area the size of Rhode Island and rife with Ebola, the team had a backlog of cases. His family endured the presence of his body, laying prone and exposed to the elements, for more than 24 hours. As the team removed the sheet, the stench of death filled the air. The white cloth around the man’s head was crimson with blood. As burial workers sprayed him with chlorine, family members erupted with emotion. I was moved imagining how I might respond if I were in the situation. To me, this picture represents the range of Ebola’s emotional impact. In the two women, we see the devastation and loss that the virus causes. In the faces of the men, we see a sense of despondence, disbelief and suspicion that also defines the response. It was a difficult but necessary picture to make."Pete Muller—Prime for the Washington PostKieran Kesner, Aug. 28, 2014. Monrovia, Liberia.
"This is a photograph of the first person I saw who had died from the Ebola virus in West Point, Monrovia. After the Liberian government mandated all schools be shut down in an attempt to stop the spread of the virus, the empty rooms of this school were converted into a temporary Ebola holding center. I entered the building alone and photographed the woman from a distance. I began to make my way closer to her, being careful to avoid the puddles of vomit and other pools of still liquid on the cement floor. Standing over her, I noticed the unbroken beads of sweat that remained on her face and realized the woman had only died a few hours before. I took a few steps back as a body removal team entered the room. Up until this point, to me, Ebola deaths seemed like statistics, but suddenly it had become real. I became enveloped in fear: fear of the invisible killer in the room, fear that I might have made a mistake, fear that I wouldn’t know for days whether or not I was sick, and fear that I would infect my family and loved ones. I desperately wanted to leave the room, to leave the country, to be home, but I couldn’t. I continued to photograph. I watched as the men burdened with the task of removing her body, clad all in angel white, lifted the woman from her mattress and placed her in a body bag on the floor. I photographed as they sprayed her one last time with disinfectant and zipped it shut."Kieran Kesner—The Wall Street JournalMohammed Elshamy, Aug. 25, 2014. Lango village, Kenema, Sierra Leone. "I arrived to Langtown village, Sierra Leone,with a team of volunteers from Kenema governmental hospital. They were there to bury Baindu-Koruma a female victim of the Ebola virus. Everyone was silent. She had been dead for two days, and everyone was terrified of going inside. As the volunteers left with the body, her husband, Idriss Koruma (who can be seen center) and relatives burst into tears. They had only realized then, it seemed, that she was gone.
The photo moved me because I felt helpless for the man – having a loved one laying on a bed but you can't say goodbye, as this is the least a human could do for one last time, but in a situation like this you can't because you'll probably get the virus and die as well."Mohammed Elshamy—Anadolu/Getty ImagesJohn Moore, Aug. 15, 2014. Monrovia, Liberia. "I arrived to Liberia the night before I entered the blue room. It was in a primary school, originally funded by USAID money, which had been closed due to the Ebola epidemic. The Liberian Ministry of Health had decided to open an Ebola observation ward there, and it was located in the West Point township of Liberia's capital of Monrovia. People were arriving to the school in ambulances and being brought in one by one. I photographed them as they made their way, weakly, into the dark building, which had neither electricity nor running water. The following day I returned to the school. I went back to the same blue room and, although the children had been moved to the classroom next door, new patients had arrived overnight. Two of them were now dead, lying on the floor, in pools of liquid. A third, a shirtless man named Ibrahim, sat near a column in the center of the room. Health workers asked him to try and move to another room, so they would be separated from the corpses lying nearby. I watched as Ibrahim struggled to rise. He got to his feet and began staggering towards the door. Just before he reached the threshold, he fell straight backwards, his head hitting hard on the concrete floor. His wife, Umu rushed into the room and stood over him, horrified, afraid to touch him, unsure what to do. A blank blackboard hung behind her on the wall."John Moore—Getty ImagesBenedicte Kurzen, September 2014."From early morning till late in the afternoon, we followed the Liberian Red Cross. They have a list of people who died and they go to their communities to collect the bodies. Every time the Red Cross workers do the same thing: they wear protective clothing, interview the family, spray the perimeter and the room, and the body. They carefully open the body bag, carry the body outside for pick up — sprayers and volunteers facing each other — and later remove their protective clothing as carefully as they can. Their work is measured, slow: any direct contact with the dead person's body can be dangerous. In this photo, it is all about the gesture. In this chlorinated, silent corridor, there is little else that can convey humanity besides this gesture. This is one human helping another."Benedicte Kurzen—NOORDominique Faget, Aug. 26, 2014. Bandor, near Monrovia, Liberia. "I went with a team from the Liberian Red Cross to Bandor from Monrovia to pick up five dead people who had been infected with the Ebola virus. After photographing the removal of three bodies, including a young pregnant woman, I followed the team to a small cottage house where we had heard the bodies of a dead couple were. Once there, one of the Red Cross team responsible for the removal of their bodies gestured to me, patting his heart — indicating that these people were still alive. I then approached and photographed this man lying silently in the doorway of his home. I wondered how many days this poor sick man, like hundreds of others, had been waiting alone?
