海角大神

Back in聽May, when the Ebola virus first crossed over from Guinea into Sierra Leone, among the first to know were staffers working for a聽US-based charity on a child malnutrition project in the country鈥檚 east.

Catholic Relief Services staffers began switching from malnutrition to Ebola prevention when the first cases were confirmed聽in neighboring Guinea. But with limited resources and knowledge聽of how to combat the disease, they were outgunned when it came to聽Sierra Leone.聽聽聽

鈥淚t moved from one town to a slightly more major town. Then it was in the next district, where our office is. [We were] watching it creep along,鈥� says CRS country health program manager Meredith Dyson.

鈥淚 don鈥檛 think that anyone at that point saw where it was going to go or understood the measures that were going to be needed to聽contain聽it.鈥澛�

Now some of the community members聽that聽worked on the malnutrition project are dead. CRS鈥檚聽child nutrition聽program has been suspended,聽along with scores of聽other聽non-Ebola aid and development projects聽in Sierra Leone, Guinea, and Liberia 鈥� their staff and funds frozen or diverted to the emergency response.

Nearly 4,500 people have died of the Ebola outbreak, virtually of all of them in just three West African countries. At the same time, people are dying of聽malaria, malnutrition, HIV/AIDS, birth complications, and countless other health problems.聽Countries are also grappling with聽low literacy rates, environmental degradation, and hunger.

Still, before the epidemic, generally things were improving, say aid workers. In Liberia, life expectancy rose from 55 years at birth in 2005 to 60.6 in 2013, according to the United Nations Development Fund. Guinea and Sierra Leone also saw improvements in life expectancy over the same period.聽

Now,聽if and聽when Ebola is finally聽brought under control, that聽modest聽progress may have been thrown aside in poor countries that depend almost entirely on foreign aid.聽

鈥淚t鈥檚 a big blow,鈥� says Asmare Ayele, country director in Sierra Leone for CARE International, an international aid organization. 鈥淪ierra Leone just came out from a 10-year war. It was declared a stable nation at the UN in March.鈥�

Figuring out what is 'essential'

Aid organizations in the region are struggling to balance their desire聽to keep their projects going聽with the risk posed to staff and recipients by Ebola.

One major hurdle: Many aid聽programs depend on gathering people together in one place, which has been banned聽in the worst affected areas.聽That means organizations have to think hard about which meetings or events are truly 鈥渆ssential,鈥� says Trevor Hughes, director of risk management and global security for International Relief and Development in Arlington, Va.

He says he would define essential as 鈥渆verything that you need to have in a society that is somewhat functioning and not going backwards.鈥�

That backward slide has already begun, with warnings of food shortages in some countries. 聽The crops CARE helped support聽in Sierra Leone聽have either withered in the fields or in the homes, with no market to bring them to. A CRS malaria program in Sierra Leone is on hold because it鈥檚 no longer safe for the community workers to draw blood in the village.

Many existing聽health聽programs聽in West Africa聽have been retooled to target Ebola directly. HIV/AIDS messaging is now Ebola messaging. Immunization efforts might now be Ebola detection efforts.

But the epidemic has ravaged already weak healthcare systems.聽According to USAID, only 40 percent of Liberia's public health facilities are operating.

Radio plugs education gap

Still, not all foreign-funded programs have been put on ice. Lisa Hartenberger Toby, an international development specialist with Education Development Center, says their work has expanded.聽The Massachusetts-based charity does education and health projects around the world, including in Liberia.

Their radio program-based education program, allowing non-traditional students to learn from home, is now being expanded to include primary school age students whose schools have been indefinitely closed.聽

鈥淚t鈥檚 always a struggle to make sure [education] is considered as part of the emergency response strategy, not a secondary one,鈥� she says.

Some聽aid聽organizations are pushing to restart programs that were suspended, arguing that the epidemic shouldn鈥檛 preclude other health interventions.聽In Sierra Leone, CRS is lobbying the government for the resumption of routine services like immunizations and prenatal care, Ms. Dyson says.聽

鈥淲e really don鈥檛 want to lose the gains we鈥檝e made. There鈥檚 a lot of [activity] right now to put more focus on those issues.鈥�

Organizations with non-health workers say that they too, are essential, even if they can't help with Ebola treatment. Newly arrived organizations have struggled to penetrate the tight-knit and distrustful communities to teach proper prevention and containment, but those who have been in the country for years have networks and the trust of locals.聽

While some staff have been evacuated from Ebola-affected countries, others have stayed. Many are in out in the communities getting the word out on prevention, distributing protective equipment, and delivering food and water.

One of the biggest challenges for organizations is getting workers to admit when it's become too much and they need a break, Mr. Hughes says.

"This is going to be a long-term thing and there is always too much work to聽do," he says.聽鈥淚t鈥檚 extraordinarily demoralizing to reach the end of your tether and get on an airplane and fly home鈥� You see what you left behind and it鈥檚 not going to end anytime soon.鈥