Research document for a radio show about the situation in Liberia After Ebola.

1. Liberia After Ebola
Anna Sutterer
Jonah McKeown
Federico Maccioni
Tomás Orihuela

2. -INDEX-
1. Booked and confirmed guests.
2. Issue summary.
3. Key points of controversy and contention.
4. Must-read articles.
5. Pre-Interviews.
6. Organization of the show.

3. 1. Booked and confirmed guests
Guest One: Dr. Adam
Levine
Official Job Title​:
Director of the Ebola
Research team with the
International Medical
Corps
Location​: Boston,
Massachusetts
E-mail address​:
alevine@international
medicalcorps.org
Twitter​:
@adamcarllevine
Phone numbers​:
617-512-5184
Skype username​:
adamcarllevine
Photo:
Guest Two: Wade
C.L. Williams
Official Job Title​:
Liberian freelance
journalist
Location​: Adelphi,
Maryland, USA
E-mail address​:
wadesugar@gmail.com
Twitter​:
@wadeclwilliams
Phone numbers​:
Skype username​:
wadesugar
Photo:
Guest Three: Kieran
Guilbert
Official Job Title​: West
Africa Correspondent
for the Thomson
Reuters Foundation
Location​: Dakar,
Senegal
E-mail address​:
kieran.guilbert@thoms
onreuters.com
Twitter​: @KieranG77
Phone numbers​: ​T:
+221 33 864 5076
M:​ +221 77 130 68 48
Skype username​:
kieran.guilbert
Photo:
Guest Four: Zeela
Zaizay
Official Job Title​:
Public Health Worker
with Effect Hope and
MAP International
Location​: ​Monrovia,
Liberia
E-mail address​:
fzaizay@map.org
Twitter​: ​@FZZaizay
Phone numbers​:
+231776512532
Skype username​:
zzaizay
Photo:

4. 2. Issue Summary
Liberia is a small West African nation of 4.3 million whose capital is Monrovia and whose
president is Ellen Johnson Sirleaf and Vice President Joseph Boakai. According to the World Factbook,
the country contains rich mineral resources, forests, and a climate favorable to agriculture, and it principal
exports are iron ore, rubber, gold and timber.
The ​country has rarely, if ever, been stable​. Political, economic and social turmoil from two
civil wars ​stunted the country’s growth and development. It is currently the ​eighth poorest nation in the
world​. Problems with the ​education and health systems were exacerbated by the devastating Ebola
virus​ epidemic, which had its height in 2014. Liberia’s death rate due to the virus was higher than any
other nation’s, with 4,089 deaths by the start of 2016.
International aid during the crisis seemed to come too little, too late​. Because there was no
fast way of dispersing money to affected countries at the start of the outbreak, ​the World Bank says that
“relying on pass-the-hat financing meant that money at that scale did not begin to flow until three months
[after it was needed] – during which Ebola cases increased tenfold. Donors ended up committing more
than $7 billion for Ebola response and recovery and overall economic impact of the crisis on Guinea,
Liberia, and Sierra Leone reached $2.8 billion, according to the latest World Bank Group estimates.​” Now
that the country has been declared Ebola-free several times after a few smaller outbreaks, much of the
funding is being redirected to other endeavors such as the fight against Zika. In the nation, there are the
problems of trust and stigma. President ​Ellen Johnson Sirleaf,​ elected in 2005 and re-elected in 2011,
has brought some political stability to the nation​. However, some believe Liberia’s natural resources,
like iron ore and rubber, are not being exploited properly and government officials are not willing to
invest in the healthcare system.

5. Experts believe the virus continues to circulate in West Africa, often without the authorities’
knowledge. The country appears to poised on the brink of another outbreak as its healthcare infrastructure
remains underfunded and understaffed.
By at least one estimate, before the outbreak​ Liberia only had 50 licensed doctors​ for a country
of over 4 million. During the outbreak, doctors were either leaving the country or were getting infected
with the virus themselves. Thanks in part from an outpouring of aid to the country during the outbreak,
the Liberia Medical and Dental Council in July this year said there were nearly 300 medical doctors
responsible for country, making the doctor per patient ratio 1:15,000. In comparison, there are 50 doctors
available to every 100,000 people in the US. It was especially difficult to get healthcare to rural areas and
villages.
Lingering medical concerns even for survivors of Ebola remain, such as the need for trauma
counseling, but it’s estimated that the Liberian government can only afford to spend about $50 a year on
its citizens’ healthcare. The ​stigma ​associated with the country having just suffered the outbreak is also
further reducing their ability to do business with the outside world; neighboring Guinea’s GDP is
expected to shrink by more than 2%. Liberia itself experienced a tiny 0.3% GDP growth rate in 2015
versus 0.7% in 2014 according to World Bank. This decline is not only due to Ebola, but also to a decline
in commodity prices, which led to business closures, especially within the mining sector, which declined
an estimated 17%. This also led to job losses and reduced fiscal revenues. The World Bank projects GDP
growth to recover to about 3.9% in 2016, buoyed by exports of gold and other commodities.
In July 2016, President Sirleaf launched the country’s first national community health worker
initiative, called the National Community Health Assistant (CHA), which aims to reach Liberians who
live more than 5 kilometers from a health center, which represents almost a third of the population. The
initiative is an effort to train, equip, and employ over 4,000 community-health volunteers between now
and 2020. By the end of 2017, the first 2,000 volunteers will be trained and deployed, according to the

