I was in Liberia for a week covering the outbreak for a couple wire services. My photos have been everywhere from The Guardian, who used one of my photos on the front page of their print newspaper, to Chinese newspapers, to the New York Post. I've been answering questions in /r/ebola and was begged to do an AMA. Here's some of my work:

Outside an Ebola hospital, guy pulls a mattress with vomit on it from INSIDE THE HOSPITAL through a busy street where people are walking around and cooking food.

Princess reacts as her deceased mother, an Ebola victim, is taken out of her house for cremation.

25-year-old Moses Massaquoi today. He's a hygenist at the biggest Ebola Treatment Center in Monrovia. He can spend up to two hours in full PPE, while most people can only do 30-40 minutes at a time. This photo of him was taken after what he described as a very very long shift.

Alphonso, a 20-year-old hygienist who had to convince his grandmother to let him work at the Ebola Treatment Unit (ETU). "I said if my fellow Liberians are getting sick, and I have the experience to help, if I don't go to help, it will be death for everybody."

Here's what I did by day-

Day one: Logistics day

Day two: Photographed a massive under-construction USAID Ebola treatment center

Day three: Headed out with the Red Cross' body collection team

Day four: Interviewed a local casket maker

Day five: Went to more rural parts of Montserrado county to get an idea how what's going on there

Day six: Visited an orphanage that takes in orphans who have parents that died from Ebola

Day seven: Logistics and flight home.

Proof: https://twitter.com/MJDiPaola/status/524634990295150592

Comments: 458 • Responses: 103  • Date: 

PCCP82112 karma

Two Thirds of the American public favor a ban of travel from Liberia, Guinea, and Sierra Leone. One of the main points of contention in the public debate on this topic is how such a ban would impact those who are volunteering there.

Can you provide a first hand account of what the impacts might be?

mdipaola251 karma

It's absolutely idiotic. My flight was filled with people wearing MSF, More Than Me, Red Cross, and IRC shirts. They have the option of taking military transports and UN flights but they don't because of how difficult it is to plan ahead for them. They get cancelled ALL the time, they get delayed for weeks, and they aren't at regular intervals (e.g. you get three flights per month, but they're all in one week). It's just not feasible to rely on military or UN flights.

With that being said, the American government can't ban flights because... well... there are no direct flights from the U.S. to Liberia/SL/Guinea.

round2ftw46 karma

More people on Reddit need to read this.

mdipaola33 karma

Yeah no kidding. I just got a question from someone who just doesn't get it.

J_Chargelot16 karma

Couldn't the US just deny entrance to anyone who has been to those countries and circumvent that problem?

mdipaola85 karma

Nope. U.S. citizens have right of return.

thehatetrain14 karma

If they did plan on banning flights from those countries, they would be capable of simply banning people who have visited / been in those countries in the last 30 days?

mdipaola54 karma

Not if they were a U.S. citizen, we have right of return.

krussell212373 karma

In the comments to one of your posts you said there were things you couldn't write about until you were safely out of the country. What are they?

mdipaola170 karma

There's serious problems with the Liberian government's release of official numbers. We know for a fact the following things:

1) the tests to confirm an Ebola case takes less than a day to do

2) they've been lagging 5-7 days behind their official reports

BUT... I got stuck at a godawful press conference while waiting for my credentials to get processed.. and I was only half-paying attention until the country's Chief Medical Officer got up and spoke about her close call with Ebola when her driver got it.

While she was up, she let it slip that she gets the lab reports at the end of the day every day.

This contradicts what they've been telling reporters, the public, and the WHO which is that it's taking 7 days to get the lab results out.

Someone here is lying, and I don't think it's the WHO, I think it's the Liberian government.

Chordata132 karma

Do you know why they would lie? I don't understand what they get out of that.

mdipaola114 karma

ALL construction is shut down. The Chinese, Lebanese, and Indians are all leaving and taking their money and construction jobs with them. I'm sure the government wants that money and construction and development back. Ebola has MASSIVELY screwed with the Liberian economy.

evidenceorGTFO21 karma

Which makes the timing and wording of Sirleaf's latest letter even more understandable.

mdipaola35 karma

I've been traveling for like the past 72 hours, link?

ckcoke22 karma

Isn't it possible that it's just a huge backlog. so while she gets the reports everyday the samples might have been waiting to be processed for a couple of days .... Also if you have more than one lab and they have different backlogs you have to correlate the data to get a by day analysis and not some random test results.
I do think that reporting is a huge issue but this might just be ineptitude and not malice.

mdipaola29 karma

She specifically said during the presser that she got the results from the lab tests that were done in the morning at the end of the day. Could be ineptitude, but the main lab that's there in Gbarnga is run by the U.S. Department of Defense.

koreancoffee24 karma

I think what ckcoke is saying is that the lab tests done that morning might not be from patient samples taken that morning -- they might be samples that are days or weeks old. There could be bottlenecks anywhere in the process, from collecting samples, to sending them, to testing them, to analyzing them. I'm not saying that they're not lying about their numbers, but I would actually be surprised if they don't have a bottleneck in the sample collection and processing. This is a pretty interesting post about the topic:

http://www.caitlinrivers.com/blog/hackebola-the-limits-of-laboratories

Additionally, because the driver was a potential threat to the CMO, they might have specifically moved that individual's sample processing to the front of the queue.

mdipaola10 karma

Yeah, I'm with you, but I'm not a supply chain analyst, I can only talk about what I heard and saw myself.

Ftumsh44 karma

Hey, I've been following your posts for a few weeks now and I wanted to thank you for publicising the human scale of the tragedy including the good news stories, not just distant pictures of people in hazmat suits.

My questions: how scared are you when you get on that plane? What personal protection are you taking? Have you made contingency plans?

Finally are you in touch with Moses? How is he doing?

mdipaola60 karma

how scared are you when you get on that plane?

