TEDMED 2017
Soka Moses: For survivors of Ebola, the crisis isn't over
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In 2014, as a newly trained physician, Soka Moses took on one of the toughest jobs in the world: treating highly contagious patients at the height of Liberia's Ebola outbreak. In this intense, emotional talk, he details what he saw on the frontlines of the crisis -- and reveals the challenges and stigma that thousands of survivors still face.
Soka Moses - Doctor
Dr. James Soka Moses began his fight against Ebola by treating patients, moved on to survivor treatment and studies and now advocates for an enlightened global approach to pandemic prevention and response. Full bio
Dr. James Soka Moses began his fight against Ebola by treating patients, moved on to survivor treatment and studies and now advocates for an enlightened global approach to pandemic prevention and response. Full bio
Double-click the English transcript below to play the video.
00:25
June 13, 2014
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started as a routine Friday
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in Redemption Hospital in Monrovia,
the capital of Liberia.
the capital of Liberia.
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Redemption is the largest
free public health hospital in the city.
free public health hospital in the city.
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We are called upon to serve
hundreds of thousands of people.
hundreds of thousands of people.
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In the best of times
it puts strain on our resources.
it puts strain on our resources.
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Monthly supplies run out within weeks,
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and patients without beds
would be seated in chairs.
would be seated in chairs.
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That summer, we had a nurse
who had been sick for a while.
who had been sick for a while.
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Sick enough to be admitted
in our hospital.
in our hospital.
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But our treatment
didn't seem to be helping her;
didn't seem to be helping her;
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her symptoms were getting worse:
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diarrhea, severe abdominal pain,
fever and weakness.
fever and weakness.
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On that particular Friday,
she developed severe respiratory distress,
she developed severe respiratory distress,
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and her eyes were menacingly red.
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One of my fellow doctors,
a general surgeon,
a general surgeon,
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became suspicious of her condition.
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He said her symptoms
were suggestive of Ebola.
were suggestive of Ebola.
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We kept a close watch on her,
we tried to help her.
we tried to help her.
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We were treating her for malaria,
typhoid and gastroenteritis.
typhoid and gastroenteritis.
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We didn't know it,
but by then it was too late.
but by then it was too late.
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The next morning I walked in
to check on my patient.
to check on my patient.
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I could tell by the look in her eyes
that she was filled with fear.
that she was filled with fear.
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I gave her reassurance,
but shortly after ...
but shortly after ...
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she died of Ebola.
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For me, her death was very personal.
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But this was just the beginning.
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A virtual biological bomb had exploded.
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But the word spread faster than the virus,
and panic spread across the hospital.
and panic spread across the hospital.
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All the patients ran away.
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Then, all the nurses and doctors ran away.
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This was the beginning
of our medical tsunami --
of our medical tsunami --
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the devastating Ebola virus
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that left an indelible scar
in our country's history.
in our country's history.
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I was not trained for this.
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I had just graduated
from medical school two years before.
from medical school two years before.
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At this time,
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my total knowledge about Ebola
came from a one-page article
came from a one-page article
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I had read in medical school.
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I perceived the disease as so dangerous,
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this one page in essence had convinced me
to run out of the hospital, too,
to run out of the hospital, too,
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the moment I heard of a case of Ebola.
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But when it finally happened,
I stayed on and decided to help.
I stayed on and decided to help.
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And so did several other
brave health care professionals.
brave health care professionals.
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But we would pay a heavy price.
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Many persons and health professionals
had become high-risk contacts.
had become high-risk contacts.
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This actually meant 21 days counting
to potentially disease or death.
to potentially disease or death.
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Our health systems were fragile,
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our health workers
lacked skills and training.
lacked skills and training.
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So in the weeks and months that followed,
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health workers were disproportionately
affected by the Ebola virus disease.
affected by the Ebola virus disease.
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More than 400 nurses, doctors and other
health professionals became infected.
health professionals became infected.