6. Liberian health minister. Other efforts are underway from organizations such as Last Mile Health, an
organization that has 300 community health workers who serve 50,000 patients, and which is headed by
Raj Panjabi, a doctor who just received the 2017 TED Prize of $1 million. T​he World Bank has proposed
the Regional Disease Surveillance Systems Enhancement Program (REDISSE) to help countries build
capacity and work collaboratively to detect and respond to disease threats in West Africa, and the
Pandemic Emergency Finance Facility (PEF) to provide surge funding for response efforts to help prevent
rare, high-severity disease outbreaks from becoming more deadly and costly pandemics.
3. Key points of controversy and contention
● Poverty, devastated systems​: Liberia is the eighth poorest country in the world. Two civil wars
in the past 30 years had been very harmful for them. The destruction of many infrastructures has
made Liberia dependent on external aid. Ebola closed schools, kept families and friends from one
another, slowed the general workforce and while infecting almost 11,000 people and killing just
over 4,000.

7. In the capital Monrovia, a lot of companies had to close and resources were scarce in most parts
of the country. According to WHO, before the outbreak the infant and mother mortality rate was
finally going down, but numbers are rising again. Agricultural production has also fallen, and the
UN has catalogued Liberia as a country on the brink of famine (which technically defined is 2
deaths/day per 10,000 people.). The nation lacks other important infrastructure such as a reliable
power grid coming from the capital, a problem which the government is ostensibly working
toward fixing with construction of a dam.
● Health care​: The availability of specialized doctors has been a problem since the beginning of
the outbreak, with around only 50 licensed doctors in a country with 4.3 million people.
According to WHO, many of the specialized doctors died from the virus. Between 30-40% of
Liberians lack access to health care, which is really similar to the numbers registered before the
beginning of Ebola. Health literacy and trust in health care delivery is also quite low, which
helped the virus spread rapidly and now poses a threat to the rebuilding of the health care system.

8. Stigma is also a problem: survivors have been kicked out of their communities, of their jobs, and
families have broken due to the epidemic. Public health education programs are needed and there
is a push to get more students with higher medical degrees to improve the system. Still, there is
little funding to accomplish these goals. Doctors and nurses who have not been compensated for
their dangerous work during the crisis have gone on strike, complaining about their salaries and
insufficient working conditions.
● Upcoming election​: The election in October 2017 is crucial to the country which has had
problems with selfish leaders and corruption. President Ellen Johnson-Sirleaf, who has been
elected twice since the end of the civil wars, has brought some stability but will step down. There
is a question about whether or not the new leader will maintain the political stability, use the
country’s wealth of resources responsibly and actually invest in the health and education systems.
Some officials have been known to keep their assets a secret and accrue wealth for themselves
while in power.
● International aid​: During the crisis, much of the international aid came late. And, for example,
many of the American treatment facilities went unused. When Liberia was declared Ebola-free,
much of the funding was redirected to other causes., without realizing that the country still needs
help stabilizing the whole of its health system and education. The research into an ebola cure has
stalled now that Ebola is believed to be eliminated, but the truth is that people are still afraid.
Also, a lot of the money that countries gave to Liberia came too late to fight Ebola.
4. Must-read articles
Ebola Evolved into a Deadlier Enemy During the African Epidemic
The New York Times

