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Living through the Ebola crisis: reflections from Liberia and Sierra Leone

Chuchu Selma, WaterAid’s Programme Manager for Liberia and Sierra Leone, on why investment and long-term solutions are vital for helping West Africa – and the world – recover from the devastating impact of Ebola.

Blog

12 Nov 2014 | UK

The Ebola crisis, which has now claimed more than 2,700 lives in my home country of Liberia, threatens everything we have worked for since 14 years of civil war ended in 2003.

When WaterAid resumed work in Liberia and neighbouring Sierra Leone in 2009, these countries' infrastructures had been decimated by years of conflict. Roads, schools, hospitals, electricity generation, even basic access to water and sanitation – all were broken or nonexistent.

No nation can face down a virus like Ebola when its hospitals do not even have a regular supply of water or working latrines.

Signs of progress

I spent part of my early years in the north of Liberia, in Lofa County, where the outbreak started. I am in regular contact with my relatives and friends there, and they are frightened. So am I.

But despite the bleak headlines there are signs of progress. Health workers and volunteers are risking their lives to stop this disease. Survivors are coming out of Ebola treatment centres to tell their stories, so that others may learn that they offer hope, not just certain death.

When the outbreak first started, there were no ambulances and no doctors in the village. If someone was ill, they would be put on the back of a moped or into a car and driven the 10 miles to the nearest health centre. That requires someone to help them  ̶  which meant contact, and the disease spreading further still.

In Monrovia, the capital of Liberia, even the hospitals were spreading Ebola, in part through their poor sanitation and lack of hygiene.

The virus is spread through bodily fluids – blood, vomit, faeces – and the toilets were filthy, if they worked at all. Soiled bedding wasn't removed quickly enough.

Even when specialist Ebola treatment centres were opened, they were quickly overwhelmed.  At one centre just a couple of months ago, I saw as many as 20 people standing by the gates with their family members, hoping for admission, only to be turned away for lack of beds. 

This has changed.

Boys bathe in the Wanjai River, Sierra Leone.
Suliaman collects dirty water as boys bathe in the Wanjai River in Sierra Leone. This village, like many others, had its communal water pump destroyed in the civil war, leaving its residents no choice but to collect water from the river. Credit: WaterAid/Anna Kari

Two sides of the story

From my home in Monrovia I see there are two sides of the Ebola story – the view from outside the country, and that of those of us here.

From the outside, the world has only just begun to wake up to this crisis. But here in Liberia, we have been facing Ebola for nearly a year already, and though it remains terrible, there are small improvements.

Everyone is glued to their radio and TV and more information is getting through. The stories of the survivors who have been returning from treatment centres fill the airwaves, showing that Ebola is not always an automatic death sentence and encouraging others into treatment early.

Service teams and health volunteers are reaching out to remote villages, and personal hygiene and disinfection kits are being handed out to help families protect themselves.

People no longer lie ill for days on end. Everyone has saved the dedicated Ebola helpline numbers onto their phones, which means that in Monrovia, help can arrive in just two to three hours. There are many more volunteers and more ambulances.

Ugandan doctors who have faced Ebola before are working side by side with local doctors, and our doctors are gaining confidence.

A critical need for investment

Everyone hopes this terrible disease will not spread further. But the challenges are still enormous.

It is hard for the West to realise that hospitals in Liberia, like most public buildings here, do not have running water or functioning toilets. Patients have to bring water in jerrycans to hospital. Even government buildings like the Ministry of Finance and Parliament don’t have properly functioning toilets and water rarely, if ever, flows through their taps.

We need investment if we are to check Ebola’s spread. Investment in safe water, sanitation systems and hygiene education must play a major role in stopping this outbreak, and in the longer term recovery from this disaster.

There are a lot of competing priorities. After 14 years of civil war, we also need better roads and a reliable electricity supply.

Yet a survey last year showed 55% of schools did not have access to safe water, and one third did not have basic toilets. Figures from the World Health Organisation and UNICEF show that 25% of Liberians do not have access to safe, clean water and 83% do not have access to a hygienic toilet.

We cannot check the spread of terrible diseases if we do not even have the basics of water for drinking, cleaning and handwashing, and proper toilets.

Humanitarian agencies have stepped in to help us fight this terrible battle. But months from now, if Ebola is finally contained, Liberia and Sierra Leone must not be left to fend for themselves.

Our struggling healthcare systems and economies will need longer-term help to make sure this does not happen again.

A young woman looks in through a window across an empty ward, Liberia.
A young woman looks in through a window at an empty ward in Kaeweken Health Clinic, Liberia, before the Ebola outbreak. This clinic, like many in the country, is without running water, which staff must instead collect from a building nearby. Credit: WaterAid/Aubrey Wade

A global problem requires a global response

Before this crisis began we had just over 50 doctors to serve our population of 4.3 million – that’s one per 85,000 people – and many doctors and nurses have died in this crisis. In comparison, in the UK there is one doctor for every 500 people.

Of the hundreds of millions of dollars now being sought to contain Ebola, little to none of it will help with longer-term solutions of fixing our broken hospitals and decimated ranks of doctors and nurses.

Nobody should see this as a West African problem alone. This is a global problem and requires a global response. Our president, Ellen Johnson Sirleaf, has warned of a lost generation from the toll of this epidemic – a destroyed economy, along with the health crisis.

We can either wait for Ebola to strike us next or we can go out and fight it together.

Our petition, calling on world leaders to take action on Ebola - now and in the long-term - received an incredible 7,819 signatures from around the world. It will be delivered to Downing Street and the G20 in Brisbane this November.