Transcript

Outbreak

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PRODUCED BY

Dan Edge

Sasha Joelle Achilli

DIRECTED BY

Dan Edge

Liberia, West Africa

September 2014

STEFAN LILJEGREN, Doctors Without Borders: I got a call saying that there is a walker on his way down to market. I could hear and see the crowd of people screaming and shouting.

I can see that he’s afraid. I see he has picked up a rock and he’s waving it around to get some space. He’s followed by a lot of people— I don’t know, 100, 200 people, angry, telling us, “You have to take him down. He is infecting our community. We don’t know where he is going.”

The pressure from the crowd is mounting. They are yelling at us. So the guys in the suits wrestle him to the ground and put him in the back of the pickup. It was like watching a zombie movie or something. And it’s just crazy. It’s pure craziness. Where am I? How did I end up here? Was this just a bad dream? But no, it wasn’t. It was for real.

9 months earlier

Meliandou Village

Guinea, West Africa

CHILD: [subtitles] In our village, there’s a huge tree. It was full of bats. One day we were crossing the river, and we heard strange noises. We came here. A bat came out, and we killed it. A boy went inside and hit them with his spear.

NARRATOR: In December 2013, the children of Meliandou village discovered hundreds of bats nesting in a hollow tree. They had no idea that bats are suspected of carrying a deadly virus. Nobody knows for sure, but the villagers now think that this is where it all began.

CHILD: We lit a fire, and they fell from the tree. We filled our bags with bats. Then we ate them.

INTERVIEWER: At that time, had anyone died?

CHILD: No, it hadn’t started yet

Day 1, Christmas Day 2013

ETIENNE OUAMOUNO: [subtitles] At first, I thought it was witchcraft. I thought my family had been cursed. My son got sick at the end of December. He had a fever. He was shivering. After two days, he got worse. He got diarrhea and stopped eating. Then he died.

NARRATOR: Nobody knew what had killed 1-year old Emile Ouamouno. His sister died nine days later. Then his mother fell ill. She was 7 months pregnant.

AUGUSTINE MOMODOUNO, Village Medic: [subtitles] At 2:00 AM, Etienne knocked on my door. He said “Augustine, open the door.” I said “What’s wrong?” He said, “My wife is bleeding.” He said, “All she does is bleed and bleed.”

I went to the house and found her in a room. The whole house was covered in blood. I was scared. At 2:30 AM, she had a miscarriage and died.

Her husband, the father of the children, went crazy. He screamed, “The village has killed me! The village has killed me!”

ETIENNE OUAMOUNO: [subtitles] When my wife died, some women cleaned the house. The ones who came here, three women, they died. Our village was in trouble, and we wanted to know why.

NARRATOR: A traditional healer gathered everyone together, including more family members who had become sick. A villager filmed the ceremony on his cell phone.

ETIENNE OUAMOUNO: [subtitles] He said, “Curses are causing the deaths in your village.” But afterwards, the deaths continued.

NARRATOR: The next victim, Emile’s grandmother, left the village to seek treatment. She infected a nurse at a local hospital.

The sickness began to spread across the Forest Region of Guinea, but for three months was mistaken for cholera and malaria.

By March, the virus had traveled hundreds of miles and killed more than 50 people. The government sent a team of scientists to investigate and take blood samples.

LAMINE KOIVOGUI, Ph.D., Dir., Guinea Institute of Public Health: [subtitles] The Ministry of Health said, “Doctor, this needs your attention. A lot of people are dying in the forest.” Nobody knew the cause of the deaths.

NARRATOR: The doctor tracked down a teenager named Khalil who was sick with the mystery disease. His colleague started filming on an iPad.

LAMINE KOIVOGUI: [subtitles] The child was there. There was blood everywhere. My colleague said, “Dr. Lamine, I’ve seen a lot of diseases, but this is a first.”

We helped him up. We leaned him against the wall, so we could take some blood. We took his blood and filled four tubes. I knew it was dangerous. I knew it was probably a hemorrhagic fever. But which one, I couldn’t tell.