9. The article advances the hypothesis that Ebola’s virus could have mutated during the 2014’s epidemic,
increasing sharply the number of deaths. According to Dr. Luban’s research, part of the 11,310 victims
registered in West Africa may have been infected by a stronger variation of the virus, first transmitted by
(supposedly) a bat in Guinea and called GPA82V. As research have proven, it alters the gene that directs
production of Ebola’s surface proteins, whose tips contact human host cells, opening a passageway by
which the virus enters. Other studies have showed that GPA82v made the virus twice as infectious to
human cells, worsening health conditions of Guinea, Sierra Leone and Liberia, which were and still are
characterized by lack of infrastructures and medical structures, wrong burial practices and poverty. For all
these reasons, Luban doesn’t deny that a new epidemic of Ebola is more than likely to happen in the near
future.
Ebola in Africa: the end of a tragedy?
The Economist
The piece illustrates the most important moments of the epidemic of Ebola that hit West Africa between
2014 and 2016, causing more than 28,000 infections and 11,315 deaths. The epidemic started in
December 2013 in a Guinean village and from then on spread sharply and rapidly to Sierra Leone and
Liberia, the country with the highest number of victims but the first being declared free from the disease.
At its outbreak, Ebola had a mortality of about 60 percent, significantly higher than the one of other
dangerous viruses. However, the high number of victims and a general level of danger for a new epidemic
that still persists, can be explained also with the inadequacy of the Health-care systems of these countries.
According to data, countries like Sierra Leone and Guinea spend less than and also the availability of
doctors (245 per 100,000 people) can’t bear the brunt of a major crisis like the one of 2014. Also for this
reason, 512 were the victims among the medical staff.
After Ebola
The Atlantic
The article describes the situation of Liberia after the Ebola epidemic of 2014, underlying how the
problems that contributed to spread the virus two years ago are still present and are even more serious.
Bushmeat, even if considered the source of the infection, is still sold in Monrovia’s streets in spite of the
government’s prohibition, and the majority of people are not aware of the causes of Ebola. Liberia is the

10. world’s eighth poorest country and is still recovering from the civil war ended in 2003. Despite been
declared Ebola-free more than a year ago, new cases have been occurring, probably through sexual
relationships. Poverty is the main cause of Ebola’s spreading, and food production has sharply declined,
with the country forced to import it because farmers haven’t returned to their lands and aids weren’t
delivered. Even the people who helped contain the epidemic haven’t been paid and survivors are looked
with suspicion. However, experts suggest that community empowerment, and a reduction of dependency
on external aids, could prevent the disease from spreading again.
Get Flexible
Foreign Affairs
In this piece, Sinead Walsh, Irish ambassador to Sierra Leone and Liberia, describes these two countries’
health systems, highlighting the progresses made in the past few years but also what went wrong during
the Ebola’s crisis and the improvements necessary to prevent the breakout of a new epidemic. Responding
to some criticisms, Walsh put in evidence that Liberia’s Health Sector Pool Fund has only four real
donors, among whom the UK and Ireland contribute for most of the investments. However, the Fund is
characterized by a structural flexibility, which allowed it to help the Liberian government during the
crisis, satisfying all of its aid request after the appropriate checks. But this flexibility, as demonstrated in
2014, also risks frustrating the efforts against a likely new epidemic. In fact, overemphasizing only the
programs related to the crisis could damage other sectors of the Health System. Despite the general
improvements achieved in Liberia and Sierra Leone after the end of their respective civil wars however,
what happened in 2014 has shown that international intervention has been slow and there’s still much to
do.
Two years after Ebola, survivors find new hope in trauma counseling
Sim Stories
The article tells the story and work of Nancy Writebol, one of the three Americans who contracted Ebola
during the epidemic of 2014. She was working at SIM’s ELWA Hospital, in Monrovia, and contracted the
virus even if she had avoided physical contact with infected people. She was cured in the US and
recovered against all the odds. Now she has come back to Liberia and help survivors overcome the social
obstacles that have emerged after the end of the epidemic through a free Trauma Healing course. Many of
these people can tell their stories of pain for the first time and show to Writebol the new challenges they

