When I fell ill with Ebola in early October, there were times when the future was uncertain and frightening. With some help, I was able to beat the disease and walk back into a changed life. Liberia, where I contracted the virus, is following the same path. There are now fewer cases of Ebola every week, and there is a sentiment that the worst is over. Earlier projections of tens of thousands of deaths appear to have been based on the false assumption that Liberians would not adapt to the threat they faced. Assisted by volunteers from around the world, Liberians tirelessly fought the outbreak and may soon declare a hard-won victory.
To be sure, the battle against Ebola is not yet over, and sustained efforts are needed to prevent a new spike in cases. Still, Liberia will enter its post-Ebola phase at some point in the near future. Questions will be inevitably be raised about how the disease spread so quickly and what measures must be put into place to prevent future outbreaks. The country’s health care system in particular will require major attention. At least 174 Liberian nurses and doctors have succumbed to Ebola in the nation, according to the World Health Organization. The total breakdown of medical services was one of the worst side effects of Ebola.
Liberian officials say the tragedy is an opportunity to fix the country’s broken health care infrastructure. “The weak health care system is to blame for the Ebola situation,” Bernice Dahn, Liberia’s deputy health minister, said. “We need to build a health system that is resilient to outbreaks.” For many Liberians, the swift collapse of health services was a frustrating reminder that, despite billions of dollars in foreign aid, Liberia is still struggling to provide basic services to its population. As anthropologist Sharon Alane Abramowitz wrote in a recent op-ed for Cultural Anthropology, Liberia’s pre-Ebola health care infrastructure was “fragmented, underfunded and understaffed.”
Building effective health systems must now become one of Liberia’s top priorities. This will not be easy. Resources are scarce in Liberia, and the priority in recent years has been achieving growth through foreign investment and equipping security forces. This has proved disastrous, as Ebola promises to derail the economy and exacerbate social tensions. There is an important lesson here: The provision of basic services such as education and health care can’t be treated as second-tier needs. Perhaps Ebola would have been brought under control before it wreaked havoc on the economy had health services been given more attention before the outbreak.
Inevitably, Liberia will need more aid to rebuild its health sector. This is a delicate issue. Some have argued that aid paradoxically makes it more difficult for countries such as Liberia to manage their own problems. Others point to aid conditionality that forces countries to follow one-size-fits-all development trajectories. There is no simple answer to this debate. But the international community will need to pitch in to help Liberia get back on its feet once the Ebola epidemic is over.
For starters, rebuilding the health care system requires ensuring that there is adequate financing for the sector and its staffers. Health care workers in Liberia are paid extremely low salaries, which often leads them to solicit bribes from patients. The issue of compensation was a flashpoint last fall, with many workers complaining that they were being asked to risk their lives for obscenely low salaries. Others simply refused to treat Ebola patients. Targeted, tightly monitored aid dollars can help fill the salary gap and thus retain talented health workers.
During the height of the crisis, workers faced patients who showed signs of Ebola but who instead may have had malaria or some other affliction. I saw someone die of diabetes complications right in front of a hospital. An affordable rapid Ebola test that works in an African setting is desperately needed. The efforts and funding to develop this technology must go alongside the research for Ebola vaccine. To better prepare for outbreaks, health clinics will need to have triage areas and a reservoir of protective equipment. It may prove to be helpful to train some community members to perform basic care services and spot Ebola symptoms as well.
The harrowing story of Dr. Ian Crozier, published recently in The New York Times, shows that even the sickest Ebola patients can be saved with the right medical care. Questions about whether intravenous rehydration is preferable to oral rehydration, the effectiveness of experimental drugs and the value of plasma transfusions are key. Eventually, the various organizations and individuals who treated Ebola patients should come together and develop a practical treatment plan that does not prioritize isolation over survival. This will encourage those who fall ill to seek treatment rather than try to avoid detection.
Liberia can’t go it alone. Fixing all of Liberia’s problems is not going to happen overnight, and Liberians will have to work out how they want to move forward from this crisis. But the world has a role to play as well. Liberia can achieve high GDP growth rates through exporting raw resources, but even if it allocates a sizable chunk of that cash to health care, a drop in iron ore prices could cause the country’s budget to be slashed overnight. Until Liberia’s revenue stream is diversified enough to include more than natural-resource extraction, the international effort to build and finance the country’s health services will need to be sustained.
The lessons of Ebola are crucial, and one hopes that Beijing, London and Washington will be able to fully grasp them. Ebola has exposed what Liberian President Ellen Johnson Sirleaf referred to as “inequitable health outcomes.” The neglect of community health clinics and limited options for the poor must end along with the outbreak. It is imperative that Liberia and the other two hard-hit countries — Guinea and Sierra Leone — don’t fall out of the international spotlight once the protective suits are off.