It’s hard to talk about— the death of a child with the father sitting there, watching his child, watching him die.

NARRATOR: Khalil’s blood would later be tested. The results— Ebola.

LAMINE KOIVOGUI: [subtitles] What did I think? I never thought it could be Ebola.

Day 87, March 22, 2014

NARRATOR: The government of Guinea had no idea how to respond. 14. All previous Ebola outbreaks had occurred over a thousand miles away. But the relief group Doctors Without Borders had decades of experience with Ebola. Within 48 hours, they set up a field hospital in the town of Gueckedou, the epicenter of the outbreak.

The first patients began to arrive.

HILDE DE CLERCK, M.D., Viral Hemorrhagic Fevers Specialist: Most of those cases all came from different villages or different areas in the city of Gueckedou. That’s a very bad sign because it means that you don’t have just one cluster or one family or one village that is hit. It means that it’s already spread out.

NARRATOR: Past outbreaks have shown that the key to stopping Ebola was to isolate the sick, monitor anyone who had contact with the infected, and safely bury the dead.

This complex operation needed a level of manpower and coordination beyond the resources of Doctors Without Borders.

Dr. HILDE DE CLERCK: I remember my headquarters asked me, “What do you think? Is it like 5 villages, or 10 villages, or 15 villages, or more?” I remember I said, “Well, if I have to choose between those three options, it’s 15 or more.” I said, like, “I think we have a big problem.”

NARRATOR: The World Health Organization, W.H.O., is part of the United Nations and has a mandate to help governments coordinate their response to outbreaks.

KEIJI FUKUDA, M.D., Asst. Director-General, Health Security, WHO: Here is a disease that we have dealt with for a number of decades before. And you know, in our own mind, we had the idea that Ebola was something which was severe but typically occurred in a certain way, and then could be handled. But at that time, we didn’t really know how complex it was going to become.

NARRATOR: The W.H.O. left the response in the hands of its officials in Guinea, who had no experience of Ebola. They set up what would become daily meetings with the government of Guinea, Doctors without Borders and other aid organizations.

MARC PONCIN, Doctors Without Borders, Guinea: Those daily meetings were a nightmare. Every day, every day, day after day, disorganized meeting, no decision taken, no one knowing what they were talking about. W.H.O. people were really not at the level required for the job. Their coordinator never worked on Ebola before. And W.H.O. was really downsizing the scale of the epidemic. Immediately, I thought, “Those people are useless. They don’t even understand what they’re supposed to do here.”

FRANCIS KASOLO, M.D., Ph.D., Dir., Disease Prevention & Control, WHO Africa: W.H.O., although it’s a very important technical agency, our powers are limited when we are operating in countries. The countries take the lead. We advise honestly. And this is what we tried to do in Guinea.

NARRATOR: The outbreak quickly spread 400 miles to Guinea’s capital, Conakry. Doctors Without Borders’ top Ebola expert spoke out.

MICHEL VAN HERP, M.D., Doctors Without Borders: [April 1, 2014] [subtitles] We are confronted with an unprecedented epidemic. The number of cases is unprecedented. So is the territory.

NARRATOR: The government of Guinea accused the group of sowing panic.

Col. REMY LAMAH, Minister of Health, Guinea: [subtitles] I summoned the Doctors Without Borders team to my office. I asked why they used that phrase, “an unprecedented epidemic.”

Dr. MICHAEL VAN HERP: [subtitles] It was spontaneous. It was so obvious to me that I didn’t think it would shock people. There was so much evidence.

Col. REMY LAMAH: [subtitles] I didn’t agree with them. I said I didn’t appreciate them saying things unilaterally, different from our official line. We had our own analysis. At that point, we thought we could contain the outbreak.

NARRATOR: The Ministry of Health now ordered its teams in the field to include only laboratory-confirmed cases of Ebola in their death count.