I wasn't really scared the whole time, I had spent a LOT of time on the phone with locals before I went... but when I landed my nerves started going. I didn't touch my face for almost three days. Then I relaxed a little bit because I wasn't shaking hands or even bumping into other people. I feel fine now BTW.

What personal protection are you taking?

I brought a TON of top-of-the-line PPE, the same stuff the burial team uses, but never actually got the chance to wear it: the rule is, if you're close enough to need PPE, you're too close.

Have you made contingency plans?

Yup. Got travel insurance and a procedure sheet for my dad to follow if I get sick. I even had a contingency plan for if I got stopped at the border at JFK Airport on my way home.

Finally are you in touch with Moses? How is he doing?

I am not but my fixer is in the process of getting his contact information so I can check to see how he's doing. He's one of the guys that really made a big impact on how I saw the country. Him and Alphonso are the two people I will remember for the rest of my life.

usrname7 karma

If you were stopped at JFK, what is your contingency plan?

mdipaola20 karma

My friend at CNN would alert my dad, who would then get on the phone with my contacts in Congress (I used to work local news and did an internship in the NJ Senate) and we'd take it from there. The plan obviously didn't need to go into place but I had a whole list of contacts that needed to be called.

Westbay2240 karma

This might seem like an odd question given the current tragic circumstances, but do you think there is any truth in the idea that the outbreak (once over) could leave behind a legacy of improved healthcare and better trained healthcare workers and civil servants in the region? Or do you think that the foreign support currently on the ground is likely to leave few long term benefits once they depart?

mdipaola52 karma

That's a really good question: I don't know. On one hand, there are laypeople getting great medical training from foreigners and fellow Liberians, on the other hand, all the universities are closed so licensing has to be stopped. My fixer had enough credits and could have graduated with his degree in the spring but the schools were shut down before classes finished.

Maybe it'll inspire a generation to go to school once this thing is over? One can only hope.

Westbay226 karma

Thanks for your response, and to echo others here, sincerely thank you for what you are doing to help others understand what is going on.

This is something I'd be really interested in you following up the next time you're in Liberia, if possible. Is there any sort of exit strategy for the aid agencies, other than packing up and leaving once the urgent need for their work subsides? Is any thought at all being given to a strategic legacy, leveraging the resources currently being deployed also into the longer term welfare of these areas?

mdipaola7 karma

I've already started prepping for the next trip, adding that to my prep notes. If I can figure out the damn kickstarter interface I'll put it there too.

kennyg1333 karma

My biggest question - in the last couple of days there were conflicting reports from the ground in Liberia. Several sources claim that MSF centers are sitting with empty beds, and that situation is improving. Others say that it's getting worse. What's your feel?

mdipaola61 karma

Several sources claim that MSF centers are sitting with empty beds, and that situation is improving.

I was at the MSF center in Monrovia (ELWA-3) and I saw people not only lined up outside, but also sitting in the inner low-risk courtyard and not in actual beds. The impression I got was that they were full.

With that being said, MSF is amazing and has the best and safest treatment center in the country.

I actually talked to and did a portrait of a local Liberian who happened to be a Physician's Assistant that worked at MSF, and he had worked at every single ETU in the country at one point or another because he started working in April, and had bounced around from every single one (Island Clinic, the ETU in Bomi, the ETU in Gbarnga, and Redemption Hospital) and he said MSF was the safest and best one.

Redemption Hospital is where I shot that photo of the guy with the mattress. That place... I don't know about that place. Made me VERY nervous.

thePOLISHbear26 karma

First of all, I would just like to say that I have the utmost respect for you putting yourself out there to bring coverage of the outbreak.

During your time covering this outbreak, what were the various stages of the virus that you saw? Also, did you see any sort of psychological effects on the patients through these stages?

mdipaola49 karma

During your time covering this outbreak, what were the various stages of the virus that you saw?

I saw every stage, including the dead stage. It wasn't fun. I expected a lot worse though, not everyone had the signature red eyes of Ebola, and not everyone was actively vomiting blood, some just had regular vomit.

Also, did you see any sort of psychological effects on the patients through these stages?

I wasn't allowed to get close enough to talk to patients unfortunately.

thePOLISHbear13 karma

Thank you for your answer, and on a completely unrelated note:

What was the process for coming back like for you? Have the procedures changed at all over time during the outbreak or do they remain relatively the same?

Eternally6525 karma

[deleted]

mdipaola87 karma

Yup. I'm doing it voluntarily, just to be safe, even though the chances of me spreading it without knowing I have it is REALLY low. I'm taking my temperature every couple of min. I just took it now. It's 98.4.

PCCP8223 karma

Are people optimistic that Ebola will be defeated?

mdipaola69 karma

Optimistic is... not the right word. They're expecting it to be defeated. You gotta realize how much public knowledge there is about the outbreak here. NO ONE is shaking hands. NO ONE is touching each other. All the radio stations play Ebola songs. The two most popular ones you can check out here:

http://www.theatlantic.com/international/archive/2014/08/how-to-make-a-hit-ebola-song/378980/

PCCP8222 karma

Day five: Went to more rural parts of Montserrado county to get an idea how what's going on there

Can You elaborate for reddit? Information on the ground is very difficult to come by.

mdipaola30 karma

I went to two rural healthcare clinics where they had to make their own PPE out of a tarp... the day I visited (unannounced, mind you) was the day one of their real PPE suits arrived.

These clinics aren't allowed to treat Ebola patients, they have to call 4422 or whatever the number is to report them and have an ambulance come. They primarily treat malaria and pregnancies. Malaria is HUGE over there.

One clinic, the one with the homemade PPE hadn't seen an Ebola patient since they reopened (a couple weeks now) and the second clinic, a larger one, had two patients that they thought had Ebola and called the ambulance to get.

