Ebola may have changed Liberia forever.
Hugging friends is no longer OK.
Nor is kissing them on the cheek to greet them.
Even hand shaking has become taboo.
Instead, there is now “the Ebola foot shake,” said Joye Collins Phillips, a registered nurse and hospital administrator from Liberia who is in Helena for an extended visit with her brother, Wilmot Collins.
Phillips will share her experiences of what happened when Ebola hit Liberia and what has changed, perhaps forever, since then. She will also talk as a Liberian about what needs to be done.
She’s a guest speaker on a panel discussion, “The Ebola Outbreak in West Africa and Helena’s Preparedness,” at 6 p.m. Saturday, Nov. 22, at St. Paul’s United Methodist Church.
Joining her on the panel is Melanie Reynolds, Lewis and Clark County health officer; and Bob Fischer, who works in the Laboratory of Virology at the Rocky Mountain Laboratory in Hamilton. He has recently traveled to Liberia to study the current Ebola outbreak.
The Nov. 22 event is sponsored by Friends of Liberia, which hopes to raise $100,000 to help Liberia with stopping the spread of Ebola and helping Ebola victims.
Phillips is an administrator at a hospital in the county of Margibi, Liberia, one of the first Liberian hospitals to treat Ebola patients.
“I want to speak as a person (not on behalf of the hospital),” she said. “I was there. I can tell what happened and what was needed.”
Since arriving in Helena Oct. 11, she was monitored daily for three weeks by the Lewis and Clark County Health Department, she said.
It’s, perhaps, easy for people in the United States to be complacent that they are prepared in case the virus hits, but that wasn’t the case in Texas, Joye pointed out.
Ebola hits Liberia
When Ebola showed up in Liberia, no one knew what it was until it had started to spread.
“It first came to Guinea,” which borders Liberia, Phillips said. “There was an outbreak and a few people contracted the virus. Almost everyone who contracted it died.”
Often, it is spread at funerals for Ebola victims or by those caring for relatives with Ebola.
“One of the beliefs or customs is that you bathe the body” of the deceased, she said. “All the people who were close (relatives) washed the body,” and none of them used gloves.
The virus causes vomiting and diarrhea. It can also spread from other bodily fluids like sweat, she said.
“We were not equipped to handle this at all,” said Phillips of the first case at the hospital, which hit in March. “We had never dealt with it.”
“This first case had a very low chance of survival,” she said. “She died in the first 36 hours.”
As the medical staff puzzled over the symptoms, they contacted Doctors Without Borders, also known as MSF. They remembered a similar disease from the 1970s in East Africa and correctly identified the illness as Ebola.
The hospital also contacted the Ministry of Health and the Centers for Disease Control, she said.
“The CDC responded right away,” she said. “They told us, ‘You need to wear protective gear. You can’t bring a person like this to the hospital.'”
The hospital had an outbuilding it immediately converted to an emergency treatment unit, she said. Within 24 hours they had remodeled it, putting in fixtures that could be easily cleaned. The hospital also established quarantine areas.
The hospital had access to hazardous material (haz-mat) suits, which the ETU medical staff wore. And it built a makeshift structure for decontamination -- where those in haz-mat suits were sprayed down with chlorine bleach before they were assisted in removing the suits.
“We called them space suits,” she said. “They looked like astronauts.”
During the peak of the disease in June and July, 14 of the country’s 15 counties were affected.
The treatment unit was full, and the hospital had to refuse patients, she said.
For a short time in May there had been a lull in the number of cases, said Phillips. But instead of having gotten rid of the disease, people had just gone into hiding.
“People were hiding in bushes,” she added. “It was like when HIV started.”
Families were in denial, as one family member after another died, she said. Once fear set in, people who were ill were stigmatized. There was nowhere to turn for help.
After parents died, children were found wandering in the street.
“That’s another problem -- there are lots and lots of orphans,” she said.
Successes and challenges
“Before I had left (in October) we had mastered the treatment of Ebola,” Phillips said. “With early intervention, it is very treatable.”
“There is no cure,” she added, “and no vaccination. We treat the symptoms with IV fluids. People go into shock because of dehydration. People who come (for treatment) at early stages have a 90 percent survival rate.
“No schools are open in Liberia,” she said. Her children -- Jamelle, 17, and Joseph, 12 -- came to Helena in late May to visit her brother and his family but now can’t go home because all the schools in Liberia are closed.
Hygiene has changed, too, she said, explaining, “We were not a very sanitary people as a whole.”
But in recent months, hand-wash stations with chlorinated water now stand outside of houses for people to use before entering the house. There’s also a pan of bleach water for people to walk through before entering the house.
“I’ve been here seven years,” she said of Liberia. “There was lots and lots of typhoid, cholera and hepatitis. But now there’s lots and lots of hand-washing. I hope the hand-washing lasts forever.”
She credits three things to the decline of the number of Ebola cases in her community -- the new ETU, quarantines, and bringing food and supplies to the door of sick people and leaving it -- rather than stigmatizing and avoiding them.
She praised the response by CDC after the case in Texas.
“When I arrived from Liberia, they took my temperature at the airport,” she said, and screened her about whether she had contact with people with Ebola. They also contacted Lewis and Clark County Health Department of her arrival, and the health department checked in with her daily.
“Things were working the way they were supposed to -- now that a system is in place,” she said.
One thing Phillips hopes comes from the Nov. 22 event is not only greater awareness about Ebola, but assistance for Liberia and its orphans.
“We have a lot of orphanages,” she said. “My main concern is orphanages which need to be financed.
“The entire infrastructure of the country suffered,” she said. “We have to build up the hospitals again and find ways to attract health care workers to come back.”
She estimates that as many as 20 percent of the doctors and nurses in Liberia died in the outbreak.
For more information about Friends of Liberia visit www.FOL.org.