On 31 March, the first cases of Ebola were confirmed in Liberia. By the end of July, the number of sick had risen to overwhelming numbers and people were dying in the streets.
Liberia’s healthcare infrastructure had suffered as a result of the long civil war, and when the Ebola outbreak occurred there were already significant gaps in care. As there were few confirmed Ebola patients in March and April, and none between the end of April and the beginning of June, the country and the aid organisations present were lulled into a false sense of security. The national health system was unprepared to cope with the explosion of cases when the situation rapidly worsened at the end of July. In the space of two months, the number of cases went from fewer than 10 in June to more than 1,000. The epidemic peaked between August and October.
Margibi and Lofa counties
In April, following reports of suspected cases of Ebola in Liberia, MSF sent a small team to Lofa and Margibi counties. In Margibi, east of Monrovia, a small isolation unit was built by a local company and MSF supported it with technical expertise and organised training for local health staff.
In Foya, close to the Guinean and Sierra Leonean borders, MSF built an Ebola management centre (EMC), and also trained local health staff and made sure that alert systems were in place to refer suspected cases. After the NGO Samaritan’s Purse suspended operations in Liberia when two of its international staff became infected, MSF took over the management of the centre and increased the bed capacity to 100. It soon became clear that a comprehensive approach to tackling Ebola was essential if the virus was to be contained in this area. A package of medical care, outreach activities, psychosocial support, health promotion and contact tracing was put into place. Nearly 700 patients were admitted to the centre, 394 of whom were confirmed as having Ebola. There were 154 survivors. The centre was closed in December.
In the capital Monrovia, MSF started by supporting the authorities and training medical staff in JFK and Elwa hospitals. An isolation unit was also constructed in JFK hospital. In August, the Elwa 3 EMC opened with a capacity of 120 beds, but this gradually increased as the outbreak worsened. The centre had 250 beds by the end of September, making it the largest EMC ever built. At this point, teams were admitting on average 152 patients per week and were being forced to turn away up to 30 people per day because there simply wasn’t enough space.
An MSF rapid response team ran mobile clinics and trained local health staff in triage and infection control. To mitigate the risk of contagion and restore public confidence in the health system, MSF supported 13 health centres with infection prevention and control – this later increased to 22 facilities, as new cases presented in different areas. MSF also began constructing a new free-of-charge paediatric hospital in the city. An ambulance service was also set up in December to transport suspected Ebola cases to an EMC.
Redemption hospital, the only facility in the capital providing free medical care to a population of approximately 90,000, closed entirely in October. To enable the hospital to start offering inpatient services again, MSF opened a 10-bed transit centre for the triage of those suspected of having Ebola. Psychosocial support was also offered to the families of Ebola sufferers.
River Cess county
Following a visit to River Cess county by the Liberian county health team, the World Health Organization and the Centers for Disease Control and Prevention in November, MSF was asked to establish a transit centre in Gozohn. This centre tested people suspected of having Ebola and referred patients to Monrovia for care.
By 8 December, the transit centre was empty but contact tracing and health promotion activities, as well as the construction of triage areas and training of health workers on infection control procedures, continued in six health centres in the region. On 15 December, the organisation Partners in Health and the county health team took over the activities.
Grand Bassa county
On 22 November, one case was confirmed in Grand Bassa county but just eight days later there were nine severely ill people. MSF deployed a team of 16 to establish a base in Quewein. At the end of December, the charity Concern Worldwide and the Liberian county health team took over the epidemiological surveillance and contact tracing. The decommissioning of the EMC and departure of the MSF team was planned for early January 2015.
Distribution of antimalarials
MSF distributed antimalarials to 522,000 people in Monrovia not only to protect them from the disease but also to reduce the number of patients presenting at EMCs wrongly thinking they had Ebola. Two rounds of distribution took place in five districts (New Kru Town, Clara Town, Gardnersville, West Point and Logan Town) between late October and December.
The number of Ebola cases declined sharply towards the end of the year, and by December Liberia was reporting the lowest incidence of the three main affected countries. However, contact tracing and cross-border communication remain essential in identifying and dealing with any new cases. Now that the peak of the Ebola crisis looks to be over in Liberia, non-Ebola health needs must be addressed as an urgent priority to ensure people do not continue to die of treatable diseases such as malaria and diarrhoea. Many hospitals have shut, health workers have died or fled, and few people have access to the level of care they need.
Alexander Kollie – his son was MSF’s 1,000th Ebola survivor
I noticed my son looking more tired than usual. I was worried about him. He didn’t have any symptoms like vomiting or diarrhoea, but he just looked tired. I called the Ebola hotline and MSF brought him to their Ebola care centre here in Foya to be tested … When the test came back positive, it was a night of agony for me … After some time, my son started doing much better. He was moving around. I prayed that he would be free of Ebola and test negative, but I was worried that his eyes were still red. I just wanted us to be together again. Then something amazing happened, something I could not actually believe until I saw it. Until that moment I saw him coming outside, I could not truly believe that it would happen. I’ve seen people with Ebola start to look strong and then the next day, they’re just gone. So I was also thinking, maybe Kollie will be one of those who will be gone the next day. When finally I saw him come out, I felt so very, very happy. I looked at him and he said to me, “Pa, I am well.”