Xedma21 karma

What do ebola survivors do after they are out of treatment? Do any of them help now that they are immune?

mdipaola59 karma

Step one: shower out and get new clothes. There's a special shower that leads from the "hot" wards to the safe zone. Their clothing is thrown away after they first come in so they're given all new outfits.

Step two: they're given a certificate to prove they're Ebola free to their family and neighbors.

Step three: a mental health counselor talks to them about any emotional issues they're facing.

Step four: if they're at MSF, they're given the opportunity to put their handprint on a wall of survivors.

Step five: if they're at MSF they are given a ride home. A counselor goes with them to explain to the family and the community that the patient is Ebola free.

When I met Christopher he was very tired but very happy. I got permission to take his photo. Since the mortality rates are 70-90% I felt... kinda weird. Like I was looking into the eyes of a member of the future history books. It was very humbling.

Xedma29 karma

Has anyone taken advantage of their immunity to help in hot zones?

mdipaola50 karma

YES. I actually did a couple of portraits of survivors who now work at MSF. They're badass and get a lot of respect from their foreign and local colleagues.

evidenceorGTFO19 karma

Men are supplied with a lot of condoms and told to use them for at least three months because Ebola persists in sperm for quite a while.

mdipaola27 karma

YES. That too. Although Christopher's wife was also in an ETU when he was discharged so he didn't get any. Chills down my spine when I found out.

Chordata120 karma

There has been some reports workers, especially the body collection teams, are not being paid what they were promised. Did you hear about any of this while you were with some of the workers?

Also, thank you for responding so much to us and turning many of your posts into a AMA.

mdipaola50 karma

All the workers I was with for the Red Cross got paid and were happy with their jobs. My mind was blown how incredible they were: very very very brave people. Their apprenticeship program is pretty impressive too. First you help out around the main office, then you get a full day of training, then you shadow a team for a couple weeks, then you get let do minor duties as part of the actual body collection team, all the while mentored by the most senior member of the team.

I do hope that if we have more cases in the U.S. that we follow this model instead of the 20-minute classes nurses and doctors have been getting on PPE.

tooloudinhere23 karma

[deleted]

mdipaola41 karma

I'm friends with a lot of reporters on my Facebook and someone posted a picture of the PPE the nurses in Chicago were using and I was like uhhhhhhh that's... not... what they're really using.... is it?

Answer came back: Yeah, that's what they're using.

My response: Fuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuck.

DefinitelyRelephant12 karma

You can't just say something like that and not link to an example so we can share in the wtfery.

mdipaola27 karma

It was a while ago (as in earlier last week), I can't find it anymore, but check out this photo from r/ebola.

Head, meet desk.

DefinitelyRelephant20 karma

Oh wow. Yeah, if I were going to be working directly with victims of Ebola I'm pretty sure it'd be level 4 positive pressure moon suit or bust.

mdipaola21 karma

BSL 4 suits are really only for studying it in a lab when you're growing great quantities of it that don't naturally exist in nature.

tooloudinhere2 karma

Yea it is pretty f'in unbelievable. Is it that MSF is so much smarter or is it just sheer incompetence on the part of the CDC.?

I see the lowest level workers in reports and blogs wearing full on hazmat suits or whatever their called so why wouldn't if you were a nurse in the u.s. take it upon yourself to demand the same? Also, after reading your comment about the Redemption Hospital in Monrovia I googled it and images showed up where those health care workers were in full on skin covering PPE. I just don't get it.

mdipaola11 karma

Is it that MSF is so much smarter or is it just sheer incompetence on the part of the CDC.?

Blame the local hospitals, not the CDC.

I see the lowest level workers in reports and blogs wearing full on hazmat suits or whatever their called so why wouldn't if you were a nurse in the u.s. take it upon yourself to demand the same? Also, after reading your comment about the Redemption Hospital in Monrovia I googled it and images showed up where those health care workers were in full on skin covering PPE. I just don't get it.

Redemption Hospital is fucking SCARY. Reporters are banned from photographing near or in it because the conditions have proven very very very embarrassing to the government, and I was chased away after I took that photo of the guy with the vomit-stained mattress.

ProfBD4 karma

I was in Liberia in January 2012 and conducted interviews in and around Redemption Hospital. I still use pictures of the public health announcements on the outside of the building in my slides. Seeing your mattress picture and especially hearing your personal account of how conditions have deteriorated there is heartbreaking to me, but I am glad to have the information. Thank you for your work.

mdipaola2 karma

Thanks for going over there in '12. Redemption hospital is a really dark place now. I'm not even a little bit religious or even spiritual but you can feel the negative energy coming from it.

evidenceorGTFO2 karma

I feel like people rather blame a large government agency that eats up a good amount of taxes.

The CDC isn't without fault -- they could have been much more supportive and less vague (there has been a statement that PPE is "optional", right?).

On the other hand, there's a ton of people in hospitals who have actually studied medicine at some point in their lives and probably also can use the internet in ways to collect useful information.

There are people who have training with infectious diseases (likely not Ebola, but how about e.g. Noro?), maybe even Hazmat training (wasn't that a thing post 9/11?).

When the CDC did their first Ebola expedition in 1976, they had no training for Ebola, either and just went with what they knew about other diseases.

Was all independent thinking lost in Dallas?!

mdipaola6 karma

I'm with you-- I'm actually very impressed by the CDC. I'm not qualified to really judge what happened in Dallas but from what I read that hospital's administrators had the intelligence of a bucket of severed maggot infested horse dicks.

sunbeamsun16 karma

I also want to thank you for being so brave in visiting and reporting what is going on in Liberia. And I think it's wonderful that you want to visit again to do more reporting but I have to ask, since they enacted a media restriction, are you at all afraid of going back and possibly being found out by their government and suffering any consequences?

mdipaola30 karma

Yeah, I'm pretty damn nervous about that, actually. That's why I waited until I was out of the country to write about some stuff about the numbers collection (it's in one of my other answers)

sunbeamsun11 karma

Yes, I read your answer (since I was very interested in what you had to say about it since you hinted at it yesterday). If there was a strong suggestion from one of your contacts in Liberia that it would be unwise for you to return due to the government's knowledge of your reporting, would you have second thoughts about returning or would it absolutely stop you in your tracks to return?

mdipaola24 karma

Nah, I'm going back either way. I have the Chinese and the UN watching m back

sunbeamsun14 karma

As much as I look forward to hearing your future reporting in Sierra Leone, I do hope you stay safe and no harm comes your way.

mdipaola18 karma

Thank you!

rlgns15 karma

Monrovia is in Montserrado.

