For survivors of Ebola, the crisis isn't over | Soka Moses

36,892 views ・ 2018-04-14

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June 13, 2014
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started as a routine Friday
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in Redemption Hospital in Monrovia, the capital of Liberia.
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Redemption is the largest free public health hospital in the city.
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We are called upon to serve hundreds of thousands of people.
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In the best of times it puts strain on our resources.
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Monthly supplies run out within weeks,
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and patients without beds would be seated in chairs.
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That summer, we had a nurse who had been sick for a while.
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Sick enough to be admitted in our hospital.
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But our treatment didn't seem to be helping her;
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her symptoms were getting worse:
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diarrhea, severe abdominal pain, fever and weakness.
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On that particular Friday, she developed severe respiratory distress,
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and her eyes were menacingly red.
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One of my fellow doctors, a general surgeon,
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became suspicious of her condition.
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He said her symptoms were suggestive of Ebola.
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We kept a close watch on her, we tried to help her.
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We were treating her for malaria, typhoid and gastroenteritis.
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We didn't know it, but by then it was too late.
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The next morning I walked in to check on my patient.
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I could tell by the look in her eyes that she was filled with fear.
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I gave her reassurance, but shortly after ...
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she died of Ebola.
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For me, her death was very personal.
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But this was just the beginning.
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A virtual biological bomb had exploded.
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But the word spread faster than the virus, and panic spread across the hospital.
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All the patients ran away.
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Then, all the nurses and doctors ran away.
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This was the beginning of our medical tsunami --
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the devastating Ebola virus
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that left an indelible scar in our country's history.
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I was not trained for this.
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I had just graduated from medical school two years before.
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At this time,
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my total knowledge about Ebola came from a one-page article
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I had read in medical school.
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I perceived the disease as so dangerous,
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this one page in essence had convinced me to run out of the hospital, too,
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the moment I heard of a case of Ebola.
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But when it finally happened, I stayed on and decided to help.
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And so did several other brave health care professionals.
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But we would pay a heavy price.
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Many persons and health professionals had become high-risk contacts.
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This actually meant 21 days counting to potentially disease or death.
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Our health systems were fragile,
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our health workers lacked skills and training.
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So in the weeks and months that followed,
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health workers were disproportionately affected by the Ebola virus disease.
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More than 400 nurses, doctors and other health professionals became infected.
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Unfortunately, my friend, the general surgeon
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who correctly identified the symptoms in that first case
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became one of the casualties.
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On July 27, the president of Liberia
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imposed quarantine on the worst-affected areas.
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She closed all the schools and universities
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and shut down many public events.
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Four days later,
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the United States Peace Corps
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pulled out of Liberia, out of Sierra Leone and Guinea
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due to Ebola.
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In August, six weeks after the nurse died,
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hundreds of people were dying of the disease each week.
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People were dying in the streets.
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Over the months that followed,
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West Africa would lose thousands of people to Ebola virus disease.
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In August, I joined a team to set up the Ebola treatment unit
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at JFK hospital in Monrovia.
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I was charged with running the second Ebola treatment unit in the city.
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Our unit provided hope for thousands of patients, families and communities.
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I not only provided care, I came face to face with Ebola.
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Living every day as a high-risk Ebola virus disease contact
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during the worst of the outbreak
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was one of my worst experiences.
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I started counting 21 days every day.
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I lived every moment anticipating the onset of symptoms of the disease.
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I measured my body temperature several times.
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I showered with chlorinated water,
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more concentrated than actually recommended.
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I chlorinated my phones, my pants, my hands, my car.
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My clothes became bleached.
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Those days you were alone,
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people were so afraid of touching anybody.
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Everyone was counted as a potential contact.
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Touching would make them sick.
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I was stigmatized.
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But if that was what it was for me, who was symptom-free,
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imagine what it was for someone who actually had symptoms,
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someone who had Ebola.
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We learned that to treat Ebola successfully,
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we had to suspend some of the normal rules of society.
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Our president declared a state of emergency in August
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and suspended certain rights.
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And the national police even supported our work during the Ebola response.
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In February 2015, gang members came in for isolation
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in our Ebola isolation unit.
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They were also know as the VIP Boys of Monrovia,
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terrifying small-time drug addicts
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whose presence could instill a tremendous amount of fear,
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although they could not legally carry guns.
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They underwent quarantine for 21 days in our unit and were not arrested.
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We told the police,
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"If you arrest them here,
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they will stop coming, they won't get treated.
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And the Ebola virus will continue to spread."
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The police agreed, and we were able to treat the VIP Boys,
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and they did not have to worry about being arrested while in the unit.
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Over the course of the outbreak, West Africa had almost 29,000 cases.
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More than 11,000 people died.
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And that included 12 of my fine colleagues at John F. Kennedy hospital in Monrovia.
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In June 2016, exactly 23 months after my first Ebola patient died,
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Liberia declared its Ebola outbreak ended.
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We thought that once the outbreak ended,
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so did the problems.
