I am Zeela Zaizay, a first responder to the Ebola outbreak in Liberia- AMA!

Was there any point at which you had lost hope and believed there would be no end to Ebola?

Yes. I almost lost all hopes in October 2014. We health workers were checking on each other everyday, and it was horrible knowing that we were falling too fast to the disease. it was horrible: we were like military cadets being trained with real riffles and live bullets. We were learning about Ebola in the midst of the most deadliest outbreak ever.

What is the biggest obstacle in your work?

One of the biggest challenges is working with less resources than you need, so you know you can't help everyone.

I aspire to work as a psychiatrist in a African community with poor mental healthcare, but I'm afraid I will be unable to reduce stigma of mental disorders. Do you have any advice?

This is an area worth venturing. You probably will serve as a trail blazer. it will not be an easy task of course, and the impact of your work may not be readily seen. But believe me, you will be one of the very few selfless persons who are not seeking direct credits for what they do. As a word of advise, it will be good to commit to long-term work. You will make great impact after you learn the culture and traditions of the people, and meet them on their level.

I just want to say bless you for all you do. What can we do to help you?

Thank you. There are lots of local agencies that are looking for donations and the funds do buy us the things we need in the field. My partner agency effect:hope is the one who bought us the items we needed like the the protective suits and they work with us to go to the local government to create strategic change plans. Right now we are working on an initiative that will address all tropical disease prevention and treatment in one government policy which will be the first of it's kind. It is a step forward to rebuilding out health care system. If you want to donate to effect:hope you can here: http://effecthope.org/

Do you like pancakes?

Yes I do! :-)

Before the outbreak, Liberia was working to build medical schools, nursing schools, and residency programs so that they wouldn’t rely so heavily on foreign trained physicians, doctors who, generous as they are with their time and compassion, tend to cycle in and out.

How has the overwhelming public health crisis affected medical education in Liberia? Compared to 2012, how do the numbers look for medical and nursing students, and for doctors and nurses? We’ve read about nurses and doctors walking away from their jobs -- was that common, or was it the exception to the rule?

Prior to Ebola, enrollment into health training institutions was expanding. There were lots of community colleges being built around the country, and a couple of specialized programs that were helping to build our capacities.

But many health workers in Liberia are poorly paid and there are generally no health insurance among other needed incentives. These among other factors, are contributing to the migration of health workers to developed countries.

Surely, health workers avoided working during the peak of the crisis. There are high turn overs of health workers; they grow in experience and shift good paying jobs or just leave the country.

Compared to 2012, the number of health workers has slightly increased because our schools and enrolling and graduating more people than before. But the ratio of health worker to the population is around 1 health worker to 580 people.

How does it feel being on the last page of the phone book?

:-) Sometimes I wish I was Aleez :-) In school I was always called last and i didn't like it.

Did the media over exaggerate the Ebola dangers or is it pretty much accurate?

I think the media didn't overemphasize the situation. Personally, I worked in hard to reach areas that never had media coverage. One of the communities I worked in was called John Logan Town that had very deplorable roads and no access to internet, and communication. The people there who suffered and died of Ebola were never covered by the media. The impact of Ebola was devastating, the health care system is still weak.

What was greatest fear while working with survivors?

My greatest fear was that the survivors stay contained the virus (a scientific fact) and that we didn't fully understand all of the ways a survivor could transmit the disease to other people (another scientific fact). But believe me, it was a great time helping people who were in the greatest need for care and love.

What safety precautions do you have you take when coming in contact with ebola and people with ebola?

1. Firstly, get your body fully covered by a personal protective equipment suit (one manufactured for highly contagious disease control)
2. Maintain reasonable distance from the affected person, unless the contrary is really necessary
3. Provide psychosocial counselling, and ensure the affected person is not combative
4. Avoid crowding the room; limit the number of health care providers to a very few people who are actually needed

Hi! Outside of ebola (and I assume malaria), what are the lesser known infectious disease threats to the region and how are you working to mitigate them?

Because the health system was so further weakened by the Ebola outbreak a huge problem we are having is that many of the other infectious diseases in the area, like leprosy, buruli ulcer, hookworm, roundworm, and yaws are rampant and people are not able to be treated for them. Or, by the time they are correctly diagnosed these diseases have already do significant physical and mental damage. With lessons learned from Ebola, I can say boldly that there are probably many other diseases we do not know of; and because of the weak health care system we are probably wrongly diagnosing.

Right now, we are strengthening our infectious disease surveillance and reporting systems, conducting integrated (multiple diseases training) trainings for health workers, and scaling up school-based health and hygiene promotion programs as parts of our strategies to mitigate.

What's it like working in those personal protective equipment suits? What's the biggest difficulty working in them?

The suits have no vents, so you get really hot in there. And no matter how much you terrible you feel, you dare not attempt creating any vent. The Ebola treatment units had no air cool systems, and we were working in hot weathers (tropical Africa)

What cultural practices made it difficult to contain or treat ebola?

I think I heard on NPR they didn't like burning their deceased, which made it hard to contain the vectors.