ALEXIS TRAORE, M.D., Guinea Ministry of Health: [subtitles] We are under their authority. If they ask us to provide only confirmed cases, that’s what we do. It’s politics! [laughs]

I don’t know why they said only to count confirmed cases. Maybe the number of probable, confirmed and suspect cases would have been too big. It would’ve scared the business world.

NARRATOR: The Ministry of Health teams now stopped investigating deaths that weren’t confirmed Ebola cases. Some of those deaths were in villages right on the international border between Guinea and Sierra Leone.

Locals cross freely between the countries every day. Luisey Kamano lived in Sierra Leone, but in March, she came to stay with relatives in Guinea. Her mother had Ebola and had already crossed the border twice since she got infected.

LUISEY KAMANO: [subtitles] People began to die. My mother, my aunts, my grandmother, they all died. I was afraid for my life.

NARRATOR: When Luisey fell sick, too, she was frightened by rumors that foreign doctors were killing people.

LUISEY KAMANO: [subtitles] I was told white people were looking for me, that they wanted to take me to Gueckedou. I was told they’d kill me with an injection. So I ran away.

NARRATOR: Luisey walked through the bush until she reached a river, the border with Sierra Leone. There were no checkpoints, no immigration police.

LUISEY KAMANO: [subtitles] I didn’t stop. The boatmen saw me and took me across. It took two minutes to cross.

NARRATOR: Like her mother before her, Luisey had crossed the border carrying the sickness with her. No one knew it yet, but Ebola was spreading in Sierra Leone.

A few days after her journey, the W.H.O. got a tip-off that Luisey was sick and had crossed into Sierra Leone. Luisey’s name and location were logged in an internal report and passed on to the Sierra Leone government.

FRANCIS KASOLO, M.D., Ph.D., Dir., Disease Prevention & Control, WHO Africa: We did bring Luisey to the attention of the Sierra Leone government, and they came back and told us that Luisey had gone back to Guinea and that he— she was not in Sierra Leone. That was the last that we heard of this particular case.

NARRATOR: The Sierra Leone government says it was never informed about Luisey. What’s certain is that Ebola was soon spreading through her home village. One of those to fall sick was a renowned traditional healer known as Mendinor.

MAMMIE LEBBIE: [subtitles] Mendinor was the best healer I ever met. She had great powers. Ghosts would follow her everywhere. Mendinor could talk to the dead.

NARRATOR: On April 8th, Mendinor died, and her body was prepared for burial.

The corpse of an Ebola victim is highly infectious, but in West Africa, it’s customary for villagers to spend hours washing and preparing the body for the funeral.

MATTU MORRU, Mendinor’s Sister-in-Law: [subtitles] We wash the body, and then dress it in clean clothes. We wash under the arms, between the legs, cut the toenails. If the hair is loose, we braid it.

NARRATOR: These traditional burial practices played a major role in the spread of the virus. Mourners often touch the body at the funeral itself.

MATTU MORRU: [subtitles] If someone is not buried properly, her ghost will return to haunt people.

MAMMIE LEBBIE: [subtitles] All the surrounding villages knew Mendinor, so many people came to her funeral. You couldn’t count them.

NARRATOR: The healer’s funeral was a catastrophe. It set off a chain reaction of infections that would lead to thousands of deaths.

The outbreak was already raging in Guinea, and now it began to spread unchecked through the villages of Sierra Leone, wiping out entire families. The healer’s niece even took the virus 250 miles to Monrovia, the capital of Liberia.

Nobody yet knew it, but the outbreak was completely out of control.

Day 150, May 25, 2014

NARRATOR: For more than a month, the government of Sierra Leone missed the deaths in its border villages. Doctors without Borders says it tried to get the government to pay attention, but Sierra Leone had turned for advice to an American company called Metabiota, who had a long-standing presence in the country researching tropical diseases. Metabiota had no experience in controlling Ebola outbreaks.

