Ebola workers do AMA on reddit

The best of yesterday’s @reddit_AMA:

I’d like to hear more about what life is like in your communities right now on a day to day basis. How easy/hard it is for families to get information on the status of a loved one or friend who is sick?

[–]morethanme1Emily Bell – More Than Me 4 points 22 hours ago

It’s hard. The Ebola Treatment Units are overwhelmed. Many families don’t have ways to communicate with each other besides face-to-face contact so often, a family member will be taken to a clinic and then the family doesn’t find out their fate unless they go with them, which can be very dangerous. People are dying of Ebola and their bodies are being burned. There are no ceremonies, and their names may or may not have been recorded before they died. It’s incredibly heartbreaking.

[–]imanihouseincBisi Ideraabdullah – Imani House

Life on the ground in Liberia continues almost as normal. People can at one point be in denial, full of fear, while rumors of miracle cures are rampant and the next moment with a group over a beer relaxing. It is very complicated. Communities have taken it upon themselves to monitor any household where there is a suspected Ebola victim. There are not enough treatment beds, or testing facilities therefore many remain at home until it is too late and thus infect the entire family.

[–]developafricaSylvester Renner – Develop Africa

Life is full of fear, uncertainty and feeling of powerlessness. Quote – “The people in the community are in a state of extreme fear as people very close to them are losing their lives to Ebola… The aftermath of this epidemic would be massive. Bread winners have been cut off from families. Children and dependent relatives are afraid of the future.” Quote from – Information about the status of a loved one is often limited.

[–]marcmaxsonMarc Maxson – GlobalGiving 22 hours ago

There’ are very few first-hand accounts of living during the outbreak on the web. I curate and repost any I find nightly at The best and most complete journal to date is here: and I’ve started an Ebola Listening Brigade as a Facebook Group to help organize more reports getting out here:

Do you support a quarantine on any of the three nations? If the situation continues to deteriorate, will you? Is there an alternate ‘grand plan’ at this point for fighting the outbreak?

[–]marcmaxsonMarc Maxson – GlobalGiving 20 hours ago

I haven’t heard of a complete strategy. Some things that got results were the 3-day home arrest (close the economy) in Sierra Leone, and the idea of home-isolation to keep the disease from spreading faster. But none of these strategies have stopped the spread entirely.

I think the focus is less on tracing to a source and more on changing behavior to limit exposure to anyone else on a daily basis. But I’m not there in the meetings, so I can’t say any more.

We can’t give pills, but there is no pill to give, no cure for Ebola. What we can do is put a human face on a crisis and facilitate the flow of money and ideas, and allow the people there to speak for themselves.

Yesterday there were 100+ #ebola tagged blogs on wordpress. I did not encounter a single one written by a West African. Other days are better, but that is not how you treat an outbreak. Not only is there a power balance problem, but health experts NEED LOCAL knowledge in order to change local behavior and stop the spread. The idea of a “Quarantine” is going to evolve for this context, or it won’t work.

[–]Internews_MatCarolynCarolyn Yi and Mat Jacob – Internews 2 points 18 hours ago

You bring up a good point about infrastructure, which hasn’t been able to keep up with the number of new cases that are emerging. What we do know is that there are ongoing efforts to build new treatment centers in Liberia, and in the meantime USAID has said they are using a three tiered response: treatment centers for confirmed cases, holding centers for those who might be infected, and home care for those unable to access other levels of care (for which kits are supposed to be distributed)

How lethal is ebola compared to SARS, H1N1, etc? Is the media doing a fair job?

[–]marcmaxsonMarc Maxson – GlobalGiving 21 hours ago

Lethality: 82% (though at any given time you might hear reports of “5000 infected and 2500 died” because of the 2-week-lag-time between infection and death.

Transmission: R0 of 2. Meaning each patient infects TWO others. It needs to be less than 1 for the outbreak to be “contained.” This is why when the media scares the public by saying 100 in Texas are being monitored, it doesn’t mean 100 or even 50 people are likely to get infected. The likeliest number is 2.

