Originally appeared in The New York Times on Oct 10 2014.
When the Ebola virus began relentlessly spreading in Sierra Leone months ago, government officials made an urgent plea to Doctors Without Borders, all that appeared to stand between the country and chaos.
“They asked us to be everywhere,” recalled Walter Lorenzi, the medical charity’s former coordinator in Sierra Leone. “They didn’t know what to do.”
Not long after, the group opened a treatment center in Kailahun, in eastern Sierra Leone, that was hacked out of the bush in just 12 days. Before opening another center three weeks ago in the southern city of Bo, the organization ran three shifts of workers, 24 hours a day, when daily rain and equipment breakdowns delayed construction.
The first to respond to the Ebola crisis in West Africa, Doctors Without Borders remains the primary international medical aid group battling the disease there. As local health systems have all but collapsed and most outside institutions, including the United States military, have yet to fulfill all their pledges of help, the charity has erected six treatment centers in West Africa, with plans for more. Its workers have treated the majority of patients, just as they have in previous Ebola outbreaks and some other epidemics in the developing world.
But it, too, has been overwhelmed by the scale of this disaster. In Sierra Leone, it has been strained by the caseload, though it was wary of a decision by other health and government officials on Friday to treat most patients at home because of a shortage of clinic beds. In Guinea the day before, it reported that its two treatment centers were stretched to the limit. In Liberia, the organization is trying to improve the quality of care at its Monrovia facility.
While also maintaining its outposts in war zones and other danger areas, the group has pushed in recent weeks to do more in the Ebola epidemic — tripling its staff on the ground, opening its training center in Brussels to outsiders for the first time and offering guidance to others joining the fight.
“We decided to scale up; we decided to do things we’ve never done before,” said Dr. Joanne Liu, the international president of the group, which is also known as Médecins Sans Frontières, or M.S.F.
The group decided long ago that it could not depend on governments and other institutions, so it built a global infrastructure that sustains a robust supply chain to the field, like that of a far-flung army.
Its state-of-the-art supply depot in Brussels, for example, has sent hundreds of thousands of masks, protective suits, large tents and medical supplies to West Africa in recent months, getting them on the ground within 24 hours. To overcome obstacles, the Brussels logistics team is innovating — developing field tents rigged so workers do not get overheated, retrofitting body bags to absorb infectious fluids and seeking fast ways to dry wet boots that must be regularly disinfected.
To minimize risks, specialists in Brussels designed treatment centers that are precisely laid out: with single entry and exit points, strict separation of high risk and low risk areas, and space for health workers in a buddy system to watch over one another while removing contaminated protective gear. When a volunteer French nurse became sick last month, they resolved to make the safeguards tougher.
And the group has drawn on its legions of volunteers and billion-dollar base of donors who are attracted by its insistence on independence and record of providing care in places where often no one else dares to go.
Other aid organizations occasionally grumble about cockiness among Doctors Without Borders workers, safety protocols so rigorous they can seem like overkill and a focus on immediate help that does little to buttress local health systems over the long term.
But the organization, which won the Nobel Peace Prize in 1999, usually delivers. Even leaders of groups that have been criticized by Doctors Without Borders for a slow response to Ebola have praised its performance in the hot zone in recent months.
“Most people equate M.S.F. with courage, operating in conflicts,” said Dr. Bruce Aylward, an assistant director general of the World Health Organization. “This is courage of an equal magnitude when you realize how few others responded.”