TIME ebola

American Patient With Ebola Has Condition Upgraded

The patient is now in serious, rather than critical, condition

The American patient being treated for Ebola is improving, according to the National Institutes of Health (NIH).

The NIH announced on Thursday that the patient has had her condition upgraded from critical to serious. The patient, who was working to combat Ebola in Sierra Leone, arrived at the NIH in Bethesda, Md. on March 13 for treatment.

The patient is one of 17 volunteers for Partners in Health who were brought to the United States for precautionary monitoring. The NIH has not released any further details about the patient.

The American patient is the second to be treated by the NIH for Ebola. The team also treated Dallas nurse Nina Pham who was infected after treating Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States.

The current Ebola outbreak reached one year this week. So far 24,927 people have been infected and 10,338 people have died from the disease.

TIME ebola

The Red Cross: ‘Ebola Started In Silence and Will End With Our Words’

Leaders of the Red Cross reflect on the year of Ebola

A year ago, the World Health Organization (WHO) confirmed the mysterious disease that had earlier swept through the tiny village of Meliandou, in Guinea’s southern forested region, had been identified as a “rapidly evolving outbreak” of Ebola, affecting several districts of the country and its capital, Conakry.

Suspected cases were also being investigated in border areas of neighboring Liberia and Sierra Leone.

Ebola had started to become an emergency.

Last month, our thoughts turned to another place in Guinea: the town of Forécariah at the other end of the country, in the west. Two Red Cross volunteers had been attacked there while attempting to provide “safe and dignified burials.”

Probably the single most-important factor in driving down cases over the past year has been a reduction in unsafe burial practices in which the still-contagious bodies of the deceased are handled by bereaved relatives. Unsafe practices still continue, however, in many places.

In Guinea, Red Cross personnel have faced an average of ten verbal or physical assaults a month; Liberia and Sierra Leone have also reported some form of “refusal to comply” with public-health measures.

Our words, our actions

In the Ebola hotspot of Kono, Sierra Leone, and according to local data, many communities still prefer traditional funerals to safer alternatives.

Most medical equipment we need to stop the outbreak is now in place, and yet new cases are still occurring, particularly in Guinea and Sierra Leone.

We need more than just medical hardware to get to zero cases. Now our words must pave the way to the last mile.

Words to break the stigma against healthcare workers and survivors, words to educate communities on prevention, words of solidarity from all over the world to say to affected people and communities: We won’t let you down, and together we can end Ebola.

We are trying to change behaviors and practices, and learning along the way that the transmission of knowledge is not enough.

Let’s use the power of words to repair misconceptions, promote dialogue, heal, reconcile and engage to overcome resistance, facilitate behavioural change, and ultimately get us to zero new cases.

Let’s do it fast: the rainy season will soon be upon us, and some areas could become very difficult to access. There is still work to do, and time is of the essence.

Adapting our response

We will not just treat our way out of this disease.

In Liberia, most people – local data suggests as many as 70 percent – believe all that’s required to ward off Ebola is to refrain from eating bush meat, rather than avoiding contact with the bodily fluids of patients.

In one district surveyed by the Red Cross in Sierra Leone, 90 percent believed this, although nationwide there has been a significant increase in safe burials.

It’s easy to imagine how health-workers in full protective garb, looking like creatures from a nightmare, spraying homes with foul-smelling chlorine, might appear to isolated villagers.

There has also been miscommunication. The black body bags our volunteers and staff were using in some communities were rejected by bereaved people for whom tradition dictates that bodies should be wrapped in white, signifying respect – a vitally important word in the context of funeral rites.

We may not have listened quite as carefully to local people as we should have at the beginning. The black bags were replaced with white ones.

Walking the right path

On the Ebola response overall, the road is forking. Down one path – characterized by sustained international solidarity and yet further heroism by local volunteers and health workers – lie zero cases, stronger health systems, and eventual recovery from the wounds Ebola has inflicted on human societies.

But if complacency or fatigue marks the other path, we may find ourselves dealing with a silent disaster that will threaten the gains already made as well as recovery.

We in the Red Cross Red Crescent warn that complacency is the enemy; but we believe we are not helpless in the face of Ebola. Our words and our actions will make a difference. They will pave the last mile back to trust and resilience.

Elhadj As Sy is Secretary General of the International Federation of Red Cross and Red Crescent Societies, responding to Ebola in 16 African nations; Yves Daccord is General Director of the International Committee of the Red Cross, which has long been present in the region, particular Liberia and Guinea, due to past conflicts.

TIME ebola

Ebola Vaccine Trial Starts in Guinea

A health worker prepares a vaccination on March 10, 2015 at a health center in Conakry during the first clinical trials of the VSV-EBOV vaccine against the Ebola virus.
CELLOU BINANI Cellou Binani—AFP/Getty A health worker prepares a vaccination on March 10, 2015 at a health center in Conakry during the first clinical trials of the VSV-EBOV vaccine against the Ebola virus.

