Some patients are surviving, but virus continues to wreak havoc.
June, 2014—”Horrible” is almost too tame a word to describe the impact the Ebola virus is having on the West African nations of Liberia, Guinea, and Sierra Leone.
“It’s an evil like I’ve never seen before—and I’ve seen evil,” said Karen, a nurse in Liberia who has spent more than 10 years with Samaritan’s Purse treating patients in some of the world’s poorest and most violence-prone countries, including South Sudan.
The evil has even extended to Samaritan’s Purse caregivers. Dr. Kent Brantly, a doctor working for Samaritan’s Purse, and Nancy Writebol, a missionary with a partner organization, contracted Ebola and are being treated.
Dr. Brantly, medical director for the Samaritan’s Purse care center serving the Liberian capital of Monrovia, and Writebol, part of the joint Serving In Mission/Samaritan’s Purse team, are undergoing intensive treatment at an isolation center at ELWA Hospital near the Liberian capital of Monrovia. They have shown a slight improvement. However, as of July 30 both remain in serious condition.
Ken Isaacs, Samaritan Purse’s vice president of programs and government relations, does not believe this outbreak has peaked. “I think the worst is yet to come,” he said on July 27. “I hope I’m wrong.”
Even with this grim news, the situation is not hopeless.
“People are surviving this; there is hope,” Karen said. “One young woman was close to death because of the virus. She had already lost her mother and sister, and medical help had done all it could for her. She accepted our offer to pray for her and, by God’s grace, later recovered. We could hear her singing in the recovery ward. It was so beautiful.”
Not surprisingly, early diagnosis and treatment is one of the keys to survival.
“We’re achieving a 70-per-cent survival rate among people who come for treatment after they experience the first symptoms,” said Dr. Lance Plyler, director of Samaritan’s Purse’s Case Management Center in Liberia. “If they wait until the symptoms are severe, the survival rate is only 10 per cent.”
Ebola is degrading (victims suffer from severe diarrhea, bleeding from the mouth and ears, and internal bleeding) and lonely. Patients must be totally isolated. Doctors and nurses must be dressed head-to-toe in protective isolation suits. The virus is so contagious that normal means of reassuring patients (by holding their hands or giving them a hug, for example) are too dangerous for medical staff.
It’s a heart-wrenching choice to have to make. Karen recalled seeing a little boy who was crying because Ebola had just taken his mother’s life. How do you comfort suffering children while dressed in an intimidating protective suit and gloves, wearing a mask and hood that leave only your eyes visible?
You do it with your eyes, says Karen, while relying on “angels in the room” to help comfort and cure.
The protective suits are unbearably hot inside. Temperatures can surpass 45 º C. Medical staff remain in them for only 90 minutes before it’s necessary to remove them, replenish some body fluids, put the suits back on, and return to work.
The suits cannot be re-used for safety reasons, Karen said, and so “we probably spend $500 a day on protective clothing alone.” That’s only one of many financial costs—other key ones being medical equipment and supplies—for Samaritan’s Purse in its fight against the deadly Ebola virus.
Treating each patient costs an average $1,200, says Plyler. The fact it costs only 46 cents per person to offer our Ebola preventative education program highlights the cost-effectiveness of prevention.
Samaritan’s Purse is one of only two non-government organizations (with Doctors Without Borders) in the fight against Ebola in West Africa. Together, we are trying to stop the deadly virus from fanning out into other parts of Africa, and ultimately, to other continents. “We are especially grateful to the Medecins Sans Frontiers, and their partner, the Samaritan Purse who, at great personal risks, has continued to assist us in the difficult fight against this pandemic, said Liberian President Ellen Johnson Sirleaf.
“We have decided to make a stand against this disease here and now,” Plyler says. “God has been preparing Samaritan’s Purse for this response. We need to draw a lot more attention to the problem.”
Saving Precious Lives
Ebola continues to wreak havoc in Liberia, but praise God, some patients are surviving.
The terrifying and highly contagious Ebola virus continues to spread in West Africa. The deadly disease, which causes massive internal bleeding and has a mortality rate of 60 to 90 percent in most situations, has claimed more than 1,350 lives.
As part of the effort to help contain the outbreak, Samaritan’s Purse has assumed responsibility for operating an Ebola isolation center in Liberia. The facility, also known as a case management center, is located in Foya near the border with Guinea—ground zero in Liberia’s battle against this killer virus and the only treatment point in the area where the disease continues to breach the border.
Samaritan’s Purse has deployed a total of 16 people to Liberia since June 18, including doctors, nurses and experts in logistics and WASH (water, sanitation, and hygiene). These medical teams include several Canadians, and are providing direct clinical care to people infected with the killer virus, not only at the clinic in Foya but also at a treatment and isolation center at ELWA Hospital just outside Monrovia, Liberia’s capital.