On the 12th they report for Montserrado, 3 deaths from outside ETUs (13 from inside). On the 16th they report for Montserrado, 11 deaths from outside ETUs (13 from inside). From the 13th to the 16th, they report a total of 110 deaths, presumably less than half or so, 55ish, were from outside ETUs, making an average of 14ish deaths from outside ETUs per day.

We know for example that the MSF beds aren't at capacity anymore (or do we?), so this leads me to wonder if people are choosing to suffer at home. If so, I suspect that the best place to fudge the numbers is with the burial team.

You say that there are 10 burial teams working hard... that's not consistent with 14ish deaths from outside the ETU. Those 10 burial teams were all for Montserrado?

mdipaola29 karma

Yes, the teams were all for Montserrado. Something is VERY not right with these numbers.

rae19887 karma

on average, how many bodies does 1 burial team 'take care of' on a single day?

mdipaola29 karma

I don't know for sure but the team I went with was averaging one per hour. 15 min spent on transit, 5 min getting consent, 10 min retrieving a body, 30 min decontamination.

FoieyMcfoie12 karma

Can you tell us any "happy" or good news stories from your time there?

mdipaola26 karma

The photo I took of Alphonso was the happiest I was there, he was not only a super friendly guy, but also very professional in his demeanor, and took down my contact information so we could stay in touch.

It's kind of hard to explain how a bond between people forms so quickly, but when you're out in the field voluntarily risking your life, and your team is also voluntarily risking their own lives, and the people you're covering are voluntarily risking their own lives, all for one common goal, you make friends FAST. We're all there for the same reason, and it's to help Liberia get this thing under control... like I wrote above, he said "I said if my fellow Liberians are getting sick, and I have the experience to help, if I don't go to help, it will be death for everybody."

That's really gonna stay with me because it's how I feel about covering this. If I have the experience to show people what's happening, and I have the ability to get over there, I have to do it.

People in the U.S. and the U.K. and other western countries aren't going to care about it unless they get a human face on it, so they won't donate, and it'll spread to a country like India or Brazil (worst case scenario) and we'll all be screwed.

Krandallsfury12 karma

Is it as bad as the media is making it out to be?

mdipaola36 karma

I am a member of the media, and I think it's pretty damn bad.

Locals treat every dead body with suspicion now, a crowd gathered in Central Monrovia as an alleged thief jumped into the river in Monrovia and died. Bystanders say he was not a suspected Ebola case, but many people are unwilling to take the risk associated with pulling out the body. As a result, the Liberian Red Cross Ebola burial team was called and arrived in hazmat suits and collect the body.

Cellcom Liberia, one of the country's largest cell phone providers, has a worker checking temperatures before shoppers are even allowed to enter Cellcom Liberia's parking lot. The worker writes down the temperature on a name tag, which is then checked by security guards after entering the parking lot, then again as they line up to enter the store, then again checked at the door to the store.

Many restaurants, hotels, banks, and stores have hand washing stations installed, and require you to wash your hands before entering. Some businesses' attempts at requiring hand-washing fall short of their goals, as many of the buckets contain water with no soap available, nor chlorine mixed into the water.

DefinitelyRelephant3 karma

What, chlorine doesn't kill ebolavirus??

mdipaola14 karma

Oops. I left out a letter. It should have read "nor chlorine mixed with water" instead of "or chlorine mixed with water." I edited it.

apestate12 karma

What is the general mode of travel for a person over there? Is there bus traffic into the countryside? Motorbike, bicycle? How do people move around?

mdipaola30 karma

Motorbike and taxi. Motorbike is a big one in rural areas because some of the roads are so bad that you can't easily get a car through.

What makes me nervous about that is if you get some Ebola patient who's on the back of a bike, they're sharing sweat with the driver, who's going to be carrying a LOT of other people.

With that being said, if you're sick enough to spread Ebola, GENERALLY you won't have the strength to get on a bike. It's not 100 percent, but just a general guideline. So I'm sure there are Ebola patients that get on those bikes and spread it. I never used a bike while I was there.

harker5512 karma

Should America be worried about Ebola?

mdipaola49 karma

Yes. But not in the way you might think... it's going to keep coming here, I have no doubt of it, but I'm willing to bet we'll never see a full-blown outbreak. The experts I was with made it clear to me that you really really really have to work at it to get it as a non-caretaker. You have to touch bodily fluids. Fomites can theoretically do it, but everyone there kinda didn't really worry about that, and they've been doing this since March.

SkeletorSwag10 karma

Is it like HIV or do you only have to come in contact with infected fluids?

mdipaola25 karma

It spreads a LOT better than HIV, you don't have to do blood to blood, you just have to do any fluids to mucosal membrane.

quaybored10 karma

Like a messy sneeze to the face?

mdipaola22 karma

Kiiiiiiiiiinda but not really. Sneezing doesn't really happen in Ebola patients. I'm sure it's possible though.

PCCP8211 karma

What was the most difficult thing You witnessed?

mdipaola30 karma

The most difficult part was leaving, but seeing Princess Manjo break down after her mother was taken in a body bag was pretty rough.

