The Ebola crisis that has made many want to flee West Africa has persuaded Derek Bangura to go back. “Since I’ve left Sierra Leone, I’ve not made that much contribution to its development,” says Bangura, a 46-year-old general physician who lives and works in London. He has not lived in his native Sierra Leone for 30 years. Now he is preparing to go to his native country for eight weeks, beginning in late December, to help combat the infectious disease that has killed at least 4,922 people. “I just felt that this is the time to make a difference,” he says.
As the Ebola crisis in West Africa continues to devastate entire communities across Liberia, Guinea and Sierra Leone, many expatriate health workers from the region have faced a complicated choice between continuing their lives in the West or returning home to help combat the disease and, in the process, risk contracting Ebola.
Public health experts, world leaders and aid organizations agree that more doctors on the front line is one of the only things that will help beat the epidemic in West Africa. “We need literally thousands and thousands of trained health workers who will need more training around Ebola to step up and volunteer,” said World Bank President Jim Yong Kim in Washington D.C. last week. The public health systems in the affected countries — including the staffing levels at hospitals and clinics — were woefully lacking even before the Ebola epidemic struck.
For decades the affected countries — like many nations in the developing world — had lost many of their doctors and nurses to the U.S. and Europe. Many trained or aspiring doctors and nurses — who may face low wages, poor working conditions and overwhelming workloads at home — are swayed by the promise of better facilities and higher salaries abroad. The result is that many African nations have an alarming shortage of qualified health care workers.
According to the Central Intelligence Agency’s figures, the number of doctors working in Liberia and Guinea before the outbreak of Ebola is one for every 100,000 citizens. Sierra Leone fares slightly better with two doctors for every 100,000 citizens. The U.S. has around 242 doctors for every 100,000 citizens.
In the best of circumstances, these nations’ health care systems are strained. The Ebola epidemic has all but broken them down completely. Stephen Kennedy, a Liberian doctor who did most of his training in the U.S. and returned home last year, tells TIME that Liberia’s “entire health care system has collapsed and people are dying from preventable diseases like malaria.”
For many Sierra Leonean, Liberian and Guinean health care workers living abroad, the epidemic has pulled them back to the places of their birth.
Abdullah Kiatamba heads the Minnesota African Task Force Against Ebola, which is organizing a contingent of Liberian-born doctors and nurses who want to volunteer in Liberia, Sierra Leone and Guinea. He says that more than 150 nurses and doctors have volunteered and hope to leave by the end of November. “If we are setting the example that we are afraid to go, why would someone want to risk their life for us when we are not willing?” says Kiatamba.
Bandura shares that sense of obligation but he also knows that not everyone feels the same way. “The people who once lived there have a kind of expertise,” he says. “I was trying to get more doctors of Sierra Leonean origin who would be handy because of their local knowledge and language — they would be ideal.” But for many of his fellow Sierra Leonean colleagues, the pull hasn’t been strong enough. “It’s all to do with the risk. They’re not willing to take that risk.”
Kiatamba in Minnesota also says that worries have weighed on the minds of many volunteers. Even those who don’t fear contracting Ebola are concerned about how volunteering might affect their jobs, their families, their immigration status and their relationships in the U.S. “These are some of the concerns right now,” he says.
These fears have been increased by new guidelines set out by the Centers for Disease Control and Prevention, which could lead to returning health workers being asked to undergo voluntary at-home isolation.
The chances of contracting Ebola in Liberia, Sierra Leone and Guinea are higher than elsewhere, especially for health care workers treating infected patients. Basic equipment — such as gloves and adequate hand-washing stations — are often missing or sparse. A recent report from the Centers for Disease Control and Prevention analyzed four counties in Liberia and found, “There was insufficient personal protective equipment to care for patients with Ebola.” According to the World Health Organization, as of Oct. 8, 416 health workers in West Africa had been infected and 233 of those workers had died from Ebola.
The risk is so high that many physicians who were already practising in West Africa have fled. The CDC report also found that several doctors working in the Liberia counties studied had “left Liberia because of the epidemic.” Also: “In two of four hospitals assessed, nursing staff members were not coming to work or had abandoned facilities; in another hospital, health care providers had not been paid for three months but were still providing basic care. Frequently, nursing students, nursing aides, and community health care volunteers were providing basic medical care and responding to obstetric and surgical emergencies.”
In August, Liberian president Ellen Johnson Sirleaf went so far as to fire state officials who were abroad and refused to return to Liberia to fight Ebola. Yet her son, a physician who lives in Georgia, was at the same time also leaving Liberia after initially helping to combat the disease, out of fear of infection. “The symbolism of me going there and potentially getting Ebola when I have a nine- and a seven-year-old at home isn’t worth it just to appease people,” James Adama Sirleaf told the Wall Street Journal about his decision to return to the U.S.
Fear of the disease is more than understandable yet there are still those who are willing to return to the countries they left in search of a new life abroad. “My connection [to Sierra Leone] is there,” says Bangura, who begins specialized training for his mission in early December. “We all know it is risky but someone has to do it.”