More than a year after the Ebola epidemic began in West Africa the end appears to be near. Liberia has been declared Ebola-free and Guinea and Sierra Leone have reported just a few cases in recent days. Members of the medical aid group that sounded the alarm about the outbreak have reflected on its effects.
Doctors Without Borders said while the number of recorded Ebola cases “has decreased, much work remains to be done.” It described health systems as being “ravaged,” as hundreds of health care workers died in the outbreak along with about 11,000 others.
Some members of the group – also known as MSF – took part in a panel discussion about how Ebola damaged the lives of both the infected and uninfected.
Ella Watson-Stryker, a health promoter, said a lot of lessons have been learned. In the beginning, MSF focused on supporting the overall intervention efforts to stop the spread of Ebola. But she said more needed to be done.
“What we didn’t do well in the beginning is broaden our scope to really be able to reach into the communities – not just the communities that were most affected, but also the communities that were not yet affected. And we stayed very much focused in Guinea in Guékédou Prefecture and we didn’t focus on Guinea as a country, as a whole. And it was months before we had a dedicated health promoter based in Conakry even though we had a lot of cases in Conakry throughout that time -even though we had a fully functioning management center,” she said.
Another lesson learned, she said, is just how scary Ebola can be.
“Ebola is a disease that creates fear and everyone’s afraid – whether it’s the leader of a small village, whether it’s the president of a country. The doctors and nurses who respond are afraid. The health promoters, who are there - trained to talk about Ebola - are afraid. And our patients are terrified. And so, I think that’s the biggest barrier that we have to overcome.”
Watson-Stryker said when people are that afraid they may refuse to face reality.
“Something that we learned again and again is that when people are afraid denial becomes a really good fallback for how to deal with that level of fear. And we saw that people were in denial when they were sick. We saw that villages were in denial that anyone in the village had died from Ebola. We saw governments in denial that there was Ebola inside their country and we saw [the] international community deny the severity of the outbreak.”
She said to overcome fear of Ebola health workers must build trust in the community. And that, she said, can take a very long time.
Dr. Craig Spencer worked as both an MSF physician and epidemiologist in Guinea. He said it’s important to celebrate the victories, but never forget what happened.
“I think the biggest challenge is something that we’ve been dealing with in a different form since the epidemic began over a year ago – and that is complacency. Everyone is rightfully excited that Liberia, as of a few days ago, has passed 42 days and is declared Ebola-free. But West Africa, as a region, and really the global community, as a whole, will not be Ebola-free until Guinea, Sierra Leone, Liberia and everywhere else that’s been touched by this virus makes it out of that window,” he said.
Earlier this year, Spencer traveled back to Guékédou in southern Guinea near the Liberia and Sierra Leone borders.
“It was amazing to me just driving back through town for the first time in months how life just kind of got back to normal. There were teenagers on the streets holding hands. Markets were bustling. You wouldn’t know that this is the same place that merely months before Ebola was ravaging and destroying communities,” he said.
Thousands of people survived the outbreak. But Dr. Spencer said its effects linger, including joint pain and vision and hearing problems, as well as post-traumatic stress and stigma.
He said, “It will be great when all of these countries are officially declared free of Ebola. But in many ways the hard work really starts at that point. A transition to a post-Ebola healthcare system is going to be an incredibly difficult and fragile task.”
He said healthcare must include prevention and treatment for a wide range of illnesses, and nutritional support to help the body heal. Spencer added that MSF has learned the importance of psycho-social support to help people get through – what he called – an “unbelievably difficult and trying time.”