Compared to other outbreaks? I don’t know. It happened to be more fatal and hit a place with much weaker infrastructure than SARS and H1N1 did, so the effects were drammatic. Also – highly corrupt countries are at greatest risk (Liberia and Sierra Leone are more corrupt than neighboring countries like Guinea and Ghana). People with power and privilege don’t obey laws, including quarantines, and therefore spread the disease as they try to flee and save themselves at the expense of others. This has been the heart of why the disease was spreading in West Africa the way it did.

Media coverage: USA media has really jumped on the Texas case in last 24 hours in a sinister way. Watch last night’s daily show as they show a clip of CDC saying “nothing to worry about” over the news media’s omenous music. It’s obvious that their agenda differs from the public health perspective.

[–]wilechile 13 hours ago

[–]enfermerista 3 points 17 hours ago

I think the fact is that the locals are being lied to in terms of individual risk so as to protect public health. For an individual who is feeling ill, it might be that they have something minor, and by seeking medical attention they increase their odds of actually being exposed to Ebola. They may be put into quarantine for a month with a bunch of other sick people and while the staff can protect themselves, the patients are not isolated from each other.

On a public health level, identifying potential cases and taking them out of the community is overwhelmingly what needs to happen.

Very few people want to sacrifice themselves for the greater good.

Were you all established outreach programs before the outbreak and changed your focus because of it? And as the outbreak spreads, are there more community organizations out there, to continue to help or will you all travel with the movement of Ebloa in Africa?

[–]pcreigh 4 points 20 hours ago

I’ll let the nonprofit reps speak for themselves regarding how much they have needed to pivot their work, but there are two articles below about how they have adapted to the situation –

Imani house was not a clinic equipped for Ebola but is quickly creating a quarantine Ebola clinic (

More Than Me works to educate girls in West Point and is now housing kids who are orphaned and abandoned due to the outbreak (

Would you have any advice for those who would like to work in the field of humanitarian relief in the future? … I am studying biomedical engineering and I have been watching The Strain, so I find all this very interesting.

[–]marcmaxsonMarc Maxson – GlobalGiving 22 hours ago

Liberia and Sierra Leone are large outbreaks that have not been contained yet – study them. Fund efforts to help. Ask what kinds of behavior change methods work in that context. An outbreak in USA is a very remote hypothetical possibility right now, and more of a distraction from the tens of thousands of people in West Africa that need our immediate attention.

[–]marcmaxsonMarc Maxson – GlobalGiving 20 hours ago

Don’t major in “international development” in college, or anything like that. Get hard skills. I got a PhD in Neuroscience and would’ve done the same had I done it over. Learn to code. Study the future, and psychology. Avoid theories and people who talk a bunch but don’t speak a foreign language – they’re probably only listening to other people like them.

[–]twentyhounds 2 points 15 hours ago

I am an epidemiologist with a background in biology and secondary training in biostatistics and epidemiology. I have peers that come from engineering backgrounds (biomedical and even mechanical). In some cases, they have received secondary/graduate training in biostats and epi, but not all. There are many jobs in disease modeling, health care infrastructure supply chain management, and health systems modeling, which you may find interesting. If you want a job out of college, I would suggest you look into learning some coding platform, as this would be a tangible, sought after skill. I use SAS, but some people prefer SPSS or R. Look into taking some courses in biostatistics, if you have not already. If you are really passionate, you could look at graduate training, like an MPH degree, although I suggest trying to get a few years work experience as a coder first. Depending on where your undergraduate education is, you may even be able to take a course at a school of public health.

[–]tlozada 2 points 15 hours ago

Wow I had no idea you could combine those two areas of expertise. This sounds straight up my alley! Thank you for all the information, I really appreciate it. 🙂

[–]twentyhounds 1 point 10 hours ago

I’m glad to answer any questions if you PM me. I actually think an engineering background is a great approach to some of the problems we try to solve. My engineer friends are able to do innovative modeling that I don’t always understand, but I’m glad someone is doing.

[–]developafricaSylvester Renner – Develop Africa 20 hours ago

Excellent question: Travel widely and immerse yourself in other cultures. Learn another language. Explore eating food at different cultural restaurants. Go on short-term volunteer trips. Learn to be flexible. Develop an appreciation for the good in other cultures. Celebrate cultural diversity. Be open to learn from and befriend people who are different from you. My quick 2 cents.