11. have to face in this new life. Having contracted the virus puts Writebol in immediate contact with the
survivors, who have often been rejected by society, in particular those who went against Liberian tradition
by cremating the corpses during the epidemic.
5. Pre-interviews
Dr. Adam Levine​, Director of the Ebola Research team with the International Medical Corps ​(Interviewed
by Anna Sutterer)
● How have you been involved in building sustainable healthcare in Liberia?
○ Helped develop a biosensor patch to remotely monitor Ebola patient vitals in ETUs with
Scripps Institute
○ ZMapp drug study with the National Institutes of Health
○ A few other studies for new diagnostic tests for Ebola
○ Biggest part: ​Collecting data on all patients they were caring for during the epidemic
(2,500 treated at IMC 5 treatment units in Liberia and Sierra Leone)
■ Gathered data on symptoms, treatments given, how they responded to treatments,
lab tests, etc.
■ Writing research papers to study the natural history of the disease and how it
affects Children/pregnant women, how to diagnose and best ways to know who
might have a more serious course of illness…
○ ”This is all information that could help us during the next Ebola epidemic whether it’s
with my staff or of course somewhere else…”
● Is there a big concern that Ebola will come back to the same areas? Will they be prepared?
○ “The reservoir for the Ebola virus still exists in the bats in the forests of West Africa as
well as much of Southern and East Africa. … It’s a very high likelihood that there will be
another epidemic in the next few years. The question will just be: ‘​Will we be able to
respond better​ and make sure that it doesn’t get as large as this one did. My hope is that
this will have been the largest epidemic the world has ever seen, but it will take a large
amount of efforts to make that the case.”
● Are you involved in communication with the local governments to get them ready?
○ “With this ​Ebola research ​one of the exciting things that we’ve done is brought together a
partnership of a number of humanitarian organizations, government organizations and
local governments in West Africa to actually collate and aggregate ​all the data that was
collected during the epidemic and guide the research into an agenda​ on how that data is
used. Using that to guide a better response to future epidemics, because without that
knowledge we are entering that next epidemic from the same square that we entered this
recent epidemic, which was square one, basically.”

12. ■ Called the ​EBD Data Sharing Platform​, an effort led by us at the IMC along with
Doctors Without Borders and Oxford University (helping manage the database)
and the West African Health Organization (represents the Ministries of Health for
all the West African countries involved.)
● Do you think there’s enough international attention for Liberia/West Africa? What’s your
perspective on the assertion that too many orgs have diverted their funding?
○ “I think that’s very true and typical of humanitarian emergencies. The emergency occurs
and it gets​ international attention​ by the media and there’s lots of donor funding coming
in, and then very rapidly the ​funding​ dries up very quickly. This is certainly a problem
being faced by Liberia and Sierra Leone and Guinea as well, that so much ​funding​ effort
was put into the Ebola response, and there certainly could be a lot more done to rebuild
the health systems especially with the human resource capacity which was literally
decimated by the Ebola epidemic (killed almost 1/10 health workers in Liberia).”
● Tell me about your time treating patients at the ETUs during the height of the crisis.
○ Deployed to Liberia in Aug 2014, at height when WHO declared it a public health
emergency of international concern
○ IMC one of the first to go in, with Doctors Without Borders
○ Never seen a case of Ebola before, going in to set up ETUs and create a response (first
month super difficult)
■ Developing protocols, working with local governments to set up places for
treatment, training international and local health care workers (90% were
Liberians), getting supplies (hard to get with not much going in/out of Liberia b/c
of the disease)
○ Developed a ​training program ​near one of their ETUs for people from other orgs and
local workers: “A lot of people talk about how slow the initial response was from the
international community. That has to do with a few different factors”: ​WHO was slow in
declaring the crisi​s and realizing it would be a much bigger epidemic than prior
epidemics, but another factor was that ​there were very few organizations that had any
prior experience with Ebola​ (not enough knowledge or cadre of skills)
○ For the EBD Data Sharing Platform: Extracting the data from the treatment units was
SUPER difficult because the papers were contaminated: had to read them across the fence
or sending people in with a GoPro and then dump the camera in chlorine to
decontaminate…
● Tell me about the treatment, ZMapp, you’ve been working on
○ Research study was led by NIH, IMC was implementing partner on the ground at the
ETUs during the crisis
■ Implementing a ​clinical trial ​for drugs/treatments DURING the crisis was tough
○ Just published the results in the New England Journal of Medicine about a month ago