Praise God, they have been able to save the lives of some. Harrison (right) was the first Ebola survivor in Liberia. Having heeded the messages shared through our awareness campaign, he immediately sought medical help after starting to experience symptoms.
Nurse Karen was free to put her arms around two female survivors (pictured lower right, middle)—a stark contrast from having to be covered head to toe in protective personal equipment while treating infected patients.
The Foya isolation center that Samaritan’s Purse is now running has been treating Ebola patients since April. A large local staff will continue to fulfill their responsibilities alongside four members of the Samaritan’s Purse disaster response team. Facilities will be expanded, and the team is reaching out to other remote health clinics in the area to provide education and training. Kendell Kauffeldt, Samaritan’s Purse country director for Liberia, and Dr. Moses Massaquoi of the Liberia Ministry of Health and Social Welfare together unveiled the new banner for the Foya isolation center.
“When the outbreak began, I told my staff that we were not going to run away from this,” Kendell Kauffeldt said during the ceremony. “We will be like the Good Samaritan who did not run away, but stayed to help. In the end, we will celebrate together how God carried us through.”
Samaritan’s Purse has been responding to this unprecedented outbreak of Ebola since March, spearheading a national awareness campaign in Liberia that has reached over 400,000 people with prevention education and hygiene items.
“This is the largest outbreak of Ebola since it was first discovered in 1976 and it is the largest outbreak in Western Africa, with cases now showing up in national capital cities,” said Ken Isaacs, vice president of programs and government relations for Samaritan’s Purse. “Along with medical treatment, awareness and education are the keys to containing this outbreak.”
Please continue to pray for our disaster response team, including our dedicated medical staff. They are living examples of the kind of courage Joshua 1:9 speaks of: “Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.”
An interview with Dr. Azaria Marthyman in Liberia
Dr. Azaria Marthyman is a physician on temporary leave from his medical practice in Victoria, B.C., to serve with a Samaritan’s Purse team of specially-trained medical specialists from across North America who are caring for victims of the deadly Ebola outbreak in Liberia.
Dr. Marthyman previously served on Samaritan’s Purse medical teams in Haiti following a cholera outbreak in 2010 and in the Philippines after typhoon Haiyan in 2013. He and his wife have seven children, three of whom were adopted from Liberia.
Samaritan’s Purse recently interviewed Dr. Marthyman between his shifts at the Foya Case Management Center near the Liberia/Guinea border—ground zero in Liberia’s battle against this killer virus.
What is the current status of the Ebola outbreak?
“The outbreak is on the rise. We are not seeing all the cases. There are now more and more deaths in the community where these individuals have not sought medical help. The cultural barriers are difficult to overcome. My fear is that an explosive number of cases will come forward in the future, unless God puts His effect to calm the storm.”
Dr. Azaria Marthyman shares his experience treating Ebola patients in Liberia, Africa on Samaritan’s Purse’s blog. Click here to read the Ebola Journal Entries.
What is the status of the international relief effort?
“Doctors Without Borders and Samaritan’s Purse are battling Ebola in Liberia. The World Health Organization (WHO) and the Center for Disease Control (CDC) are also involved, especially in the laboratory. The Red Cross is helping with social movement issues. The Liberian Ministry of Health is involved heavily but they lack capacity. The Foya Case Management Center is the only treatment point in the area.”
What do you do to treat the patients who come to you?
“Patients who can eat and drink are encouraged to do so. We give them Plumpy Nut, a high-energy, balanced nutritional food made from peanut butter balls and other ingredients. We also give them multivitamins daily and take measures to control fever and pain, maintain cardiovascular stability, and treat any concurrent disease such as malaria . . .
“We also spend time on psychological counseling. People are comforted by spiritual discussions.”
What difference has your own faith made in your experience helping treat Ebola patients so far?
“My faith in Christ brings me hope and trust. I try to instill confidence in God to give hope to patients. When a people lose hope, they stop trying. We inherited national staff that—praise the Lord—includes many Christians. We continually give God praise and glory as we go about our clinical management.”
Will the disease eventually run its course? If so, how long do you think that might take?
“Sometimes, viruses run out of steam naturally, but I personally believe that Ebola is here to stay and will periodically surface. We are now seeing spurts where entire families get sick and die, or certain communities come down with high numbers of cases.”
How are you and the people working with you protecting yourselves from becoming infected?
“Ebola is transmitted by direct person-to-person contact, especially via body secretions such as vomit, urine, blood, tears, saliva, etc. So we protect ourselves by wearing hazardous material protective gear. It gets really hot inside my protective suit. By the time I remove it, I am wet head to toe with perspiration.”