[–]nickhamlin 4 points 19 hours ago

I work at GlobalGiving as well, and my background is in mechanical engineering (i.e. not nonprofit work). That said, I use lots of the math/programming/stats skills I got out of engineering everyday at GG (I’m a Business Intelligence Analyst). /u/marcmaxson has a similar story.

For those looking to get a start in nonprofit work, Idealist is an excellent resource for finding jobs, internships, networking etc. LinkedIn Groups are also rich sources of more specific information, if, for example, you’re particularly excited about Public Health.

[–]nickhamlin 2 points 18 hours ago

Nonprofits have a huge range of needs, so if you’re interested in getting some experience but aren’t in a position to make the leap full-time, part-time volunteering can be a great way to go while you’re working a day job. I was in exactly the same situation and did the same thing at my last job before coming to GlobalGiving. Organizations post opportunities for this sort of work all the time on Idealist, Craigslist, etc. There are also options at GlobalGivingTime

Also, if you’ve been in the private sector and are considering a switch to non-profit work, ProInspire is a fantastic resource.

I’m in the army and on my way there within the coming weeks to provide helicopter support for USAID. Anything beyond the obvious I should know before I get there? I’m somewhat excited about going as this will be my first humanitarian type mission in the 12 years I’ve been in the army. I look forward to working with you guys.

[–]acarro84 18 hours ago

[–]marcmaxsonMarc Maxson – GlobalGiving 18 hours ago

Good for you! Follow basic precautions as you would for any new place. You’re more likely to get a GI infection from the water than any serious disease, so just wash hands, keep clean, and wear protection when working in places where ebola patients are likely to be found.

[–]developafricaSylvester Renner – Develop Africa 3 points 17 hours ago

Avoid shaking hands and hugging. Use your hand sanitizer frequently. You understand protocol very well. Follow it rigidly.

[–]coniform 9 points 22 hours ago

How much bleach needs to be added to the water to make a good sanitizer?

First,I am hearing that the virus mutates…and has up to 50 times already. Has this impacted the efforts to stop it in West Africa, or are the procedures the same? … Thirdly, if an aide worker contracts and gets through a bout of Ebola, is he/she then immune? And finally are we anywhere close to a vaccine?

[–]marcmaxsonMarc Maxson – GlobalGiving 23 hours ago

All viruses mutate 1000 times faster than bacteria because they have no machinery to regulate mutations like bacteria and people. Most mutations have no effect or make the virus even weaker. It takes a combination of dozens of coincident mutations to make a virus more powerful, on the order of tens of thousands of them, so the 343 recorded mutations in Ebola since 2013 is not unusual or particularly alarming. Flu viruses are different every year too. When a scientist says ‘it mutated’ that doesn’t mean the function of the proteins that make the virus work have changed, just that the DNA sequence has changed.

Resistance: If someone has Ebola, their blood has antibodies, giving them resistance. And this is one way that experimenters have treated Ebola – through blood transfusions.

Vaccine: ZMAPP is a first round experimental vaccine that worked on all 18 monkeys tested, and two humans, but clinical trials use thousands of people, so months to years away.

So, maybe this is stupid, but I am an American in the midwest with a severe anxiety disorder and I have been sent into a complete spiral of fear.

[–]RandomWomanNo2 19 points 22 hours ago

The comments on Reddit have ranged from “I’m an expert, everybody calm down” to “I’m an expert, and nobody is taking this seriously enough.” Rumors are flying all over the place and a lot of them are terrifying. How scared should I really be? Because right now all I can do is cry and hide in my house.

[–]marcmaxsonMarc Maxson – GlobalGiving 22 hours ago

If you live in America, calm down.

It should comfort you that we can take the temperature of people in airports. People without a fever are not contagious.

It should also lower your anxiety that there is one doctor for every 400 people in America compared to one for every 20,000 in Liberia. We can AND WILL contain this one case in Texas. Their healthcare system is overwhelmed right now. No hospital beds have been free for weeks. If you were in Liberia, you have good reason to be anxious.

Also note that our best modeling of ebola spreading estimates that the one case in Texas will only result in two other people being infected. The 80-100 people being quarantined are just to be sure nobody else has any remote possibility of being affected.

