Going viral

In the weeks before Nancy Writebol contracted Ebola while working in a hospital in Liberia, the American missionary watched families visit loved ones battling the deadly virus. Some sent small gifts into the isolation ward: bottles of juice, boxes of tissue, and cell phones to communicate with patients in isolation.

Some faced the virus together.

Writebol remembers an Ebola-stricken mother comforting a daughter fading from the disease. After the girl died, Dr. Kent Brantly entered the room to care for the mother. In full protective gear, the physician knelt next to the bereaved woman’s bed and began to sing a hymn. Writebol and others listened from outside: “We were all just standing there with tears in our eyes.”

The mother’s sorrow was brief: Within days, she died of Ebola.

By late October, at least 4,800 people in West Africa had died in the worst Ebola outbreak on record. Some health experts believe the numbers could be twice as high: More than 18,000 infections and 9,000 deaths. In villages and towns across Liberia, Sierra Leone, and Guinea, many Africans are dying wretched deaths, with no tests to confirm the virus.

The U.S. Centers for Disease Control and Prevention (CDC) warns those numbers will escalate. The agency reports if the virus isn’t thwarted, Ebola could infect as many as 1.4 million people in West Africa by the end of January. That scenario would mean hundreds of thousands of deaths in the next few months.

Combating Ebola is grueling and dangerous work. Patients suffer extreme vomiting, diarrhea, fever, and pain. Some endure bleeding from the eyes and mouth. Healthcare workers must wear heavy, stifling gear to protect against contact with patients’ bodily fluids. The virus kills at least half its victims.

The severity of the West African outbreak flows from the region’s decrepit healthcare services. Before the epidemic, fewer than 50 doctors worked in Liberia’s public health system in a country of more than 4 million people.

In the Liberian capital of Monrovia, the public hospital was unfit to treat Ebola victims. For months, the task of battling the Ebola epidemic in Liberia fell almost entirely to two Christian organizations: SIM (originally Sudan Interior Mission) and Samaritan’s Purse (SP). Those groups, and other Christian organizations, continue to work in the region, where several secular groups—particularly Doctors Without Borders—do good work as well. But like many health crises and natural disasters of the past, Christians are on the front lines, often because they were there all along.

As the outbreak worsened in Liberia earlier this year, Writebol remembers some people praying the disease wouldn’t reach the group’s hospital. Her prayer was different: “If it does come here, let us be the hands and feet of Jesus.”

AMERICAN NEWSPAPERS HAVE emphasized worries about protecting the United States: The CDC took a hit after it told a nurse who had attended an Ebola-stricken Liberian and then developed a fever that it was fine to fly. She did, and only later found out that she did have Ebola. President Barack Obama resisted widespread calls for a travel ban from the hard-hit West African nations, as the Department of Homeland Security announced such passengers would fly into one of five U.S. airports for Ebola screening.

The greater drama has been playing out in West Africa. In March, the Ministry of Health in Guinea notified the World Health Organization of a “rapidly evolving outbreak of Ebola virus,” but that bureaucracy downplayed the news. The Christian groups SIM and SP worked together to increase the number of hospital beds available for Ebola victims, but the number of patients kept increasing, and on July 26 both Brantly and Writebol learned they had Ebola.

Both workers went into isolation. Writebol—an SIM missionary—remembers her husband, David, reading her the New Testament book of Philippians through a window: “For me to live is Christ, and to die is gain.” Another doctor read passages from Oswald Chambers’ devotional My Utmost for His Highest. Writebol prayed Psalm 23: “Though I walk through the valley of the shadow of death I will fear no evil, for You are with me. …”

SP evacuated Brantly and Writebol to the United States in August, and both recovered after taking the only doses in existence of the experimental drug ZMapp.

For most Africans, leaving isn’t an option. In some places it’s forbidden. In Makeni, the fourth-largest city in Sierra Leone, officials have quarantined residents as Ebola has gripped parts of town.

An Oct. 1 New York Times article reported horrendous conditions in the city’s government hospital: scattered corpses oozing bodily fluids, nurses not wearing gloves, buckets of vomit, children bleeding from the eyes, patients languishing under trees outside, and “pools of infectious waste.”

Kim Kargbo knows Sierra Leone well: She grew up as a missionary kid in the country, and then served as a nurse. She’s been working for the past five years to help disabled women in Makeni. I caught up to her at her office in an old military depot near the Memphis, Tenn., airport.

Climb two flights of fire-escape stairs and knock on a metal door with peeling paint, and you’ll find Kargbo, the director of Women of Hope International (WOH), eager to talk about the challenges facing disabled women: Often despised even by parents, disabled women are among the poorest and most ostracized members of the community.

WOH maintains a small staff of African workers in Makeni overseeing a variety of ministries, including Christian discipleship, skills training, and fair trade projects. Kargbo says one of the most transformative lessons for the women—including many Muslims—is a simple one: “You have inherent value because you are made in the image of God.”

