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

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

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TIME public health

WHO Urges Mass Measles Vaccinations in Ebola Regions

Guinea Ebola Vaccine
Youssouf Bah—AP A health worker, right, cleans a man's arm before injecting him with a Ebola vaccine in Conakry, Guinea, March 7, 2015.

The risk for diseases like measles has risen amid Ebola

The World Health Organization (WHO) is urging mass vaccination for preventable diseases like measles and whooping cough in Ebola-affected countries.

The organization says the risk for additional outbreaks is high due to interrupted immunization practices in the area. The agency is calling for an “intensification” in routine vaccinations, and a measles vaccination push in countries that no longer have Ebola cases.

In Guinea, Sierra Leone and Liberia resources and personnel shifted away from usual immunizations to tackling the Ebola outbreak which has infected more than 24,700 people and killed more than 10,190.

MORE: Why West Africa Might Soon Have 100,000 More Measles Cases

“Any disruption of immunization services, even for short periods, will result in an increase in the number of susceptible individuals, and will increase the likelihood of vaccine-preventable disease outbreaks,” the WHO said in a recent letter to officials in susceptible West African countries.

The announcement comes after researchers at Johns Hopkins Bloomberg School of Public Health published a study earlier in March in the journal Science predicting that there could be an outbreak of up to 100,000 measles cases over the next 18 months in Ebola-affected areas if nothing is done to amend disrupted vaccine programs.

“When there’s a disruption of medical services, measles is always one of the first ones in the door,” study author Justin Lessler told TIME.

Liberia, Guinea, and Sierra Leone are rolling out immunizations for several preventable diseases in regions of the countries that are Ebola-free. Liberia and Guinea have targeted children under the age of five for measles vaccinations since they are at a high risk for infection.

Read more about the risk for measles amid Ebola here.

TIME ebola

Ebola Cases Surge in Guinea, as Liberia and Sierra Leone Show Progress

Members of the Guinean Red Cross move the body of a person who died from the Ebola virus on March 8, 2015 at the Donka hospital in Conakry.
Cellou Binani—AFP/Getty Images Members of the Guinean Red Cross move the body of a person who died from the Ebola virus on March 8, 2015 at the Donka hospital in Conakry.

As long as Ebola remains in one of the West African countries at the center of the epidemic the whole region remains at risk

Even though the latest Ebola epidemic first surfaced in Guinea more than a year ago, the tiny West African nation has been largely spared the catastrophic escalations in case counts experienced by neighbors Liberia and Sierra Leone. At the peak of the crisis, Liberia was reporting 442 new cases a week, with corpses filling hospital morgues and rotting on street corners. Now, nearly two weeks after Liberia’s last known Ebola patient was declared free from the disease, Guinea has reached its own grim milestone, with 95 new cases in the week ending March 15, the highest weekly tally of new cases so far this year according to the World Health Organization [WHO]. Sierra Leone, meanwhile, is seeing some success, reporting 55 new confirmed cases last week in its lowest weekly total since June, when the epidemic first started to spin out of control.

Even though Guinea’s reported caseload was down from that country’s peak of 156 at the end of December, it still represents a near doubling of infections, from 58, in the span of one week. That’s a troubling sign for the region as a whole, particularly as WHO noted with concern that the chain of transmission in Guinea is happening largely out of sight of health workers who can monitor and isolate the contacts of infected people, a process that helps stop the spread. Another cause for concern is that most of the infections in both Guinea and Sierra Leone have occurred along a narrow, well-trafficked corridor along the two countries’ shared border. “The population is highly mobile, with a great deal of movement throughout surrounding districts and countries,” says the weekly situation report. “Limiting the movements of cases and contacts is challenging but essential to prevent the seeding of new outbreaks.”

Thursday marks the 13th day since the last patient tested positive for Ebola in Liberia; but the WHO requires 42 days — twice the maximum incubation period for the highly infectious disease — before it can be declared Ebola-free. Even then Liberia can hardly afford to relax if its neighbors still harbor the disease. Ebola spread in Guinea for four months before it crossed the border to Liberia, launching the epidemic that has so far claimed 10,194 lives.

TIME ebola

Lack of Ebola Cases Shifts Vaccine Trials Away From Liberia

A man walks past an ebola campaign banner with the new slogan "Ebola Must GO" in Monrovia, Liberia on Feb. 23, 2015.
Zoom Dosso—AFP/Getty Images A man walks past an ebola campaign banner with the new slogan "Ebola Must GO" in Monrovia, Liberia on Feb. 23, 2015.

Scientists are racing against the clock to create a vaccine before the outbreak is over

The National Institutes of Health (NIH) may relocate its clinical trials of Ebola vaccines to Guinea, since there are no longer enough Ebola cases in Liberia for a proper efficacy trial.

