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One woman walked in, and Ebola epidemic began

A middle-aged woman walked into the emergency room of Phebe Hospital with a fever on the evening of June 23.

Phebe was known as one of the best hospitals in rural Liberia, supported by the local government and international religious and academic partners. Phebe was especially known for its high-quality nursing care, serving as a training hospital for nearby Cuttington University, one of the country's few nursing schools.

A few hours after arriving in the emergency room, the woman was admitted to the medicine ward with a list of potential infections -- all the usual suspects in Bong County: malaria, typhoid, sepsis.


An epidemic had been raging for months in nearby Guinea, but Ebola was not considered as a possible diagnosis. After all, nobody at Phebe had ever seen a patient before with Ebola, and as the axiom goes in medicine, when you hear hoof beats, think horses, not zebras. Certainly don't start imagining unicorns.

The nurse who cared for the woman that night drew her blood and helped her to the toilet to urinate. When the woman began vomiting and soiled her sheets, the nurse cleaned up the mess, as nurses do all over the world every day.

For a disease whose transmission depends on the direct contact of one human being with the body fluids of another, Ebola has no better customer than nurses.

The other thing about nurses that the virus finds particularly helpful is they tend to work in shifts. Before the week was out, Bong County's first Ebola patient had died, and seven nurses caring for her had fallen ill. Six of them would also die in the coming weeks.

The remaining clinical staff, watching their colleagues falling ill all around them, abandoned the hospital. When the patients saw what was happening, those well enough to walk out did just that.

Over the ensuing months, the epidemic rippled across Bong. Hundreds of individuals were infected, and perhaps more importantly, basic social institutions also began to collapse.

One by one, all three hospitals in the county shut down due to fear of the spread of the virus, followed by most of the primary care clinics. Women were left without midwives to deliver their babies, accident victims without emergency rooms to care with them. Next the primary schools closed, then the secondary schools, and finally Cuttington University.


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