But as Ebola fades, Hamann of IRC worries that so, too, will the good practices.
“Terms like IPC (infection prevention and control) and triage, those didn’t really exist pre-Ebola,” she says. “The fear is that now that Ebola’s over, all of that will just go out the window."
Nadimpalli of Doctors Without Borders, which has done a similar rehabilitation and training at another Monrovia hospital, says health workers in Liberia now have a “healthy fear” and are happy to follow the rules, but he notes that it can be hard even in the United States to get doctors to wash their hands.
Senkungu, the Ugandan doctor working at Redemption, says the coming high-malaria season will put the hospital to the test. The hospital typically sees about 50 percent more patients during that season—June, July, August—and in the past doctors have crammed patients two or three to a bed.
He’s worried, even though IRC will stay heavily involved this summer. What about when the organization leaves? Will doctors and nurses continue to wash their hands before examining every patient? Will the hospital be able to maintain stocks of important supplies, or continue to pay the staff who disinfect the wards—whose numbers IRC tripled? Even now, under IRC’s leadership, motivation among the health workers who are employed by Liberia’s Health Ministry (as opposed to by IRC directly) is low, and many show up late or not at all for their shifts, according to John Shakpeh, the acting head of nursing, and Saidi Makokha, who is in charge of hygiene and sanitation at the isolation unit.
It can take years for these sorts of changes to take root. Tolbert Nyenswah, Liberia’s assistant health minister, who led the country’s Ebola response, says hospitals like Redemption will need two to three years of outside support before they can operate on their own. But IRC’s current funding is set to run out at the end of the year. Such is the curse and blessing of emergency funding: It is plentiful but time-limited.
The work at Redemption will hopefully help Monrovia be better prepared, but about half of the people in Liberia live in rural areas.
And just under a third of Liberia's population lives both in a rural area and more than three miles from a health facility, says Na’im Merchant of Last Mile Health. That may not sound far, but three miles is often used as a benchmark for healthcare access because that’s how far most people can walk in an hour. And walking is the principal means of travel in much of rural Liberia, notes Merchant, a consultant who advises the charity on how to strengthen health systems.
“Not only is the national health spending low in the country overall, but the problem is compounded by the fact that as you get out into rural areas, there’s no health system really present in remote communities,” said Josh Albert, Last Mile Health's country director for Liberia. “If you think about a disease like Ebola, if it’s walking into a hospital in Monrovia, you’re already so far past the place you want to be in terms of containing it.”