10,000 people will be vaccinated

An efficacy trial for an Ebola vaccine launched in Guinea on Wednesday.

The vaccine, VSV-EBOV, was developed by the Public Health Agency of Canada and has already shown positive results in smaller safety trials. NewLink Genetics and Merck are collaborating on the vaccine, and the Guinean government and World Health Organization (WHO) are leading the trial, which is taking place in Basse-Guinée, a community where many Ebola cases spread.

MORE: 14 Emotional Dispatches From Key Ebola Fighters

The trial is using what’s called a “ring vaccination” strategy, which means that when a person is infected with Ebola, a group, or ring, of their contacts will be vaccinated. Some of the contacts will be vaccinated immediately, and some will be vaccinated three weeks later. The format was chosen so that everyone could get the vaccine, instead of giving some people a placebo. The hope is that the people who are vaccinated will create a “ring of immunity” from the virus, which could prevent its spread. Similar strategies have been used for smallpox, according to the WHO.

The trial plans to vaccinate 10,000 people in 190 rings in the next six to eight weeks, and all of those vaccinated will be followed for three months. The trial is voluntary, and researchers estimate that results may be available in July.

“We are committed to ending this epidemic,” said Dr. Sakoba Keita, the national coordinator of the Ebola fight in Guinea, in a statement. “Combined with control measures that we are putting in place with our partners, a safe and effective vaccine will allow us to close this trying chapter and start rebuilding our country.”

A total of 3,429 people have been infected with Ebola in Guinea, and 2,263 have died. The country recently experienced an uptick in cases.

TIME public health

What Ebola Taught the World One Year Later

On March 5, Liberian physicians discharged Beatrice Yardolo, an English teacher, from the hospital, hoping that she would be their last Ebola patient. Unfortunately, last Friday another person in Liberia tested positive for the disease that has killed more than 10,000 people in West Africa.

The bad news was a reminder that the world must remain vigilant and insist that we get to zero Ebola cases everywhere. We also must support Guinea, Liberia, and Sierra Leone in their efforts to build back better health care systems to prevent the next epidemic.

Beatrice survived Ebola but she and the other survivors have paid dearly because of the outbreak. She lost three of her 10 children to Ebola, her home was encircled in quarantine, and she’s been unable to work. She and her country face a daunting road back to recovery and they remain at risk of Ebola as long as there is a single case in the region.

It didn’t have to be this way. The first global alert on the Ebola outbreak came one year ago, when its spread was still relatively limited to forested areas in southeastern Guinea. Once we recognized the severity of the epidemic, the World Bank Group committed more than $500 million to the three governments to help finance their immediate response. Although we disbursed the money in record time, it started flowing about eight months after the outbreak began because we and the rest of the international community failed to react sooner.

The lessons from the Ebola outbreak are clear, and more to the point, they are not new. With every previous outbreak—SARS, Avian flu and others—the global community has committed to building better systems that would be capable of stopping the next epidemic. The political will to do so lasts a few months, but then we forget.

This time, we must not forget and we should turn each of the lessons below into a clear plan to finally build a pandemic response capacity that is equal to the challenge.

First, we must ensure that every country has a robust and resilient health system. This means a system that can deliver quality, essential health care and preventative services to everyone. Countries also need effective disease surveillance and diagnostic capabilities to rapidly identify, treat, and contain outbreaks. The Ebola crisis has made clear the significant economic downsides of failing to invest adequately in the health sector: These three countries have lost at least $1.6 billion in income.

Second, communities must be empowered to serve as the front line for disease prevention and response. We know, for example, that a major driver of this epidemic was unsafe burials. It was only when traditional and faith leaders led the messaging and response that aggrieved family members and communities embraced safe practices. The substantial investments that have been made during the response in community health workers and community mobilization efforts should now be strengthened.

Third, the Ebola crisis exposed the fragility of these countries. A health crisis became a development crisis. That’s why, for example, we are providing more than 10,000 tons of maize and rice seeds to more than 200,000 farmers across the three countries in time for the April planting season. We also know without investments in safe schools, roads, electricity and telecommunications, countries won’t be able to provide effective basic health services or contain the next outbreak.

Last but not least, the global health system is ill-equipped both in terms of outbreak preparedness and response. A speedy response can save thousands of lives and potentially trillions of dollars. To help do this, the World Bank Group is developing the concept of a global pandemic emergency facility.

Our goal is to work with partners to create a new financial instrument that can rapidly disburse a large amount of funds within eight hours, not eight months, of an outbreak. We need strong technical coordination led by a much bolstered World Health Organization; timely interventions involving corps of medical professionals, logistics experts, transport, pharmaceutical and communications companies; and financial support from public and private financial institutions.