13. ■ “It was really exciting because it really was the first study ever done of a
therapeutic treatment for Ebola, and the first study to show that a treatment has
very likely efficacy in treating Ebola.”
○ Control group had 40% mortality, treatment group had 22% mortality
○ Only drug that has been shown in a control trial to be effective for treatment.
● In a video you made during the crisis, you said “this is a case where we can solve the
problem entirely,” and that you’d come back for a party when Liberia was declared
Ebola-free. At this point, are you happy with the outcomes? What’s left to do?
○ You can never be happy with an outcome when ​12,000 people died​, and 12,000 is
actually an ​under representation of how many people died because those are the numbers
of how many died directly from Ebola.​ There were probably hundreds of thousands of
people that died from other diseases ​because of the health care system being shut down
by the epidemic. (people who died of car accidents and women who died in labor and
children who died of malaria… because they weren’t able to get care).
○ But it ​could have been a lot worse​: “it’s a testament to the response from both the local
governments and communities and the Ministries of Health in the different countries and
the international humanitarian response and the funding that came in from them to fund
the response. I think there’s a tendency in the world to see everything as an unmitigated
negative.
○ “I think for the future what we’ve learned from this is that ​we can combat these
epidemics​, whether it be Ebola or new emerging infectious diseases, but we need to work
together, we need to have funding in place, and that ​funding needs to be available
relatively quickly​,​ and we need to be trained and prepared. That means both the
international humanitarian community to be trained and prepared and also the local
doctors and nurses on the ground and on the front lines… really it’s those front line
healthcare workers that are our best bulk work and security against future pandemics.”
Kieran Guilbert, West Africa Correspondent from Thomson Reuters Foundation ​(interviewed by Tomás
Orihuela)
● What would you say about the international aid that Liberia had to fight Ebola?
○ The problem was a slow start because the WHO didn’t declare enough warnings. The
slow response​ caused thousand of lives, the outbreak couldn’t be holded and it provoked
the spread to numerous countries who are better prepared. It happened in March and it
wasn’t until June that it was declared by the WHO.
○ Guinea or Sierra Leone were downplayed, they weren’t as responsible as Liberia was. All
the countries took long to react. However,​ Liberia was a little quicker​ than its neighbors.
Once the world was fully engaged, there was a widespread, universal consensus that this
outbreak was dangerous.

14. ● What could have been managed differently?
○ WHO was cautious. They had never seen an outbreak like this in years, and they were
cautious to be too alarmist. They ​didn’t want to raise a false alarm​ that could hit tourism
or the countries economies without being sure.
○ Another NGO’s were calling it and they proved them wrong. That months costed a lot of
lives. I think what’s interesting is that WHO seem to have learned from this, because
when zika first appeared, they were quicker and more authoritative
● What was the main difference with how other West African countries dealt with it?
○ Obviously Liberia was the country that had the more ​deaths​, but there was not a huge
difference between Liberia, Sierra Leone and Guinea. Liberia was the quickest one, so
they had the advantage of having U.S. aid.
○ The problem with Liberia is that they have one of the ​weakest health care systems​, one of
the lower rates doctor/patient in the world, a really poor GDP. The problem is that Liberia
suffered a civil war which ended in 2003, the country was demolished by this civil war.
○ Health care​: A lot of facilities were being rebuilt, this worked against Liberia. In the
Monrovia hospital it was staggering to see how doctors were working. You couldn’t
imagine a more extreme example of a hospital in transition.
● What can it be done about the health care system?
○ Doctors say that Ebola was a​ necessary evil​ to reform the health system. If it hadn’t been
for an outbreak like Ebola, there wouldn’t have been any improvements. Another not
deadly disease would have also had a huge impact due to the lack of health control and
prevent control.
○ There have been reformations: they have isolation units, they have clean water, simple
things like temperature tracks. It’s things like this that weren’t put in place before Ebola.
○ The money from donors who had to act had created a more modern system. We’re talking
of big hospitals in Monrovia and also little units in rural areas.
○ Funding​: The problem is that the aid funding is now coming to an end, because Ebola has
ended. This transition between emergency funding and long-term developed aid is tricky.
With the outbreak under control, there are a lot of issues in West Africa where donors are

15. putting their money: Boko Haram in Nigeria, for example.
● People say that Liberia After Ebola is even worse now, what do you think?
○ It depends what aspect are you looking at. The health system for example is in the best
shape since the civil war, 25 years ago. Even with the lack of funding and the shortage of
doctors it’s in the best shape since years.
○ I’m sure that ​villages and rural areas​ the effect has been worse. In agriculture for
example, people have died, families are broken and it’s harder for them to recover from
that.
○ In a way this outbreak could save a lot of lives from crucial aspects. In terms of human
lives and cost of the economy, I completely understand it.
○ I think there’s a hope of recovery in Liberia, having a peaceful future. Sirleaf has brought
some stability. However, there have been accusations of corruption, so it will be
interesting to see who the next president will be.
Wade C.L. Williams, Liberian Freelance Journalist ​(interviewed by Anna Sutterer)
● You wrote about the “too little too late” international aid during the Ebola crisis. What’s
the situation now? Is there much happening now to help rebuild?
○ “Liberia continues to get the level of ​international attention​ it got during the Ebola
epidemic. I think that if it’s not the actual money that they gave to fight Ebola, which
most of it was not used during the epidemic because it came in late. “
○ Some of the ​facilities built by the Americans​ were not used at all… those fundings were
taken away, not left in Liberia for the government to use but diverted to things like
fighting the Zika virus
○ “The government has also received ​funding ​from elsewhere in terms of rebuilding the
health sector in Liberia. We haven’t seen a drastic change in the way the government
operates or puts in money to rebuilding the health sector and rebuilding the education
system. Even though they have the capacity to sort of track Ebola, I don’t think they have
the sustained capacity to tackle other epidemics that might hit in the future.”
● Is there a general fear among the public that something like the Ebola epidemic could
happen again?