[–]developafricaSylvester Renner – Develop Africa 3 points 21 hours ago

Yes – temperature screening is taking place at airports – both arrivals and departures

We do not believe that this crisis will spiral out of control. Experts have stated that in the United States, we have the infrastructure and capacity in place to ensure this virus does not become an epidemic: . At the same time, we do believe that it is critical for people to understand the disease, how to avoid it, how it can be contracted and what to do if someone is infected. We believe that information is the best weapon against this disease. The better we can spread this vital information, the better chances we have at beating this serious issue.

Are you facing resistance from these communities, even though you’re offering help and resources?

[–]developafricaSylvester Renner – Develop Africa 9 points 23 hours ago

On a community level – we have found out that due to misconceptions, myths, cultural and traditional beliefs, some communities strongly deny the existence of the disease and resist any efforts of response. However, continuous sensitization and dialogue with community leaders and evidence of death of close relatives from the disease are helping some people to change their negative perceptions and cooperate in the response interventions.

No resistance experienced so far. We work alongside them in partnership – letting them know we are supporting their efforts. This helps to secure “buy in” and on-going good cooperation. We do extensive local research and ask what they specifically need help with. Being responsive to their specific needs helps a lot.

[–]GG_AlisonAlison Carlman – GlobalGiving 5 points 23 hours ago

I think that speaks volumes about the fact that you are so well-rooted in your local communities already. It’s so important that we support folks like you that were already present before the outbreak. (And will be present helping with recovery long after the epidemic has subsided!)

[–]morethanme1Emily Bell – More Than Me 9 points 23 hours ago

Great question. We have experienced some resistance from the powers “in charge” as you say, but are working as best we can with the procedures in place. A small organization like ours is able to act more quickly than a government agency with bureaucracy and red tape, and that’s where we experience resistance. Misinformation can come into play here as well and we work hard to ensure that all partners understand what we are and aren’t doing on the ground and how we can work together. We also recognize where we need to wait for permission before taking action.

[–]imanihouseincBisi Ideraabdullah – Imani House 3 points 23 hours ago

Thanks, As to the Ministry of Health, we are doing our best through our clinic, to be supportive of their objectives.
We are close to our community and are providing inclusive community outreach and awareness. Imani House honors their opinions, concerns and misconceptions that have been spread throughout Liberia.

Read the rest on Reddit:

IamA First Responder to the Ebola Virus outbreak in Liberia

Compiled from reddit’s IAmA live question and answer channel, hosted by Sean Casey on Sep 19, 2014:

Source: First responder transcriptMore than Me’s Katie Meyler transcript

Monrovia is generally like this: the food is spicy, the people are warm, the colors are bright. It has a complex history. The infrastructure was completely destroyed in a 14-year civil war and now they’re trying to rebuild.

Q: Is the situation out there as bad as the media portrays it to be?

Situation is indeed vey bad, several studies show that the number of cases double each 2 to 3 weeks. If you remember the story of the chess board and the grains of rice, we have already a lot of cases in the current square, next square will be 2 times bigger. This can arrive with some possibility everywhere but the question is can it be fastly managed. A successful containment stops the problem at square one.

It is exponentiation growth

An exponential fit to the number of cases from mid-July through to mid-September suggests that their number now doubles every 24.3 days (as opposed to every 29 days previously).

Exponential Growth’ in the Ebola Outbreak: What does it mean?

The effective reproduction number, Rt, of Ebola virus disease was estimated using country-specific data reported from Guinea, Liberia and Sierra Leone to the World Health Organization from March to August, 2014. Rt for the three countries lies consistently above 1.0 since June 2014. Country-specific Rt for Liberia and Sierra Leone have lied between 1.0 and 2.0.

If reproduction number is below 1 then it will die out by it self. If it is above 1 then it will spread.

Q: recent murder of several relief workers will lead to aid agencies withdrawing from impacted areas

I don’t think that this will stop agencies from responding, but it will definitely impact how and where they work. Staff safety is paramount for all of us, and we need to know that we can do our work without threat of violence. The violence in Guinea is worrisome, and hopefully the authorities there will do what they can to prevent this from happening going forward.

Q: What do you feel is the source of distrust that Ebola is real/dangerous? I’m specifically thinking of the clinic that was attacked and looted.