Dominique Faget—AFPAhmed Jallanzo, Aug. 20, 2014. Monrovia, Liberia."Violence had broken out in the slum township of West Point as the government tried to quarantine tens of thousands of residents in order to stop the spread of the deadly Ebola virus. As I walked through the town to cover the reactions of residents towards security forces, I saw 15-year-old Shakie Kamara bleeding profusely, a pool of blood forming around him, with his right hand placed underneath his broken leg to keep it in balance. He was caught in clashes with police and had been shot. The ambulance service was somewhat slow to respond as he repeatedly cried for help. The tragic irony is that no one dared try to help for fear of contracting the Ebola virus from his blood and bodily fluids, as avoiding contact is one of the measures of preventing the disease from spreading.
Ahmed Jallanzo—EPATommy Trenchard, Aug. 20, 2014. Monrovia, Liberia.
"What's tragic about the case of 15-year-old Shackie Kamara is how needlessly he died. [He was shot in the legs during clashes with police]. Ebola didn't kill him, but the fear, panic and confusion it creates led to the circumstances in which he died. He is a symbol of what Ebola can do to a country or a community. The quarantine of West Point was heavily criticized and lifted shortly afterwards. It achieved little, and Ebola remains rife throughout the city. It is also telling that he died of a treatable wound. After health staff started getting ill and hospitals became seen as sites of infection, the whole health system collapsed. If you get sick or injured in Monrovia, there is simply nowhere to go."
Tommy Trenchard—NPRGlenna Gordon, Sept. 29, 2014. Monrovia, Liberia."Ebola is a disease that divides husband and wife, mother and child, doctor and patient. Health care workers in protective gear that look like space suits attend to patients. Men with chlorine spray-cans take away bodies. Families aren't given the chance to say goodbye to their loved ones. Because the virus is transmitted through touch, it overrides the basic human need for contact and connection. In this picture, health care workers hold hands and pray before doing the risky work of entering an Ebola isolation ward. They find a way to connect despite the layers of latex. No one wants to be alone when facing Ebola. I'm not a religious person. At times like this though, there's little to do but hold hands and pray for each other."
Glenna Gordon—The Wall Street JournalSylvain Cherkaoui, April 19, 2014. Gueckedou, Guinea."Doctors Without Borders sent me to Guekedou Forest in Guinea to cover the current Ebola crisis. After receiving an alert a team of doctors went to look for a woman who was exhibiting symptoms of the Ebola virus. When one doctor took her temperature, it was confirmed: she was infected and had to be admitted to the care center. After donning protective gear, I followed her into the field hospital and took this picture when health care workers told Finda that she had Ebola. What I did not know was that she had an extremely high viral concentration. The next morning, members of her family came to visit. Not long after, maybe minutes later, a nurse told me that Finda had died during the night. It happened so fast, I was shocked and deeply moved."
Following a call, an MSF team goes to consult Finda Marie Kamano, 33 years, she feels great weakness with vomiting and dysentery. With fever, and nose bleeds, what the symptoms are caused by the Ebola virus.
After giving her a little water to drink, the woman doctor must tell her that her test is positive to Ebola, Finda remains impassive, several members of his family have died during the last weeks.Sylvain Cherkaoui—Cosmos/Redux for MSF
For his part, Dr. Philip Zokonis Ireland has already started thinking about the future. Ireland contracted Ebola while working at Monrovia’s John F. Kennedy Medical Center in July. His recovery was long and difficult, plagued by anger, depression and what he thought at the time might be permanent nerve damage in his hands. Eventually his appetite, his optimism and his manual dexterity returned, and he says he is a better guitar player now than before Ebola. But the anger remains, he says by phone from J.F.K. Hospital, where he has returned to his old job as a clinician. “Most of my anger had to do with how Liberia’s health care delivery system let us down. So I have decided to use the rest of my life span to develop better health care in Liberia.” He has set himself an arduous task. With only 50 practicing doctors for a nation of 4 million, Liberia’s health care system was already among the worst in the world when Ebola struck, the result of deep poverty and devastating civil war. Ebola laid bare the dangers of physician shortages, a lack of equipment, funding inadequacies and poor communication between clinics, hospitals and the country’s Health Ministry. “We need help. And I am not talking a couple of million dollars here or there,” he says, citing the old proverb about teaching a man to fish. “We need help in the form of doctors and public-health experts who can teach us to have a better public-health system. We need medical schools, and labs. We need to convince our government that public health is the No. 1 priority.” Already he is noticing a worrying lack of government focus on strengthening the system. Ebola, he warns, will burn itself out eventually. “But if we don’t do anything significant to improve our health system, especially health education, it could come back. It might be Ebola, or it might even be worse.”
