MONROVIA, Liberia – Life is edging back to normal after the deadliest Ebola outbreak in history.
At the height of the epidemic, Liberians met horrific deaths inside the blue-painted walls of the Nathaniel V. Massaquoi Elementary School, as classrooms became Ebola holding centers and the education of a nation’s children, shuttered in their homes for safety, was abruptly suspended.
Now, parents are streaming into the schoolyard once again, not to visit their stricken loved ones, but with their restless children in tow, registering for the start of classes in a delayed and shortened academic year.
Eager to learn and to play with her friends again, Florence Page, 11, bounded ahead, brimming with pent-up energy, as her mother, Mabel Togba, paused to look warily into the school building through its padlocked doors.
“They still haven’t told us that Liberia is free of Ebola, so I’m still afraid,” she said. “But it’s better than to leave my children at home doing nothing.”
New cases in Liberia, where streets were littered with the Ebola dead just a few months ago, now number in the single digits, according to the World Health Organization. In neighboring Sierra Leone and Guinea, the other two nations in the Ebola hot zone, new cases have fallen sharply in the last month, dropping to fewer than 100 in a week at the end of January — a level not seen in the region since June.
With a virus as deadly as Ebola, officials warn that the epidemic will not be over until cases reach zero in all three countries. But after nearly 9,000 deaths from the disease, the WHO announced last week that it was focusing on a goal that had seemed out of reach last year: ending the Ebola epidemic, no longer simply slowing its spread.
Here in Monrovia, the capital, ambulances and body collection vehicles that once barreled through the streets are a rare sight. Soccer matches are now played throughout the city on weekend mornings. Buckets filled with chlorine water are gone from most entrances, or sit empty. People can be seen shaking hands once again, squeezing into taxis and touching during conversations.
Residents’ precautions
While many have emphasized the enormous assistance hauled into the region by the United States and international organizations, there is strong evidence, especially here, that the biggest change came from the precautions taken by residents themselves.
“Fundamentally, this is about the extent to which societies change their behaviors, how they change them, and the speed at which they change them,” said Dr. David Nabarro, the United Nations special envoy on Ebola, who made frequent trips to the hot zone at the height of the epidemic. “I believe for various reasons people in Liberia changed quickly and dramatically. I believe Sierra Leoneans changed quickly in some areas and less quickly in some areas.”
When Ebola struck the densely crowded neighborhoods of Monrovia over the summer, the first time a capital city had faced Ebola’s full onslaught, the impact was devastating. Hundreds of new cases appeared around the country every week, hospitals collapsed or overflowed with patients, and sick people lay along the road, sometimes dying before help arrived.
Reeling from the explosion of infections in August, volunteer Ebola watchdog groups sprang up in many neighborhoods, typically overseen by local elders and led by educated youths, drawing from a long history of community organizing to survive war, poverty and government neglect.
Education and prevention
With little or no outside help in the early months, the groups educated their communities about Ebola, a disease new to this part of Africa, and collected money to set up hand-washing stations at key spots. They kept records of the sick and the dead. Many also placed households under quarantine and restricted visits by outsiders.
As the sick were turned away at the gates of treatment centers because of a lack of beds, people inside homes began protecting themselves better, covering their arms in plastic shopping bags as they cared for ailing relatives.
By mid-October, new cases in Liberia had dropped precipitously, from hundreds per week to dozens. A few clinics run by Liberians and international charities had opened, but the drop took place a solid month before any of the treatment centers built by the U.S. military had even begun accepting patients.
“Heroes emerged in every community,” said Dr. Mosoka Fallah, a Harvard-trained Liberian epidemiologist who acted as a liaison between neighborhoods and the government. “The volunteer task forces may be the biggest reason behind the drop in October.”