A relief van drives through the Kono District of Sierra Leone during the rainiy season. (Laura Miller)

It’s been nine weeks since the first case of Ebola hit Sierra Leone, the epicenter of the outbreak ravaging West Africa. There are now over 600 confirmed cases in the country—and 200 deaths.

Sierra Leone has fallen into turmoil. Health workers have been attacked, schools have shut down, and the government has declared a state of emergency.

“I don’t think the world ever expected what has happened here,” said Laura Miller, the health coordinator for the International Rescue Committee.

As the overall death toll in West Africa climbs toward 750, aid workers like Miller are rapidly shifting gears from development projects to disease containment.

Miller has spent the last three years in West Africa, working to help improve health conditions for Sierra Leonean mothers and children. In a country still rebuilding from a crippling decade-long civil war, her job was already difficult. Now, Ebola threatens to undo years of hard-won advances. Not only is the disease killing health workers, it’s sowing panic and distrust.

“It’s just really horrible,” said Miller in a recent Skype interview from the Sierra Leonean capital, Freetown. “I’ve been here for a long time. It’s just kind of like everything we’ve done for years is just falling apart.”

Miller, 31, grew up in New Haven, Connecticut, where her father was a physician and her mother a midwife. She attended Temple Emanuel in nearby Orange. “I was interested in traveling and I was raised by parents with a very strong social conscience,” she said. “That kind of combination often leads to doing international work.”

In college, at Clark University, Miller got involved with an organization that helps people apply for political asylum in the U.S. That led to work with political refugees in Ghana, where she began to see health care as central to the fight for of human rights. She enrolled in a public health master’s program at Columbia University.

While in graduate school, Miller worked in Uganda for the IRC, an organization founded in 1933 to help resettle German-Jewish refugees. When she graduated, the organization sent her to Sierra Leone, where she fell in love with the country and the people.

“My job used to be mostly focused on reproductive and child health,” Miller said. She had been overseeing efforts to provide clinical support in health centers, making sure they were equipped with basic supplies like gloves and syringes. She had also been working to establish blood banks to help mothers survive postpartum hemorrhaging, the cause of one in four maternal deaths in Africa.

That work was Miller’s life for the past three years. Then everything changed.

On May 26, the Ministry of Health announced the first confirmed case of Ebola in Sierra Leone. In the weeks since then, Miller has been working 14-hour days, trying to figure out how to contain the disease and making hard decisions about how to spend limited resources—like spending $5,000 to fix the electricity at a mortuary.

The IRC is also enlisting community leaders to go door to door in an effort to reduce fear and panic by explaining how the disease spreads and encouraging people to seek help if they should contract it.

It’s harder to get Ebola than people think, Miller said. “You have to physically ingest somebody’s bodily fluids at a time that they are severely sick.” But once you get it, your chances of survival are slim. “There’s no other disease that’s like Ebola,” Miller said. “Over 50 percent will die, and they will die fast and pretty ugly.”

The virus lives on in the body of the host, even after death. This presents a particular danger in Sierra Leone, where death rituals are an important part of the culture. “There’s a lot of touching of the body in Sierra Leone,” Miller said. “Usually female leaders are involved in the cleaning.” In the case of an Ebola death, that can mean exposure to large amounts of blood.

One of the IRC’s main challenges is convincing people to send infected family members to get care. “It’s really hard to put someone you love away, knowing they’re going to get on an ambulance and die alone and be buried in a mass grave,” Miller said.

The threat of an Ebola outbreak isn’t only the loss of life to the disease, but what Miller calls “the non-Ebola Ebola victims,” people harmed by the hysteria that accompanies an outbreak. That includes all the people who won’t go to a health facility for fear of infection: Children with malaria won’t be treated; mothers will give birth at home without medical supervision.

Matters are further complicated by the fact that health workers have the highest risk of infection.

“A health system does not function without health workers,” she said. The country already had a shortage of trained doctors and nurses, due to the civil war’s interruption of education. “Losing 100 to 200 health workers in Sierra Leone would be catastrophic.”

Miller said she herself is not in danger, since she doesn’t work directly with Ebola victims. The IRC has yet to lose any staff, but many of the 200 Sierra Leoneans who work for the organization have lost family members.

Every previous Ebola outbreak has been contained, but Miller has found herself wondering: What if this one isn’t?

Thomas MacMillan is a freelance journalist based in New York. You can follow him on Twitter @TRMacM.

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