More than a year and a half after the start of the largest Ebola outbreak in history, the damage wrought by the epidemic in west Africa continues to extend far beyond lives lost.
The outbreak infected more than 28,000 people and took more than 11,000 lives. The global response to the Ebola outbreak was slow, and the health systems in affected countries like Sierra Leone and Liberia were hard-pressed to accommodate a public health emergency of such proportions.
But part of what made Ebola so difficult to address was that it was "a disease of affection," Tolbert Nyenswah, MPH '12, Liberia's deputy health minister for Disease Surveillance and Epidemic Control, explained to an audience of more than 300 at the 2015 Pulitzer Center-Johns Hopkins Bloomberg Symposium on September 17.
Nyenswah spoke of Liberia's continuing struggle to recover from 14 years of civil unrest following its Civil War. The conflict created major disruptions in the normal flow of the country's social and economic activities, including the functioning of its health system. Even so, people affected by Ebola in Liberia say that the disease was worse than war.
"Everybody said to me, 'Ebola is worse than the war. Because during the war, we knew our enemy," said Pulitzer Center grantee Carl Gierstorfer, who spoke during the symposium about his reporting on the psychological effect that Ebola had on one community in Liberia.
"With Ebola, it was, suddenly, those that cared for one another were infecting themselves. So it happened within families and in the communities." Gierstorfer said he witnessed "an incredible power within these communities to overcome these rifts and to move on."
The result of his reporting: the documentary, We Want You to Live: Liberia's Fight Against Ebola, which Gierstorfer previewed as part of his remarks.
"Just last month there was a sense of optimism in [Sierra Leone] after the last Ebola patient was discharged from a treatment center. So the fight continues," said Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, which organized the 2015 symposium with the Pulitzer Center as part of their Campus Consortium partnership.
Pulitzer Center grantee Erika Check Hayden shared the same idea of community resilience as she recounted stories of the "survivor nurses" she met while reporting on the Ebola outbreak in Sierra Leone.
Check Hayden showed pictures of three nurses, Zainab, Kanko, and Mariatu. "These people were motivated by their experiences to keep on going and giving. And they were such an amazing presence." The three women were infected with Ebola, and each survived. They used their battle with the disease as a source of strength for others. Kanko told her, "When I see patients suffering, I think about myself. This is the way I lay down when I was sick. I say 'I was like you.'"
The two final speakers shared their insights into the unintended consequences of the Ebola outbreak, and how to use lessons learned in the response as a way to move forward.
Justin Lessler, assistant professor in epidemiology at the Bloomberg School, discussed his research on the effect that the disruption of health services had in Ebola-affected countries.
Lessler and his team modeled the potential increase in cases of the measles in areas where the Ebola outbreak either stalled or shut down routine public health practices, like measles vaccinations.
"So you start seeing headlines coming from the countries, just a few, like the ones I have here, telling about people dying from routine health problems, and dying from preventable causes, because the health system couldn't provide them with the care they needed."
While public health officials, health workers, and community members confronted the unforeseen psychological and technical problems that came with Ebola, researchers and policymakers worked to understand what stopped the outbreak.
"So what turned it around? I think it's clear that we're not going to be able to say that any one thing did it. That would be rather unrealistic, and not really fair to what happened. Clearly it was a big effort around building trust, trust in the community, trust in the health force," David Peters, chair of the Department of International Health at the Bloomberg School, told the audience.
He emphasized how critical it was that community members in affected countries were willing to change sensitive cultural practices after learning that they contributed to the spread of the disease. Communities stopped traditional bathing and dressing of dead bodies, handing over the responsibility to care for their loved ones to hazmat workers with protective gear.
The symposium highlighted the need for the global public health community to take any and every disease outbreak seriously, and for health workers to take careful consideration of cultural sensitivities.
Although the disease is under control, there is still work to be done. Researchers in Liberia continue to test survivors to better understand how long the disease remains active, and how it can be transmitted even after someone is declared "Ebola free."
At this year's symposium, questions from the audience probed the issue of clashes between religious authorities and public health officials, the role of the military in future public health epidemics, and the potential for research into the transmission of the disease between humans and animals.
To hear more of the panelists' comments and their dialogue with the audience, please view this webcast of the 2015 symposium.
A documentary by Carl Gierstorfer follows one community’s fight for survival against Ebola through...