More than two and a half years after the Ebola outbreak officially began, Doctors Without Borders/Médecins Sans Frontières (MSF) is closing projects in West Africa that had been specifically dedicated to caring for people who survived the disease.
The Ebola outbreak that swept across West Africa infected more than 28,700 men, women, and children and killed more than 11,300. Whole families were ripped apart and communities were devastated by the disease. Across Liberia, Guinea, and Sierra Leone, schools closed, economies ground to a halt, and health systems collapsed, leading to even greater loss of life. The shocking human toll of the outbreak was exacerbated by the painfully slow international response.
"The suffering caused by the Ebola outbreak was immeasurable," said Brice de le Vingne, MSF operations director. "It has left an indelible mark on every MSF staff member who traveled to work in West Africa. For our staff from the region, the impact was even greater—they were living with the daily threat of the disease, while at work they faced the devastating reality of Ebola head-on. But for those who were infected with the disease, and for their families, it was nothing short of hell."
Those who survived Ebola often found the struggle was not over—many faced significant medical and mental health problems after recovering from the virus. Addressing their needs was challenging, as the magnitude of this outbreak was unprecedented. Organizations like MSF had a limited understanding of what kinds of assistance people would need to pick up the pieces.
"As the outbreak subsided, it became apparent that Ebola survivors and their families would need significant support," says Petra Becker, MSF head of mission in Liberia. "The majority of survivors experienced physical disorders such as joint pain and neurological or ophthalmological problems. At the same time, many survivors—as well as their friends, family, and caregivers—experienced significant mental health problems, including post-traumatic stress disorder and depression, after being confronted so closely with death."
MSF set up dedicated survivors’ clinics in the three worst-affected countries. The first opened in Monrovia, Liberia, in January 2015, and provided more than 1,500 medical consultations before closing in August 2016. A second clinic in Conakry, Guinea, cared for 330 survivors and more than 350 of their relatives in the Coyah and Forécariah districts of the city. A similar clinic in Freetown, Sierra Leone, provided mental and medical health care to more than 400 survivors and their families, organizing more than 450 individual and group sessions to provide psychological support.
"Over time and after treatment, the severity of people’s psychological and physical disorders has gradually diminished," says Jacob Maikere, MSF head of mission in Sierra Leone. "Yet many survivors say that they are still deeply disturbed by the smell of chlorine, which immediately transports them back to the horror of the Ebola management centers."
Fighting Discrimination and Stigma
Ebola survivors and their families also faced stigma when they returned to their communities.
MSF, together with other organizations and in partnership with national initiatives, sent teams out into affected communities to spread health messages and to help reduce stigma and discrimination. In Guinea, for example, MSF reached 18,300 people through group and individual sessions.
"Stigma remains a huge issue for those who survived Ebola and for their families, despite awareness and information campaigns during and after the outbreak," says Maikere. "The discrimination takes many forms, with people losing their jobs or their partners, or being rejected by their family or community, all of which can have a hugely destabilizing impact on their lives."
Health Sector Among the Hardest-Hit
Health workers in the three worst-affected countries paid a heavy price for responding to the disease. Many lost their lives, and those who survived witnessed countless deaths and had to live with the constant fear that they too would be infected in their own communities as the virus spread.
"Health workers in Sierra Leone, Guinea, and Liberia saved many of their fellow citizens from Ebola," says Ibrahim Diallo, MSF head of mission in Guinea. "But the virus created such fear in the country that many were viewed with suspicion or even discriminated against because of the contact that they had with people who were sick."
Handing Over Post-Ebola Care
In late September, MSF ended its medical and mental health programs for Ebola survivors in Guinea and Sierra Leone, and post-Ebola activities in Liberia will finish before the end of 2016. Most medical conditions affecting survivors, such as eye and joint problems, have now been treated, and MSF has arranged for those who need ongoing mental health support to receive continuing care within their national health systems or from other organizations.
MSF will continue its efforts to provide services focused on the unmet health needs of vulnerable people throughout the three affected countries. "Any strengthening of health services in the three affected countries must include improving infection control measures, surveillance systems to ensure early monitoring of potential cases, and basic contingency plans allowing for a quick response to an outbreak of Ebola or other diseases," says Mit Philips, MSF health policy advisor. "The countries also need catch-up plans for services that lapsed during the epidemic, such as treatment for HIV and tuberculosis, as well as preventative services for which coverage remains low."
To these ends, MSF opened Bardnesville Junction pediatric hospital in Monrovia, Liberia. From January to August 2016, the hospital provided more than 3,280 emergency consultations and admitted 880 children as inpatients, mainly for malaria. The hospital’s neonatal unit has cared for 512 newborn babies.
MSF also provides care for HIV patients in Conakry, the capital of Guinea, and maternity care in the Tonkolili and Koinadugu districts of Sierra Leone. The organization also positioned emergency supplies in the region to ensure medical teams can respond quickly to any future outbreaks of Ebola, or to other epidemic threats.