JEAN-PAUL GONZALEZ, M.D., Senior Scientist, Metabiota Inc.: I said this outbreak will not last more than few weeks, and that was after we identified the first week. The first two weeks, we said, “OK, that’s a normal outbreak. We are confident it will be over in two months.”

AMARA JAMBAI, M.D. , Dir., Disease Prevention & Control, Sierra Leone: We were getting out advice from Metabiota, and a complacency set in. What can I say? Yes, it was Ebola, but the magnitude had not hit us. So we took steps at that time that were advised from Metabiota. But we never knew that it was going to be so big.

NARRATOR: The government decided to treat Ebola victims at the state hospital in the town of Kenema, which already had a ward for Lassa Fever, a disease similar to Ebola but less infectious.

But within days, the hospital was overrun with patients. Then the nurses started to die.

JOSEPHINE SELLU, Dpty. Head Nurse, Kenema Govt. Hospital: If you go to the morgue, you see dead bodies— 15, 16, 17, 18, dead bodies all in body bags. Then I start to wonder, “What is happening? Maybe this is the end of the world. Maybe everybody’s going to die.”

NARRATOR: Far from containing the outbreak, the hospital was helping to spread it. Will Pooley, a British nurse, volunteered to work on the Ebola ward.

WILL POOLEY, R.N., Volunteer Nurse: When a patient arrived, they’d walk in past these corpses that would be piling up across the path, and sometimes next to the path, smelling quite bad until the burial team came, and it might take days. I was constantly gob-smacked that this wasn’t a bigger deal. People— people weren’t— you know, that this wasn’t being shouted out.

NARRATOR: The government called in Doctors without Borders. The plan was to build a dedicated Ebola clinic in the neighboring district. The group says that the government and their advisers, Metabiota, were still underestimating the scale of the problem.

MICHEL VAN HERP, M.D., Doctors Without Borders: [subtitles] Metabiota and the government acted as if they could solve it themselves. But when you asked practical questions about controlling an outbreak— “Where’s the list of patients, the list of infected villages?”— they had no response.

INTERVIEWER: Do you think Metabiota was the right organization to be doing outbreak response?

JEAN-PAUL GONZALEZ, M.D., Senior scientist, Metabiota Inc.: No, we are not specialists in outbreak response. We know how to do it because we have some kind of expertise in the domain, but we are too small. I mean, we are a very small company.

NARRATOR: The government and Metabiota had no system in place to monitor people who had been in contact with Ebola victims. This lack of contact tracing meant that hundreds of cases went undetected.

AMARA JAMBAI, M.D., Dir., Disease Prevention & Control, Sierra Leone: [subtitles] Contact tracing, I would say, is where we got it wrong. We wasted, like, a month.

INTERVIEWER: And a month is a disaster—

Dr. AMARA JAMBAI: We lost time, yes. We wasted time. We lose a lot of lives, and we would have done much better had we really followed up the chain of transmission better. It was wrong. Yeah.

NARRATOR: The outbreak had now spread to three countries, Guinea, Sierra Leone and Liberia, some of the poorest nations in the world. Four neighboring countries risked infection at any moment.

The W.H.O. was considering declaring an international health emergency, which would have acted as a global distress signal. But officials were concerned about causing panic.

FRANCIS KASOLO, M.D., Ph.D., Dir., Disease Prevention & Control, WHO Africa: At that time, I think all of us thought, “Wait a minute. Let’s be cautious. Let’s see how it evolves.” We are deploying people in the field. We think we are making headway.

With hindsight, if I went back to June 2014, I would probably be saying something entirely different. I’d probably be standing up and calling my director general and saying, “Please do it.”

NARRATOR: The W.H.O. opened a new coordination center in Guinea to try to improve the response across West Africa.

MARC PONCIN, Doctors Without Borders, Guinea: There was absolutely no change at field level, still the very same few organization on the ground doing the work, no additional people coming to support, more people at coordination level, more useless people, more meetings to be organized. But on the ground, on the field, impact— zero.

