June 13, 2014 started as a routine Friday in Redemption Hospital in Monrovia, the capital of Liberia. Redemption is the largest free public health hospital in the city. We are called upon to serve hundreds of thousands of people. In the best of times, it puts strain on our resources. Monthly supplies run out within weeks, and patients without beds would be seated in chairs. That summer, we had a nurse who had been sick for a while. Sick enough to be admitted in our hospital. But our treatment didn't seem to be helping her; her symptoms were getting worse: diarrhea, severe abdominal pain, fever and weakness. On that particular Friday, she developed severe respiratory distress, and her eyes were menacingly red.
One of my fellow doctors, a general surgeon, became suspicious of her condition. He said her symptoms were suggestive of Ebola. We kept a close watch on her, we tried to help her. We were treating her for malaria, typhoid and gastroenteritis. We didn't know it, but by then it was too late. The next morning I walked in to check on my patient. I could tell by the look in her eyes that she was filled with fear. I gave her reassurance, but shortly after...she died of Ebola.
For me, her death was very personal. But this was just the beginning. A virtual biological bomb had exploded. But the word spread faster than the virus, and panic spread across the hospital. All the patients ran away. Then, all the nurses and doctors ran away. This was the beginning of our medical tsunami—the devastating Ebola virus that left an indelible scar in our country's history.
I was not trained for this. I had just graduated from medical school two years before. At this time, my total knowledge about Ebola came from a one-page article I had read in medical school. I perceived the disease as so dangerous, this one page in essence had convinced me to run out of the hospital, too, the moment I heard of a case of Ebola. But when it finally happened, I stayed on and decided to help. And so did several other brave health care professionals. But we would pay a heavy price.
Many persons and health professionals had become high-risk contacts. This actually meant 21 days counting to potentially disease or death. Our health systems were fragile, our health workers lacked skills and training. So in the weeks and months that followed, health workers were disproportionately affected by the Ebola virus disease. More than 400 nurses, doctors and other health professionals became infected. Unfortunately, my friend, the general surgeon who correctly identified the symptoms in that first case became one of the casualties.
On July 27, the president of Liberia imposed quarantine on the worst-affected areas. She closed all the schools and universities and shut down many public events. Four days later, the United States Peace Corps pulled out of Liberia, out of Sierra Leone and Guinea due to Ebola.
In August, six weeks after the nurse died, hundreds of people were dying of the disease each week. People were dying in the streets. Over the months that followed, West Africa would lose thousands of people to Ebola virus disease. In August, I joined a team to set up the Ebola treatment unit at JFK hospital in Monrovia. I was charged with running the second Ebola treatment unit in the city. Our unit provided hope for thousands of patients, families and communities. I not only provided care, I came face to face with Ebola. Living every day as a high-risk Ebola virus disease contact during the worst of the outbreak was one of my worst experiences. I started counting 21 days every day. I lived every moment anticipating the onset of symptoms of the disease. I measured my body temperature several times. I showered with chlorinated water, more concentrated than actually recommended. I chlorinated my phones, my pants, my hands, my car. My clothes became bleached. Those days you were alone, people were so afraid of touching anybody. Everyone was counted as a potential contact. Touching would make them sick. I was stigmatized. But if that was what it was for me, who was symptom-free, imagine what it was for someone who actually had symptoms, someone who had Ebola.
We learned that to treat Ebola successfully, we had to suspend some of the normal rules of society. Our president declared a state of emergency in August and suspended certain rights. And the national police even supported our work during the Ebola response. In February 2015, gang members came in for isolation in our Ebola isolation unit. They were also know as the VIP Boys of Monrovia, terrifying small-time drug addicts whose presence could instill a tremendous amount of fear, although they could not legally carry guns. They underwent quarantine for 21 days in our unit and were not arrested. We told the police, "If you arrest them here, they will stop coming, they won't get treated. And the Ebola virus will continue to spread." The police agreed, and we were able to treat the VIP Boys, and they did not have to worry about being arrested while in the unit.
Over the course of the outbreak, West Africa had almost 29,000 cases. More than 11,000 people died. And that included 12 of my fine colleagues at John F. Kennedy hospital in Monrovia. In June 2016, exactly 23 months after my first Ebola patient died, Liberia declared its Ebola outbreak ended. We thought that once the outbreak ended, so did the problems. We hoped that life would go back to normal. Today, there are more than 17,000 survivors in West Africa. People who actually had Ebola virus disease, lived through it and survived. We counted survival rate as a success: the end of suffering for the patient and fulfilling joy for families. Every discharge from the unit was a moment of jubilation. At least so we thought.