That feeling of distrust that Ebola is real isn’t as prominent as before because there are so many people getting sick and dying now. The clinic that was attacked and looted in West Point was a politcal issue. It had a lot to do with the fact that there was no communication between higher ups and the local people. There’s a saying that “nothing good ever comes from West Point” so there’s a feeling in West Point that everyone hates them and when they saw Ebola patients from outside of West Point coming in, they thought that they were trying to bring Ebola into their community because they didn’t believe that Ebola was in West Point at that time

The virus already feels uncontrollable, but I think with the help coming that it will change things, but it needs to get here fast enough.

Q: What is the reaction from the community?


We know of one woman named Finda whose whole family died but she survived Ebola. Yes, there’s definitely a stigma for survivors. More Than Me wanted to hire Finda for the awareness team but she didn’t feel comfortable being in West Point anymore because of the stigma.

I don’t see anyone working to change this right now. There are dead bodies and sick bodies everywhere. Right now, people and workers are afraid. The main services happening at the moment are that sick people are being brought to holding centers and dead bodies are being picked up to be cremated. All the ETUs and the one holding center are full right now. (ETU = Ebola Treatment Center)

The West Point Commissioner asks US what to do. The community of West Point is pleasantly shocked to see an international person return and me being here gives us extreme credibility. It makes the community feel they’re not alone, that we actually care, that there’s hope. We aren’t just here when the sun is shining, but here through the storms as well.

The community is helping themselves and I’m supporting them. They want rain boots? I get them rain boots. Their t-shirts aren’t working? We get them new ones. That’s what we’re able to do. On top of that, we can help coordinate the awareness workers’ messages, coordinate meetings with partners on the ground, etc.

In West Point, the awareness team is telling families to wash their hands every 15 min if possible, don’t touch bodily fluids of sick people, isolate any sick people you have in the house, and designate one caretaker for the sick. And make sure the caretaker is hydrated and the sick person but the caretaker must use plastic bags to protect themselves from touching them.

We are bringing home nurses to these families with food, and an ebola kit that has everything a family would need to care for a sick person: new bed sheets, vitamin b, rice, bleach bucket, clorox, oral rehydration solution, etc.

The only hospital I’ve been in, that isn’t an ebola place, is Star of the Sea Clinic in West Point. The doctors see Ebola patients coming in nonstop and they have nowhere to send them so it’s definitely getting more risky for the staff there.

Avoiding infection

I’m not touching people, washing my hands constantly, washing my clothes in chlorox. But the main thing I can do is not touch anyone.

West Point and Capital Hill – the two neighborhoods where we’re working – treat us like family. I don’t feel at risk at all being there. The community protects us. I feel like the bond between me and these communities of Liberia is magical right now.

(This next question shows trust isn’t just a problem in Liberia, but everywhere. Someone didn’t believe this was the person she claimed to be.)

Q: For proof, could you please mention this AMA on the MoreThanMe website or tweet about it from @MoreThanMeORG

We’ve tweeted the link and posted on our facebook page:

Q: What will be most effective?

Definitely donations. All humanitarian responses require funding, and this one is particularly expensive, given the scale and all the inputs required.

We especially want to raise funding to support training and equipment for Liberian first responders. This is something we integrate into all of our work, but it’s particularly important here, as this response requires enormous human resources. Around 90% of our staff here are Liberians, and our first priority is to support them to work safely and effectively.

Biggest needs are qualified staff, nurses that know how to control infection. Secondly, put pressure on your governments to help. Donations in kind are tricky because the need to respond to specifications. Money for buying those items is better.

We need all kinds of things, but many of them are quite specialized – like doctors and nurses, and specific models of personal protective equipment. The most useful input that the average person with some interest in helping can provide is money to support the operations. Ebola response is very expensive – operating one 70-bed treatment unit can cost up to $1 million/month!

Q: Where to find local accounts?

I don’t know any local Liberians sharing their stories anywhere. Carielle Zoe is a Liberian journalist who’s sharing on her social media, and I’m sharing stories constantly on instagram. (@katiemeyler)

Just today, this morning i prayed and sat with a 15-year old sick boy and he died this afternoon. I went to the courthouse in the afternoon and the people handcuffed were vomiting everywhere and asking me to take them to the hospital.