Day 189, July 3, 2014

NARRATOR: Kenema Hospital in Sierra Leone was now overwhelmed. The W.H.O. had sent two doctors to help with the caseload, but the patients kept coming, and the nurses kept getting infected.

WILL POOLEY, R.N., Volunteer Nurse: You’d have to be crazy to think that anything but shutting that place down would be the thing to do. And everyone knew that. Everyone in town, everyone in Kenema knew that’s what needed to be happening.

Had that have happened months before that, there— there’s a whole cohort of nurses and lab techs and cleaners that wouldn’t have died. So many lives would have been saved.

NARRATOR: There were now so many deaths at the hospital that wild rumors started to spread through the town.

JOSEPHINE SELLU, Dpty. Head Nurse, Kenema Govt. Hospital: This crazy woman came out and stood right at the center of the town in the marketplace and started shouting, “There is no Ebola!”

CRAZY WOMAN: [subtitles] I say to everyone it’s not real. Ebola’s not real. It’s cannibalism. There is no Ebola!

JOSEPHINE SELLU: This woman was shouting, “I am a nurse. I am telling you people that we are just cannibal— doing cannibalism. We are the one that are killing people. We are removing their parts.”

CRAZY WOMAN: [subtitles] There is no Ebola!

JOSEPHINE SELLU: And everybody in the marketplace, the whole marketplace— haywire, running, “Oh, there is no Ebola. A nurse is confessing that there is no Ebola. Come and see the nurse. Come and see, a nurse is confessing.”

Now everybody started throwing stones at us. They said, “We are going to the hospital. We are going to burn the Kenema Government Hospital down.”

WILL POOLEY: I was walking up to the unit, and there was this stream of nurses and lab techs and just security guys from the hospital. And they were all, like, walking at a very hurried pace past me in the other direction.

I could hear this mob, an angry mob. It’s a really unique sound. And the W.H.O., they all evacuated. They got in their cars and drove off, leaving just a handful of people in the whole hospital, really, when there was a risk of the hospital being overrun.

NARRATOR: The police used tear gas to disperse the crowd. The streets went quiet for now, but Sierra Leone was on the brink of chaos.

The outbreak had now killed more than 800 people in three countries. As the death count rose, Doctors without Borders had been urging the W.H.O. to declare an international emergency.

JOANNE LIU, M.D., Intl. President, Doctors Without Borders: I said that I’ve been telling the world for the last few months that it’s an unprecedented, out-of-control Ebola epidemic. I don’t have the authority. People don’t listen to me. But you need to step up and declare it because you have the authority and you have the legitimacy.

KEIJI FUKUDA, M.D., Asst. Director-General, Health Security, WHO: We felt that if you simply go around and say things are out of control, or they’re this way or whatever, in a categorical way, it really doesn’t help. And at this time, we knew that we had something which was not ordinary, but we were not dealing yet with a full-blown, you know, global crisis.

NARRATOR: Then the outbreak moved to another level. An infected Liberian took the virus to Nigeria, Africa’s most populous country. And two American health workers forced Ebola into the headlines around the world.

NEWSCASTER: We are just getting word in from the CDC. It’s confirmed the first Ebola case diagnosed—

NEWSCASTER: —infected missionaries flown from Liberia and in isolation at an Atlanta hospital—

NARRATOR: The W.H.O. declared an international emergency.

MARGARET CHAN, M.D., Director-General, WHO: [August 8, 2014] I am declaring the current outbreak of Ebola virus disease a public health emergency of international concern. The committee acknowledges the serious and unusual nature of the outbreak and the potential for further international spread.

NARRATOR: The W.H.O. now put a high-level team in Geneva in charge of the response. They came up with a plan that would require thousands of Western medics and experts to be put into action.

BRUCE AYLWARD, M.D., Asst. Director-General, Emergencies, WHO: We were looking at one of the most dangerous pathogens that we knew, growing at an exponential rate across a broad geographic area, something we had never seen before.

