Fighting the Ebola outbreak: Report from Liberia



Lofa County, which borders both Sierra Leone and Guinea, is my home. It is also the epicenter of the Ebola virus disease (EVD) outbreak in Liberia and although Monrovia, our capital, is fast catching up, the impact of Ebola on Lofa County has been devastating in too many ways.

In the first wave of the epidemic, the fear and stigma associated with the disease divided a community into two ethnic groups who had lived harmoniously for nearly a century before the war and worked hard to reunite as a community after the war. People from one side of the community were afraid to attend the burial of an early victim and members of the victim’s group felt ostracized by their neighbors. The first fatality in Montserrado County was actually someone from Lofa who had traveled to the capital seeking medical treatment.  The first health worker to die in this epidemic was a nurse who I knew very well.

I was fully aware that family members and health workers were at the highest risk for Ebola because they are in closest contact with victims. I knew that Ebola had fatality rates as high as 90%—and saw signs of fear and ignorance even among health workers as early reports showed that potential cases were being turned away from hospitals and clinics. An RBHS project staff member has lost a nephew-in-law who was refused treatment at two public facilities and died en route to a third. I knew that we had a lot of work to do among health workers, but I also believed that with adequate awareness, knowledge, and precautions, we could battle and contain the disease. My optimism was temporarily rewarded in May, when we were able to say that there had been no new cases in 42 days.

Dr. Macauley and members of the RBHS packing up before departing on a mission to train health workers on Ebola response protocol. With five years experience working to rebuild Liberia's health system, RBHS has been able to respond to the Ebola outbreak on national and county levels, coordinating training and support to frontline health workers.
Dr. Macauley and members of the RBHS team pack up before departing on a mission to train health workers on Ebola response protocol. With five years experience working to rebuild Liberia’s health system, RBHS has been able to respond to the Ebola outbreak on national and county levels, coordinating training and support to frontline health workers and streamlining the delivery of essential supplies.

But that optimism was tempered when the cases started to increase again in June and my heart grew heavier as the toll among health workers began to climb.  I grieved with many of my colleagues at the death of a renowned ER doctor, who had been my mentor during the early stages of my training; at losing a popular physician’s assistant, who had peppered my training at the JFK Medical Center with good natured humor and hard work; and at the tragedy of the County Health Services Administrator’s death and 9 (yes, NINE) of his family members. I was angry and saddened at every report of a corpse or patient abandoned at a facility or a community center and of known contacts running away from tracers.

When I returned to Liberia after the war, my goal was (and is) to contribute to the development and strengthening of our public health system.  I lead USAID’s flagship health project and I teach in the MPH program at Cuttington University. I am an officer of the Liberia Chapter of the West Africa College of Physicians, a charter member of the Post-Graduate Education Board, and a Fellow of the Liberia College of Physicians and Surgeons.  I am also the president of the Alumni Association of the A. M. Dogliotti College of Medicine at the University of Liberia and a Rotarian—I am a doer!

I choose to do what I do best —put resources to work where they’re needed, challenging bureaucratic, administrative, and individual obstacles.  With USAID’s concurrence, the Ebola response has become an approved activity in the RBHS workplan and I was able to put the technical, training, and logistical expertise of our staff to work to fill critical gaps in the response.  Working hand-in-hand with Ministry colleagues and other partners, we adapted training packages for health workers and the general public, put together a training schedule for all 15 counties, and trained the teams that would go out to these counties.  Personal protective equipment and other supplies were streaming into the Ministry of Health and though they eventually went out to priority sites, the distribution process was cumbersome and deliveries were untracked.  Our administrative team­—in collaboration with the Clinton Health Access Initiative—managed commodity supply and delivery for 7 counties during the early days of the project, and helped the Ministry with a simple system for tracking deliveries and distribution.

I am still saddened by each fatality and still grieving the deaths of so many talented and committed colleagues. Yet, I am relieved that the United Nations Mission in Liberia (UNMIL) will soon be supporting the Ministry of Health and Social Welfare (MOHSW) in its fleet management and warehousing operations.  I know that training and supporting health workers while mobilizing and supporting community structures and leaders will help Liberia somehow.  I am frightened and I am grieving, yet I am still a doer; I am grateful that, through the large RBHS project, we are able to put our expertise and resources to work where they’re so urgently needed.


Learn more about the Ebola outbreak and ongoing response efforts taking place in Liberia.

16 responses to “Fighting the Ebola outbreak: Report from Liberia”

  1. Thanks for sharing this. A terrible situation – yet important for people outside of West Africa to see first hand reports.

  2. It doesn’t feel like much when I say, that you are having a human tragedy, playing out there amongst you all. A human tragedy to add to all of the others around the world. But you are all in my thoughts.x

  3. Our toughts and prayers are with you and your team in this difficult moment.
    But more than prayers, let us know what we can do to help.
    Having worked with you at WHO, I personnally know your dedication for heath of people who need it the most and that you have the skill and capacity to support our countries to overcome this terrible outbreak.

    Ousmane dia

  4. My dear Rose, I have been thinking non-stop about you and your large team and all of the family members, colleagues and friends who are being affected by the Ebola outbreak and its spread. Your blog is so personal and moving. Thanks for writing it. I hope you’ll also post it elsewhere. The news coverage scares us into action, but it does not get to the heart of the community issues you raise. Know that we are all thinking about you and all those who find themselves in the middle of this epidemic and if there is anything we can do from a distance to support you, please don’t hesitate to let us know. In sadness but also hope, Pat

  5. Dr. Rose the iam proud of your efforts and commitment to ensuring that the people of Liberia live a good life. Long Live Dr. Rose, Long live the people of Liberia. Put the women at the forefront of anything and you will be amazed the the results.

  6. Thank you for your heartfelt, sensible approach to using the available resources and knowledge to address this tragic situation. We grieve with you, but we also celebrate the good work you are doing in the face of this most difficult challenge.

  7. Thinking of you and your team, and all those affected, at this time. Your thoughtful and informed approach will make a difference in a very challenging situation. I am sad at the losses around you and humbled by your courageous work.

  8. Dear Rose, Thank you for taking the time to write such a moving and illuminating account of what is happening and giving faces to the numbers that we read about. Your posting is so compelling that I wonder how it can be shared more broadly. I know first-hand that you are indeed a doer, which, together with your enormous technical and practical experience, is bound to make a difference. I don’t know what we in D.C. can do from a distance to help but do let us know. Please, please take care of yourself. Rebecca

  9. Rose, thank you for such a lovely piece. I’m not surprised that you are in the thick of things. How blessed Liberia is to have you. I pray God’s continued protection and strength as you fearlessly serve the people and fight this dreadful disease by overcoming ignorance.

  10. Rose. You can stand up to be an example to the many who share into the struggle of providing strong feelings towards uplifting the health system of this community. I am of the conviction that people around you are motivated to doing more because of the mind and soul you commit. To the many who want to come in and help, your story can be a motivation. Please guide me to a reliable path through which health workers outside the country can be of help .

  11. My dear friend Rose
    Fenella and I have been praying and looking for you since this emergency started. We knew you would be at the forefront of helping your country fight this deadly disease.
    I hope to join you in Liberia very soon. I am trying to do my part from home.
    love and care

  12. Great job Dr. Macauley and also to your Team for the great job you all are still doing in Liberia! My God guide and bless you always!

  13. The very fact that Rose has stayed in Liberia and Africa , instead of going to USA or elsewhere after graduation and the fact of being there when Ebola struck hard and harder and deeper into families like plague of the ancient , really impresses me . She was my Dogliotti class fellow .

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