PCCP8211 karma

If someone had no training whatsoever, could they volunteer over there and not be a liability?

mdipaola13 karma

In a direct patient care capacity? Nope. But NGOs are looking for support staff with other skills.

lola_m_flores10 karma

How many bodies, would you estimate, that the Red Cross collections teams gathered while you were with them?

mdipaola23 karma

I was with them for four hours, they made one stop per hour, and collected three bodies. There was one stop where they didn't collect the body because it was outside of Monrovia and in a small village where the people weren't willing to give up the body.

The team didn't push the issue because 1) they have a right to refuse if the person didn't die of Ebola, 2) the villagers said his symptoms fit malaria.

What happens in that case is they have to call the Ministry of Health, which takes two days to send out a team to collect blood, then takes seven days to get the blood tested. If the guy didn't die of Ebola, they get a certificate and can have a normal burial.

PCCP8210 karma

Can you describe what Liberia is like, culturally? In what ways is it similar to a western nation, and in what ways does it differ?

mdipaola23 karma

I'm not the right person to ask this, lemme see if I can get my Liberian friend to make a reddit account and answer this for you.

oldsillybear9 karma

From your experience in Liberia, would there be anything a volunteer could accomplish, if they do not have medical training?

mdipaola10 karma

Yeah, but they'd have to have some sort of other skill that would be useful as a support staff member (e.g. logistics, driving, contact tracing, door-to-door canvassing, etc).

Actually I met one of the door-to-door canvassing teams, they talk to people about Ebola and then mark the building they talked to with a chalk mark that says MOH/MSF. That could be done with no training.

The body collection teams are also made up of people who volunteered to do it (but get paid) and a lot have no medical training. They go through a pretty rigorous apprenticeship though.

oldsillybear7 karma

Thanks. There must be some way to help beyond constantly saying "just calm down" to coworkers and friends wringing their hands over how we're all gonna die in January.

mdipaola24 karma

HA. That's funny and I know what you're talking about. I have to deal with the same shit. One of my friends was leading a Facebook crusade against me coming back into the country. Although if it gets into Brazil or India, I'm buying a cabin in Montana.

vinochick8 karma

1) Bravo to you sir for quarantining yourself for the incubation period as you have proven yourself a responsible human being to the rest of our species. 2) Do you think people exposed to Ebola should be in mandatory quarantines and per se canceling cruises and plane rides they may have planned before being exposed?

mdipaola14 karma

Bravo to you sir for quarantining yourself for the incubation period as you have proven yourself a responsible human being to the rest of our species.

I'm not actually quarantining myself, I'm just working from home and avoiding direct contact with other people.

2) Do you think people exposed to Ebola should be in mandatory quarantines and per se canceling cruises and plane rides they may have planned before being exposed?

Depends on how you define exposure... if you're in the same room as an Ebola patient and don't touch them, you're generally fine. If you're in the same room as an Ebola patient and you touch them, you're fucked.

If someone makes physical contact of any kind with someone who's sick, my belief is that they should have mandatory monitoring but no quarantine. It's pretty damn hard to catch this thing. More info here: http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full

obi-wan-kenobi-nil8 karma

How knowledgeable is everyone over there about Ebola? Is there a lot of misinformation, or is everyone pretty much on the same page?

mdipaola23 karma

Everyone's on the same page, at least in Monrovia. The songs and PSAs are on every single radio station, and NO ONE is shaking hands.

zotc8 karma

What is the sense in Liberia of the international response? Do they look favorably at aid groups or feel like they've been abandoned?

mdipaola25 karma

They look favorably at the aid groups, not just because they're helping, but also because they're giving the Liberians jobs.

c0mputar7 karma

MSF and many media sources in Liberia have noted that recent capacity increases have not been met with an increase in admissions, nor have previous occupancy level highs been maintained. Demand appears to have dropped. For instance, ELWA-3 was expanded to double capacity and only have ever filled half (as it currently stands).

The Montserrado district experienced, during the months leading up to Sept and Oct, a demand for beds exceeding availability. At some point during the past 1-1.5 months, the demand appeared to fall as the occupancy capacity increased. We have seen 450 spaces occupied decline to 300 now, with a recent report stating there are only 400 active cases in the whole country (~300 in Montserrado).

The MSF and some anecdotal diaries have cautioned that there is significant under-reporting of cases, which is likely true, but we do know how many spaces are occupied at the clinics. Regardless of the lacking ability of the government to report cases, it still appears that the outbreak is stabilizing in Liberia by judging it based off occupied beds. Perhaps the aggressive education and surveillance system in place to make people aware and prepared has been very effective at reducing Re.

So my question to you is this:

Has there been any re-evaluation in the number of cases outside the health care system that are neither reported or admitted, or is the 2-2.5x multiplier still reliable even though it was derived during a period when treatment capacity was actually full and less than half what it is now?

In other words, do responders in Liberia feel that the tide has shifted but, regardless, they maintain a cautioned tone to prevent another resurgence?

Thanks for having this AMA, and I feel like someday you'll be posting pictures from Sierra Leone (which may be the dark horse of this outbreak), so stay safe!

mdipaola25 karma

ELWA-3 was expanded to double capacity and only have ever filled half (as it currently stands).

Could have fooled me. There were people outside in the ward's courtyard instead of inside in ward beds.

Has there been any re-evaluation in the number of cases outside the health care system that are neither reported or admitted, or is the 2-2.5x multiplier still reliable even though it was derived during a period when treatment capacity was actually full and less than half what it is now?

This is a good question to ask a statistician or a scientist.. and I am neither, but I'll tell you what I think: I think it's not even close to under control. I saw body teams are picking up dead Ebola victims from outside the ETUs, and as long as there are Ebola victims outside the ETUs, dead or alive, we're totally screwed.

someday you'll be posting pictures from Sierra Leone

That's where I'm headed next, I'm getting a UN ID card so I can hop a free flight from Liberia to SL... but I have to get to Liberia first to get it.

c0mputar8 karma

Seesh, maybe even the MSF is unable to keep up. Maybe it's a responder problem and not a capacity problem. Not enough doctors. Well time will tell, but if bodies are still being collected at the door, we can only hope they had been dropped off there already dead and not that there aren't enough doctors to get the sick inside quicker. The former allows potential for education and surveillance to get people into clinics sooner, the latter means we need more doctors which is a harder problem to resolve.