What do you require to improve your ability to treat patients?
“Water, Sanitation and Hygiene (WASH) procedures are key components to what we do here. We are managing with what is already in place. But without community health measures—improved hygiene, early detection of cases, quick isolation, contact tracing etc.—we will continue to have Ebola infections. The fight has to be in the community.”
Would you be able to cure a greater percentage of the patients if you had additional resources?
“For now, we are managing. If the Ebola cases continue to rise, we will need to increase capacity. We will need more Samaritan’s Purse personnel I would think. We are improving the infrastructure and layout of our treatment facility to add more capacity.”
Is the mortality rate still around 70 percent (compared to the normal 90 per cent)?
“The rate quoted by the World Health Organization is 64.1 percent but our internal numbers (at the Foya center) are at 45 to 50 percent, which means we are saving about half of the Ebola patients.”
Compared to North American standards, what are the conditions in which you are working?
“It’s hot because there is, of course, no air conditioning. Also, as physicians, we have to rely more on our personal diagnostic skills as we do not have the luxury of tests.”
What is the emotional state of the general population?
“Denial is the main issue. There is also a general lack of trust. People can’t understand what is happening so they are becoming very suspicious of outsiders.”
What is the emotional state of the medical personnel?
“It is generally positive . . . staff safety is of high priority.”
How are you and the civil authorities dealing with the remains of people in urban areas who succumb to the disease?
“Locally, our team goes out to spray bodies with chlorine solution, and decontaminate houses. Logistically, this will become difficult if the volume of cases continues to increase. We need community-level education and training to teach people to do these things on their own. The Ebola outbreak cannot be tackled by just increasing the number and size of treatment clinics. It has to be battled at the community level.” (Samaritan’s Purse is leading an Ebola preventative education program that has provided information to more than 400,000 people in Liberia so far).
In rural areas, is there a danger of contaminated human remains spreading the disease? If so, are the civil authorities able to do anything about it?
“The Ministry of Health has been overwhelmed. There is lack of treatment capacity, funding, and human resources. The issues with respect to diseased human remains are the same in the country as they are in the city.”
How would you describe the risk of Ebola spreading to other African countries, and of eventually reaching across the entire continent and possibly beyond (like AIDS)?
“The risk is definitely there for continued spread geographically. The borders between West African nations are not well-guarded and cross-border traffic is not well-regulated.”
Have you had opportunities to share the hope of the Gospel in the midst of such suffering?
“Yes. Every interaction with patients, I point them to Jesus who gives eternal life. I am often on the go, and so my time with each patient varies. I do have time for short prayers with patients. When people say thank-you, I point them to thank Jesus who is the reason I am helping here in Liberia. I am thankful that other nurses and doctors also witness.”
Battling Ebola in Liberia
Samaritan’s Purse is providing direct care to patients suffering from the deadly disease.
The terrifying and highly contagious Ebola virus continues to spread in West Africa. The deadly disease, which causes massive internal bleeding and has a mortality rate of 60 to 90 percent in most situations, has claimed more than 480 lives.
In response to this resurgence, Samaritan’s Purse deployed a team of medical personnel to provide direct clinical care to those infected with the disease.
“This is one of the most deadly diseases in the world, and it must be contained as quickly as possible,” Samaritan’s Purse President Franklin Graham said. “We’re sending a team of highly skilled doctors and nurses, and we want to do all we can to help bring this outbreak under control.”
On July 8, Samaritan’s Purse assumed responsibility for the Foya Case Management Center (CMC) in northern Liberia, near the border with Guinea. The handover ceremony included representatives from the community, Medecins San Frontieres (Doctors Without Borders), and Liberia’s Ministry of Health and Social Welfare.
“When the outbreak began, I told my staff that we were not going to run away from this,” Kendell Kauffeldt, Samaritan’s Purse Country Director, Liberia, said during the ceremony. “We will be like the Good Samaritan who did not run away, but stayed to help. In the end, we will celebrate together on how God carried us through.”
The Foya CMC has been treating Ebola patients since April. A large local staff will continue to fulfill their responsibilities alongside four members of the Samaritan’s Purse disaster response team. Facilities will be expanded, and the team is reaching out to other remote health clinics in the area to provide education and training. Kendell Kauffeldt (left), Samaritan’s Purse country director, Liberia, and Dr. Moses Massaquoi of the Liberia Ministry of Health and Social Welfare together unveil the new banner for the Foya Case Management Center.
Samaritan’s Purse has been responding to this unprecedented outbreak of Ebola since March, spearheading a national awareness campaign in Liberia that has reached over 400,000 people with prevention education and hygiene items.
