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Dr Nathalie MacDermott carried out two stints working to stop the spread of ebola in West Africa.

Now returned home, she explains how although communities are beginning to return to some form of normality, death and tragedy are still poised to return.

She also writes of the her own emotions at the trauma she witnessed first hand.

I returned to Liberia again at the end of November following three weeks in the UK for interviews and presentations.

Shortly before my return to Liberia, the President had announced she was stepping the country down from a state of emergency as case numbers were down.

She also announced she hoped Liberia would be ebola free by December 25.

On my return to Monrovia the atmosphere was completely different – almost all businesses and restaurants were open again, people thronged through the streets and market places, and it was almost as if ebola no longer existed in Liberia.

Too confident?

Several facilities were no longer taking temperatures or ensuring people washed their hands before entering them.

The concept of “no touch” seemed to have disappeared for the people on the streets.

Unfortunately, ebola had not disappeared and it continued to lurk in small clusters throughout the city and other parts of the country.

But then how long can you remain in a “state of emergency”?

Five months is a long time to be subject to curfew, no touching policies and limited trading.

It was unnerving seeing people so relaxed, the thought that ebola might come roaring back at any moment played on many people’s minds.

Somehow, we have been fortunate and that has not happened; even with the festivities and potential travel over the Christmas period, re-opening of schools and the borders, numbers continued to fall and now we have reached the point where there have been no new confirmed cases of ebola in 19 days.

An exciting moment

The last patient unfortunately passed away and we are now nearly two weeks without any confirmed cases in country.

We are at an exciting moment, one I am not sure many of us thought we would reach so soon. It makes me want to shout for joy but also cry at the same time.

There has been so much death here; ebola has taken a toll on these nations in far greater ways than we yet understand.

It is only as the state of emergency ends in all three countries and people are able to relax that the true emotional toll will reveal itself.

The grief is hidden under the layers of stress that lie upon all of us – Liberians and international workers alike.

We remain in a state of constant vigilance chasing an enemy we don’t fully understand, hoping it is going but not daring to believe it might actually have gone. We wonder if it will raise its ugly head again in some remote area and trigger another outbreak.

We wonder when we might ever be able to relax – yes Liberia may soon be declared ebola free, but the borders remain a risk.

Until ebola is gone from Sierra Leone and Guinea, Liberia will not be safe. Even once it is gone from all three countries the potential for another outbreak remains high, maybe not immediately, but some years in the future.

Will we bury our heads in the sand again?

The questions remain: will the lessons learned in West Africa from this epidemic ensure that any future outbreaks will be controlled and prevented from escalating to this level?

Has the international community learned its lesson to not bury its head in the sand? Some days I am reassured the answers to these questions may be “yes”, but there are many days I despair at what I see and I question from a long-term perspective – what have we, national governments and the international community, actually achieved here?

I guess bringing the largest ebola epidemic in history under control is a great testimony to all that we have achieved, but if we have not learned lessons for the future then we are condemning ourselves and thousands of people to recurrent episodes such as this one.

On my return this time, I have not only been involved in constructing and overseeing the Samaritan’s Purse community care centres (CCC) but I have also been involved in developing and implementing the rapid isolation and treatment of ebola (RITE) strategy in three counties as well as training five counties in how to implement this response themselves.

We completed one full rapid response to a cluster outbreak in Gbarpolu county in December, quite an experience setting up a mobile treatment facility in the middle of the jungle.

We have also now set up six community care centres, operated four and closed two. Two others will likely not open as there is no longer the need.

We have trained more than 100 healthcare workers in the management of patients with ebola and how to operate an Ebola treatment facility.

'The most challenging thing I've ever done'

Our teams have also distributed close to 80,000 infection prevention kits to communities and reached more than one million people with ebola awareness messaging.

I look back at the last six months and wonder how we ever achieved anything on this level, perhaps it is why many of us have hardly slept during this time!

The experience has been incredible. It has been the most challenging thing I have ever done, on a professional, personal and emotional level.

The costs have been huge but the satisfaction of knowing Liberia may soon be declared ebola free make it all worth it.

The learning curve I have been on has been at times extreme, but the wealth of knowledge I have gained has been immense and could not have been gained in any other way.

There is also no doubt in my mind that this is exactly where God wanted me, at this particular time – as it reads in the Bible in the book of Esther “for just such a time as this”.

I wonder how it will feel when we are free of ebola in West Africa.

I wonder how I will feel when ebola is no longer a problem, or at least not a current problem.

It will haunt me forever

I wonder how I will re-adjust to a life that is not filled with the constant adrenaline that has propelled me through this response.

Eight months consumed with fighting ebola, what is left when it is gone?

One thing that is certain is that every affected nation will need a period of grieving and every individual involved will need that time also.

The toll ebola has taken on the individual, as well the three affected nations, is enormous.

That toll is greater than many will ever be able to understand and the sacrifices made on countless parts are incomprehensible to most.

It is so difficult to explain the cost of ebola unless you have experienced it.

The things I have seen, as have many others, will haunt me forever – no person should have to die as my patients died.

I can still see their faces, even from eight months ago; I remember their names and I remember how they died.

We have not had time to properly grieve for all that we have seen. There has been too much to do to end this epidemic, and that is what has kept us going all these months.

I dare not cry

But it means we have not given ourselves the time we need to decompress all that has happened.

I dare not start crying at the moment, because I don’t know when I will be able to stop.

I wonder when the nightmares will end and when a normal sleep pattern will return.

This is an expected response to the trauma we have all suffered over the last few months, our national colleagues even more so than our international ones.

Time will heal our wounds, but it won’t ever erase the memories of this period. I can only pray we never face an epidemic of any kind on this scale again.