If we had this in place, Ebola might never have reached Beatrice Yardolo’s village. Her health would have been strong, her job secure, and all of her children thriving. We must do better next time. We owe it to Beatrice and to the thousands of other Ebola survivors to stop the next epidemic in its tracks, before it robs nations of hope and opportunity. As an infectious disease physician and president of the World Bank Group, I promise to do everything in my power to support the building of a global pandemic response capacity that can protect people and the global economy. This time, all of us must insist that we don’t forget.

Jim Yong Kim, MD, PhD, is president of the World Bank Group. He is a co-founder of Partners in Health and formerly directed the World Health Organization’s HIV/AIDS department.

TIME ebola

14 Emotional Dispatches From Key Ebola Fighters

From U.S. lawmakers to responders to survivors, Ebola fighters share their deeply personal experiences on the one-year anniversary

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.

  • Iris Martor

    Iris Martor
    Jackie Nickerson for TIME

    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

    Bryan Schutmaat for TIME

    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

    Bryan Schutmaat for TIME

    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.”

  • Ella Watson-Stryker

    Jackie Nickerson for TIME

    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

    Bryan Schutmaat for TIME

    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.”

  • Nancy Writebol

    Nancy Writebol
    Rajah Bose—The New York Times/Redux

    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

    Bryan Schutmaat for TIME

    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.”

     

  • Kaci Hickox

    Kaci Hicox
    Bryan Schutmaat for TIME

    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.”

  • Anna Younker

    Anna Younker

    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.”

  • Amanda McClelland

    Amanda McClelland
    Tommy Trenchard—WHO Weekly

    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

    Anthony Fauci
    Alex Wong—Getty Images

    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

    Rick Sacra
    Stephan Savoia—AP

    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 [2015], 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.”

  • Katie Meyler

    Katie Meyler
    Jackie Nickerson for TIME

    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

    Clay Jenkins
    Chip Somodevilla—Getty Images

    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.”

TIME ebola

Ebola Continues to Punish Survivors One Year After Start of Outbreak

A woman mourns at the grave of her late brother at the National Cemetry on Disco Hill, Margibi County, Liberia, March 11, 2015.
Ahmed Jallanzo—EPA A woman mourns at the grave of her late brother at the National Cemetry on Disco Hill, Margibi County, Liberia, on March 11, 2015

Ebola has almost disappeared, but the suffering continues and little has been done to fix the health services that could not stop it

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.”

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.”

TIME ebola

Ebola Outbreak May End This Summer, Official Says

Over 10,000 people have died from Ebola

The Ebola outbreak that has claimed thousands of lives in West Africa could end by the summer, a top health official said.

“We have been running away from giving any specific date, but I am pretty sure myself that it will be gone by the summer,” Ismail Ould Cheikh Ahmed, the head of the United Nations Mission for Ebola Emergency Response, told the BBC.

While there are still confirmed cases of Ebola in the most affected countries—Liberia, Guinea, and Sierra Leone—the outbreak has been substantially declining over the last few months. The requirement for declaring a country “Ebola-free” is to reach 42 days with no new cases, and Guinea recently experienced an uptick in infections.

The widespread emergence of the outbreak is about to reach one year. To date, over 24,000 people have been infected with Ebola, and over 10,000 have died from the disease.

[BBC]

Read next: Slow International Response to Ebola Epidemic Cost Thousands of Lives: MSF

Listen to the most important stories of the day.

TIME ebola

Slow International Response to Ebola Epidemic Cost Thousands of Lives: MSF

A Doctors Without Borders (MSF), health worker in protective clothing carries a child suspected of having Ebola in the MSF treatment center on October 5, 2014 in Paynesville, Liberia.
John Moore—Getty Images A Doctors Without Borders (MSF), health worker in protective clothing carries a child suspected of having Ebola in the MSF treatment center on October 5, 2014 in Paynesville, Liberia.

Group says medical staff faced an “indescribable horror" after they were forced to turn away ill patients

Paris-based Doctors Without Borders (MSF) has slammed the international community’s slow response to the Ebola outbreak in West Africa, saying it cost thousands of lives that could otherwise have been saved.

The leading international medical charity released a report Monday coinciding with the one-year anniversary of the outbreak’s start. It said warnings that the disease’s spread was out of control were dismissed as alarmist and that early calls for help were ignored by local governments and the World Health Organization (WHO), reports Reuters.

“For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences,” said MSF’s general director Christopher Stokes in the report.

MSF dubbed the response a “global coalition for inaction.”

The Ebola epidemic has killed more than 10,200 people over the past year, most of those deaths were in the three worst affected West African countries of Guinea, Liberia and Sierra Leone.

MSF first declared there was an Ebola outbreak at the end of March last year but this was rejected by the WHO. Three months later the body officially confirmed the outbreak.

