GANTA, LIBERIA — The site of the U.S. military’s future Ebola treatment center is now an overgrown grassland next to an abandoned airstrip on the Guinean border.
Two miles away, in a converted eye clinic that now houses a makeshift Ebola ward, this county’s sole doctor is waiting. He will soon run out of protective gear. Some of his employees haven’t been paid for a month.
“We all know we need the new treatment center,” said the doctor, Paye Gbanmie. “I worry that we could run out of space here.”
The U.S. military aims to quell that anxiety when it erects the new treatment center, slated to be finished later this month and manned by newly imported doctors. Just the sight of American helicopters flying over Ganta, a city of about 50,000, has lifted hopes here.
But a modern treatment center won’t be enough to eliminate Ebola in a place where the outbreak appears to rise and fall every few weeks and where victims sometimes disappear into remote communities with the disease. The question is whether those victims can be persuaded to use the new facility once it is built, preventing the spread of the disease in some of the country’s most vulnerable areas.
Although it once looked as if Ganta might be spared from the epidemic, that illusion was shattered in August, when people with the disease began fleeing from Monrovia, the epicenter of the outbreak. Many of them ended up here, a six-hour drive away, in search of care in the homes of their relatives and away from the capital’s congested slums.
Almost as soon as they arrived, they infected dozens of their friends and family members.
“Monrovia might be the best place for work or school, but this is where they come when they’re sick,” Gbanmie said.
Roseline Tokpah, 40, was one of the first. She left Monrovia and made the nearly 200-mile trip to her family’s native village on the outskirts of Ganta. Her parents, brothers and sisters tended to her. Her pastor prayed over her. All of them made physical contact. After she died, Liberian health officials traced about 30 Ebola cases in Ganta back to her. Many of them died, too.
“We didn’t know it was Ebola. We didn’t see the sickness in her,” said Alphonso Togbah Mulbah, her cousin and one of her few surviving relatives.
After that, the circle of transmission continued to widen. Health officials have recorded more than 100 suspected or confirmed Ebola cases here since August. Many more likely went unrecorded. Without nearby health facilities (the renovated eye clinic only opened in early October), options were limited.
Health officials say they have seen progress in slowing the spread of the disease in some parts of Liberia. In Monrovia and other key cities, there are now available beds in Ebola treatment centers. Awareness of Ebola and the need to treat it appears to have grown.
In Ganta, the military’s new treatment center will be an asset, taking the burden from overworked doctors like Gbanmie. But it will not end the outbreak in Nimba County, where Ganta is located and where it is impossible to know how many infected people are living in the forest or in the slums.
Many still don’t seek treatment, infecting many of those around them. To public health experts, one day it can look as if they are winning the fight against Ebola, and the next it is as if the outbreak has started all over again.
When Morgan J. Hennessey arrived in Ganta to work for the Centers for Disease Control and Prevention in early October, Ebola appeared to be in one of its quiet stretches in the county.
“I was thinking, ‘Why did they send me here?’ ” said Hennessey, a doctor who lives in Fort Collins, Colo.
And then yet another Ebola victim found his way from Monrovia to Nimba County. He rode on the back of a motorcycle, arriving at a refugee camp for citizens of the Ivory Coast. Within hours, he had made physical contact with more than 28 people — many of whom were now expected to come down with the virus.
“There was nothing, nothing, nothing,” Hennessey said. “And then it was suddenly like, ‘This is going to be really bad.’ ”
It was a lesson for Hennessey about how the virus worked.
“It’s like a fire. It just takes one spark — especially one spark in the wrong place — for things to get really bad.”
Since August, a steady stream of people with Ebola have made the trip from Monrovia to Nimba County, and the cycle of infection has repeated itself anew. The names of those people, like Tokpah, are now known across the county and uttered with bitterness.
Ebola victims are still being treated at home in Nimba County. Their families refer broadly to the care from relatives as “country medicine.”
Would they be more inclined to seek treatment in a facility built by the United States? Liberian officials are counting on that, but locally, country medicine still has a huge appeal.
“Maybe the message just moves slower here,” Hennessey said.
The idea for the Ganta treatment center was born as both American and Liberian health officials took notice of the trends in Nimba County during late summer. Their priorities are in part based on “the changing patterns of epidemiology — basically where the outbreaks are occurring in Liberia,” said Carol Han, a U.S. Agency for International Development spokeswoman.
Many of the health workers being trained by USAID will be dispatched there. But they will not arrive until about four months after the disease’s August crescendo.
“Training of health-care workers commenced this week with a pilot course and is expected to train up to 500 workers per week,” Capt. R. Carter Langston, a spokesman for the U.S. military in Liberia, said Thursday.
In early September, local officials in Nimba County realized that the problem was not just about the lack of health-care facilities. It was about the way the disease could sneak into the county and explode. They tried to invent their own solution.
The road to Monrovia — partially paved by Chinese development funds — meant that what happened in the capital would continue to happen here. Just like its carriers, the disease could get to Ganta in under six hours.
Officials decided they would have to block the road to the capital, even if it meant keeping food and other resources out of Nimba. They created a police checkpoint.
“It seemed like the only way,” said D. Dorr Cooper, the mayor of Ganta.
But that quickly proved to be untenable. There were too many cars to stop. It was too valuable a transit route.
“We realized we couldn’t lock ourselves out of the rest of the country without creating an economic crisis. We gave up the idea,” Cooper said.
Teams trained by international agencies have been sent to spread word across Nimba about Ebola’s danger and the need for formal medical care. So far, that campaign appears to have been less effective here than in other parts of the country.
When the military finishes its treatment center late this month, it is unclear how many of the cases in Nimba County will be treated there and how many will remain at home. But the peaks and troughs of the disease will continue, regardless of treatment methods.
“We know it’s not over,” Cooper said. “It could get bad.”