Besides supportive treatment what are some experimental treatments that have worked?

The link to your proof looks like you do more leprosy work. In your opinion which has more stigma Lepromatous Leprosy or Ebola

In West Africa, we honour the dead. For us, it was a cultural dishonour to burn our dead loved ones. We found it hard accepting the "burning".

Ebola has more stigma than Leprosy in Liberia, because we probably watched it consume our loved-ones like wild fire. I am a front-line staff of effect:hope and Medical Assistance Program International. effect:hope used to be The Leprosy Mission of Canada but a few years ago expanded it's mission to end all neglected tropical diseases, including leprosy. I don't think the website has been fully updated to reflect this yet!

What was your greatest risk of being exposed to Ebola?

I once wiped sweat off my face (touched my face), while working in the ETU. I immediately flushed my face with 0.5% chlorinated solution. But I really felt I was already infected.

Zeela - Happy National Nurses' day from U.S.A. Thank you for all you have done and are doing for your patients and the community.

If you could no longer work in this area, what would you want to do for your livelihood?

Happy Nurses Day back to you. I assume you are a nurse also :-). I am totally committed to saving lives, if I had to do something else i would work with the Pre-service training Institutions to transfer my knowledge and skills.

There are very few doctors left in the country.

Where'd they all go?

Several died, and many of the foreign doctors returned to their countries.

What was the environment like in the survivor's camp, and how large was the camp itself?

The environments were horrible and fearful initially. health workers were limiting contacts with patients. And the patients were watching their colleagues die. No one was sure whether he or she would survive. One thing that was common to all was that, we were all praying continually in our hearts. But by December 2014, we were turning the tables around. The sizes of treatment units varied significantly. some were 50 bed facilities, while some were up to 500 bed. In facility had several sections, and occupied really large land spaces.

Did your family find it hard to accept that you will be working on the frontlines to battle such a scary disease?

My family didn't know of all that I was doing. We hated journalists taking and posting photos of us. Our families would totally reject us if they knew how much risks we exposed to. After it all, it was fun letting them see some of our personal photos only after we had contained the disease and gotten clear bills of health.

That was brave of you given that Ebola can spread quite easily. But isn't Ebola lethal? Because the last time I checked it didn't have a cure. So do you just ease the passing? Do you think euthanasia should be allowed for such patients? Is there any hope for recovery at all?

Ebola cannot be cured. But with timely and quality support care, a person has a better chance of surviving the disease. I Liberia, the death rate of people affected is around 48%.

We do not just ease pains, we work to increase their chances of surviving. Absolutely, euthanasia is not an option :-)

You mentioned fighting against the stigma that comes along with Ebola. Would you say the stigma is greater or lesser in Liberia than it is in North America?

it is much greater in Liberia because there are more people at risk. There is an impression around the survivor that they are still diseased or cursed and in small communities this can ostracise people and families. Because Ebola is spread through direct contact the survivors still have the stigma of not being touched. It is still a current reality.

What motivates you?

I grew up in rural Liberia and watched one of my brothers die of a disease we never got to understand. The health system was never able to diagnosed the disease. I am committed to helping people who are either at risk of, or affected by diseases that are neglected or not on the list of the top tens, such as Buruli Ulcer.

Do you work closely with the WHO? Have they been instrumental in the fight against ebola in liberia? If so what tactics have they used to combat the disease?

Yes, I work closely with WHO, and it has been instrumental. WHO, like the rest of the world, was learning Ebola from a new perspective. It was hard for them like all of us. We have all been working hard over the years, and their leadership and inspiring role has been superb.

Several tactics, including but not limited to: 1. Improving emergency response time through health worker training and provision of logistics 2. Increasing epidemic disease surveillance preparedness and reporting systems by creating district level health teams 3. Increasing the numbers of Ebola treatment centres 4. Establishing community care centres that provided care for people suspected of Ebola 5. They had people with technical expertise come into Liberia to provide support.

I lived in Liberia during the outbreak, working at orphanages in Paynesville and Buchanan. Living right next to ELWA Hospital, my colleague was once harassed in the nearby Total saying that Ebola was fake, brought to Liberia by ELWA in order to get citizens to accept Jesus. Did you ever experience anything like this?

Also, thank you for your service to such a wonderful, beautiful country.

Oh yes, I did. There were lots of misconceptions about the disease, and many of them I experienced. Some people said it was a hoax to divert financial resources, some said it was politically motivated. There were lots of them. I am glad that you (someone from the scene) are in on this. Did you listen to ELBC television station play the song "Ebola yea Africa, condition in Africa"? I hated watching that song which said Ebola was a condition only in Africa, and that it was created for Africa. Many times, I had a lot of time spent on convincing some colleagues that our energies were firstly to be committed to containing the outbreak.

Wow, I'm studying public health and just submitted a paper that I wrote on reducing the stigma faced by Ebola survivors in West Africa. My question is what local or international policies do you think could be adopted that would help identify outbreaks like Ebola faster, allowing us to fight them before they reach the epidemic level?

