On May 30th, I attended a limited showing of the movie Facing Darkness which is a documentary produced by the Christian organization Samaritian’s Purse about how they assisted with the Ebola crisis in Liberia. It is a fascinating piece of film and I highly encourage all to go and see it. There will be more showings on April 10th so check your local theaters for viewings. Honestly, I cannot recommend this movie enough.

What’s interesting as a nurse medically is why did Ebola take such hold in Liberia? What factors contributed to it being so widespread? What was the tipping point as they say— or those circumstances that when combined cause something to take on a life of its own.

There were several factors that aided the spread of Ebola in Liberia and I’ll discuss a few here. I often hear people say that widespread disease and outbreaks couldn’t possibly happen in the US— that our medical system could easily handle the onslaught of victims and prevent the spread quickly. I am not so convinced. After events like Katrina it’s easy to see how any local healthcare system could be overwhelmed.

Here are some factors that aided the spread of Ebola in Liberia.

1.  Liberia’s infrastructure was devastated by civil war. Liberia had been rocked by two civil wars. One lasting from 1989-1996 and the other lasting from 1999-2003. Because of the wars, much of their infrastructure, including healthcare, was limited. The Ebola outbreak in Liberia started in March, 2014. It would seem that a decade would be long enough for a nation to recover, but think about how long it took to rebuild Ground Zero after the 9/11 attacks. Liberia is an economically depressed emerging nation. It’s in the top ten of poorest countries. Before the outbreak, 4 million people were being cared for by fifty physicians (yes, 5-0.) 

2. Cultural practices spread the disease easily. Liberians have a very affectionate culture. Ebola is spread by direct contact with an infected person. Culturally, Liberians prolong touch via handshakes and hugging. Also, their care of the dead includes direct handling and washing of the body. In some instances, the bath water used to bathe the deceased family member is drunk. If a person dies from Ebola, their corpse is teaming with virus and these practices will infect family members.

3. People lived in close proximity to one another.  Ebola in Liberia was both an urban and rural issue. When the disease hit urban centers, its spread happened much more quickly.

4. Liberians didn’t believe Ebola was real. Early in the outbreak, people believed Ebola was merely a myth. That it didn’t exist.

5. There was distrust of the medical profession. As the Ebola outbreak became more prolonged, many Liberians began to believe that medical people were proactively spreading the disease instead of trying to stop it. They wouldn’t bring sick family members to the hospital which led to more infection. In fact, medical professionals were physically attacked in some instances because of this belief.

The Atlantic did a follow-up piece on Ebola in Liberia in its July/August 2016 issue. If you think Ebola cannot happen again to such a degree, where 11,000 Liberians were infected, think again.

As the article highlights, several factors that added to the outbreak are still present.

1. People still eat bushmeat. Bushmeat is a concern as an origin for Ebola infecting humans.

2. There remains little understanding among the Liberian population of how Ebola is spread.

3. There have been three small outbreaks since Liberia was declared Ebola free in May, 2015.

4. It is possible that Ebola could spread via sexual transmission months after victims are symptoms free.

5. The poverty is worse.

I highly recommend viewing Facing Darkness on April 10, 2017. It is an eye-opening experience.