Unknown Enemy: One Year Later

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It has been one year since the deadly Ebola Virus Disease, EVD, stealthily but ferociously attacked the country and began a systematic devastation of every fiber of the Liberian society in the worst outbreak of the disease in human history. 

In a three pronged attack, EVD had also viciously overrun Guinea and Sierra Leone, the other sisterly states in the Mano River basin, leaving a trail of death, economic decimation and traumatized populations who could not fathom the nature, origin or power of their common enemy.

The unknown foe immediately proved for certain that none of these worst hit countries was any match for it – at first.  It had hit the three neighborly states with the weakest health infrastructures on the continent and among the world’s poorest nations, ironically, with some of the richest natural resources on the planet.

The human toll was astonishing with thousands falling dead everywhere except for a few areas protected from the crisis by poor access roads. 

Until the advent of Ebola hand washing buckets, Ebola burial teams and the Ebola Treatment Units (ETU), it was predicted that Liberia, already leading in the death toll, could see hundreds of thousands killed by the virus by end of 2014.

That prediction and the infection of several international medical workers who were repatriated and infected others in their countries of origin as well as the realization of the impossibility of absolute containment of the disease in the West African sub region, convinced the international community that the Ebola epidemic had the potential of becoming a crisis of global proportions. 

That scenario along with President Ellen Johnson Sirleaf’s impassioned letter to the world and her appeal to U.S. President Barrack Obama helped turn the corner, leading to what is now acknowledged as the most massive international collaboration ever forged to fight and eradicate a deadly disease threatening humanity. 

Following is a compact chronology of the Ebola crisis in Liberia depicting the country’s remarkable success in transitioning from an epicenter of the epidemic to the hardest hit state which, with its community mobilization strategy and the outpouring of help from the international community, gave the EVD a speedy and decisive routing – almost. 

However the stubborn virus has of late attempted a sly comeback with a single case of confirmed infection possibly caused by sexual transmission from a survivor.  This disrupted Liberia’s eager and impatient count down to zero cases and the coveted prize of being declared Ebola Free by the World Health Organization (WHO).

Now, Ebola is no match for Liberia and the world.  We are ready, right? A reflection of the harrowing event is humbling with its impact stigmatizing survivors. And one year since the epidemic entered the country and began a systematic destruction of the fiber of the Liberian family, one thing has proven certain: the resilience of Liberians to remain vigilant in the wake of the desolation.

 Initially thought of as an attempt by the Liberian government to generate outside income, the government announced inadequate budgetary means and appealed to the international community for assistance. Though dragging its feet, the World Health Organization (WHO), initially described the situation by a spokesman as ‘relatively small, still'. As a result the virus gained major impact as confused and infected Liberians did not know what to do. The most telling effect gained momentum when later the Ministry of Health announced that there is no cure for the virus.

 “That was the most unfortunate message to a population that was so suspicious of the presence of the virus in their various communities, anyway,” said Joe T. Slewion of New Kru Town, when he was interviewed for this article. Majority of Liberians, including those in the poorer and vulnerable communities, could not be convinced there was any genuine infection in the country. And what was to allow the increase of the infection was the inability of the Liberian government to have understood what kind of virus it was rampaging through the country.

As distrust increased and the Liberian government's insistence on keeping open the country’s borders with Sierra Leone and Guinea, pandemonium broke out as infected Liberians were carried to nearby health centers, particularly the Redemption Hospital in New Kru Town in Monrovia.  Most were abandoned to their fate. And the most distressing experience was when health care workers, who were expected to manage the situation, became victims themselves, due to inadequate understanding of the scourge, leading to the deaths of even doctors, including Dr. Samuel Brisbane, Dr. Sam Mutooro Muhumuza, a Ugandan; Dr. Patrick Nshamdze, a Cameroonian; Dr. Abraham Borbor, Dr. John Dada, Dr. Thomas Scotland  and others. Many nurses and others fell, too, as they battled the stubborn, incurable virus.

With the international community dragging its feet and WHO unable to promptly initiate interventions, what could have been controlled went beyond expectation and the Liberian death  toll increased.

Though the first confirmed cases were reported in Foya, Lofa County, by March 22, Monrovia was the center of attention as a suspected Ebola carrier had passed through several communities on her way to Harbel, Firestone.

It was not until June 2014 that the Liberian government began to take effective measures to ensure a sense of containment. It became necessary that to prevent the scourge, there had to be some form of containment to prevent people from infecting others, health experts said. Therefore, by August 20, the Liberian government announced the quarantine of several communities, including the populous West Point Township in Monrovia, enforced by the Armed Forces of Liberia (AFL). The outcome of the West Point quarantine caused the death of 16-year-old Shakie Kamara, who was shot in his legs, and 17-year-old Titus Nuah, who was also shot in the stomach by AFL soldiers, who were part of the joint security operations to ensure compliance of the Liberian government’s order to quarantine the township.

