Dr Maria Barstch spends her days in the small house that serves as MSF’s Ebola survivor clinic in Freetown, Sierra Leone. The peak of the epidemic may have passed in Sierra Leone but new cases continue to emerge almost every day, and with new cases come new survivors. While they are relieved to have defeated the deadly virus, some survivors are facing other debilitating symptoms of the so called “post-Ebola syndrome.”

Across from Dr Maria sits Mamadou, a young boy who looks no more than 11. He’s 15, he says, he had his birthday in December, the same month he lost his mother to Ebola and just before he fell ill himself. “Ow da body?” asks Dr Maria, in Kriol, a local language. Mamadou stares at the floor. He had never seen a doctor before contracting Ebola, but now makes sure to see Dr Maria every week.

MSF has also opened a survivor clinic in Liberia, housed at the site of MSF’s new pediatric hospital in Monrovia. In both Liberia and Sierra Leone, many survivors have previously sought treatment at local public or private hospitals and clinics but were refused care as soon as staff knew they were Ebola survivors.

“They are afraid of us. Even when you show your survival certificate people take a step back and say they cannot do anything for you,” says Jestina Dorley, one of the  patients who survived Ebola at ELWA 3 in Monrovia. For other survivors, money is another constraint with Ebola having left them without jobs and support systems. Even basics like food and shelter, let alone healthcare, are a real struggle.

Dr Maria flicks through Mamadou’s files to remind herself of the health issues she has helped him with during his previous visit: inflammation in his left eye, nondescript itching all over his body, , body aches and weakness.

“I see a lot of people with severe joint pain,” says Dr Maria. “I also see a lot of rashes and skin infections, eye problems, general fatigue and weakness and genito-urinary tract infections. Many issues can be treated very easily here in our clinic but without treatment some of the complications can be very severe and can cause irreversible damage.”

One of the most common and serious complications seen in Ebola survivors like Mamadou is an inflammation of the eye called uveitis. It is a complication also seen after other severe viral illnesses but the results can be debilitating.  “This is where we, at the MSF survivor clinic, can have a huge impact,” adds Dr Maria. “Most patients suffering from uveitis can be treated with eye drops by an ophthalmologist but, if left untreated, uveitis can lead to blindness. We refer patients to the specialist before the damage becomes irreversible and the success rate is high.”

Invisible scars: signs of depression among Ebola survivors

The mental health impact of surviving Ebola cannot be underestimated. Tony Henry is an Ebola survivor from Monrovia: “For many of us, surviving Ebola means coming back to an empty house where most of our loved ones passed away, to a job that is no longer there, to a neighbourhood where old friends are now avoiding you.”  

MSF psychologists see patients like Tony every day. “Our initial observations indicate that, three months after discharge, around one quarter of the survivors followed up by MSF showed signs of post-traumatic stress disorder and a similar proportion presented signs of depression. Some also suffered from memory loss and recurrent nightmares,” says Dr Richard Bedell, MSF’s Project Medical Referent  in Liberia.

But there is hope according to Dr Sylvia Wamser, MSF psychologist in Freetown: “It is very nice to see how open patients are to receiving mental health care. We listen to them and explain that what they are experiencing is actually a very normal reaction to an abnormal situation. We help them unlock coping mechanisms and also teach some easy breathing exercises which helps deal with anxiety. For many patients we see improvements within four or five sessions.” 

Integrated care for survivors crucial

MSF’s two survivor clinics – one in Freetown, and one in Monrovia – have so far provided more than 1000  outpatient   consultations. This two-pronged approach, combining adequate medical   and mental healthcare, is essential to provide the support required after having survived Ebola. As the epidemic continues, and as more patients survive the disease, MSF will continue its efforts to ensure patients are not left to cope alone once they leave an Ebola management centre.