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.”