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Unfortunately, my friend,
the general surgeon
the general surgeon
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who correctly identified
the symptoms in that first case
the symptoms in that first case
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became one of the casualties.
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On July 27, the president of Liberia
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imposed quarantine
on the worst-affected areas.
on the worst-affected areas.
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She closed all the schools
and universities
and universities
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and shut down many public events.
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Four days later,
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the United States Peace Corps
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pulled out of Liberia,
out of Sierra Leone and Guinea
out of Sierra Leone and Guinea
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due to Ebola.
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In August, six weeks after the nurse died,
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hundreds of people were dying
of the disease each week.
of the disease each week.
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People were dying in the streets.
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Over the months that followed,
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West Africa would lose thousands of people
to Ebola virus disease.
to Ebola virus disease.
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In August, I joined a team
to set up the Ebola treatment unit
to set up the Ebola treatment unit
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at JFK hospital in Monrovia.
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I was charged with running the second
Ebola treatment unit in the city.
Ebola treatment unit in the city.
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Our unit provided hope for thousands
of patients, families and communities.
of patients, families and communities.
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I not only provided care,
I came face to face with Ebola.
I came face to face with Ebola.
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Living every day as a high-risk
Ebola virus disease contact
Ebola virus disease contact
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during the worst of the outbreak
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was one of my worst experiences.
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I started counting 21 days every day.
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I lived every moment anticipating
the onset of symptoms of the disease.
the onset of symptoms of the disease.
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I measured my body
temperature several times.
temperature several times.
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I showered with chlorinated water,
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more concentrated
than actually recommended.
than actually recommended.
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I chlorinated my phones,
my pants, my hands, my car.
my pants, my hands, my car.
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My clothes became bleached.
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Those days you were alone,
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people were so afraid of touching anybody.
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Everyone was counted
as a potential contact.
as a potential contact.
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Touching would make them sick.
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I was stigmatized.
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But if that was what it was for me,
who was symptom-free,
who was symptom-free,
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imagine what it was for someone
who actually had symptoms,
who actually had symptoms,
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someone who had Ebola.
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We learned that to treat
Ebola successfully,
Ebola successfully,
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we had to suspend
some of the normal rules of society.
some of the normal rules of society.
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Our president declared
a state of emergency in August
a state of emergency in August
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and suspended certain rights.
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And the national police even supported
our work during the Ebola response.
our work during the Ebola response.
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In February 2015,
gang members came in for isolation
gang members came in for isolation
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in our Ebola isolation unit.
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They were also know
as the VIP Boys of Monrovia,
as the VIP Boys of Monrovia,
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terrifying small-time drug addicts
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whose presence could instill
a tremendous amount of fear,
a tremendous amount of fear,
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although they could not
legally carry guns.
legally carry guns.
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They underwent quarantine for 21 days
in our unit and were not arrested.
in our unit and were not arrested.
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We told the police,
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"If you arrest them here,
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they will stop coming,
they won't get treated.
they won't get treated.
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And the Ebola virus
will continue to spread."
will continue to spread."
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The police agreed, and we were able
to treat the VIP Boys,
to treat the VIP Boys,
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and they did not have to worry
about being arrested while in the unit.
about being arrested while in the unit.
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Over the course of the outbreak,
West Africa had almost 29,000 cases.
West Africa had almost 29,000 cases.
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More than 11,000 people died.
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And that included 12 of my fine colleagues
at John F. Kennedy hospital in Monrovia.
at John F. Kennedy hospital in Monrovia.
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In June 2016, exactly 23 months
after my first Ebola patient died,
after my first Ebola patient died,
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Liberia declared its Ebola outbreak ended.
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We thought that once the outbreak ended,
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so did the problems.
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We hoped that life
would go back to normal.
would go back to normal.
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Today, there are more
than 17,000 survivors in West Africa.
than 17,000 survivors in West Africa.