16. ○ “Liberian people forget easily. Like people forgot the war and move on with their lives.
It’s a resilient country, people are more concerned about the day to day bread and butter
issues.”
○ Right now the ​economy ​is in shambles and the ​health sector​ is also really affected in that
way. Up to today people still lack access to health care. It’s not that there has been a
drastic improvement in the way government responds to these things.
● What are the most pressing issues facing Liberians after the Ebola crisis?
○ Talked to an economist who said Liberia was projected to grow by 5 to 7% before Ebola,
and now it’s projected to only grow 1% “I think that’s an extreme effect on the economy.
When you have the ​economy ​in that state, you find also there are political agitations.”
○ “People want to put food on the table for their families but they don't have money or they
don't have jobs… you find a lot of ​political tension​. And as the election draws near, this
will also have an impact on the election and the peaceful transition.”
● What are presidential candidates saying about it?
○ “I think most of​ Liberian elections​ are not issues-based. … Liberian elections over the
years have mainly been based on personality. Especially ​the media has not been able to
hold the politicians accountable​ or ask them how they will address the economy or what
their platform is as it relates to health care delivery and agriculture. These are not things
the politicians will normally discuss.”
○ “There’s an issue of ​corruption​. Most people come to public service with nothing. Most
of the politicians don’t declare their assets when they run for public office. They take
office and then you see they begin to amass wealth, so we do not know how much money
they had before taking office… It also leads to a society that is not transparent and leads
to more and more corruption​.​ It would be a good thing if the media is able to hold them
accountable to make the elections more about issues and more about how they can deliver
to the people.”
● What issues would you like them to discuss? What are the most pressing problems?
○ “The ​issue of impunity and corruption​ are two key issues. Making leaders accountable. It
also boils down to allocating resources to areas like building infrastructure and improving
healthcare for citizens. If you have a transparent regime or a country where impunity is

17. held accountable you will find that people become afraid to embezzle for health care
delivery.”
■ Example​: people give money to officials to build a hospital for a village and then
it’s diverted to something else or something to benefit the official.
○ “There have been investigative teams set up but ​nothing happens​, just one report after
another. Recently the Legislature was paid over $600,000 for a sitting fee because they
stayed more than the required time. $300,000 of that money went missing. … We have a
country where impunity abounds. Definitely you will not be able to deliver on your core,
basic services that you are supposed to surrender to the people.”
● What could be done about the health care system?
○ “The healthcare system, like many other areas in Liberia which were affected by the war
and made worse by the Ebola epidemic, it needs a ​complete overhaul​. In​ ​Liberia the
number of specialized medical professionals, there are not many of those. If you are sick
with a major problem, you cannot survive in Liberia. You have to be flown out of the
country to seek treatment like in Ghana.”
■ There’s a lot of ​death in young people​, between 20-35 yrs old
○ Some people ​don’t trust the system​, would rather get medication and treat themselves.
They don’t want to go to the hospital because they don’t have faith in the healthcare
system, that they will be treated well. (e.g. the government hospital John F. Kennedy
Medical Center is commonly referred to as “Just For Killing”... they don’t feel the
physicians have the right training)
● How does the government addresses the issues?
○ “The government has not been able to show that they are ready to ​invest ​in the health
sector​.​ Even with the Ebola epidemic and the kind of examples and lessons learned from
Ebola, they still have not been able to show that they are ready to reform the health sector
and pour more money into it.”
■ Depends on their key priorities, for example with the election coming up they
would rather put more money into a free and fair election (“money that probably
would have gone toward the health sector”)
○ “I think the Ebola epidemic was a missed opportunity by the government to get the kind
of help that they needed. They were concerned about stopping the disease and not putting