These days, ministry has shifted as Ebola has swept into the city. Kargbo returned to Makeni in August to deliver supplies to a local hospital and to train her staff to help educate clients about the virus. (They also trained churches to help the suffering.) The staff and others from the community also are distributing hygiene supplies.

Kargbo says returning to the city was like “stepping into a country I had never been to.” Fear has gripped the town, and officials have set up checkpoints to take temperatures of residents. (If a resident has a fever, it’s unclear where he might go for treatment.) Some shop owners insist customers wash their hands not with soap (although that kills Ebola) but chlorine, which has peeled the skin of many Africans and left exposed wounds. For the disabled women WOH serves, the outbreak has been especially difficult: With food prices soaring, it’s harder to buy basic supplies.

WOH staff began food distributions in October to prevent clients from growing malnourished. A spreadsheet of 300 names includes the range of disabilities: “blind, leper, polio, war wound, amputee, elephantiasis, hearing impaired, club foot, paralysis.”

Clients may come once a week for a supply of rice, beans, onions, and palm oil. The staff delivers food packages to clients under quarantine in their homes, but program manager Ruth Ada Kamara said sick women still show up.

Kamara knows the work is risky. Five women in the program have died from suspected Ebola cases, including the mother of a disabled girl, and a mother of four children now alone. (The UN estimates at least 3,700 children have lost one or both parents in the crisis.) But Kamara said she doesn’t consider doing something else: “The goodness of what God has done for you—you want to share that goodness with others. … We will not run away from them.”

Part of sharing God’s goodness is sharing the gospel, and Kamara says the staff is clear: “We can’t promise them money. We can’t promise them food supplies. But if they have Jesus, that’s the ultimate hope.” The day Kamara and I spoke, she described how a pregnant woman collapsed during the distribution: “I didn’t know what to do. Do I touch her? I had to help, so I just put on some gloves and picked her up.”

BACK IN LIBERIA, SIM workers are continuing to help Ebola victims. SIM USA president Bruce Johnson says a top priority is keeping the hospital running to treat patients with other illnesses as well. With overflowing hospitals, many West Africans are dying from treatable illnesses like malaria and complications from pregnancy.

Johnson says the staff—including 200 Liberian workers—is still under tremendous pressure. Though government groups and nonprofits have promised millions in aid, resources, and manpower, Johnson says he has “no more beds than there were four months ago.” The U.S. military plans to send 3,000 troops to build 17 treatment centers with 100 beds each, with the first one scheduled to open this month, but if the crisis escalates more will be needed.

Meanwhile, 350 Liberian SP workers are carrying home care kits to villages and teaching residents how to set up isolation units in their homes, dig secure pits for waste disposal, and care for the sick. The kits include plastic tarps, basic protective gear, and chlorine solution. SP workers (who have all remained Ebola-free) have discovered villages where nearly all the residents have fled or died. In one village, 20 people remained. Ten were feverish.

Stopping Ebola in West Africa is key to containing its spread to other continents. Some aid workers say the United States should ban travel from West Africa, since military transport and charter flights could transport aid workers, but others say that would hinder help. If medical companies are quickly able to produce drugs that could treat or prevent the virus, tens of thousands of lives could be saved.

Writebol, who says she feels stronger every day, continues to pray for those remaining in Liberia. She contemplates returning someday and says she wouldn’t change her ordeal: “It doesn’t mean it was easy or there weren’t dark days. But our lives are not our own. And we want to be faithful to glorify Him.”

Early survivor

The first non-African to contract Ebola, in 1972, was probably missionary doctor Thomas Cairns. From his home in Minnesota, Cairns, 72, told me he had been working at a remote African hospital for two years when he performed an autopsy on a patient who died from a mysterious illness. During the procedure, he nicked his finger with a scalpel. Twelve days later, he was sick.

Cairns’ hair turned white. He temporarily lost hearing in his left ear. He experienced severe headaches, nausea, vomiting, diarrhea, and fever: “It’s like the worst imaginable flu you can think about.” His medical colleague—working from a primitive lab—ruled out malaria and other infections. Cairns’ wife, a nurse, cared for him at home, making sure he had plenty of fluids. (She never grew ill.) With no email or phone, no one in the United States knew about Cairns’ plight. Local Christians prayed. Slowly, Cairns recovered.

Four years later an epidemic broke out 200 miles away. Researchers named the virus Ebola, after the nearby Ebola River. They tested blood samples from natives and dozens of foreign workers. Cairns was the only subject with antibodies to the virus. Since surviving Ebola patients develop immunity to the virus, doctors believe Cairns was one of the first survivors.

Now semiretired, Cairns credits God’s grace for his recovery. When he looks at the outbreak today, he urges prayers for suffering victims and caregivers, and for an end to the epidemic “by whatever means, physical or divine.” Cairns served in Africa for 19 years after his recovery: “We felt called of God. We were there as career missionaries. Why would we leave?” —J.D.