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People who actually had
Ebola virus disease,
Ebola virus disease,
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lived through it and survived.
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We counted survival rate as a success:
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the end of suffering for the patient
and fulfilling joy for families.
and fulfilling joy for families.
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Every discharge from the unit
was a moment of jubilation.
was a moment of jubilation.
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At least so we thought.
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The best description
of the moment of discharge
of the moment of discharge
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and a rare glimpse into the moment
that defines our life post-Ebola
that defines our life post-Ebola
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was vividly expressed
in the words of my best friend
in the words of my best friend
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and fellow doctor, Philip Ireland,
in an interview with "The Times."
in an interview with "The Times."
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He said at the time of his release,
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"There were a lot of people there
from JFK hospital:
from JFK hospital:
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my family, my elder brother,
my wife was there.
my wife was there.
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A lot of other doctors were there, too,
and members of the media were there.
and members of the media were there.
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And I felt like Nelson Mandela,
it felt like the 'Long Walk to Freedom,'
it felt like the 'Long Walk to Freedom,'
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and I walked and raised
my hands to the heaven,
my hands to the heaven,
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thanking God for saving my life."
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And Philip said,
"Then I saw something else.
"Then I saw something else.
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There were a lot of crying people,
people happy to see me.
people happy to see me.
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But when I got close to anybody,
they backed away."
they backed away."
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For many Ebola survivors,
society still seems to be backing away,
society still seems to be backing away,
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even as they struggle
to lead a normal life.
to lead a normal life.
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For these survivors, life can be compared
to another health emergency.
to another health emergency.
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They may suffer debilitating
joint and body pain.
joint and body pain.
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The suffering gradually decays
over time for most.
over time for most.
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However, many continue
to bear intermittent pain.
to bear intermittent pain.
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Some survivors are blind,
others have neurological disabilities.
others have neurological disabilities.
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Some survivors experience stigmatization
every day, in many ways.
every day, in many ways.
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A lot of children are orphans.
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Some survivors experience
post-traumatic stress disorder.
post-traumatic stress disorder.
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And some survivors
lack opportunity for education.
lack opportunity for education.
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Even families can be split apart
by fear of Ebola, too.
by fear of Ebola, too.
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There's no definitive cure
for transmitting Ebola virus through sex.
for transmitting Ebola virus through sex.
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However, there are successful
interventions for prevention.
interventions for prevention.
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We have worked hard on semen testing,
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behavioral counseling,
safe sex promotion and research.
safe sex promotion and research.
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For the past year, there have been
no cases of sexual transmission.
no cases of sexual transmission.
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But some male survivors
have lost their spouses
have lost their spouses
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out of fear they will be
infected with Ebola.
infected with Ebola.
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That's how families are torn apart.
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Another tremendous challenge
for Ebola survivors
for Ebola survivors
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is obtaining adequate health care.
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In theory, Liberia's public
health services are free of charge.
health services are free of charge.
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In practice, our health system
lacks the funding and capacity
lacks the funding and capacity
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to expand care
to all at the point of need.
to all at the point of need.
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Many survivors have waited
many months to undergo surgery
many months to undergo surgery
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to heal their blinding cataracts.
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Few had to relive
the traumatic experience,
the traumatic experience,
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when their blood was retested for Ebola
at the point of admission.
at the point of admission.
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Some survivors experienced
delayed or deferred admission
delayed or deferred admission
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due to limited bed capacity.
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No bed available for one more patient.
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This is neither national policy
nor officially condoned,
nor officially condoned,
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but many people are still afraid
of the sporadic resurgence of Ebola virus.
of the sporadic resurgence of Ebola virus.
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The results can be tragic.
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I have seen Beatrice, an Ebola
survivor, several times now.
survivor, several times now.
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She's 26 years old.
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Many of her family members
became infected, she luckily survived.
became infected, she luckily survived.
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But since that day in 2014
she was discharged
she was discharged
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to cheering health workers,
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her life has never been the same.