While the West Point saga overshadowed what came to be known as the Ebola Fight, the Ministry of Health introduced several measures, including no handshakes, no hugging, along with reduction of passengers on buses and taxies as well as meticulous hand washing with chlorinated water, in an attempt to stem the tide. But one of the most affected sectors was bush meat sellers, since it was widely believed, though yet to be proven, that such products were potential carriers of the virus. “I am ruined because they claimed the virus came from bush meat,” said a woman who lost close to US$2,000, a substantial amount in a country in which the average person lives on one US dollar or less a day. Also visible were many who began to wear surgical gloves, as unconfirmed sources released atrocious measures into the various communities. At one point, rumors went wild, informing residents to wake up at midnight to bathe with salt water from the Atlantic Ocean. Also prevalent at this time were reports that several wells had been poisoned by unidentified people, and many communities carried out vigilante actions against strange persons found in their localities. It prompted the Liberia National Police (LNP) and authorities of the Ministry of Commerce and Industry to begin an exercise to test in their various laboratories wells that had been suspected poisoned.

 “We were a vulnerable people,” admitted Christopher Doe. “What else could we have done since it appeared that the only thing certain was the fact that Ebola was killing us at such an alarming rate?” The increasing number of deaths horrified Liberian communities and, with the government striving against the volcanic tide of death caused by the virus, many Liberians found no hope. By now several humanitarian organizations, including the Samaritan’s Purse, Doctors Without Borders, Save the Children; the Liberian National Red Cross (LNRCS),  Direct Relief, and others, were operating in the country. Apart from some of them, some operated with little or no knowledge of the insidious disease and its ravages. In the end, with the dead unabatedly numbering in their thousands, the Liberian government had succeeded to get the assistance from WHO to admit the grim reality and compelled the Liberian government to shut down all schools, along with the reduction of non-essential staffs at the various ministries and agencies. The Liberian government provided the first US$5 million in the fight, and urged the international community to bail Liberia out of the tragedy. Now, the world was responding to the crisis, though by now thousands of Liberians had died and families torn asunder.

The success story out of the dark pages was the eventual setting up of the Incident Management System (IMS), under the watchful eyes of Assistant Health Minister for Preventive Services, Tolbert Nyenswah. The then Health and Social Welfare Minister, Dr. Walter T. Gweningale, irked lawmakers and others when during the heat of the wanton deaths, he was reported to have remarked that he was a minister for the living and not the dead. He got into more trouble when he refused to reinstate leaders of the National Health Workers Association of Liberia (NHWAL) that he had fired, and had sworn not to reinstate to their various positions. At a hearing at the Senate, he made a feeble defense and when he was subsequently requested to reappear, his physician, Dr. Robert Kpoto, claimed that he (Dr. Gwenigale) was suffering from high blood pressure. Though the comical aspect of the then minister’s utterance was not lost on the Liberian people, the Ebola virus kept its rage on and dissipated families at will. As corpses were found on street corners, contaminating communities, the Liberia National Red Cross, which led the effort to dispose of the corpses of Ebola victims, took the option to cremate the dead.  The Government of Liberia had obtained permission from the resident Indian Community to use their crematorium located at Boys Town, near Marshall, Margibi County.

There was some resistance from several Liberian communities since traditional burial rites hold a special place in Liberian society. But eventually, with the infections increasing in communities that insisted on handling their own dead, causing more deaths in the process, increasing awareness helped to stem the tide.

With the situation completely out of hand, and the number of the Liberian deaths increased in several communities, the WHO, MSF and other humanitarian groups declared that the epidemic was out of control, prompting US President Barrack Obama, to get the American Congress to commit more funds to the global fight against the virus. But what moved the American President to do more, was the passionate appeal made by President Ellen Johnson Sirleaf in a letter she sent to him. President Obama acted immediately by deploying 3000 US soldiers to Liberia and the West African sub-region to help build Ebola Treatment Units around the country and provide logistical expertise in the fight against the virus.

All along, the world was desperately working overtime to develop a vaccine, and by this time, the rate of infections had reduced, as a result of the vigorous awareness carried throughout Liberia.

With massive international support coordinated by healthcare professionals and others who were not even paid for their services, Liberia began to record a steady decline in new Ebola cases day by day and month after month thereafter.

The experience of abandonment, inadequate understanding of the enemy we were fighting against, messages of hysteria hindered the progress. But with surprising reduction of infections, came the Liberia-United States Joint Clinical Research Partnership study of two vaccines, the ChAd3-ZEBOV, manufactured by Glaxo SmithKline, and the rVSV-ZEBOV, manufactured by Merck/NewLink, initially with 600 volunteers, but with a larger target of more than 3,000 persons.

It is of interest to note that the Ebola epidemic exposed the weakness in Liberia’s health sector and has provided the government a chance to use available resources, along with the assistance with international partners to rebuild. Overall the lessons in the Ebola crisis must not be lost on Liberians and the future government. The fact cannot be overlooked that the government was overwhelmed with the sudden appearance of the virus and the failure of the international community, specifically the WHO, to have reacted with extreme urgency.   This threatened the very existence of Liberia as a nation. But Liberians as a people, at the proper time, decided to take charge of what they had left and one cannot minimize their resilience and determination to survive an insidious disease that was so bent on destroying them.

Contributing Writers: Alaskai Moore Johnson, Observer Health Correspondent and Claudia Smith

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