That's a big question but here is a short answer: The key to identifying Ebola or other diseases with epidemic potential is better awareness in the community. The quicker the right information and knowledge on identification, treatment and referral is communicated, the more effective the chances to stop them.

Were any of your family members or close friends affected by Ebola?

Many of my close friends were fellow health workers. I lost a considerable number of them. Of course, I lost family members. I don't think there is a Liberian who didn't lost a family member.

What are the most extreme measures you've had to take to keep yourself safe from infection?/What's been your biggest infection scare?

Some extreme measures have been: One of the most extreme measures was sleeping in my rough terrain vehicle (Toyota Land Cruiser Hard Top) when I was working far away from my home, to purposefully avoid touching beds that were not absolutely restricted to me and me alone :-)

The CDC was projecting that infected could grow larger than a million in just a few months at the peak of the hysteria here in the US. But the actual number of effected didn't even come close to that. Why do you think their projection reached so high?? Thank you so much for doing this AMA.

I think their projections were statistically correct. Exponentially considering the rate at which the disease was spreading, the unhealthy cultural practices that were occurring in West Africa at the time, and the misconceptions people had about the disease, among others, any statistician would project such high figures. What everyone of us did (including CDC) was to eliminate the factors that were leading to the rapid spread, and that worked. if we had not tackled the outbreak with much seriousness and commitment, the world would have seen the CDC projection become a reality.

How well does the general population understand the nature of Ebola? I realize that question is very broad. Feel free to be as specific or as generic as necessary.

Related: Is the spread of Ebola at all related to the level of knowledge / understanding of the local populace? For example, would Ebola be better controlled in a population that better understood infectious diseases, the importance of quarantines / isolation, the importance of hygiene, how contagious Ebola is, etc.? Conversely, would Ebola just as difficult to control, even in a population that understood all of the facets of infectious disease prevention?

Thanks for your work and for your time.

Edit: potato fingers + smart phone = wurds

In Liberia there is now a good understanding of the nature of Ebola but still a lot of stigma around it. Because the people with Ebola were kept isolated and people were told to not have contact with them there is still fear around reincorporating them back into the community. In terms of the spread of Ebola, yes, it is most definitely better controlled in a population that understands the nature of the disease and is better aware on what necessary measures need to be taken in order for it not to spread. This alongside a health system that is able to effectively respond to those who do get sick. Both information and knowledge in the community and the expertise and system to deal with an outbreak are essential to control the spread of infectious diseases. The population of Liberia is much better aware now than it was in the beginning of the outbreak, but the health care system also needs strengthening to be able to respond effectively when such a crisis hits its population.

What treatments were actually used, and what worked most effectively?

What countries handled the initial outbreak the best, and worst?

What would you recommend be done in case of some future outbreak?

How were you and your colleagues personally affected by the disease? I know many responders and medics contracted the disease and some died, how bad was it?

Treatments were individualized; most of them were: a. psychosocial support and counseling for all clients and health workers as well Antimalarial drugs (to eliminate co-infection of Malaria) b. Intravenous fluid therapy (for those who had diarrhea and vomiting) c. Diet therapy/improved nutrition for all clients d. Anticoagulants for those who were bleeding e. Immunity boosters for all clients

Do you think Ebola will become endemic in Africa?

I do not think it will become endemic in Africa because we are actually improving our knowledge, skills and practices necessary prevent it from becoming endemic. Initially I thought Ebola was something we could contain like other viral hemorrhagic fevers we had been experiencing. By the way, I was already trained in the management and control of viral hemorrhagic fevers before the outbreak of Ebola. But I actually got frightened by October 2014, when the rate of spread was far too beyond our comprehension. But with the gains we have made thus far, I am confident our conceited efforts can stop Ebola from becoming endemic (always present) in any country or continent.

What has been the most disappointing misconception you have encountered regarding the disease, and do you ever get tired of attempting to correct it? For example: people believing it turned some into zombies.

The most disappointing misconception I have encountered is the misconception that the disease can be cured by alternative (non-medical) treatment. I saw several people getting infected and dying because they believed the misconception.

Did it bother you always being last when things were done in alphabetical order?

Surely, it did :-) Sometimes, I wished I could spell my name the other way around - Aleez :-)

What is the biggest misconception those of us in the west had during the outbreak?

I seriously think the biggest misconception was that "Ebola" was the real problem. The elaborate Ebola outbreak was an effect of having a broken health system. The real problem is a "weak health system", which is responsible for the high maternal and newborn (neonatal) death rates, the high burden of Malaria, diarrhea, and a long list of other diseases that can be prevented, early diagnosed and early managed by a resilient health system

There is no proof here... Wanna post a picture or something? The link you put in your post goes to a 404 page...

It worked for me though? It was a picture of the guy holding a sign: http://effecthope.org/wp-content/uploads/2016/05/zeela-zaizay-reddit.jpg

Oh weird... Must be the dumb reddit app screwing up links again... Thanks for the help. They really got to fix the reddit app

You can also see more proof on the effect:hope Facebook!