Monrovia in Times of Ebola

By Luc Evrard, Médecins du Monde Communications Director

When first setting foot in Liberia, my head was spinning with images of men in biohazard costumes fighting Ebola (and haunted by the fear of contagion), but I was both surprised and relieved.

In Monrovia, Liberia’s capital, one of the 3 countries most affected by Ebola, along with Guinea and Sierra Leone, life goes on as normal. Liberians are busy working and doing their thing, just as they normally would. Well, almost…

Ebola has affected just one in a thousand people here and seems to have reached a plateau. It seems unable to paralyze one of the poorest countries in the world (and one where far more people die every year from malaria, not to mention other diseases). The Ebola threat is nonetheless ever present. Strange recycled plastic tanks have started to appear everywhere, outside shops, houses and in some village squares. Chlorinated water, the virus-killer, is also ubiquitous and it’s strongly advised to regularly wash your hands with it. 

At government ministries you have to have your temperature taken. Someone flashes an infrared thermometer at your temple. No temperature, no risk of contagion. You may enter.

You also see ambulances with their roaring sirens once or twice a day. This is not surprising given the dangerous and chaotic traffic that streams through the streets of Monrovia. But then you notice the hazmat-suited crews behind the wheel, with their face shields, gloves and diver-like goggles. They are wearing PPE, Personal Protective Equipment, made famous by Ebola and vital protection here for anyone who is in close contact with a sick person. The lack of PPE at the outbreak of this disease took a heavy toll on health professionals – more than 150 died. Many hospitals closed as a result.

Désinfection Ebola Liberia

You also come across Ebola Treatment Centers (ETCs), those fort-like isolation camps, surrounded by barbed wire, built in a rush by governmental and non-governmental organizations to care for the sick. There was only one ETC when the virus peaked in August this year: ELWA 3. Some people died queuing outside because there weren’t enough beds. The situation is now reversed. There are now 600 beds for 167 people being treated. What was a slow start in international aid is now ramping up. Workers from China have almost finished building a new prefab centre, stamped with the Chinese flag near Samuel Doe stadium. But, in a glaring paradox, traditional hospitals are still closed. In Liberia, it is now easier to be treated for Ebola than for any common disease.

The Togolese doctor Pierre Sallah, general coordinator for Médecins du Monde – Doctors of the World, works in Liberia where he’s been living with his wife and two young children since 2012. He’s an experienced humanitarian aid worker who didn’t think twice about staying when Ebola’s panic gripped Monrovia and triggered a mass exodus of those who were able to leave. “Humanitarian work is about committing oneself. What impression would people have if we left when they most needed us?” he says.

MdM works at the heart of this fight. Every day, 400 Community Health Volunteers (CHVs) walk the streets of Monrovia’s most deprived neighborhoods and suburbs.

They go door-to-door relaying prevention messages. “Hello! Do you know what the symptoms of Ebola are? Or how you can contract the virus? Or how you can protect yourself? What should you do when in doubt?”

Alex Gandha, a teacher who became unemployed when his school closed, lost a former colleague at the start of the epidemic. He channels all of his persuasive resources into what he believes to be his mission. “It’s my duty,” he says. “Most of the time, people are very welcoming. But in many cases, people have nothing, not even soap to wash – let alone chlorine…” Nonetheless, this meticulous exercise has started to bear fruit. “People are changing their habits,” rejoices Dr. Sallah. “They are taking more precautions. That’s the main reason behind the decline in numbers of people contracting Ebola since October. What is hard to change though and needs extra efforts is the shortage of supplies and medicines in our health centers.”

Consultation Liberia

MdM supports five centers in Monrovia: Clara Town, Soniwein, Chocolate City, Bromley Virginia and Duport Road. 600,000 Liberians live nearby and have no other alternative when they need care. Those five centers are all different. For instance, the one in Soniwein stands next to a public waste dump. Visitors to Chocolate City also see women in labor. But all centers have one thing in common: they are very poorly equipped. Lacking other supplies, health professionals often care for patients with goodwill alone. “Without the medicines and supplies MdM brings, we would have nothing to relieve or prescribe to those patients,” says Akoi Kullie, a medical assistant at Chocolate City health centre. 

“It was hard before. Ebola hasn’t helped.” Health Minister Walter T. Gwenigale agrees. We met him one early evening at his home while he was watching a football game and sipping his favorite aperitif. It all started with the customary exchanges of courtesies regarding our work, but he then went on to say that “Ebola has ruined the ten-year health plan launched in 2011”. Given there were only 50 doctors in Liberia before Ebola struck (that is, one doctor for every 80,000 people), it’s tempting to think the plan was already in deep trouble.

Ebola or no Ebola, everything about Liberia’s health system needs improvement. Korlia Bonarwolo believes this can be done and he knows what he’s talking about. This 25-year-old medical assistant caught Ebola in June while taking care of a sick colleague who later died. For three long weeks, he hovered between life and death. “I was terrified, I didn’t think I was going to make it,” he explains. He managed to pull through, has now built up strength, and has gained back the 10 or so kilos that he’d lost. As a strong-willed survivor he now works in one of the capital’s ETCs. Immunized, he can come close to sick people without fearing contamination or wearing a PPE.

“I help people who have Ebola. I provide care but also hope,” he says. “I’m living proof that one can survive Ebola. It keeps their spirits high, along with those of our medical team”. Along with other survivors, Korlia has just launched the ’Survivors Association’ to help Liberia find its way out of Ebola and raise its head high again.

Doctors of the World is battling Ebola in Liberia, Sierra Leone, and elsewhere. It is currently preparing its response in Mali. MdM communications director Luc Evrard visited Liberia in late November 2014.