We needed clinical management, people to go in there and manage the Ebola cases. We needed public health expertise on the ground to be able to do the contract tracing. And I realized that capacity to manage something on this scale doesn’t exist.

NARRATOR: The problem was the W.H.O. had no standing army of emergency medics and no authority or budget for this kind of operation. They now needed to persuade wealthy countries to send people to fight the outbreak, and that would take time.

Day 226, August 9, 2014

NARRATOR: Back in West Africa, the virus had found a new hunting ground, West Point slum, the most densely populated district of Monrovia, the capital of Liberia.

FINDA FALLAH: [subtitles] People in our family started dying. My husband got sick. He was bleeding from his mouth. My mother died on Wednesday. My sister died on Thursday. My husband died on Friday. They all died.

ELLEN JOHNSON SIRLEAF, President of Liberia: I was called by the minister of health to say that people were dying— total, total confusion, chaos, disbelief, fear, no means to respond because we didn’t have the knowledge, we didn’t have equipment, we didn’t have the means whereby we could attend to people.

We did not have full awareness of how quickly this disease could spread, how deadly this disease was. We were confounded because it just spread so rapidly in these communities.

NARRATOR: Monrovia had one small Ebola clinic, and it was full. For the infected, there was nowhere to go. The government decided to use a school in West Point as a makeshift isolation center for suspected Ebola cases.

Finda, whose husband had just died, was forced to come here with her six children, even though none of them appeared to be sick.

FINDA FALLAH: [subtitles] We felt alone. There was no medicine. The place was cold. I thought we would die. People said, “If you go in there, you won’t come back.”

NARRATOR: A local journalist filmed Finda and her children in the isolation center. There was no separation between the sick and the healthy. Very quickly, Finda’s son, Sasko, fell sick.

FINDA FALLAH: [subtitles] I told them my son was sick, but there was no medicine. He would just look at me and cry. They kept telling me a doctor was on his way, but no doctor came. I was holding him when he stopped crying. He went cold in my arms.

Day 233, August 16, 2014

NARRATOR: Outside, crowds were protesting that the slum was becoming a dumping ground for Monrovia’s Ebola victims. And once again, rumors were spreading that Ebola was a hoax, a conspiracy to kill poor Africans. Four days after it opened, the isolation center was overrun.

SAMUEL TARPLAH, Head nurse, West Point Isolation Center: They came. They put all the patients out. One little boy who was 6 or 7 years old, he was lying on a mattress. At that time, he was dead. There’s a body on the ground. They removed the mattress. I couldn’t believe it! For human beings to come with bare feet, with naked hands, touching even bodies that Ebola killed! And they saw the blood on the floor. They saw fluids on the floor. And they’re marching through it with their feet!

NARRATOR: The looters took mattresses and sheets contaminated with the virus. And the Ebola victims disappeared back into the slums.

FINDA FALLAH: [subtitles] We ran outside. There was no treatment, and people were getting more sick. People were dying. There was no treatment. What would you do?

NARRATOR: West Point was now out of control.

ELLEN JOHNSON SIRLEAF, President of Liberia: [August 19, 2014] Fellow citizens, it has become necessary to impose additional sanctions. The communities of West Point in Monrovia are quarantined on a full security watch. This means there will be no movement in and out of those areas.

We ordered the military to quarantine the place, to stop anybody from leaving. Our fear was people would run away and come from there, and then go into other communities. That’s why we did that.

NARRATOR: The quarantine backfired immediately. The army shot a teenage boy, who later died from his wounds. And the infected had nowhere to go except the streets. So the virus was spreading more quickly.

By now, one of Finda’s children, Sasko, was dead. The rest desperately needed help.

FINDA FALLAH: [subtitles] We had no place to go. We were sleeping on the street. I thought I’d be better off dead. Everyone I cared for was dying in my arms. Better for me to die, too, so I’m not a burden. All I could see now was death. I was losing my mind. I just laid the children down.