18. in those things which would lead to a more​ ​sustainable health care delivery. You cannot
only blame the​ Liberian government​. You also can blame the ​international community​ for
taking so much money into liberia but then having nothing to show for it.”
● What’s your vision for where the nation will be in the next few years?
○ “There is hope for Liberia if we make the right decision and ​elect the right leadership,
also if we start holding public officials accountable. If they steal money, you punish
them, they go to jail and other people will learn that you cannot just violate the public
trust without consequences.”
○ “The government makes money, the government generates revenue, you have this health
system and education system and economy that’s in shambles. Why is it so hard with the
number of natural resources that we have (to care for the small 4 million population)?
Because we have leaders who are not making the right decisions, who are refusing to
tackle the issue of impunity.”
Guest Four: Zeela Zaizay Public Health Worker with Effect Hope and MAP International ​(Interviewed by
Anna Sutterer)|
● What is your work now in Liberia?
○ Supporting the ​Ministry of Health​ in strengthening the health system, providing intensive
and comprehensive management of tropical diseases.
○ Working with the ​government​ to give kids in schools access to water sanitation and
hygiene services, make sure the kids take on healthy behaviors as a part of their lifestyles.
○ Direct contact with ​health facilities​ that are providing care for tropical diseases (serving
as a technical assistant to the Ministry of Health to manage the response to tropical
diseases)
● Tell me about your experience as a first responder to the crisis.
○ Was a ​registered nurse​ working with the government prior to Ebola
○ Member of the case management committee with the government​ when the outbreak
occurred, worked with the government to respond with as much supplies and protocol as
possible until it became an issue of priority for many other organizations (internationally)
to respond
○ Had leverage as a ​faculty member/nurse​ to work in many ETUs and provide a kind of
support and help where it was needed
○ Has some experience in the ​area of water​: “Water was very essential to fighting Ebola.
The health facilities needed water that was quite chlorinated to certain percentages.”

19. ○ The work was quite intense, I would say. I was working with ​Ebola facilities​ but also we
were working with ​community people​ because it is very important to strategy was ​getting
the common people at households to take the Ebola fight as their own fight​ and to help
them with knowledge and resources. So we were part of the foot soldiers who were
reaching various communities and organizing them into Ebola response teams, getting
them resources, coaching them and guiding them.
○ Providing ​schools​ with resources and making sure we are supporting them so the kids are
practicing personal hygiene on a daily basis
○ Triaging= putting aside kids​ who have a fever or unusual symptoms, getting them access
to health care without contact with other kids
○ “We do believe these practices, over time, will become the usual behavior of the people.
When that happens, we can be very ​confident​ that Liberia will not fall prey to non
communicable disease like what we experienced with the Ebola outbreak.”
● What kinds of resources does Liberia have now? What’s your perspective on the amount of
funding and ability to get the system stabilized?
○ “I do believe that ​much has changed​ since the outbreak. There has been increased partner
support to Liberia and increased local support.”
○ There are still areas that have ​weaknesses​.
■ Laboratory ​confirmation of diseases​: “With the experience of Ebola we need to
not only test for Ebola because Ebola is not the only cause of diseases and death.
So we need to decentralize labs…” allow for other lab findings to be
implemented.
■ Supplies for the ​health facilities​ have been consumed in larger quantities than
before “because health workers have been working in professionalization and
control more than ever before” need support with daily medical supplies like
gloves/bandages/syringes/etc.
■ Need ​medication and supplies ​for not just the diseases that aren’t mentioned
much in the media or known much globally: “We need to put more emphasis in
strengthening the entire health care system​ quite comprehensively. One of the
areas that is under formed in the system is of the neglected tropical diseases. (e.g.
leprosy, elephantiasis, buruli, etc.) These conditions are quite expensive to
manage and lead to long-term suffering of the people. They occur most with
people living in poor sanitation situations and poor economic situations. In
Liberia we are managing these kinds of cases and we need lots of support for
them.”
● Tell me about the distrust among people for the government and health care delivery.
○ “There are lots of myths surrounding ​health care prior to Ebola​. One of the things the
Ebola outbreak did was reduced the myths among the population because the people
experienced the fight. They knew it was a reality.”
■ There are some ​misconceptions that JFK hospital is a killing ground.​ “I was there
just a few days ago, I visit these facilities quite frequently, and JFK has improved