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We hoped that life would go back to normal.
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Today, there are more than 17,000 survivors in West Africa.
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People who actually had Ebola virus disease,
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lived through it and survived.
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We counted survival rate as a success:
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the end of suffering for the patient and fulfilling joy for families.
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Every discharge from the unit was a moment of jubilation.
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At least so we thought.
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The best description of the moment of discharge
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and a rare glimpse into the moment that defines our life post-Ebola
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was vividly expressed in the words of my best friend
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and fellow doctor, Philip Ireland, in an interview with "The Times."
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He said at the time of his release,
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"There were a lot of people there from JFK hospital:
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my family, my elder brother, my wife was there.
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A lot of other doctors were there, too, and members of the media were there.
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And I felt like Nelson Mandela, it felt like the 'Long Walk to Freedom,'
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and I walked and raised my hands to the heaven,
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thanking God for saving my life."
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And Philip said, "Then I saw something else.
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There were a lot of crying people, people happy to see me.
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But when I got close to anybody, they backed away."
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For many Ebola survivors, society still seems to be backing away,
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even as they struggle to lead a normal life.
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For these survivors, life can be compared to another health emergency.
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They may suffer debilitating joint and body pain.
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The suffering gradually decays over time for most.
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However, many continue to bear intermittent pain.
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Some survivors are blind, others have neurological disabilities.
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Some survivors experience stigmatization every day, in many ways.
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A lot of children are orphans.
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Some survivors experience post-traumatic stress disorder.
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And some survivors lack opportunity for education.
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Even families can be split apart by fear of Ebola, too.
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There's no definitive cure for transmitting Ebola virus through sex.
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However, there are successful interventions for prevention.
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We have worked hard on semen testing,
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behavioral counseling, safe sex promotion and research.
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For the past year, there have been no cases of sexual transmission.
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But some male survivors have lost their spouses
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out of fear they will be infected with Ebola.
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That's how families are torn apart.
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Another tremendous challenge for Ebola survivors
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is obtaining adequate health care.
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In theory, Liberia's public health services are free of charge.
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In practice, our health system lacks the funding and capacity
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to expand care to all at the point of need.
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Many survivors have waited many months to undergo surgery
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to heal their blinding cataracts.
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Few had to relive the traumatic experience,
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when their blood was retested for Ebola at the point of admission.
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Some survivors experienced delayed or deferred admission
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due to limited bed capacity.
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No bed available for one more patient.
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This is neither national policy nor officially condoned,
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but many people are still afraid of the sporadic resurgence of Ebola virus.
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The results can be tragic.
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I have seen Beatrice, an Ebola survivor, several times now.
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She's 26 years old.
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Many of her family members became infected, she luckily survived.
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But since that day in 2014 she was discharged
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to cheering health workers,
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her life has never been the same.
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She became blind as the result of Ebola.
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In 2014, the baby of a dear friend of mine was only two months old,
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when both parents and child were admitted in an Ebola treatment unit in Monrovia.
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Luckily, they survived.
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My friend's baby is almost three years old now,
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but cannot stand, cannot walk, cannot speak.
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He has failure to thrive.
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There are many more hidden experiences and many stories are yet untold.
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The survivors of Ebola deserve our attention and support.
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The only way we can defeat this pandemic
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is when we ensure that we win this final battle.
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Our best opportunity is to ensure
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that every survivor receives adequate care at the point of need
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without any form of stigma and at no cost to them personally.
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How can a society consider itself healed
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when a person's entire identity
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is defined by the fact that they recovered from Ebola?
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Should a previous disease that a person no longer has
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become the sum total of their identity,
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the identifier in their passport
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that deters you from traveling to seek medical care abroad?
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Simply the ID that denies you health care.
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Or prevents you from having a relationship with your spouse.
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Or denies you of family, of friend or home.
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Or prevents you from carrying on your normal job,
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so you can put food on the table or have a roof over your family's head.
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What is the meaning of the right to life
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when our life is clouded by stigma and barriers that fuel that stigma?
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Until we have much better answers to those questions in West Africa,
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our work is not over yet.
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Liberians are a resilient people.
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And we know how to rise to a challenge, even a devastating one.
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My best memories of the outbreak
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center on those many people who survived the disease,
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but I cannot forget the hard-working nurses, doctors, volunteers and staff
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who risked their own safety in service of humanity.
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And some even losing their lives in the process.
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During the worst of the contagion,
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one thing kept us making those perilous daily journeys into the Ebola wards.
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We had a passion to save lives.
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Was I afraid during the Ebola outbreak?
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Of course I was.
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But for me, the opportunity to protect our global health security
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and keep communities safe at home and abroad was an honor.
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So as the dangers became greater, our humanity became stronger.
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We faced our fears.
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The global health community working together defeated Ebola,
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and that ...
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that is how I know
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that we can defeat its aftermath
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in our hearts, in our minds and in our communities.
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Thank you.
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(Applause)
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