NARRATOR: As West Point descended into chaos, Doctors Without Borders had been constructing ELWA 3, the biggest Ebola Hospital ever built. But when it opened, it was immediately clear it would not be enough.

Brett Adamson was the field coordinator for the clinic.

BRETT ADAMSON, Doctors Without Borders: People were dying outside. Families were dying in taxicabs outside. They were arriving seeking care. The families had nowhere else to go. The center was full. And essentially, they were waiting— you know, the center was waiting for someone to die to then make space.

NARRATOR: Stefan Liljegren was recruited on short notice to work at the clinic. He had no Ebola experience.

STEFAN LILJEGREN, Doctors Without Borders: I arrive, and there are mattresses just next to each other full of people, and they’re dead. And I look back at them and, “OK, so that’s how a dead person look like.” They’re telling me that, “Stefan, we can’t just watch. We need to go in and move bodies. Are you ready for it?”

And I think I start to panic and my pulse goes very high. There are dead bodies in there, and in gruesome positions. We go to the next one, and there are dead bodies in there, as well. And we go up to a man in a chair, and the guy with the spray goes up and he starts spraying down his face. And that’s when it really hits you, yeah? He’s— he’s really dead.

And we place out the body bag, zip him up and we carry him away. And family are crying and screaming and yelling, and many are in panic. That was my first day with Ebola.

BRETT ADAMSON: A normal medical round for me would be going in, pronouncing five or six people dead. And it’s extremely horrible because people are dying sometimes very distressing deaths beside a child, the mother that was trying to care for her child dead. And then you’ve got a baby and trying to work out how on earth are you going to try and deal with an unaccompanied child in an overfull center.

It was really hard. It was just so far beyond what could normally be expected of humanitarian workers, I would say. The pointlessness of it— that’s what it felt like. Normally, if you work to the point of exhaustion, you can come away from something and feel a degree of satisfaction, knowing that you did what you could. I didn’t feel any satisfaction at all.

It was never about feeling like you’d failed in the level of medical acuity. We did everything we could. It was about feeling the shame of what the world had to offer for Liberia at that time, and yeah, the sheer number of deaths. It was just really seeing death.

NARRATOR: After sleeping on the streets for five days, Finda and her surviving children were finally picked up by an ambulance crew in West Point. They were taken to the new clinic. But when they arrived, there was no room for them.

FINDA FALLAH: [subtitles] I was just praying for God’s intervention. I prayed that God would save me and the children. It was just them and me now.

STEFAN LILJEGREN: It’s just crazy to stand there and look in the face of people and tell them that there is no space. It’s surreal, really surreal. If you had to make a choice, who do you take? If I have to take someone, I have to take this woman that lies on the ground here. She is very, very sick, and if I have to take someone, I have to take her. “I can’t take you. There is no space for you here today.”

NARRATOR: Eventually, the Doctors Without Borders team found room for Finda and her children. But by now, Finda’s youngest boy, Tamba, was slipping away.

FINDA FALLAH: [subtitles] He just looked at me, crying, “Mama, I don’t want to die.” Then he stopped talking. That was when they came for him. Then he died in my arms.

NARRATOR: Eventually, Finda would lose three of her children. Three survived.

By now, Ebola cases were rising exponentially. Doctors Without Borders made a direct plea to the United States to provide thousands of soldiers to help isolate and treat patients.

The Director of the U.S. Centers for Disease Control and Prevention came to the Monrovia clinic to see the situation for himself.

TOM FRIEDEN, M.D., Director, CDC: I still get goosebumps thinking about it, and I will never forget the experience. In ELWA 3, I saw a level of devastation that I have never seen. I went into one of tents and there was a woman lying on the ground. She had beautifully plaited hair. And I looked more closely, I realized that she was dead, and the staff were too busy trying to care for the living to even remove her.

It was seeing a country essentially in freefall and knowing, knowing with certainty, that no matter what we did, it was going to get a lot worse before it got better.

