Five years after Ebola

As clouds dumped late summer rain in Liberia, William E. Pewee was on his way to work as registrar at the Eternal Love Winning Africa (ELWA) Hospital, a 54-year-old mission hospital in the capital city of Monrovia. Although he claims not to be a good singer, before his day started Pewee sang a song of worship to God.

He’s thankful to be alive. Five years ago, he was lying sick on a hospital bed at ELWA, bleeding from his eyes, ears, and nose. He’d contracted Ebola, a dangerous virus that swept the country in 2014 and killed thousands of people. Pewee picked up the contagious virus while praying with an ELWA patient who turned out to be positive.

Dr. Rick Sacra also caught the virus from an ELWA patient. The longtime missionary doctor, an American who had worked at the hospital since the 1990s when staffers were treating gunshot wounds from the country’s civil war, became a patient himself during the Ebola outbreak.

Today, the room where Sacra was treated for Ebola is now a cramped hospital study library. Inside, when I visited, Sacra was working with ELWA medical residents on a PowerPoint presentation regarding a case of palpable purpura. The residents discussed vasculitis, adjusted font sizes, and boiled hot water for tea to stay awake.

In the hospital’s new dental clinic, clinic manager Loranso Gbogar was taking phone calls. During the Ebola outbreak, Gbogar came down with typhoid, and ELWA was the only hospital taking patients like him. Much of the devastation of Ebola was that other diseases and conditions went untreated as hospitals and clinics closed.

Though Pewee, Sacra, and Gbogar recovered, many others did not. The virus killed 11,000 in West Africa from 2014 to 2016, the largest Ebola outbreak in history. Liberia bore the heaviest burden of fatalities.

Amid this crisis, ELWA Hospital, run by Serving in Mission (SIM), opened the capital city’s first Ebola treatment unit and became one of the primary treatment centers for the disease. Without this small mission hospital, many people—not just Ebola sufferers but other patients needing emergency cesarean sections or treatment for deadly fevers—would not be here today. Not only did ELWA’s medical workers weather the epidemic, they went on to contribute to the development of life-saving treatments. The hospital is now helping rebuild local institutions and training new health workers at a time when Ebola is on the move again in Africa—a yearlong outbreak in the Democratic Republic of Congo has so far killed about 2,000.

It’s easy to forget how much panic Americans felt about the spread of Ebola in 2014, panic that could have derailed clinical care and breakthrough research. Workers at New York’s LaGuardia Airport went on strike over fears about possible exposure to Ebola from travelers. Airport officials quarantined nurse Kaci Hickox, returning from treating Ebola patients in Sierra Leone, even though she had tested negative for the virus.

During that time, Republican politicians in the United States called for a travel ban on West Africa. At one point, the governors of New York and New Jersey ordered all health workers returning from the Ebola zone to be quarantined for three weeks upon arrival in the United States, hampering health workers from going to serve in the crisis. Donald Trump, not a candidate at the time, took to social media to condemn President Barack Obama for sending “innocent soldiers” to West Africa and to call for a ban on flights from West Africa to the United States.

Sacra and other doctors argued a travel ban would hurt clinical care and research in West Africa, ultimately hurting other countries as the virus spread with few medical workers to treat or contain it. The United States at one point even blocked Centers for Disease Control and Prevention (CDC) experts and other government personnel from working in Ebola-affected areas.

But later, CDC experts started a lab on ELWA’s campus. A partnership between U.S. federal health experts and the Liberian Ministry of Health has since resulted in the largest-ever studies on Ebola survivors and helped with the development of new vaccines.

Yet while U.S. politicians debated travel bans, ELWA hospital workers were risking their lives to treat the sick.

One was deputy nursing director Marthalyne Freeman. In the hospital’s emergency room this August, Freeman rushed a dose of adrenaline to doctors who were performing CPR on a teenager. The boy had arrived at the hospital comatose, suffering from cerebral malaria.

Five years ago, Freeman was one of the few workers who volunteered to stay at her post to treat Ebola victims. Her own family asked her not to come home while she worked in the Ebola treatment unit (ETU), worried about the risk, so she slept in a vacant bed at the hospital. At that time, the outbreak was so bad that bodies were stacked in the streets for cremation.

“I woke up, and it was like a nightmare,” she remembered. At one point, a needle penetrated her protective gear and pricked her skin while she worked in the ETU, but she did not get sick. “I believe the Bible, but I did not feel the Bible. But when I went through the Ebola crisis, I felt the Bible. It was realistic. The reality of the Word was seen.”

Joshua Sweegaye, a staffer at the affiliated ELWA radio station, remembered asking Freeman, “Are you not afraid?” She answered him, “If we are all afraid, we will die.”

While Freeman was working in the ETU, her own daughter and son-in-law, Naomi and Dorbor Sirleaf, tested positive for Ebola. The hospital admitted the couple to the unit where Freeman worked.

Freeman would tell patients afraid of the isolation unit that her own daughter was in there. Dorbor’s sister, who accompanied him to ELWA, died next to him in the ETU. He lost most of his family to the virus, 14 in all.

In the hospital chapel this summer, Naomi and Dorbor gathered for a photo with their 8-year-old twins, named Praise and Praises, who were born in ELWA Hospital.

“We are the only few who are alive,” Dorbor said. “The only person who can comfort me is mother Marthalyne.”

Survivors like Dorbor, as well as ELWA workers, faced stigmatization from fellow Liberians because of the horrific nature of the disease and how little understood it was. Dorbor recalled that his family members couldn’t draw water in their community for a while after their recovery. Nurses remembered that their neighbors avoided them because they worked at ELWA.

