No contact: Life inside the Ebola outbreak

updated 9:15 AM ET, Fri, September 19, 2014

By John Bonifield, Jen Christensen and Jacque Wilson, CNN

Dr. Jose Rovira with the World Health Organization takes a swab from a suspected Ebola victim in the town of Pendembu, Sierra Leone.

Courtesy Tommy Trenchard

Editor's note: These stories were gathered from writings submitted to CNN and interviews conducted with people on the ground in West Africa. They have been edited for clarity.

Burying the bodies

Daniel James, Red Cross Society volunteer
Kailahun, Sierra Leone

The first body we had to bury was at a village called Gbanyawalu. When the corpse was turned over on his back for swabbing, it took in a breath — like somebody who has suffered from suffocation and was gasping for air. We nearly ran out. Even the World Health Organization worker was not expecting such a reaction from a corpse that was there three days before our arrival.

Daniel James, burial leader

On July 10, I was called into the office of Constant Kargbo, under-secretary general of Disease Management Programmes and Operations for Sierra Leone's Red Cross Society. He said to me: "My man, I want to send you to Kailahun for dead body management. Will you go?" I took about five minutes to think on it.

I joined the Red Cross when I was a child to work for humanity and to alleviate the suffering of the most vulnerable. I said, "I am from Kailahun. I must go to save my people."

When I reached Kailahun, it was like a war-torn country. My family was not happy; they were all scared and worrying. They called asking me to go back. My sister shed tears over the phone, but I reassured her.

On average, we bury six bodies a day. The hardest part of the job is to take blood samples from the corpses.

My guys are professionals now. Our personal protective equipment and a chlorine solution are our protection; they are our medication and they are our doctors. We maintain the ABC Rule: Avoid Body Contact.

My last word of caution to them whenever we come from the field is: "Gentlemen, you have done safe work and I am confident you are safe in this moment. When you go home, be mindful of your personal activities until we meet again tomorrow."

With this, no one has ever complained of even a simple headache. Thank God.

Workers wearing personal protective equipment stand inside the contaminated area at the ELWA Hospital in Monrovia, Liberia. The hospital is run by Médecins Sans Frontières, also known as Doctors without Borders.

Dominique Faget/AFP/Getty Images

Who lives and who dies?

Pierre Trbovic, Medecins Sans Frontieres
ELWA-3 Ebola Treatment Center in Monrovia, Liberia

Soon after arriving in Monrovia, I realized that my colleagues were overwhelmed by the scale of the Ebola outbreak. Our treatment centre — the biggest MSF has ever run — was full, and Stefan, our field coordinator, was standing at the gate turning people away. On an MSF mission, you have to be flexible. This wasn't a job that we had planned for anyone to do, but somebody had to do it — and so I put myself forward.

Pierre Trbovic, hospital gatekeeper

The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car. He pleaded with me to take his teenage daughter, saying that whilst he knew we couldn't save her life, at least we could save the rest of his family from her.

Other families just pulled up in cars, let the sick person out and then drove off, abandoning them. One mother tried to leave her baby on a chair, hoping that if she did, we would have no choice but to care for the child.

I had to turn away one couple who arrived with their young daughter. Two hours later the girl died in front of our gate, where she remained until the body removal team took her away.

Once I entered the high-risk zone, I understood why we couldn't admit any more patients. There are processes and procedures in an Ebola treatment centre to keep everyone safe, and if people don't have time to follow them, they can start making mistakes.

There was no way of letting more patients in without putting everyone, and all of our work, at risk. But explaining this to people who were pleading for their loved ones to be admitted, and assuring them that we were expanding the centre as fast as we could, was almost impossible.

In Monrovia, we estimate that there needs to be more than 1,000 beds to treat every Ebola patient. There are currently just 240. Until that gap is closed, the misery of turning people away at our gates will continue.

Pierre’s story was first published by The Guardian

A man suspected of having Ebola lies near a busy street in Monrovia, Liberia, as a child looks on.

Abbas Dulleh/AP

So much is missing

Lt. Rebecca Levine, U.S. Public Health Service
Freetown, Sierra Leone

Our flight to Sierra Leone was almost completely empty.

When we got to the hotel, we met in the lobby with two officers. I wanted to go up and give them a hug, but nobody makes direct contact here. You can't shake hands, and you certainly can't hug. It seems really against human nature and totally the opposite of what you want to do in a crisis.

Lt. Rebecca Levine, contact tracer

It's been pretty emotional just seeing the reality of how this is affecting daily life. The price of everything has skyrocketed, and people can't afford to feed their families. All the schools are closed, so kids are not learning.

Several of the local health care workers had lunch with me today. They offered to share with me this amazingly gorgeous plate of food, and I couldn't eat it. All of us are so afraid of eating anything out of the normal. Nobody wants to get sick with gastrointestinal symptoms like vomiting and diarrhea — anything that you might attribute to an upset stomach or food poisoning are also the symptoms of Ebola.

