Moving Beyond Ebola: Rebuilding Liberia’s Health Care System

A Liberian nurse prepares to go inside an Ebola patient ward to draw blood from confirmed patients for testing in Bong County last October. / Morgana Wingard, USAID

In early March, global health leaders cheered as Liberia announced it had zero cases of Ebola. After weeks with no new cases, however, the Liberian government confirmed on March 20 that a patient had tested positive for the disease.

With the ongoing possibility of future Ebola cases, now is the time to build momentum toward a stronger Liberian health system that can stop the disease in its tracks before it turns into another large-scale outbreak. That’s where frontline Liberian health care workers Dorbor Dennis and Richard Mulbah come into the picture.

Over five days in February, Richard and Dorbor were trained to become experts in the critical skills in infection prevention and control (IPC) that all Ebola-fighting health care workers need to stay safe while preventing future epidemics. The curriculum included instruction on how to correctly use personal protective equipment (PPE), such as suits, masks and gloves.

USAID is teaming up with Jhpiego, a nonprofit organization affiliated with Johns Hopkins University, to teach critical infection prevention and control procedures to Liberian health care workers. / Kelly Dale, Jhpiego

They, along with 19 colleagues, will take what they learned in Monrovia back to eight counties in Liberia to conduct their own trainings for county and district health teams. In turn, those trained will work together to conduct refresher trainings at county facilities and provide guidance and mentorship—all to make sure lessons learned are being practiced on a day-to-day basis.

Marie, a training participant, learns how to put on personal protective equipment during a practice session. / Kelly Dale, Jhpiego

Think of it as a multiplier effect to make sure as many health care workers as possible get and maintain the skills needed to keep patients, and themselves, alive. The program aims to boost the IPC skills of more than 3,200 health care workers from hundreds of Liberian health care facilities.

Dorbor knows firsthand how such skills can save a life. He cared for a dozen fellow health care workers who had been infected with Ebola — and then he looked after their patients, too.

“I only had informal training in wearing and removing PPE, and no buddy to assist me, no one to disinfect me,”  Dorbor recalled. But he knew the importance of his work and the value of keeping himself safe.

“Today I ask myself, ‘why was I not infected?’” he said. “Because I carefully followed all of the IPC procedures I knew. I only wish these procedures were institutionalized in the health care delivery system of Liberia and her neighbors.”

Richard watched four nurses, including his own brother, die from Ebola. Then, the unthinkable happened—his wife became sick, too.

Health care worker Richard Mulbah gets his graduation certificate after completing the USAID-funded training. / Chandrakant Ruparelia, Jhpiego

“Fortunately, my wife recovered,” Richard said. “But it is because of these experiences that I have taken an interest in advocating for proper IPC practices in health facilities in Liberia.”

The IPC training is part of a program funded by USAID’s Office of U.S. Foreign Disaster Assistance and led by Jhpiego—an international health nonprofit organization affiliated with Johns Hopkins University. Besides teaching correct use of PPE, the curriculum includes instruction on proper hand washing, disease screening, triage and isolation techniques and safe and dignified burial practices.

Trainees break into small groups to learn about proper infection prevention and control. / Kelly Dale, Jhpiego

A health system is only as strong as its workers. Richard and Dorbor, alongside the county and district health teams supported by Jhpiego and USAID, represent substantial momentum toward a stronger and better-prepared health system in Liberia.

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