SIM is trying to help address this problem through its trauma healing program for survivors of Ebola. SIM missionary Nancy Writebol, who contracted Ebola while working at the hospital, now leads the program. Writebol and her Liberian counterpart Jeremiah Kollie have worked with everyone from the police to the men who staffed the much-hated cremation teams during the Ebola outbreak.

Writebol has experienced stigma too, even in the United States: She recalled, after being declared Ebola-free and returning home, that someone from her home church put up her hand to keep her away, fearful of getting Ebola.

DISTRUST OF HEALTH WORKERS has also been a hurdle to defeating the current Ebola outbreak in Congo, aside from the ongoing political violence there. About 200 health facilities have come under attack during the outbreak. Liberia has faced the same issue, but trust appears to have grown, even if patients still come to ELWA as a last resort. Dorbor Sirleaf said: “Now everyone prays for hospitals.”

When the Ebola virus hit West Africa, no treatment existed for it. But the 2014 outbreak spurred scientific research, which has lessened the severity of the Congo outbreak. Since the Liberian outbreak, medical researchers introduced new Ebola vaccines and are developing others. Writebol and Sacra both have given their antibody-filled blood to researchers working on solutions to Ebola.

Seven of those infected in the West Africa outbreak agreed to an experimental drug, ZMapp, which had only been tested on animals. Writebol was one of those seven. She remembers the ZMapp she received in 2014 was marked “not for human use.” Health workers have since used ZMapp to treat patients in Congo, lowering death rates by about 50 percent in one trial.

And now there’s a big breakthrough, better than ZMapp. Researchers just announced two new antibody drugs that have cured 90 percent of Ebola cases for those who get treatment early. The drugs, developed by two American pharmaceutical companies and the U.S. National Institutes of Health, could halt the Congo outbreak entirely.

The scientific discovery comes in part from Congo itself. The blood of a survivor of an outbreak in Congo in 1995 helped develop one of the new antibody drugs, and both drugs descend from decades of research by Congolese doctor Jean-Jacques Muyembe.

AS CONGO FIGHTS its Ebola battle, ELWA Hospital’s Liberian staff is helping Liberian institutions rebuild: After the Ebola crisis, the Liberian government tapped ELWA medical director Dr. Jerry Brown to run JFK Hospital, the big government hospital in Monrovia. ELWA has become a teaching hospital, preparing Liberian medical workers to be on the front lines of the next health crisis.

While ELWA is mostly Liberian-run and self-sustaining, it has relied on outside capital to become a full-fledged teaching hospital. After the outbreak, Samaritan’s Purse built ELWA a new, larger hospital complex as well as housing for medical residents, and African Mission Healthcare is building hospital faculty housing and supporting the residency program.

Still, resources are always slim. Sacra estimates 11 experienced Liberian doctors died from Ebola, out of about 250 who were in the country at that time, undermining a health infrastructure that had just started rebuilding from 14 years of civil war.

Post-Ebola, the chaos of a limited health infrastructure remains part of ELWA workers’ everyday lives. They care for patients in kidney failure with no dialysis, for those with diabetes with no consistent insulin, for palliative patients abandoned by their families because the families can’t pay the hospital bills. The country has no intensive care unit, and it’s waiting on its first pathology lab that can do biopsies.

And ELWA has its own foibles and failures. The doctors there were frustrated for a full day by a lost key to the ultrasound room (the key turned out to be locked inside the room). Sacra stayed up until 1:45 a.m. one night writing out a remedial test for a flailing doctor in residency. At one point a hospital bed was broken, and the administrators hadn’t arranged for a replacement, so the ward was short a bed. Antony Cyrus Suah, a physician assistant who worked at ELWA during the Ebola crisis, said it was “more stressful than five years ago” because of the current demand for beds.

Post-Ebola, the chaos of a limited health infrastructure remains part of ELWA workers’ everyday lives.

But those stresses lessen at the sight of someone healing. Ibrahim Ly, a young Muslim boy, came to the ELWA emergency room with cerebral malaria, a severe form of malaria with a poor prognosis. His uncle Mamadou Yéru Ly said they came to this hospital because “people told us it was good.”

In the ER, the boy lay rigid, unable to move or speak, staring blankly at the wall. He lay there as another boy with cerebral malaria died next to him. But after two days in the pediatrics ward, Ibrahim was sitting up in bed, eating. The next day he was walking around, and the hospital discharged him, the geckos on the sidewalks scattering as he skipped out.

THE REST OF THE WORLD has since moved on, but “the Ebola times,” as Liberians call them, still cast a shadow. The high-school graduating classes were small this year because the students started high school in the Ebola years when everything in the country shut down.

At the Liberian church on ELWA’s campus, a small tank of bleach water with a spigot stood outside for parishioners to wash their hands before a service—a practice that began in the Ebola times. At the worship service, a man giving announcements reminded everyone to keep up the practice of hand washing.

This particular Sunday at the International Church of Monrovia, Sacra was on duty for intercessional prayer. He began by reading 2 Corinthians 4:16-18: “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. …” He thanked God for the country’s peace of the last 15 years, and then prayed against the spread of Ebola in Congo.

“We praise you for the news this week of new treatments,” he said. “Bring the outbreak of Ebola to an end.” He concluded his prayer: “We present our bodies as living sacrifices this morning.” A chorus of amens rose up.

After church, he walked to the hospital to do rounds.

—This story has been corrected to reflect that ELWA Hospital opened the first Ebola treatment unit in Monrovia.