The governments of Guinea and Sierra Leone also downplayed the epidemic, according to the report, and Sierra Leone withheld crucial data that prevented MSF from identifying affected villages.

“The Ministry of Health and the partners of Kenema hospital [outside the capital Freetown] refused to share data or lists of contacts with us, so we were working in the dark while cases kept coming in,” said MSF’s emergency coordinator in Sierra Leone, Anja Wolz.

By the end of August, medical centers were overwhelmed and health workers were forced to turn away infected patients.

“We had to make horrendous decisions about who we could let into the center,” said MSF coordinator Rosa Crestani. “We could only offer very basic palliative care and there were so many patients and so few staff that the staff had on average only one minute per patient. It was an indescribable horror.”

Numbers of Ebola cases are falling but MSF say the outbreak isn’t over yet. Liberia recorded its first new case in more than two weeks on Friday, Sierra Leone launched a national lock down over the weekend and cases in Guinea are rising again after a dip earlier in the year.

TIME public health

Scathing Report Calls Lab Safety at CDC ‘Insufficient’

The Centers for Disease Control Buildings in Atlanta on June 20, 2014.
Tami Chappell – Reuters The Centers for Disease Control Buildings in Atlanta on June 20, 2014.

A new public report from outside experts assessing laboratory safety at the U.S. Centers for Disease Control and Prevention (CDC) comes down severely on the government agency.

In 2014 and early 2015, the CDC was the site of a series of mishaps, from a lab technician the agency thought was potentially exposed to live Ebola virus through an accidental tube swap to the possible release of anthrax. In response, the agency formed an external laboratory safety workgroup to assess the CDC’s internal protocols and provide advice and recommendations. The CDC just publically posted the report, which describes the CDC’s commitment to safety as “inconsistent and insufficient at multiple levels,” to its website.

“Safety is not integrated into strategic planning and is not currently part of the CDC culture, enterprise-wide,” the report says. “Interviews and surveys demonstrated that many employees neither understand the agency’s response to accidents nor how that information is communicated to the larger agency community outside immediately affected labs.”

The authors write that “disturbingly” many of these responses were among people who work in the CDC’s highest biosafety level labs. “Laboratory safety training is inadequate,” the report authors write, adding that across the CDC, workers say they fear negative repercussions for reporting instances where there may have been an exposure to hazardous material. Staff at the CDC view the Environment, Safety, and Health Compliance Office (ESHCO)—the office meant to protect CDC workers and create a safe working environment—as having “inadequate expertise” in lab safety, the report says.

The report makes recommendations, like “staffing [ESHCO] with scientists with professional qualifications in research and/or laboratory safety” and establishing consistent safety practices across the agency.

“CDC concurs with these recommendations, has made progress towards implementing them, and will soon report on that progress,” the CDC says in a statement on its website. “CDC’s aim is to improve the culture of laboratory safety across the agency and minimize the risks associated with laboratory work.”

“It should be noted that although the [workgroup] presented its findings to the full committee in January, it began its review of CDC’s laboratories last August and did the bulk of its assessment at CDC in August and September,” CDC spokesman Tom Skinner told TIME. “So the said report reflects observations of the workgroup made several months ago.”

Skinner the CDC has made progress, and is implementing actions to “address the root causes of recent incidents and to provide redundant safeguards across the agency.” Some of these changes include establishing new positions for lab safety oversight and implementing new training procedures and safety protocols.

TIME ebola

U.N. Health Agency Resisted Calling Ebola an Emergency

The World Health Organization (WHO) headquarters building in Geneva, Switzerland on Wednesday, March 11, 2015 .
Raphael Satter — AP The World Health Organization (WHO) headquarters building in Geneva, Switzerland on Wednesday, March 11, 2015 .

Internal documents reveal top WHO officials stalled on calling Ebola an emergency

Top officials at the World Health Organization (WHO) dragged their feet in declaring the Ebola outbreak an emergency, according to a report by the Associated Press.

Internal documents from the U.N’s health agency revealed that officials at its Geneva headquarters were aware of how serious the Ebola outbreak was, but continued to put off calling it an emergency due to a number of concerns, including the effect on the economies of the affected countries, and the impact on the annual Muslim pilgrimage to Mecca.

By the time the WHO did call the outbreak an emergency nearly 1,000 people had already died, the AP reports. The WHO is the only group that can declare a health emergency of international concern.

Declaring the epidemic an emergency might have spurred international attention and resources much earlier, possibly saving lives. In an emailed comment to the Associated Press, the WHO said: “People often confuse the declaration of a Public Health Emergency of International Concern with our operational response. It is very different. WHO mounted a strong operational response a year ago when we were notified the outbreak was Ebola.”

Read the entire report at the Associated Press.

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