MONROVIA/DAKAR (Reuters) - The two women came from opposite ends of Liberian society - one a beauty queen and daughter of a prominent lawmaker, the other an ordinary home maker from a remote northern town.
When they both needed urgent healthcare, however, these differences meant little. Neither had the deadly Ebola infection, but both were turned away from hospitals overrun by an outbreak that has killed more than 3,800 people, 2,200 in Liberia alone.
In the end, it was Comfort Fayiah, the ordinary 27-year-old, who survived, giving birth to twins in the street as passers by did what they could to provide some privacy.
Nikita Forh, 21, died at her father’s plush Monrovia home, unable to secure the treatment she needed to fend off an asthma attack because doctors at the JFK hospital in the capital requested a certificate proving she did not have Ebola.
“I told them that if I carried my daughter home she would not make it through the night, but they did not listen,” Edward Forh, a member of the house of representatives for Montserrado County, told national radio.
“My daughter died before my eyes like a dog. Those nurses killed my child,” he said. “I will sue the government.”
Liberia’s Medical and Dental Council says it is investigating Forh’s case and warned that any medical staff caught rejecting or refusing sick people would be investigated.
“We took an oath to restore or protect lives,” Dr John Mulbah, the council’s director, told a news conference.
With Ebola, that oath has become much more complicated. Medics lacking equipment and training fear unwittingly exposing themselves and other patients to Ebola in caring for other healthcare needs.
The cases highlight how the trail of social and human destruction Ebola has left in its wake as it spreads through Liberia, Sierra Leone and Guinea extends far beyond just those who contract the deadly haemorrhagic fever.
Health systems which were already struggling to tackle issues ranging from malaria to complicated pregnancies before Ebola have since been utterly overwhelmed.
Many clinics became places of infection rather than treatment so were closed down. Health systems have been gutted of personnel, some too afraid to come to work while others have succumbed to the deadly virus.
Liberia had only had around 50 trained doctors for the country’s 4 million people before the outbreak of Ebola struck.
According to the latest figures from the World Health Organisation, across the region, 382 healthcare workers have caught Ebola. Of these, 216 have died, with Liberia and Sierra Leone being hit particularly hard.
Over six months into the Ebola outbreak, the global response is slowly picking up steam. Hundreds of millions of dollars in aid and equipment have been pledged and new beds for Ebola patients are gradually being rolled out.
Liberia is gradually scaling up the number of emergency treatment centres from six at present to around 20, a development for those without Ebola as well as those with it.
“The purpose of increasing the number of Ebola treatment units is (also) to allow medical staff at other facilities to know that they are safe when treating other patients,” said Sean Casey, emergency team director at International Medical Corps, which runs a treatment centre outside Monrovia.
Casey cited the case of a man who tested negative for Ebola but was referred to another clinic to be checked for tuberculosis. “We had to intervene directly with the hospital director to demonstrate this man did not have Ebola and only then did they eventually accept to treat him,” Casey said.
Health experts have warned that deaths from diseases like malaria, diarrhoea and pneumonia are likely to soar in West Africa as people are either unable or unwilling to make it to clinics to get treatment.
Deaths from malaria alone, which even before the Ebola crisis killed around 100,000 a year in the West Africa region as a whole, could increase four-fold in Ebola-hit countries as people miss out on life-saving treatments, experts have warned.
It is already happening.
Medecins Sans Frontieres (MSF), the leading international medical charity on the ground, commissioned research that found a drastic drop in availability and use of heathcare in Monrovia in August compared to the same month in 2013.
The number of beds available were down by 47 percent and in health structures that remained open, there were 49 percent fewer outpatient consultations. Research also showed antenatal care down 40 percent and 41 percent fewer assisted births.
“We are entering the peak season so with health centres being closed and people self treating, we would expect the mortality of malaria to be very high this year,” Thomas Curbillon, head of MSF’s mission in Liberia, told Reuters.
“The only thing (people) can do is treat themselves,” he said, adding that MSF was working to get as many other health structures functioning as possible.
UNFPA, a U.N. agency that works on pregnancy and family planning, estimates that in neighbouring Sierra Leone, there will be some 123,000 pregnant women and girls in 2015. Half a million more would be expected to seek contraception.
However, in a briefing on the impact of Ebola there, it says there are already clear signs of people steering clear of health facilities for fear they will catch Ebola.
Between May and July, the number of women attending reproductive health clinics fell by 25 percent. The number of people seeking family planning help at Marie Stopes clinics had fallen by over 90 percent, it added.
“If this trend continues, drastic increases in maternal mortality, infant mortality and unwanted pregnancies are to be expected,” UNFPA warned.
Writing by David Lewis; Additional reporting by Daniel Flynn in Monrovia; editing by Philippa Fletcher