On Feb. 2, the NIH launched an initial safety trial for two vaccines to protect against Ebola in Liberia. The plan was to test 600 people for overall safety and then launch a second phase of the trial in 27,000 people to see whether or not the vaccine prevents infection with Ebola virus compared to a placebo.

The safety test was successfully completed the week of March 9—but around the same time, Liberia announced that it had released its last confirmed patient from its Ebola treatment centers. The West African country began the count to 42 days without new cases, at which point it can declare itself Ebola-free. That’s great news for ending the outbreak, but it poses a problem for Ebola vaccine trials.

Now that Ebola is not the risk it was to Liberia several months ago, the trial is unlikely to continue according to the original plan. “It doesn’t make sense to expand the study in Liberia when there are fortunately no new infections occurring,” says Dr. H. Clifford Lane, the deputy director for clinical research and special projects at the National Institute of Allergy and Infectious Diseases. “We need to be sure we enroll a population that is still at risk for Ebola virus infection so we can show the protective effect of either or both of the vaccines.”

Lane says the NIH is now in discussions with other countries, predominantly Guinea, to move the second part of the trial.

When asked if there is any fear that the trial could be cancelled due to lack of cases, Lane said, “I hope not.”

MORE: American Health Worker With Ebola Heading to U.S. for Treatment

Lane says the reason the NIH is concentrating more on Guinea than Sierra Leone—the country hardest hit by the outbreak—is that there are already several large-scale vaccine trials unrolling in the country compared to Guinea. “I think the greater opportunity is [in Guinea] because there isn’t as much going on with vaccines,” he says.

“I hate to give a timeline, only because it never comes out that way, but we have to move quickly if we hope to get a result,” he says. “I actually hope the standard control measures will begin to show results in both of the countries that still have cases.”

One of vaccines being tested is developed by the NIH and pharmaceutical company GlaxoSmithKline (GSK), and the other vaccine comes from the pharmaceutical company Merck.

On Thursday, the World Health Organization (WHO) reported that deaths from Ebola in Liberia, Sierra Leone and Guinea have surpassed 10,000, and total cases number more than 24,500. The NIH also announced that an American healthcare worker who was volunteering in Sierra Leone tested positive for Ebola and arrived on Friday for treatment in the NIH’s specialized unit in Bethesda, Maryland.

TIME ebola

Ebola Deaths Top 10,000

A grave digger works in the U.S.-built cemetery for "safe burials" on Jan. 27, 2015 in Disco Hill, Liberia.
John Moore—Getty Images A grave digger works in the U.S.-built cemetery for "safe burials" on Jan. 27, 2015 in Disco Hill, Liberia.

The number of new cases is declining

More than 10,000 people have died from Ebola in West Africa, according to new numbers released Thursday.

The World Health Organization found that 10,004 people have died from the disease in Sierra Leone, Liberia, and Guinea. So far, more than 24,350 people have been infected.

Cases of Ebola have slowed overall, and Liberia recently reported the country has no confirmed Ebola patients in its treatment centers. However, the outbreak still has not been declared over in any of the three most affected countries. Sierra Leone, the hardest hit country, experienced a small outbreakof the disease in February among a community of fishermen. The country has reported 11,677 cases so far.

MORE TIME Person of the Year: Ebola Fighters

Vaccine trials for Ebola are still underway in West Africa, and researchers are still awaiting data on their effectiveness. Medical aid groups like Doctors Without Borders/Médecins Sans Frontières have warned the international community not to get complacent even amid encouraging declines in new cases.

“From the outset, this outbreak has been characterized by its unpredictability and geographic spread,” the group told TIME earlier this month. “Practical collaboration between surveillance teams based in each country need to be implemented as soon as possible to avoid importing new cases into areas considered Ebola-free.”

Read next: Why West Africa Might Soon Have 100,000 More Measles Cases

Listen to the most important stories of the day.

TIME

Liberia Releases Its Last Ebola Patient (For Now)

Liberia  Ebola West Africa
Abbas Dulleh_AP Ebola patient Beatrice Yardolo surrounded by Chinese military health workers as she leaves the Chinese Ebola treatment center were she was treated for the Ebola virus infection outskirts of Monrovia, Liberia on March 5, 2015.

But don't hold your breath

Liberia released it’s last confirmed Ebola patient on Thursday.

According to the Associated Press, the patient was a 58-year old English teacher named Beatrice Yardolo who was undergoing treatment at a Chinese-run Ebola center in the capital of Monrovia.

The World Health Organization (WHO) confirmed with TIME that the country currently does not have any confirmed patients in its Ebola treatment centers. Starting Thursday, Liberia can begin its count to 42 days of no new cases—two times the typical incubation period for the virus. At that point, Liberia can be declared Ebola-free.

