SEATTLE — West Africa’s 2014 Ebola epidemic was the deadliest outbreak of the disease since its discovery in 1976. Liberia was the country hit hardest during the outbreak, reporting between 300 and 400 new cases each week at the epidemic’s peak. The World Health Organization announced in January 2016 that Liberia was Ebola-free, making it the last country to be affected. However, despite the physical absence of the disease, hospitals in Liberia are still dealing with the epidemic’s aftermath.

One such hospital is Redemption Hospital in Monrovia, Liberia’s capital. Redemption, which is government-run and offers free care to all, was the first hospital in Liberia to receive an Ebola patient. Its difficulty in recuperating indicates not only the overwhelming magnitude of the Ebola epidemic but also the unpreparedness of the Liberian health system to handle it.

Redemption, in particular, lacked the resources it needed to combat the disease. “When Ebola struck, we lacked protective equipment, running water was sporadic and there was waste everywhere,” Redemption administrator Dominic Rennie said. “We had two or three patients in each bed as we wouldn’t turn people away… conditions were ripe for Ebola to spread.”

During the outbreak, doctors and other healthcare workers died at alarming rates. Many of Jude Senkungu’s colleagues from Redemption, including his roommate, lost their lives. “The first thing I felt was shock…. The second thing was fear and despair,” Senkungu said. “The situation felt hopeless… and [I] could hardly sleep because of the fear that I could also be a case. That’s when you really kneel down and pray.”

The Redemption workers were overwhelmed by the many incoming Ebola cases and feared that they too would contract the disease. Eventually, they stopped coming into work. The hospital closed temporarily in October of 2014, four months after its first Ebola patient had come in.

Thanks to aid and support from various organizations, Redemption was able to get back on its feet only a few months later. Two such organizations, the USAID Office of U.S. Foreign Disaster Assistance and an NGO called International Rescue Committee (IRC), partnered to rehabilitate and reopen Redemption’s pediatric and emergency departments.

IRC also trained Redemption healthcare staff on measures to prevent and contain infection for future outbreaks. These measures included installing handwashing and disinfecting stations at every entrance in the hospital and equipping the hospital with temperature checkpoints. IRC additionally updated the hospital’s triage system so that Ebola patients could be effectively identified and separated from other cases.

Since reopening in January 2015, Redemption returned to seeing about 1,000 patients each week, many of whom leave the hospital alive and healthy. Healthcare workers at Redemption feel safer with the new health measures in place.

“I was nervous at first, but the system is improving,” said Redemption triage nurse Kula Quiqui. “Everything is getting better. People here feel more protected, and we now have PPE (personal protection equipment).”

Redemption faced new Ebola outbreaks in July and November 2015 and with improved care was able to contain the cases to only a few each time.

Health experts caution that it may be challenging to maintain such reforms due to dwindling emergency funds, lack of continued aid and intervention and the difficulty of changing old healthcare habits. Additionally, there is a lack of trust among the public, with families declining to visit health facilities and turning to home remedies instead.

While the system at Redemption may not be perfect, it is a vast improvement from how the facility functioned before and during the Ebola outbreak. Its many reforms are promising and have already proved successful.

Just to the north of Redemption and Liberia lies Guinea, the West African country that was considered “ground zero” for the Ebola epidemic. As in Liberia, there has been a lack of trust in Guinea’s hospital system since the outbreak. Bakayoko Sekou of the Dubreka hospital reported that at the disease’s height, the number of births per month at the hospital dropped from 95 to single digits. People associated the hospital with sickness and feared that a visit could prove fatal.

USAID is working in Guinea to reinvigorate the public’s confidence in the healthcare system and is using hospital renovations and other efforts to improve available care. At the Dubreka hospital, in particular, USAID offered support in refurbishing the hospital’s pediatric and maternity wards. Thanks to the efforts of USAID and the resilient hospital staff, the Dubreka hospital is back to assisting with 100 births per month.

Though recovery from the Ebola epidemic has not been easy for the Redemption and Dubreka hospitals, both facilities have gained the knowledge and resources they need to contain and fight future outbreaks. Things are already looking up for the facilities, but only time will tell if the new reforms are effective.

– Sabine Poux

Photo: Flickr