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She became blind as the result of Ebola.
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In 2014, the baby of a dear friend of mine
was only two months old,
was only two months old,
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when both parents and child were admitted
in an Ebola treatment unit in Monrovia.
in an Ebola treatment unit in Monrovia.
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Luckily, they survived.
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My friend's baby
is almost three years old now,
is almost three years old now,
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but cannot stand,
cannot walk, cannot speak.
cannot walk, cannot speak.
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He has failure to thrive.
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There are many more hidden experiences
and many stories are yet untold.
and many stories are yet untold.
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The survivors of Ebola
deserve our attention and support.
deserve our attention and support.
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The only way we can defeat this pandemic
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is when we ensure
that we win this final battle.
that we win this final battle.
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Our best opportunity is to ensure
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that every survivor receives
adequate care at the point of need
adequate care at the point of need
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without any form of stigma
and at no cost to them personally.
and at no cost to them personally.
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How can a society consider itself healed
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when a person's entire identity
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is defined by the fact
that they recovered from Ebola?
that they recovered from Ebola?
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Should a previous disease
that a person no longer has
that a person no longer has
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become the sum total of their identity,
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the identifier in their passport
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that deters you from traveling
to seek medical care abroad?
to seek medical care abroad?
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Simply the ID that denies you health care.
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Or prevents you from having
a relationship with your spouse.
a relationship with your spouse.
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Or denies you of family,
of friend or home.
of friend or home.
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Or prevents you from
carrying on your normal job,
carrying on your normal job,
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so you can put food on the table
or have a roof over your family's head.
or have a roof over your family's head.
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What is the meaning of the right to life
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when our life is clouded by stigma
and barriers that fuel that stigma?
and barriers that fuel that stigma?
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Until we have much better answers
to those questions in West Africa,
to those questions in West Africa,
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our work is not over yet.
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Liberians are a resilient people.
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And we know how to rise to a challenge,
even a devastating one.
even a devastating one.
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My best memories of the outbreak
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center on those many people
who survived the disease,
who survived the disease,
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but I cannot forget the hard-working
nurses, doctors, volunteers and staff
nurses, doctors, volunteers and staff
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who risked their own safety
in service of humanity.
in service of humanity.
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And some even losing
their lives in the process.
their lives in the process.
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During the worst of the contagion,
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one thing kept us making those perilous
daily journeys into the Ebola wards.
daily journeys into the Ebola wards.
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We had a passion to save lives.
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Was I afraid during the Ebola outbreak?
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Of course I was.
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But for me, the opportunity
to protect our global health security
to protect our global health security
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and keep communities safe at home
and abroad was an honor.
and abroad was an honor.
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So as the dangers became greater,
our humanity became stronger.
our humanity became stronger.
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We faced our fears.
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The global health community
working together defeated Ebola,
working together defeated Ebola,
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and that ...
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that is how I know
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that we can defeat its aftermath
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in our hearts, in our minds
and in our communities.
and in our communities.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Soka Moses - DoctorDr. James Soka Moses began his fight against Ebola by treating patients, moved on to survivor treatment and studies and now advocates for an enlightened global approach to pandemic prevention and response.
Why you should listen
At the height of Liberia's 2014 Ebola outbreak, newly trained physician James Soka Moses took on one of the toughest jobs in the country -- working in one of Monrovia’s largest Ebola Treatment Units, managing a high volume, highly contagious patient population while adopting a collaborative, systems-based public health approach. Once Ebola transmissions reduced, he turned his focus to Liberia’s thousands of survivors through the Ebola Survivor’s Clinic, providing treatment, support and training for patients and leading an important program to mitigate sexual transmission of the disease. In 2017, Moses was featured in the CNN documentary Unseen Enemy, which recounts the effects of the Ebola, SARS and Zika pandemics, as well as the consequences of emerging infectious disease threats on global health security.
Soka Moses | Speaker | TED.com