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There’s no room for complacency in the fight against Ebola

It looks like the United States is Ebola-free, as of earlier this month. This is good news, of course. The bad news, though, is that America seems to have lapsed into a state of glazed Ebola fatigue.

With no immediate threat here, it's easy to forget about the suffering over there. It's easy to forget that children have been shut out of schools all over Sierra Leone since the summer, that nearly half of Liberia's workforce is no longer on the job because the virus crippled the economy, and that the relief effort in West Africa is really only just beginning.

The reality about Ebola is this: though there are no cases in America, the situation isn't under control at the epicenter, in West Africa. And this is exactly why Doctors Without Borders' president, Dr. Joanne Liu, headed to West Africa this week, returning to the three most-affected countries for the first time since the summer.

The medical relief organization has never been so busy in the field, responding to the medical needs of nearly 70 humanitarian crises. Still, Dr. Liu has chosen to keep focused on Ebola. "We need to understand that the only way to get over this Ebola epidemic is by increasing the response locally," she told Vox. "It’s not by barricading yourself an ocean away. This is not the way we are going to get control until we contain the epidemic."

Liu talked to Vox about how she plans to keep the public invested in fighting the Ebola epidemic, why Ebola has been so challenging personally, and what she thinks is in store for the future of this outbreak.

How to keep public attention on Ebola

Julia Belluz: Now that Ebola isn't an immediate issue here, with no new domestic cases, it seems public and media attention is waning — despite the continuing urgency of the situation in West Africa. How do you keep people interested in this epidemic?

Joanne Liu: We are thinking about this. We want to keep the pressure on. What will happen, with any natural disaster, is there’s a real interest initially, people have promises and pledges, and you discover one year down the road that only 30 percent of those pledges have turned up in the field. With the [2010] earthquake in Haiti, the event happens. Many people are displaced. Many people died, people are injured. But this will not change that much, because the event happened.

With Ebola, you keep having cases and chains of transmission. You keep dealing with cases, and new cases and new chains of transmission. It’s a moving epidemic, and you need to be adaptable and flexible.

Julia Belluz: Doctors Without Borders is dealing with countless different diseases in dire situations in so many countries around the world. How is Ebola different?

Joanne Liu: Ebola is different in the fact that it’s a strictly a medical emergency — with some political challenges — but the heart of the issue is a medical problem, whereas in other places, the political landscape — meaning the insecurity and access issues related to security — takes over and dictates the medical action you will provide.

The thing is, with Ebola, it’s a spectacular disease because it kills fast. It kills in a spectacular way. The caring for patients is, as well, very spectacular because of the personal protective equipment you have to wear. Everything is exaggerated. One thing we cannot be oblivious to is how much fear has been played into Ebola.

The cover of the New York Post on October 24, at the height of the US's Ebola fears (Timothy A. Clary/AFP/Getty Images)

On the present situation and future fears

Julia Belluz: The reports from the World Health Organization right now suggest that Ebola cases in Liberia and Guinea are dropping, but that Sierra Leone still has out-of-control spread. What's your take on this news? Does this represent a real turning point?

Joanne Liu: Strictly speaking, when we look at our figures, there is deceleration in the number of cases in a few spots in Liberia and Guinea, but they are still on the rise in Sierra Leone.

There are a few things we need to be conscious about: we have had those decelerations in the past. Basically, it happened while it was spreading in other communities and after that, there was another surge in other hot spots. So we need to make sure it’s an opportunity to consolidate our Ebola isolation centers and case management, strengthen the community information and education. That is key. We need to use this time for that. But the main thing is to not let down our guard.

There’s no room for complacency, no room for mistakes. Every time you go down that path, you pay: you get infected, more people are infected. Ebola does not allow you to make mistakes.

Julia Belluz: How has fear about Ebola affected the response?

Joanne Liu: I find it difficult how [the media] portrayed African people's fears when they were initially tackling the epidemic. Then when Ebola got to their home country, I saw the widespread anxiety and global fear in the Western world. I think people got a bit of a glimpse of what it is when you live with Ebola in your home country.

Fear can be our best and worst enemy. I find Ebola somehow brought the worst and best out of people. At one point, we didn't pay attention to it but when the American missionaries got infected, we paid attention.

Julia Belluz: How has fundraising and recruitment been for Ebola at Doctors Without Borders? And have the threats of quarantine on returning health professionals deterred volunteers?

Joanne Liu: Fundraising is more or less okay because people like to get to Doctors Without Borders because they know what we’ve done. We’re a hands-on organization.

I think what happened in the States recently [with the quarantines and talk of travel bans] has been a cold shower on people. We took a public stance against the quarantine of the returning volunteer because it wasn't based on science, it was based on fear. It was criminalizing people who volunteer overseas. Some people have been saying to us that they would like to get some guarantee about what will happen to them when they get back before volunteering.

Julia Belluz: What most concerns you most about the epidemic going forward?

Joanne Liu: Right now there’s a huge issue of health-care access. We don't have enough statistics because everybody is so stretched, but it seems you can easily die today because of not having access to emergency surgery from an open fracture in West Africa because there’s no place to go. Most of the big hospitals have been closed because of Ebola. There’s Ebola, and there’s the consequences of Ebola on the state of the health-care infrastructure.


