After the outbreak: Picking up
Ebola wiped out nearly 10% of Liberia’s doctors and nurses. Take a look at life for those it left behind
Musu lies on her side in a cot in the Tubmanburg public hospital in Liberia’s northwestern Bomi County. She grips the cream-coloured bed rails, waiting for her father to clean her fresh surgical wounds.
The 11-year-old is recovering from an operation to fix severe burn scars on her face and neck, the excruciating injuries left over from a fall into a fire four years earlier.
The scars were not properly treated while she healed, so the skin on the left side of her face and neck has thickened and tightened, creating what doctors call “burn contractures”.
She could not move her head, blink her left eye or properly close her mouth.
“That’s an extremely difficult case,” says Kevin Strathy, the plastic surgeon from Florida, in the United States, who performed the surgery late last year.
At the time, he was the only plastic surgeon in the country.
Musu endured her debilitating injuries for four years because serious burn contractures can only be fixed with plastic surgery, and Liberia has no plastic surgeons.
She and her family thought she would live with her injuries forever. That was until Strathy and his wife Natu, a surgical nurse, arrived in Tubmanburg to perform free plastic surgeries on Liberians in need.
Despite efforts by the Liberian government and the international community to rebuild and strengthen the country’s healthcare system after the Ebola epidemic of 2014 and 2015, many of the systemic issues that got in the way of responding to the Ebola crisis remain. The virus spreads by direct contact with infected bodily fluids. Nursing sick loved ones, traditional burial ceremonies and even handshakes became potentially deadly acts. Within a few months, thousands were infected.
Four years after the start of the outbreak, prohibitively high costs for treatment and access to medicine still get in the way of preventing, diagnosing and treating even basic ailments.
“If you talk to someone who is using the health facility, if she says it’s much worse, I would not really argue with her,” says Alex Gasasira, the World Health Organisation’s (WHO) representative in Liberia. “The system is complex and there are still many, many weak points.”
When the Ebola epidemic hit Liberia in 2014, its healthcare system, already frail from years of civil war, collapsed. Hospitals and clinics were overrun to the point that even women in labour were turned away. The government struggled to co-ordinate the distribution of basic medicine and protective gear. As the virus spread, international funding and aid workers flooded into the country in an attempt to stop what many thought might become a global pandemic. More than 5000 people died before Liberia was declared Ebola-free, a number that includes nearly 10% of the healthcare workforce, according to 2015 estimates published in The Lancet medical journal.
It was the highest fatality rate among healthworkers in the three countries — Guinea, Liberia and Sierra Leone — most affected by the epidemic.
The viral catastrophe that was Ebola has now been replaced by a much less talked about silent healthcare crisis.
It is difficult to measure whether or not the system is worse off now than it was before the epidemic because the data is still being gathered. The next Demographic and Health Survey is only expected later this year and the most recent one is from 2013, pre-Ebola. The ministry of health conducts an annual review each year, which provides some insight into the system.
In 2016 less than half the country’s government health facilities had medication in stock for common illnesses, the review states. Only 57% had the basic equipment necessary to provide health services and nearly half had no electricity.
But the annual report, along with other data gathered by the ministry of health, says Gasasira, is prone to underreporting. It relies heavily on data gathered in health facilities and misses what happens out in the communities.
Vandross Payne, an unemployed graphic designer, sits on a tan and green wicker chair in a living room in Sinkor, a neighbourhood in the capital, Monrovia.
Just a week earlier Payne (41) was released from Liberia’s biggest public hospital, John F Kennedy Medical Centre — or, “Just For Killing” as it is not-so-affectionately called here. He’d gone to the hospital to get help for rectal bleeding, he says — the result of untreated haemorrhoids. During his month-long stay he received multiple blood transfusions. When the bleeding didn’t stop, the doctors decided to operate.
Payne suffers from a host of chronic medical problems that require regular treatment: glaucoma, a build-up of pressure in the eye that can lead to vision loss and blindness; hepatitis C, which can cause liver damage and lead to cirrhosis, liver cancer, or liver failure; and the haemorrhoids. But he only seeks medical care when absolutely necessary, he says, because he can’t afford it. The rest of the time he self-treats with medication from the pharmacy. But even that is sometimes too expensive.
“Every time you feel sick you worry about money,” Payne says. “If you don’t have money then that’s it.”
On paper, healthcare is free for Liberians. But in reality it is far from it: costs vary across the board depending on where you live and what type of facility you go to.
According to the US-based research organisation Institute for Health Metrics and Evaluation, Liberians spent $27 (R354) per person on outof-pocket healthcare expenses in 2015.
The month Payne spent recovering in John F Kennedy Hospital left him weak. His cheeks are hollow and his cheekbones protruding.
It also left him $120 (R1570) in debt. He hasn’t had the strength to work so paying the money he owes has been difficult. The last time he went to the hospital he did not receive treatment, Payne says, but was asked to pay off part of the debt before being sent away. He still owes the hospital $75 (R980).
All that is left for Payne, he says, is to ask around for money. “I am still young and don’t want to die yet.”
Agirl in a white dress that looked like it was once part of a princess costume was waiting with her mother when Diana Culbertson did her early-morning rounds in August 2017 in the pediatric ward at JJ Dossen Hospital in the southeastern city of Harper.
The mother had brought her daughter — she looked about six years old — to the hospital because she was vomiting. The girl tested positive for malaria and was put on medication.
According to the Institute for Health Metrics and Evaluation, malaria was the second leading cause of death in Liberia in 2016.
The girl seemed to be recovering quickly. She’d stopped vomiting and was smiling, but Culbertson was