Even as Ebola swept through his family, killing them one by one until almost everyone was gone, four-year-old Sam somehow survived.
An ambulance attendant, Foday Gallah, had to leave Sam behind as he rushed the boy’s parents and siblings to the Ebola treatment units. All of them died. But the boy still seemed strong and healthy.
Then, a few days later, a neighbour called Mr. Gallah and told him Sam was sick. The attendant broke down and cried. Then he frantically dressed himself in protective clothing and rushed to the house, where he found Sam alone on the floor of a room.
“I saw him lying in a pool of vomit,” Mr. Gallah said. “I picked him up in my arms. He was still vomiting, but I wanted to save him. I ran with him to the ambulance. I was totally focused on saving him.”
As he ran, Mr. Gallah didn’t pay close attention to his protective clothing – his gloves, mask, gown and boots. A brief moment of carelessness, or perhaps a weakness in the clothing itself, was all it took. A few days later, he too was writhing in pain on a hospital bed, diagnosed with Ebola.
This is how Ebola destroys families and health workers, in a swift and relentless chain of transmission, across some of the world’s poorest countries. It’s an epidemic that the world ignored when the first serious warnings were issued in March. And it’s an epidemic that hundreds of health charities are still unwilling to tackle today, leaving the crisis in the hands of a shamefully small number of agencies.
Liberian assistant health minister Tolbert Nyenswah, a key leader in the fight against Ebola, had warned of the looming epidemic in March, when the virus began spreading across West African borders. But it took until August before the World Health Organization finally declared Ebola a global health emergency – a declaration that should have been made several months earlier, he says. “They came in very late,” Mr. Nyenswah said in an interview. “And because they came in very late, we are suffering this today. The world underestimated this disease, and today we are paying the consequences.”
Thousands of lives could have been saved if the world’s major health agencies had acted faster, he added. “They should have come in immediately, like it was a major terrorist attack on the whole world.”
Today the neglect continues. While some aid agencies are offering money or personnel, most are still reluctant to enter the Ebola region. Their help could be crucial. Hundreds of health professionals and experienced managers are desperately needed. But the foreign agencies that could provide them – with a few notable exceptions – have failed to mobilize. Without them, there might not be enough trained staff to operate the 27 new Ebola treatment units that are being urgently built in Liberia over the next few weeks.
International Medical Corps, one of the just two Western-based health groups running Ebola treatment centres in Liberia, has been obliged to recruit doctors in the developing world because so few Westerners are volunteering. While about 400 U.S. doctors volunteered to help IMC in Haiti in the first two months after the devastating 2010 earthquake, fewer than 10 have volunteered to help the Ebola-afflicted countries.
“We’re sourcing candidates in the Philippines, Ethiopia, Jordan, India,” said Sean Casey, the Ebola emergency response director at the IMC.
Fear is not the only explanation. Many hospitals are reluctant to allow their physicians to volunteer in the Ebola fight because it could cause anxiety among the hospitals’ patients and staff. “I think it’s collective ignorance,” Mr. Casey said in an interview.
“I think the hospitals and the doctors know the realities of the infection, but there’s a potential perception that a hospital could get known as the one that has the Ebola doctor.”
Many relief organizations have overestimated the risks of Ebola. Of the hundreds of volunteers who have worked for Médecins sans frontières (Doctors Without Borders) in Ebola treatment centres in Africa, only one has caught the virus. The best-run Ebola treatment centres, in fact, are considered among the safest places in Liberia, since so many safety measures are in place.
“You can really control your own risk here,” Mr. Casey said. “If you follow the standards and wash your hands, you can be safe here. The odds are really good that nothing is going to happen.”
Even though hundreds of millions of dollars have been pledged by institutions such as the World Bank and the U.S. aid agency USAID for the Ebola fight, only a “trickle” of international health organizations have come into West Africa to use those funds, Mr. Casey said. “The need is obvious, the money is there, but the agencies aren’t coming in and asking for it. There are lots of financial resources but there’s nobody to give it to.”
Leaders of United Nations agencies such as UNICEF are trying to persuade more relief agencies to overcome their fears and prejudices about Ebola. Too many non-governmental organizations are “sitting on the fence,” said Sheldon Yett, the UNICEF country representative in Liberia. “Any health-based NGO that still isn’t here needs to take a long hard look at themselves in the mirror and ask themselves why. If that’s why you exist, you should be on the ground in Liberia now. This is the biggest public health emergency in many many years.”
Volunteers who take basic precautions are “very very unlikely” to catch the Ebola virus, Mr. Yett said. “We talk about stigma and ignorance in Liberia, but let’s be frank, there’s plenty of stigma and ignorance in our own countries, and irrational fear of being on the ground. We have an obligation to counter that fear.”
The greatest health risks are not in the top Ebola treatment centres, where foreign volunteers are most likely to work. Much greater dangers are faced by the Liberian volunteers and care-givers who work with few protections.
Gordon Kamara, a nurse at a private Liberian ambulance service, was at the health ministry in Monrovia this week to beg for more protective equipment. He was given only a small fraction of the gloves and boots that he requested. “It’s nonsense,” he fumed. “I’ve got more than 15 Ebola patients to pick up today. What do they expect me to do? I can’t work like this. The death rate is going to rise.”
Mr. Gallah, the 37-year-old nurse who caught the Ebola virus from four-year-old Sam, works at the same private ambulance service. He says his protective clothing is thinner and less safe than the more expensive suits used by MSF and others. That may have caused his infection.
After treatment at the MSF Ebola centre in Monrovia, he and Sam both recovered. Now, a few days after his release, he moves slowly and weakly as he recovers at home. But his cellphone still constantly rings with Ebola patients needing ambulances. He tries to help, checking their symptoms on the phone and then giving them a colleague’s number.
He wants to return to the ambulance service as soon as his strength allows it. “I can’t wait to get back,” he says. “People are dying, and they need us.”Report Typo/Error