However, the situation is still fragile, according to the medical aid group Doctors Without Borders/Médecins Sans Frontières (MSF). Though MSF is not treating any confirmed patients in its Liberian Ebola treatment center, they still accept suspected cases. It’s quite possible that a person with suspected and later confirmed Ebola comes into their facility at any point.

“This is an encouraging sign for Liberia. However, there is no room for complacency as the overall number of new Ebola cases in [West Africa] has risen this week,” MSF said in a statement sent to TIME. “From the outset, this outbreak has been characterized by its unpredictability and geographic spread. People move easily over the porous borders that separate Guinea, Liberia and Sierra Leone, so until 42 days pass without a new case in any of the three worst-affected countries we need to remain vigilant.”

MSF says serious gaps still persist in the response to the outbreak: “Significant improvements need to be made in contact tracing and surveillance, and we still need to improve regional coordination. Practical collaboration between surveillance teams based in each country need to be implemented as soon as possible to avoid importing new cases into areas considered Ebola-free.”

So far a total of 23,983 cases of Ebola have been reported in Liberia, Sierra Leone and Guinea, including 9,823 deaths. The WHO announced Thursday that Guinea will be launching a large efficacy trial for an Ebola vaccine.

TIME ebola

Liberia’s Children Go Back to School but Ebola Is Not Over Yet

Students stand in line before heading to their classrooms at Don Bosco High School in the Liberian capital Monrovia on Feb. 16, 2015.
Zoom Dosso—AFP/Getty Images Students stand in line before heading to their classrooms at Don Bosco High School in the Liberian capital, Monrovia, on Feb. 16, 2015

All across Liberia, streets are filled with the excited laughter of children returning to school after a six-month hiatus. The children, decked in the smart cotton uniforms of both public and private schools, line up in front of their classrooms to wash their hands in chlorine solution and wait to get their temperatures read by teachers wielding infrared thermometer guns.

Once inside they will pick up lessons abandoned in August, when an Ebola epidemic cut a swath through the country, infecting nearly 9,000 and killing at least 3,826. “The Ebola outbreak has had a devastating effect on our health and education systems and our way of life in Liberia,” Liberia’s Minister of Education Etmonia Tarpeh said in a statement. “We have managed to beat back the spread of the virus through collective efforts. Reopening and getting our children back to school is an important aspect of ensuring children’s education is not further interrupted.”

Ebola taught the nation to fear contact, to avoid unnecessary gatherings and to distrust a government and an international community that seemed both unwilling and unable to bring the crisis to an end. But with the start of school — deemed safe by the Ministry of Education, even though the virus has not been completely eradicated from the country — Liberians are regaining a sense of normalcy and can allow themselves to hope for a time when Ebola is little more than a bad memory. “It’s a good sign,” says school nurse Iris Martor. “We can’t let down our guard, but we can start thinking about the future again.”

Not all schools have opened. Some have yet to receive basic sanitation kits from the government and the U.N. Children’s Fund, and others are still being cleaned up and disinfected after having served as holding centers for the ill. Some, like Martor’s More Than Me Academy, which serves underprivileged girls from Monrovia’s West Point slum, won’t open their doors until March 2.

Schools have already reopened in neighboring Guinea, where the outbreak started in late 2013, and are expected to open in Sierra Leone, which has seen the highest number of infections, at the end of March. Of the three most affected countries, Liberia has recovered the quickest. It has seen just a handful of new cases every week since January, compared with an increase from 39 to 65 new cases in Guinea and 76 new cases in Sierra Leone in the week ending Feb. 8, according to the World Health Organization (WHO). Still, it’s a dramatic decline compared with the hundreds of new cases every week during the peak of the epidemic in September and October.

On Monday, officials in the three countries announced that they had set a target of reducing the number of new cases to zero within 60 days. It is an achievable goal, but similar targets have been set in the past, only to be undermined by a sudden flare-up in unexpected areas.

Ebola, which kills nearly half its victims, is spread through contact with infected bodily fluids. Practices like the washing of the dead are deeply ingrained in West African society; all it takes is one improperly conducted funeral for a new chain of transmission to start, undermining weeks of work. The WHO, in its most recent assessment, noted that Guinea reported a total of 34 unsafe burials last week.

Elsewhere in the country, village mobs attacked health workers from the Red Cross and Doctors Without Borders, accusing them of bringing the virus. Sierra Leone was forced to quarantine a fishing community in the capital, Freetown, after the discovery of a cluster of five new cases. “We are very, very far from the end of the outbreak,” Iza Ciglenecki from Doctors Without Borders told reporters at a science conference in California on Saturday. For most illnesses, it is enough to get the number of cases down to a low rate for doctors to be satisfied they have an infectious disease under control. Not so for Ebola. Until the number of new cases stays at zero for 42 days — twice the maximum incubation period — no one can afford to let their guard down, not even the students washing their hands in chlorine in the schoolyard.

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