The burial team, Dr Fallah (mentioned in NYT) and hospital workers, journalists, awareness workers and me are all in the midst of this outbreak, but I’m not sure that any one of them besides journalists are sharing their personal stories.

This is hitting uneducated people who don’t know how to use social media. And for health workers, they are so overwhelmed with the situation that there’s no time to share stories.

Q: I’m worried about some American doctors in Monrovia at Cooper Hospital. I’ve heard rumors that all the other medical facilities closed except EWLA Hospital or possible JFK government hospital. Can you speak to the risks they are facing or give some local knowledge about their neighborhood, etc? I’m realizing I know very little about Morovia (though a reasonable amount about Ebola).

If anyone is interested in reading about their experience, one of the surgeons keeps a diary here.–james-appels-personal-log-of-daily-events/

Q: How does it affect you?

It’s hard to see, for sure. I went to pick up a 12-year-old patient on Monday and spoke to him briefly before he boarded the ambulance. An hour later he was dead and the next day I saw his body being carried away for burial.

Q: What is UN/WHO doing?

WHO has staff supporting several ETUs. There are currently six open in Liberia: – Fyoa (MSF) – ELWA III (MSF) – ELWA II (Ministry of Health) – JFK (Ministry of Health with WHO) – Island Clinic (Ministry of Health with WHO) – Bong (IMC)

There is a body in WHO called the GOARN, Global Alert and Response Network. They publish regularly on alerts or updates.

Q: Sean what does your ‘average’ day look like?

Hectic! It usually starts at around 6am and ends at around midnight. In Monrovia, lots of coordination meetings. In Bong, troubleshooting at the ETU, coordinating with government representatives, and sometimes chatting with patients. No two days are ever the same – it’s one of the things I love about my job.

We have a psychosocial team that provides support to our staff and their families.

We provide IV fluids, oral rehydration solution, pain medication, presumptive malaria treatment and symptomatic care.

I think there are lots of untold stories about the very brave health workers here. They’re the real first responders, and they’re continuing to work despite the fear and risk. One of our nurses saw six of her colleagues die from Ebola, but she’s continuing to fight the disease by working with International Medical Corps at the Bong ETU.

We’re seeing quite a few families present together. It’s normal for relatives to care for each other when they’re sick, so this is a common vector for transmission.

Q: Some people there think it is a hoax.

Sadly very true. Ebola is not an hoax. The consequences of negating it are yesterday’s news about killings in Guinea.

Q: On the likely number of cases:

Q: Why don’t they close the airports and put military at all exits of the cities infected? It boggles my mind they haven’t done this yet.

Closing an airport increases risk in bordering countries as people that want to travel, will, but not via official land crossings to the information can not be collected, the temperature can not be taken.

MoreThanMe – latest ebola project report via GlobalGiving

In this together – By Emily Bell – Project Leader

School Nurse Iris handing out care packages

School Nurse Iris handing out care packages

Dear MTM Family,

Thank you for your continued support. Our report this month is going to be a little bit different. As your probably know, there is an Ebola outbreak in West Africa affecting Liberia, Sierra Leone, and Guinea. On July 30th, President Sirleaf recommended that schools close to avoid large gatherings. We decided we needed to close the MTM Academy for the safety of our girls, staff, and community.

On July 31st, the girls and their families came to the school. We gave students care packages that included workbook pages to keep them busy and learning, medicine for fever and bacterial illnesses, Ebola awareness posters, health care referral forms, oral rehydration solutions, chlorine, soap, and rice. All students, parents, and staff also attended an awareness class led by doctors and staff from UNICEF, the IRC, and Ministry of Health. While the school is closed, all expat staff members are being relocated to the US.

To date, we’ve had no reported cases of Ebola related illness in students or staff.

On Friday August 22nd, our founder Katie Meyler arrived in Liberia to help the West Point community, where the majority of our girls live. She has been meeting with community leaders, government officials, health officials, and police to coordinate a faster response to Ebola in West Point. You can follow her journey at

Thank you for your continued support. We hope to reopen school as soon as it’s safe for our girls. Until then, we will keep fighting for a better, faster, more organized response to the outbreak, both in West Point and across Liberia. Please direct any questions, comments, or words of support to

In this together,

Emily & the MTM Team

Katie in West Point checking on students