Who is going to man all the new clinics opening up? Can't be journalists such as yourself .

Thanks again.

mdipaola13 karma

Maybe it's a responder problem and not a capacity problem.

They DO need more doctors.

Who is going to man all the new clinics opening up? Can't be journalists such as yourself

USAID has been saying local staff, and I don't doubt that they'll get SOME volunteers... but I doubt that they'll get enough.

Orbital-NZ7 karma

Day one of working at home and you open up reddit. How much work do you think you'll get done?

mdipaola5 karma

Hah. I'm doing my regular reporting duties from home. Doesn't take a lot of effort. There's very little I can do without having feet on the street.

passivejanitor7 karma

I have a profession where I touch other people's dookie and urine frequently. Will gloves and face equipment be enough to prevent contracting Ebola?

mdipaola18 karma

Unless you're working in Liberia, Sierra Leone, or Guinea, I wouldn't take any precautions other than the ones you took before this outbreak started. But that's just me.

With that being said, if I was working in Liberia, Sierra Leone, or Guinea cleaning up human waste, I would either quit my job or get full PPE training. It's not worth the risk.

Mythid6 karma

Thanks for doing this...

As of now how easy do you think it would be for someone who is infected to travel to the U.S. undetected?

mdipaola17 karma

Depends: if someone's infected but not showing symptoms, they could get through easily. If someone's infected and showing symptoms, it would be much more difficult, while still being possible.

All of this assumes the person is either a U.S. citizen or had a visa to come here beforehand. It's not like someone can get sick and be like "Oh cool I'm gonna go to the U.S. to get treatment. You gotta have a visa or you can't even get on the plane."

TravasaurusRex6 karma

I first want to thank you for making this information available and doing the AMA. I read through all of the comments and saw that you kept saying "If Ebola spreads to India or Brazil we are all screwed". This might sound like a dumb question, but why do you feel that way?

mdipaola17 karma

Those two countries have the most extensive system of slums. We saw what happened when Ebola spread through West Point, which is not that big of a slum, in not that big of a city (just under one million people) but imagine it going through the slums of Sao Paulo (11+ million people).

negatroyd5 karma

What is day-to-day life like in Liberia? Where do people buy food? Are restaurants open?

mdipaola15 karma

Social order is intact and people are walking around normally. Restaurants, shops, and markets are open. My fixer buys bags of rice from a regular market. This isn't China during SARS, people are out and about.

I ate at an Ethiopian restaurant the entire time because I met the owner beforehand and trust that she runs a tight kitchen. I had my typhoid shot but it's only 75 percent effective, so I wasn't gonna take any risks.

evidenceorGTFO5 karma

Ethiopian

And it's also seriously delicious, right? ;-)

mdipaola13 karma

It really is, and it happens to be my favorite cuisine. I was in heaven.

PCCP825 karma

What do aid-workers ( MSF, Red Cross, govt employees etc) worry about most?

mdipaola18 karma

They worry about getting sick. Everyone decontaminates VERY carefully. The body collection teams have someone that sprays them down, and the MSF guys basically repeatedly douse their fully gloved hands in bleach water when they exit the wards.

breathingcarbon5 karma

First of all, thank you for the work you have been doing, it's fantastic.

It sounds like this situation has decimated an already fragile country. Do you have a sense of what will be needed to rebuild society, the economy etc. after this outbreak is contained?

mdipaola11 karma

I read somewhere that Liberia had one of the top two fastest growing economies in the world. They've got incredible natural resources (like gold) and I met a couple mining guys on the plane who were evacuating the country because they didn't want to get sick.

Liberia, as a country, has waaaaaaaayyy too much to gain from its natural resources to not rebuild quickly.

gambitasdf5 karma

Are there any cases where an ebola patient has purposely infected others out of malice? I can imagine people might try and do this to their worst enemy. Is there any law against this? Altho if ebola kills within weeks, I can't see it as any real deterrent.

mdipaola11 karma

Are there any cases where an ebola patient has purposely infected others out of malice?

This is a good question for a cop, but I can't imagine one can do that much malicious infecting once they're sick. You gotta understand: once you get to the point when you can spread it, you're so weak that it becomes EXTREMELY hard to move around.

Is there any law against this?

I'm a reporter, this is a good question to ask a lawyer. Hopefully one will be reading this AMA and give you a good answer.

Keurigirl5 karma

Thank you for this AMA! I have been thinking about setting some kind of goal for my facebook friends/communities asking for donations to go to Africa. If I do this, where is the best place in your opinion to donate to? MSF? Doctors without Borders? Somewhere else?

mdipaola11 karma

MSF is the same thing as Doctors without Borders.

They're good, More than Me is good and International Rescue Committee is good. They're the ones that I see actually on the ground.

miserable_failure5 karma

I have less of a question about your experience abroad and your experience returning / before you left. How have your friends/family/acquaintances reacted?

How does the generally public in Liberia understand the disease? Is it a curse from the devil? Do they understand it's a virus? Do they understand how it's transmitted better than those in us?

mdipaola6 karma

How have your friends/family/acquaintances reacted?

I explained what was going on and how hard it is to actually catch this thing before I left so the response was a lot less panicked than it could have been when I came back.

I did have one friend on Facebook trying to get me banned from re-entering the country, despite the fact that I had ZERO contact with anyone who had Ebola.

How does the generally public in Liberia understand the disease? Is it a curse from the devil? Do they understand it's a virus? Do they understand how it's transmitted better than those in us?

