Liberia—Moving Beyond “Ebola Free”

A lthough the ongoing Ebola epidemic has brought much attention to Liberia, diseases of poverty, such as malaria, tuberculosis (TB), and maternal–newborn complications , rarely make the headlines. Along with the other West African countries that bore the brunt of the epidemic, Liberia ranks near the bottom of the Human Development Index, a composite measure that assesses whether persons enjoy a long and healthy life, can acquire knowledge, and have an adequate standard of living (1). In Liberia, before the Ebola outbreak, ≈50 doctors attempted to care for ≈4 million persons (2). In an already fragile health-care setting , Ebola took a terrible toll: >8% of the health care workforce in Liberia died from the virus (3). The consequences of such a dramatic loss will be felt for years to come, especially in the areas of infectious disease and maternal and infant mortality (3). As we renew our commitment to make Liberia " Ebola free, " we should remind ourselves that in the 21st century, Liberians still die from 19th century diseases. The focus must go beyond " getting to zero. " As concerned clinicians, we argue that much more work needs to be done. In early 2015, we went to Grand Gedeh County as short-term clinicians, working with a nongovernmental organization (NGO) to support Liberia's existing health care infrastructure. Unlike emergency response NGOs, our NGO turned its attention to assisting local hospitals, clinics, and communities in their routine, day-today health care activities. Tucked away in Liberia's remote southeastern corner, Grand Gedeh County had largely been spared from the epidemic; at that point, only 1 case had been reported since the epidemic's onset. We would not wear the protective space suits so familiar in the public eye. Instead, we would work in surrounding communities , meeting with local health workers and psychosocial officers, or on the wards with Liberian nurses and doctors, tending to persons who suffered, and at times died, from easily preventable diseases. The public hospital offered a glimpse into the state of Liberian health care facilities in the wake of Ebola. The building itself lacked electricity most hours of the day; it had no running water, and there was a severe shortage of medications and basic supplies. The only available pain medication at the hospital was oral acetaminophen tablets. We witnessed 5 neonatal deaths in 10 days. In the community , we listened to first-hand experiences about …