On the steep Ebola learning curve

Julia Belluz: Where were you when you first heard about this Ebola outbreak, and what were you thinking?

Joanne Liu: I talked to one of our experts who presented [information about the epidemic] to the Doctors Without Borders board meeting in Switzerland in March. I knew there was a sense of urgency. We had gotten this clear rumor of 15 cases of people with bleeding signs and hiccups. Nine of them died. We were very concerned. We shared this information with the Doctors Without Borders operational center in Belgium. They were quite concerned, because hiccups and bleeding are usually hemorrhagic fever. Within a few days, we had confirmation.

One of the things she was trying to convey to us at the meeting was, "Listen, guys, if at the beginning we have cases in four locations which are 200 kilometers apart, this is unusual business."

Back then we were saying it’s the most geographically widely spread Ebola epidemic. We didn't know it was out of control and unprecedented, but we knew we had elements that would make it different.

Julia Belluz: Doctors Without Borders has been called the canary in the coal mine on this epidemic, warning the world about it at least six months before there was any real political action. Why did it take so long for others to get clued in?

Joanne Liu (Doctors Without Borders)

Joanne Liu: This is what I find absolutely a pity, is the fact that 2014 has been a really, really rough year in terms of crises around the world. It’s very difficult to redirect attention and resources to new crises when somehow everybody has split attention everywhere: Syria, Iraq, South Sudan, Central African Republic, Gaza, Myanmar, Ukraine, just to name a few. We all feel that we are basically stretched. Even for Doctors Without Borders, we have never been so much deployed in terms of human resources in the field as we are right now. We have increased by 20 percent our human resources in the field since the beginning of the year.

Julia Belluz: Do you have any frustrations or regrets about Doctors Without Borders' own response to this crisis?

Joanne Liu: The frustration is the fact that we could have done better and bigger; we were a bit late. If there were rumors since December about Ebola in West Africa, how come they didn't come to our ears sooner?

But there’s a limit to what you can be aware of. In hindsight, could we have moved faster? All of us could have done better, including Doctors Without Borders. The thing is, how much it takes to redirect attention, and how much it takes to put a crisis under the spotlight. The main thing about Ebola, too [is] there were 18 previous outbreaks that were self-contained within a few weeks. Basically what happened in March, when we got the official word that we had infected patients, and that it was geographically spread, [the public and the global health community] didn't clue in.

Julia Belluz: Has Ebola changed the organization?

Joanne Liu: I didn't have much of a baseline, because i hadn't been in function so long before it started. When I started in October 2013, I remember saying that when I got elected, the first place I would go would be Syria. I thought, "This is really not covered enough as a humanitarian crisis." I still think today we don't hear as much, and I don't think it’s better there than a year ago, if not worse.

In July I knew I had to go to West Africa. By the time I went, it was August. I basically cancelled my summer vacation to go there, because we could tell there was something that needed to happen because the world wasn’t waking up.

What Ebola has done, how it changed my life, it’s in terms of the high profile name I have been allowed to have. It has allowed us to get a high-level dialogue going with different stakeholders. We have been having such a high-profile role initially in the Ebola epidemic. We still have some, but now there are more players. You end up talking to high-profile people in the United States, United Nations, World Health Organization — these were people were not as accessible before.

The personal challenges of fighting Ebola

Julia Belluz: You've only been in the president's role since October of last year, which means you were hit with the largest-ever Ebola outbreak after less than six months on the job. That must have been difficult.

Joanne Liu: You feel the weight of your responsibility. That’s one thing. it’s very difficult. I just remember being absolutely concerned, thinking about what we can do do to make things move. You don't realize how, actually, it’s really hard to figure out — especially since it’s my first year as president. It's very hard to figure out what kind of leverage you really have until you try it out.

Julia Belluz: What was your biggest lesson?

Joanne Liu: What I have discovered is that the legitimacy to speak and talk is by your actions. The fact that Doctors Without Borders was in the field right at the beginning — we opened centers, our staff took amazing risks, we scaled up quickly — paid off. I am paying a huge tribute to our staff. Our staff have been there since March, facing Ebola on a daily basis. Our local staff have been there every day since the beginning.

Julia Belluz: Were there any other personal challenges for you?

Joanne Liu: It’s difficult to say personally. I am part of a big organization. I am part of a big thing. So I guess I find it difficult to answer at the personal level, because I really do feel part of a bigger thing, a bigger group taking decisions together. The most difficult thing when I'm thinking back about it is the fact that — not that we want it to be right, because in those kinds of specific environments, you don't want to be right you wish you’re wrong when you ring the alarm — but how people downplayed what we were saying at the beginning.

As president, I now feel that I’m paying a big tribute to my staff because they never let me down. They are still today asking me to do more, make more resources available. They want to get treatment trials as soon as possible going and rolling. And I feel fortunate to be at the leading role of an organization that wants to do more.

Julia Belluz: You must be tired. How do you stay motivated?

Joanne Liu: I think my reward is the fact that maybe we are going to get an upper hand on this epidemic. That’s going to be my reward. I think things are progressing and I do hope that on my visit [this week] I will see that.


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