No they get it, and they get it REALLY well. Locals treat every dead body with suspicion now, a crowd gathered in Central Monrovia as an alleged thief jumped into the river in Monrovia and died. Bystanders say he was not a suspected Ebola case, but many people are unwilling to take the risk associated with pulling out the body. As a result, the Liberian Red Cross Ebola burial team was called and arrived in hazmat suits and collect the body.

Cellcom Liberia, one of the country's largest cell phone providers, has a worker checking temperatures before shoppers are even allowed to enter Cellcom Liberia's parking lot. The worker writes down the temperature on a name tag, which is then checked by security guards after entering the parking lot, then again as they line up to enter the store, then again checked at the door to the store.

Many restaurants, hotels, banks, and stores have hand washing stations installed, and require you to wash your hands before entering. Some businesses' attempts at requiring hand-washing fall short of their goals, as many of the buckets contain water with no soap available, nor chlorine mixed into the water.

Shaeos5 karma

You have 24 more days to go. How do you intend to use them?

mdipaola9 karma

I'm going to be doing my usual thing that I would do at the office, except at home. Talk to sources, write articles, stuff like that.

Shaeos5 karma

Anything special planned for being allowed back to society?

mdipaola5 karma

Nah, this is all part of the job.

motown_missile5 karma

Any symptoms yet?

mdipaola16 karma

My temperature is 97.4 F, and I haven't had contact with anyone, much less someone who was sick.

Tenaciousgreen5 karma

Backed! I think your kickstarter is an awesome idea.

Why such a strong personal interest in Ebola?

mdipaola11 karma

It's the big story right now. It's killing a ton of people. I can't feel empathy for my fellow human beings?

flatspoon5 karma

Welcome back! What are your thoughts on the people who think ebola is a goverment-created fake illness?

mdipaola5 karma

Idiots.

rushsummers4 karma

What was the security like when re-entering the country? Did they screen you?

mdipaola15 karma

I went through three processes of screening.

First in Monrovia, at the airport, I filled out a questionnaire with questions like "Have you had contact with anyone who was sick?" and "Have you had contact with any dead bodies?"

Then they did a visual inspection and took my temperature. Then before I boarded the buses to drive to the plane that's waiting on the tarmac, they took my temperature again. Both times taken with a handheld no-contact thermometer.

No special rooms for screening on this side.

I flew through Casablanca so I had to go through screening there. As I got off the plane I got my temperature taken once through a handheld scanner and once through an infared temperature camera. I'll upload video of this process shortly.

In the U.S., I went through regular customs and the guy asked me what countries I had been to, I said Liberia, he brought me back to the CDC quarantine station where I was greeted by two Coast Guard people, then I had my temperature taken, and they asked me questions about my exposure. Then after that, I talked to a second person to give him my contact information and find out what my seat number was, and an emergency contact.

After that... I got a piece of paper telling me I had been to a country with Ebola (duh), and that's it!

PlatonicOrgy3 karma

I wonder how many people go through Casablanca from those areas? It would be horrendous if cases started popping up there.

mdipaola8 karma

My flight was completely full. But honestly I don't think it's going to spread to a new country until there's a lot more people sick in Liberia/SL/Guinea.

CommitPhail4 karma

How do you feel? Are you worried at all?

mdipaola8 karma

Not even a little. But if I was a medical professional or had shaken hands or even accidentally bumped into someone in-country I'd be scared shitless.

4waystreet4 karma

[deleted]

mdipaola10 karma

Tons of interaction with MSF, went there three days but only got a tour on one day.

They've actually been getting a ton of coverage and you have to book your visits with them two days in advance. I had to wait three days because CBS, BBC, and Anadolu were ahead of me... and then I had to leave early on the day that I got to hang out with them because BBC was back.

evidenceorGTFO3 karma

So one "visitor" per day, as per their guidelines?

mdipaola5 karma

There are multiple "tours" per day, but only one at a time.

SparkyD424 karma

Do you personally think things will continue to escalate? Or does it seem like things are more under control than the American media is making them out to be?

mdipaola26 karma

No, I think things are escalating right now-- the burial teams are working flat out and there are about 10 of them. I think the numbers are being under-reported, especially from the Liberian government.

atesbo4 karma

Did you see anything there that surprised you or that you really weren't expecting based on your research prior to heading to Liberia?

mdipaola16 karma

Part of preparing for a trip like this is knowing exactly what you're walking into, what challenges you're going to face, and how to deal with them.

To mitigate expected problems I spoke to my fixer every day for about a month before I came, getting updates on everything from how full the ETUs were, to weather, to road conditions.

As a reporter, you spend a LOT of time walking into situations where you don't know what the fuck is going on and the less you know, the more you jeopardize your own safety.

The one thing I expected but was still surprised by is how friendly Africans are. Everyone waves and smiles at each other and says hi regardless of whether they know each other or not. People who were complete strangers to me would ask about how my family was doing, how I was doing, how I liked the country, stuff like that.

No one is shaking hands now but if they still were I'm sure my wrist would be broken on the first day from so much hand shaking.

sunbeamsun3 karma

On your next visit, are there any specific places/situations/people you are hoping to report about that you wish you had been able to in your last visit?

mdipaola12 karma

I want to go to Gbarnga, Greenville, and a gold mine in Grand Kru that had a cluster. I'm also planning on getting myself over to Sierra Leone on a UN flight using my currently-being-arranged UN ID card.

sebasebaseba3 karma

You've said that you were at ELWA-3. When was this?

mdipaola5 karma

Four days ago, Friday.

sunbeamsun3 karma

Did anyone talk to you about how they felt toward their government or if they feared any economic/government collapse due to Ebola's impact?

mdipaola9 karma

NO ONE is happy with the government. NO ONE. Sirleaf's son, a doctor in the U.S. has refused to come back to Liberia, and that's what's currently pissing everyone off, but what people are pissed about changes daily. It's been fuckup after fuckup and there's no shortage of things for people to be pissed at the Liberian government for.

msx83 karma

How do you feel?

mdipaola5 karma

I feel great. Temp is 98.3 F right now.

hoodyupload3 karma

Do you think Ebola can be contained in liberia and other west africa countries as Nigeria did ?

mdipaola3 karma

Not unless a LOT more medical staff shows up.