You just have to be careful of everything all the time. It's wearing on me in a way that I didn't really expect. It's not just the absence of human contact but also the fear of it. Somebody brushes by you in a room and you think, "Where have they been? What do they have?"

My real fear is that this is just the tip of the iceberg. As the cases continue to mount, another day where contact tracing isn't happening goes on.

The more I learn about the contact-tracing system, the more I realize how much there is to do and how much is missing. The person who is supposed to be in charge of monitoring the contact-tracing supervisors doesn't even have a computer. It feels like a really daunting challenge to overcome, especially in a district of 3 million people where it's really easy for people to hide.

I saw signs outside of a church that were basically saying Ebola is here because of evil spirits — as a curse that people just need to pray hard enough to make go away. We know that it's going to take more than prayers.

Workers in Monrovia, Liberia, place the body of a man suspected to have died of Ebola hemorrhagic fever inside a plastic body bag for burial.

Abbas Dulleh/AP

'We can defeat this'

Tim Callaghan, U.S. Agency for International Development
Monrovia, Liberia

I got here a little over six weeks ago to coordinate the USAID response to Ebola in Monrovia. I was the director in Haiti after the earthquake in 2010, and was in the Republic of Georgia after the fighting with Russia in 2008.

Here it is painful for me. Unlike the Haitian earthquake — where you knew how to distribute food and provide plastic sheeting — in Liberia we really need to change mindsets so people don't put themselves at risk.

Tim Callaghan, disaster coordinator (right)

We've pulled people from all over the U.S. government to come to West Africa. There's someone from the Centers for Disease Control and Prevention, from the Department of Defense, from Health and Human Services. We have a firefighter from Los Angeles County. We're all trying to improve incident command and response.

Much of our work involves education about what Ebola is and isn't, helping infection control practices, setting up labs and clinics. Health care facilities here were challenged even before Ebola.

We have some momentum. I was recently in Dolotown to see the health facility we are funding. We want to put a mobile lab there to speed up testing. It is a four-hour ride on terrible roads to the nearest lab. It takes days to determine if someone is sick.

The town was quarantined early on; it's out of quarantine now. The people there were amazing.

I saw this young man with a megaphone advising people what Ebola is, urging his community to "stop it together." These young people stopped our car driving in and told us to get out, to wait in line for them to check our temperature. There was no exception. They wrote it down with the date and pinned it to my jacket. I plan to keep that for a long time.

Those who do have high temperatures were isolated and tested. While they wait, community members brought food and water. Thankfully, none had Ebola.

Seeing people in the community work together to solve these problems is tremendous.

The big thing here is to be very disciplined. It's difficult. We need to educate families that they can't touch a dead person. When someone dies you want to hug them or hold them. You can't.

I did Peace Corps before USAID. My mother, who lives in Brooklyn, cried for a week when I told her I was leaving my job on Wall Street to do that. But my family knows this is important. We all must battle this together. We can defeat this, but we are still far behind.

Ebola can spread even after a person infected with the virus dies. Workers must be careful not to come in contact with any bodily fluids, such as blood or sweat.

Abbas Dulleh/AP

Changing tactics

Dan Ward, Medical Teams International

I grew up in Africa; my parents brought me to Tanzania when I was 6 months old. Now I'm a development program specialist based in Uganda, brought into Liberia to do logistics during the Ebola outbreak.

Needs keep changing, and we need to keep changing tactics.

We have several clinics throughout Monrovia. One day, we were going down the street from clinic to clinic, doing an assessment to see what the needs are. The first clinic was open. There were 20 people in the outpatient area, but the staff was not taking temperatures. You could have someone seeking treatment for Ebola, but they wouldn't know. That's how it's spreading. We needed to get education to health workers there.

Dan Ward, medical logistics

The second clinic was closed. They had an Ebola patient who died. All the workers had to be quarantined for 21 days.

The third was a private clinic. The operator closed it because he didn't have proper equipment. We're trying to get him emergency supplies.

Supplies are coming into the country, but this is a bureaucratic culture, and we have to spend a lot more time than usual on tedious paperwork. There need to be shortcuts. But we are not going to be able to build enough treatment units even with President Obama ramping up U.S. response. The physical limitations are serious and the messaging is confusing still.

We are saying don't touch people with Ebola; that's not realistic anymore. There's no place to take loved ones. When you have a family member who is sick, we have to say, "Here is how you can help while maintaining the dignity of self and family."

Greeting someone here is usually an event, with a vigorous handshake. Now no one touches. It's lost some of its essence. When you walk down the sidewalk you're careful not to touch anyone accidentally. The staff now has vehicles; they don't use public transport or taxis. We wash our hands constantly with bleach.

I'm struck by the compassion and courage of the people here. Health care workers don't have sufficient supplies and yet they still provide services. Our whole objective is to help keep them alive.

My family worries, but I try to be careful, and I feel this is what I should be doing.