NARRATOR: Tom Frieden called President Obama.

Dr. TOM FRIEDEN: I was frankly furious. What I said was that this isn’t about response in the next three months, it’s response in the next three days that matters. Cases were increasing exponentially. They were doubling every three weeks. Each month of delay would result in a tripling of cases.

Pres. BARACK OBAMA: [September 16, 2014] The world still has an opportunity to save countless lives. Right now, the world has a responsibility to act, to step up and to do more.

NARRATOR: Ten months after the outbreak had begun, the fight-back was under way. The United States sent in thousands of troops and medics, and other countries followed suit.

The United Nations created a new emergency mission of the W.H.O. and other agencies to coordinate the response. Work began building new treatment centers and training burial teams.

But the outbreak was still ahead of the response and even threatened to spread beyond Africa.

NEWSCASTER: A second health care worker in Dallas has tested positive for the Ebola virus.

NEWSCASTER: Federal public health officials confirm the first human-to-human transmission of Ebola in the U.S.

TONY BANBURY, Head, U.N. Ebola Emergency Response: We definitely arrived too late. I was absolutely petrified it would just be this, like, black plague with this inexorable spread across the continent and beyond. We were also deathly afraid that someone would get on a plane and go to Dakar or Jakarta or Johannesburg, somewhere, and land in an urban setting and Ebola get totally out of control. We didn’t have a plan B.

Day 299, October 21, 2014

NARRATOR: Then in Monrovia, something extraordinary happened. Cases began to drop sharply.

BRETT ADAMSON: When we saw the numbers starting to go down, I was really worried. It was cause for more concern than jubilation because the response still seemed so inadequate that it was inconceivable that it could be successful. And of course, the fear is that if people are not presenting, that they were staying at home, which means if they’re staying at home, they’re infecting more people, that then the curve would bounce back in a much more dramatic way. And that was the fear.

NARRATOR: But the drop in numbers was real. With death all around them, Liberians were changing how they lived their lives. They stopped trying to nurse their sick and began to bury their dead safely.

BRUCE AYLWARD, M.D., Asst. Director-General, Emergencies, WHO: The entire Monrovia knew Ebola was real, Ebola kills, Ebola’s going to kill me unless I do one or two things differently.

There was a huge fear, and they changed their behaviors in ways which suddenly slowed down and took the heat out of this thing. And that’s what turned it around. Liberians turned their country around. We got in there a little bit afterward and took a lot of credit.

NARRATOR: Thousands more were still to die across West Africa, but the changing behavior of the population, and the massive international response, gradually turned the tide.

The fight against Ebola is still far from over. But health officials are already worrying about the next outbreak and how the world will respond.

Dr. BRUCE AYLWARD: Sometimes, the world has got to learn things the hard way. There are going to be more of these, no matter what we think. More and more new diseases are emerging. We’ve seen pandemic flu. We’ve seen SARS. We’ve seen Ebola like this. And we are not prepared. Ebola was not an exception, Ebola is a precedent.

NARRATOR: Officially, more than 10,000 people have died. The true figure is believed to be much higher.

JOSEPHINE SELLU, Dpty. Head Nurse, Kenema Govt. Hospital: Thirty-seven health workers died at the Kenema Government Hospital here. Thirty-seven, including doctors, nurses, porters, cleaners, security, lab technicians. Thirty-seven of them died in this hospital.

WILL POOLEY: Nurse Rebecca, Alex Smogboy, Nancy Yoko, Sister Barlou, Dr. Khan, Nurse Alice, I.P. Borry—

FINDA FALLAH: [subtitles] Tamba Musa, 10 years old, Surna Sorie, 13, Fayah Flageh, 6, Tamba Nilo, 3, Sasko, 7, Falla Marko, 4. All of them got sick. Three died. Three lived.

ETIENNE OUAMOUNO: Touko Tho, Hawa, Elene, Koumba, Serron, Nondoh, David, Emile.

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