Samaritan’s Purse Ramps Up Response to Ebola
The terrifying and highly contagious Ebola virus has reemerged in West Africa, bringing the death toll from the deadly disease to 467 lives and climbing. In Liberia alone, the total number of reported cases of Ebola has risen from 51 to 107 since June 24. This is the deadliest Ebola outbreak in history. The disease causes massive internal bleeding and has a mortality rate of at least 80% in most situations.
In response to this resurgence, Samaritan’s Purse is ramping up its emergency response by deploying a team of medical personnel to provide direct clinical care to those infected with the disease.
A 14-member Samaritan’s Purse Disaster Assistance Response Team of doctors and nurses from North America will be departing for Liberia the week of June 30. More could follow in a few days or weeks.
“This is one of the most deadly diseases in the world, and it must be contained as quickly as possible,” said Franklin Graham, President of Samaritan’s Purse. “We’re sending a team of highly skilled doctors and nurses, and we want to do all we can to help bring this outbreak under control.”
Samaritan’s Purse has been responding to the Ebola crisis in Liberia since March, spearheading a national awareness campaign that has reached thousands of people with prevention education. In addition, the organization has provided more than 300,000 people with hygiene items to combat the spread of the disease.
The organization will work in cooperation with Liberia’s Ministry of Health, the World Health Organization, and the U.S. Centers for Disease Control and Prevention to provide life-saving care for patients in multiple locations—ELWA Hospital in Monrovia and clinics in remote areas along the border with Guinea. Samaritan’s Purse has aircraft stationed in the country that will support this emergency effort and has shipped medical equipment and supplies to Liberia, including protective clothing and IV fluid.
Busy on the Ground
“God is definitely working here,” said Dr. Lance Plyler, leader of the Samaritan’s Purse Disaster Assistance Response Team. “It’s really incredible how things are coming together,”
At ELWA, a new, larger case management center, funded and constructed by Samaritan’s Purse, can accommodate 20 confirmed patients and 10 suspected cases of Ebola. Several Samaritan’s Purse medical personnel, including a World Medical Mission post-resident, are working alongside other hospital staff to treat patients at this facility. All medical staff there, including nurses, technicians, and a local doctor, have been trained in safety protocols. Medical personnel must wear protective gear to work with patients (pictured below).
Nurse Kelly Sites, a disaster relief team member, has been providing care for Ebola patients at ELWA since late June.
“Today I went in with one of my patients who I’ve had for about four days, and I gave her a bath in her bed and did a lot of other care for her,” she said. “She stopped, and we held hands and she looked into my eyes today and said thank you so much for being my friend. She told me that she loved me and she thanked me for caring for her. This experience has been one of the most rewarding of my whole career.”
Samaritan’s Purse also will be assuming responsibility for the Ebola case management center in Foya District, Lofa County, Liberia, with an anticipated handover date from Doctors Without Borders on July 8. Facilities will be expanded there, and the disaster relief team anticipates reaching out to assist smaller, ill-equipped clinics in remote areas of northern Liberia.
Samaritan’s Purse has aircraft stationed in the country that will support this emergency effort and has shipped medical equipment and supplies to Liberia, including protective clothing and lactated ringers solution. A second shipment arrived on July 1 and was distributed to the ELWA case management center on July 2 and to the Foya center on July 3. A third shipment is en route.
Health care providers must don personal protective equipment in order to care for Ebola victims. Suiting up takes 30 minutes and the decontamination process can take another 30 minutes. Given West Africa’s heat and humidity—it’s the middle of the rainy season—workers should only stay in the gear for 60 to 90 minutes. The protective gear includes boots, a surgical cap, a Tyvek suit, two sets of gloves, a ‘beard’ to cover the neck and chin, a facemask, goggles, and a waterproof apron.
“No Magic Bullet”
There’s no magic bullet for Ebola,” said Dr. Lance Plyler (pictured left), team leader and Samaritan’s Purse chief medical officer.
No commercially available vaccine for the disease currently exists, though great progress is being made on that front, he said. Supportive care for patients—including fluid and electrolyte management, proper nutrition, and antibiotics—does have the potential to reduce mortality rates.
“What will contain the outbreak is what we’ve been doing all along,” Plyler said, emphasizing the importance of proper hygiene and public understanding of the virus.
Transmission of the virus to humans likely occurs through contaminated bush meat. It then spreads from person to person through contact with bodily fluids. Casual contact, such as a sweaty handshake with an infected individual, can lead to infection. Unprotected health care workers are at great risk. Traditional burial practices in West Africa also seem to be contributing to the spread of Ebola.
The latest reports from the World Health Organization show 441 confirmed cases of Ebola in the region since February 2014. This outbreak is unprecedented in terms of geographic scope, number of infections and deaths, and perhaps most ominously, in its proximity and therefore potential impact on large metropolitan centers.