DiscoConspiracy3 karma

While you were there, were you able to see whether or not it was difficult to quarantine people? Did most people abide by the quarantine?

mdipaola5 karma

Once you're sick enough to really spread it, you're generally to sick to move. The disease kinda quarantines you automatically.

lovelybone933 karma

Will you go stir-crazy from being in the house for over three weeks?

mdipaola7 karma

I'm not doing a full quarantine because I have zero symptoms and have had zero contacts with anyone who's had Ebola (or even the common cold) so I won't be stuck in the house.

With that being said, I'm not gonna be shaking hands or making physical contact with people just in case. I'm also taking my temperature obsessively. It's 98.5 right now.

throwapeater3 karma

have you considered sneaking out for chinese take out?

mdipaola9 karma

I've been out of the house multiple times. I'm not quarantined. I'm just working from home for 25 days.

Hysiq3 karma

Have you come across any Liberians that don't believe ebola is real? I understand that many thought it was a government conspiracy or that ebola wasn't a problem in Liberia.

mdipaola7 karma

I didn't come across any myself but I know they exist: I talked to a UN peacekeeper that met some, and a couple doctors that met some.

tooloudinhere2 karma

Given that the CDC is imposing self monitoring and isolation on folks who have had very limited exposure to ebola and are at such low risk do you find it a bit ass backward someone like yourself receives no such attention from the CDC?

mdipaola8 karma

Huh? No... I haven't had any exposure whatsoever to anyone who was sick with a cold, much less someone with Ebola. With that being said, I am self-monitoring anyway.

It absolutely makes sense to have isolation and monitoring for people who have had limited exposure to Ebola.

oldsillybear2 karma

I wanted to say my hat is off to you, I love your photo and writing style. With that brown-nosing out of the way, a question (and I think I already know the answer):

Are you planning to go back to Africa soon?

mdipaola9 karma

Yup, that's what the Kickstarter is for

wooki_cooki1 karma

Did you visit any hospitals? Are there even hospitals there? If so were they clean? And were they completely filled up and chaotic? I would imagine it's crazy in there like the ER except everyone is wearing suits and stuff.

mdipaola3 karma

All the regular hospitals are closed, although some are reopening for non-Ebola patients like malarial cases and prenatal care.

They're exactly what you would expect an African hospital to look like. I visited two "hospitals" that were called hospitals but looked more like clinics.

Neither of them had doctors inside although one of them had a doctor they could call to come if they needed it. Nurses and aides seemed to be doing most of the patient care. And at the rural "hospital" I went to the medical director was an RN

DianaM20140 karma

Did you wash your hands?

mdipaola1 karma

Many many many times an hour.

skrimpster0 karma

I've been asking this question to random people for years, but this is the first time I've been able to for a legitimate reason:

Did you see or touch any monkeys while you were on the island?

mdipaola8 karma

No... I had a monkey sit on my lap when I was a kid at Kabini Lodge in India though.

Titandm900 karma

What is your opinion on the ease of which infected individuals could leave Liberia and come to places such as the United States? We have already seen Mr. Duncan come here after knowing he was exposed. Do you think we are doing enough to prevent it from arriving here again?

mdipaola14 karma

What is your opinion on the ease of which infected individuals could leave Liberia and come to places such as the United States?

It's actually a LOT more difficult than you think. There's a three-month waiting period to get a visa to come to the U.S., even if you have a relative that's a U.S. citizen and can give you a letter of invitation.

It's not like someone can get sick and be like "Oh cool I'm gonna go to the U.S. to get treatment." You gotta have a visa or you can't even get on the plane.

If you've got Ebola, you don't have three months to wait. You've got a week. Tops.

We have already seen Mr. Duncan come here after knowing he was exposed.

Yeaaaaaaaah, that's... not... really... accurate.

Do you think we are doing enough to prevent it from arriving here again?

No. I think we need to be sending more doctors to Liberia, Guinea, and SL.

the_eric-2 karma

What is it about possibly being exposed to Ebola that gives people the insatiable urge to travel?

mdipaola7 karma

I wasn't possibly exposed to Ebola. What makes you think I was? You have to have direct contact with bodily fluids to be exposed.

liberal_logic-8 karma

Thanks for increasing everyone else's possibility of getting Ebola by coming home, or even going to Liberia in the first place! Ebola is one step closer to being cured by your need to go there to take some photos and ask locals some questions! Will you feel like it was worth it if you or someone you don't know gets sick because of you?

mdipaola10 karma

Not sure what reality you're living in, but not only did I not have contact with anyone who had it, but I didn't have contact with anyone, period. You have to have direct contact with the bodily fluids of someone who has it in order to get sick.

tooloudinhere0 karma

I'm sure you had no contact with bodily fluids of an infected person but how can you be 100% confident the food you ate and every public toilet you frequented wasn't touched by someone who was infected?

Btw, I disagree with OP. I think it is extremely important for reporters like yourself to tell the world the truth. If this was done earlier maybe we wouldn't be in this position.

mdipaola2 karma

It isn't foodborne and there are no public toilets in Monrovia. People do their business on the side of the road.

tooloudinhere0 karma

"People do their business on the side of the road."

How can you be 100% confident you didn't step in any doogie which can then get on your hands while undressing?

mdipaola3 karma

By the time you're sick enough to spread it through diarrhea you're generally too sick to stand up, much less be walking around outside. Also I don't make a habit of jumping in puddles of diarrhea. Also you wear special waterproof boots that are decontaminated periodically throughout the day.