20. a lot. There has been lots of management systems put in place.” It has improved
the sanitary conditions, handled a large influx of admissions to the hospital.
○ The government of Liberia has ​medical partnerships​ that are coming into the country and
providing support to JFK.
○ * “There is a point I’d like to raise that not many people explain. The issue of some
unbecoming behaviors​ is not unique only to health care workers in Liberia. Liberia went
through 15 years of brutal civil crisis. So a population who lived and grew in an
environment of chaos and of civil unrest will definitely be expected to be portraying
unbecoming behaviors in any profession. So it will take time and lots of work for any
health care workers to become very customer friendly, not only health care workers but
for any profession out there. The health care workers are actually better than other
professionals in Liberia.”
● What about the concerns that politicians and government officials are not willing to
invest in the healthcare system?
○ “On the issue of politicians being committed to supporting the health care system,
what I’ve observed is that there are a couple of ​politicians​ who are building
structures intended to be used as clinics and hospitals. Running a hospital is
financially intense beyond raising the walls and the structure. I want to commend
anybody who contributes to work on the health care of the people at that level.”
○ The ​Liberian annual budget ​isn’t that large. It’s unrealistic that the Liberian
budget can support and sustain health care. (much of the budget coming from
international partnerships)
○ May not have enough information to talk about ​corruption​ diverting funds from
health care/other investment.
● What are your hopes for the election? Will the next leader continue the stability President
Johnson Sirleaf has begun?
○ “What I do see happening, having lived in and grown up in Liberia, is I have come to see
a group of people who are ​able to adapt so quickly to change​. I saw a group of people
who were very violent in a short period of time, but they have been able to sustain peace
for a period of years. ... It was displayed in the Ebola outbreak, we saw that. I am not very
frightened that Liberia will break out into chaos because I strongly believe there are
Liberians who are out for peace.”
○ “In the issue of who succeeds Ellen, I strongly believe that there are many ​candidates
who are contesting the position and that many of them are qualified. I want to believe that
whoever gets into power might lead us into sustaining the gains that Ellen began.”
● Anything else you’d like to comment on?
○ “With the lessons learned from the Ebola outbreak, Liberia is a trailblazer in several
areas. One is that Liberia has developed what is known as ​the world’s first national
strategic plan for the integrated case management for neglected tropical diseases​.”

21. ■ “Currently, the plan has been circulated and we started implementing it this year
as the inception stage. It has won the attention of the WHO who has been a major
contributor in this document and for that reason, Liberia will be used to test this
structured plan on the case management. So there are quite some good
innovations​ coming out and we are working to make sure all the health facilities
in Liberia are able to provide basic care and make sure every health professional
has been trained to control and prevent infectious diseases.”

22. 6. Organization of the show
Guest 1: Dr Adam Levine,
Possible Questions
● Tell us how your experiences working with patients at the Ebola Treatment Units inspired your
research today
● Is the Ebola virus still a threat? What’s preventing another outbreak?
● How have governments and NGOs worked together to combat the virus?
● What kinds of results is your research into an Ebola vaccine yielding? What is the status of the
ZMapp treatment?
● What needs to be done to move forward with recovery and research?
Guest 2: Wade Williams, freelance journalist
Possible Questions
● You’ve been critical of the international response to the Ebola crisis in Liberia. Was the problem
that the response came too late, or that the response was not sufficient?
● How has the government addressed the recovery after Ebola and how effective has their response
been?
● How important is this upcoming presidential election (October 2017)? Is post-Ebola talk a big
platform for some of the presidential candidates? What are they saying about it?
● What issues would you like to see politicians discuss? Who has the best plans to tackle the
pressing issues, in your view?
● What is the attitude of Liberian people at the moment in their post-Ebola economy, health and
education systems?
● How do you see Liberia changing in the next few years?
Guest 3: Kieran Guilbert, West Africa Correspondent for the Thomson Reuters Foundation
(critical of WHO)
Possible Questions
● [Note: He does NOT know much about the politics of the issue.]

23. ● What role did WHO play on fighting Ebola in Liberia?
● What made Liberia unique in terms of dealing with Ebola?
● How has Ebola changed Liberia from a humanitarian point of view?
● What can still be done to improve the health care system?
● People say that Liberia After Ebola is even worse in many ways than during the outbreak: what
do you think?
Guest 4: Zeela Zaizay, Public Health Worker with Effect Hope and MAP International
(Interviewed by Anna Sutterer)
Possible Questions
● Tell us about your work during the crisis and now after with the Ministry of Health, schools,
communities and health facilities.
● How have the health resources changed since the Ebola outbreak? What’s been done and what
still needs more focus?
● You’ve been a registered nurse with the Liberian government. Can you tell us what it’s like to
work in that health care system? Do you empathize with the doctors and nurses who have gone on
strike because of low wages and working conditions?
● What have been the biggest lessons Liberia has learned from this crisis?
● What are your hopes for government intervention, international intervention and the Liberian
people moving forward as they attempt to stabilize and rebuild broken systems (health, education,
economy…)?