A New Health Crisis in Liberia

MONROVIA, Liberia — While the terrifying spread of Ebola has captured the world’s attention, it also has produced a lesser-known crisis: the near-collapse of the already fragile health-care system here, a development that may be as dangerous — for now — as the virus for the average Liberian.

Western experts said that people here are dying of preventable or treatable conditions such as malaria, diarrhea, pneumonia and the effects of high blood pressure and diabetes, such as strokes. Where services do exist, Ebola has complicated the effort to provide them by stoking fear among health-care workers, who sometimes turn away sick people or women in labor if they can’t determine whether the patient is infected. And some people, health-care workers said, will not seek care, fearful that they will become infected with Ebola at a clinic or hospital.

“If you stub your toe now in Monrovia, you’ll have a hard time getting care, let alone having a heart attack or malaria,” said Sheldon Yett, the Liberia representative for UNICEF. “It’s a tremendous threat to children and a tremendous threat to families.”

Good data on the deterioration of non-Ebola health services is difficult to find. But representatives of several Western non-profit groups confirmed a recent small measles outbreak in Lofa County — a town about 270 miles from Monrovia, where the epidemic first hit Liberia — that probably came about because vaccinations are no longer being provided. Measles is highly contagious and can be fatal.

Liberia had made some strides in recent years in areas such as reducing its infant mortality rate. Now, according to the World Health Organization, which cited Liberian government statistics, the Ebola outbreak has caused significant declines in most public health measures.

When compared with 2013, the period of May to August 2014 saw a sharp drop in the percentage of infants delivered by a skilled birth attendant (52 percent to 38 percent); the percentage of women who received prenatal care within six weeks of confirming their pregnancies (41 percent to 25 percent) and women who receive treatment for malaria (47.8 percent to 29.4 percent), among other measures.

For a few weeks in August, the government ordered all health facilities nationwide closed because so many nurses were becoming infected with Ebola.

“If you broke a leg and you needed surgery, sorry,” said Sister Barbara Brillant, national coordinator of the Liberian Catholic Church’s health council. “If you had appendicitis and needed surgery, sorry. It’s not available.”

When Fatumata Fofana went into labor in the last days of July, she couldn’t get into JFK Hospital, the city’s main general care facility, which was closed at the time. Family members finally found a spot for her in a medical clinic, but complications developed. Her brother, Mohammed Sheriff, said he desperately sent a friend to scour the city for help, to no avail.

After two days, Fofana, 35, moved to another clinic about a half-mile from her home, where a kind of physician’s assistant was on duty. But her baby died. It wasn’t long before Fofana was dead herself.

Accounts such as Sheriff’s, verified by an administrator at the clinic where Fofana perished, are disturbingly common in Monrovia. A 40-year-old teacher who lives in the Pipeline community of nearby Paynesville said he was told at a private hospital in Monrovia in mid-August that his intense stomach pain was caused by an inflamed appendix that needed to be removed. But because of the fear of Ebola transmission, the hospital was not performing such operations, he said. He has been at home since, taking medication. He hopes to have the surgery “when Ebola is over.”

“What I’m depending on is the intervention of God,” he said Saturday. He asked that his name not be made public to avoid trouble with his medical insurance later.

Pregnant women are especially vulnerable in the new environment. While treatment of some kinds of problems can be deferred, the arrival of a child cannot. As a Washington Post photographer watched one day last week, a woman in labor arrived at the JFK Ebola treatment center in a taxi, sent by workers at the hospital’s recently reopened maternity ward because she had no evidence she was free of Ebola.

But no one came to the Ebola facility’s gate — and even if someone had, the woman’s chances of gaining entry were next to zero. With no evidence that she had Ebola, the isolation center would not bring her inside among those who have the virus.

On Wednesday, 32-year-old Comfort Fayiah gave birth to twins in the dirt outside her small, whitewashed church in the Du Port Road section of Paynesville. Because Ebola had shut so many health clinics, her options were few. She went to a private hospital, but it wanted $450 for a procedure she needed, she and her husband said.

She was assisted only by a woman known as a “church mother,” Edith Reeves, who wrapped her hands in plastic bags and delivered the first baby not far from a trash-strewn gully. Another man summoned by the pastor later pitched in as well.

The newborn girls, Faith and Mercy, lay swaddled on a thin mattress on the floor of Reeves’s bedroom at the Fresh Anointing House of Worship on Friday, as Fayiah described the frantic moments before she gave birth. She said Reeves had prayed over her and decided to try to get her to a nearby clinic. But before that could happen, the babies arrived.

“I told the mother my legs were heavy,” Fayiah said. “My legs were so heavy, I couldn’t walk.”

“I blame the hospital,” she added. “They wanted me to die.”

The doctor who runs the small private hospital acknowledged that Fayiah did not have the money for the procedure she needed, but he said she left on her own. “She came here and somebody took her away from here to go deliver” her children, he said in his small, dark office, where he was donning rubber gloves, surgical scrubs and a mask. He said Fayiah “was not in labor” when she and her husband arrived at the hospital.

Brillant, the Catholic Church’s representative, said she has managed to keep some of her health network open. Catholic Hospital, the city’s largest private hospital, is still closed, the result of 11 nurses contracting Ebola. But six of her system’s eight clinics are open, and two are delivering babies.

“We cannot let Ebola run our lives,” she said. “People have malaria, they need to get their medicine. People have HIV, they need to get their medicine.”

For Fofana and her family — including her four other children — any progress comes too late. For three days, she was racked by pain, her brother said, but no one could help.

“In those three days, she was crying, ‘Help me, help me,’ ” he recalled.

“We blame the government,” he added later. “All the hospitals [were] closed. Nowhere to go. If all the hospitals are closed, where can we go?”

Michel du Cille and Samwar Fallah contributed to this report.