The best description of the moment of discharge and a rare glimpse into the moment that defines our life post-Ebola was vividly expressed in the words of my best friend and fellow doctor, Philip Ireland, in an interview with "The Times." He said at the time of his release, "There were a lot of people there from JFK hospital: my family, my elder brother, my wife was there. A lot of other doctors were there, too, and members of the media were there. And I felt like Nelson Mandela, it felt like the 'Long Walk to Freedom,' and I walked and raised my hands to the heaven, thanking God for saving my life." And Philip said, "Then I saw something else. There were a lot of crying people, people happy to see me. But when I got close to anybody, they backed away."
For many Ebola survivors, society still seems to be backing away, even as they struggle to lead a normal life. For these survivors, life can be compared to another health emergency. They may suffer debilitating joint and body pain. The suffering gradually decays over time for most. However, many continue to bear intermittent pain. Some survivors are blind, others have neurological disabilities. Some survivors experience stigmatization every day, in many ways. A lot of children are orphans. Some survivors experience post-traumatic stress disorder. And some survivors lack opportunity for education. Even families can be split apart by fear of Ebola, too.
There's no definitive cure for transmitting Ebola virus through sex. However, there are successful interventions for prevention. We have worked hard on semen testing, behavioral counseling, safe sex promotion and research. For the past year, there have been no cases of sexual transmission. But some male survivors have lost their spouses out of fear they will be infected with Ebola. That's how families are torn apart.
Another tremendous challenge for Ebola survivors is obtaining adequate health care. In theory, Liberia's public health services are free of charge. In practice, our health system lacks the funding and capacity to expand care to all at the point of need. Many survivors have waited many months to undergo surgery to heal their blinding cataracts. Few had to relive the traumatic experience, when their blood was retested for Ebola at the point of admission. Some survivors experienced delayed or deferred admission due to limited bed capacity. No bed available for one more patient. This is neither national policy nor officially condoned, but many people are still afraid of the sporadic resurgence of Ebola virus.
The results can be tragic. I have seen Beatrice, an Ebola survivor, several times now. She's 26 years old. Many of her family members became infected, she luckily survived. But since that day in 2014 she was discharged to cheering health workers, her life has never been the same. She became blind as the result of Ebola. In 2014, the baby of a dear friend of mine was only two months old, when both parents and child were admitted in an Ebola treatment unit in Monrovia. Luckily, they survived. My friend's baby is almost three years old now, but cannot stand, cannot walk, cannot speak. He has failure to thrive. There are many more hidden experiences and many stories are yet untold.
The survivors of Ebola deserve our attention and support. The only way we can defeat this pandemic is when we ensure that we win this final battle. Our best opportunity is to ensure that every survivor receives adequate care at the point of need without any form of stigma and at no cost to them personally. How can a society consider itself healed when a person's entire identity is defined by the fact that they recovered from Ebola? Should a previous disease that a person no longer has become the sum total of their identity, the identifier in their passport that deters you from traveling to seek medical care abroad? Simply the ID that denies you health care. Or prevents you from having a relationship with your spouse. Or denies you of family, of friend or home. Or prevents you from carrying on your normal job, so you can put food on the table or have a roof over your family's head.
What is the meaning of the right to life when our life is clouded by stigma and barriers that fuel that stigma? Until we have much better answers to those questions in West Africa, our work is not over yet.
Liberians are a resilient people. And we know how to rise to a challenge, even a devastating one. My best memories of the outbreak center on those many people who survived the disease, but I cannot forget the hard-working nurses, doctors, volunteers and staff who risked their own safety in service of humanity. And some even losing their lives in the process. During the worst of the contagion, one thing kept us making those perilous daily journeys into the Ebola wards. We had a passion to save lives.
Was I afraid during the Ebola outbreak? Of course I was. But for me, the opportunity to protect our global health security and keep communities safe at home and abroad was an honor. So as the dangers became greater, our humanity became stronger. We faced our fears. The global health community working together defeated Ebola, and that...that is how I know that we can defeat its aftermath in our hearts, in our minds and in our communities.
Thank you.
