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.
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.