by Dr. James Appel

“EVERYONE IS EXCITED ABOUT THE MILLIONS OF DOLLARS”— Adventist Mission Doctor Speaks Out on the Ebola Crisis and Foreign Aid–Monrovia, Liberia, September 15, 2014.

Dr. Gillian Seton, a young surgeon trained at Loma Linda University, has been at the SDA Cooper Memorial Hospital in Liberia in the midst of the Ebola virus plague ravaging that country since February, 2014.

Dr. James Appel has been asked by Adventist Health International to join her in the overwhelming job of providing care for non-Ebola cases that have been neglected due to other hospital closures by Ebola quarantine.  Dr. Appel is a very experienced mission doctor and has written extensively about providing Seventh-day Adventist health care in the Muslim country of Chad since 2004.  His blogs about their daily experience caring for patients during the Ebola Crisis are available at

After one month in Liberia, working with Dr. Seton and her dedicated Liberian nurses and doctors, Dr. Appel daily triages Ebola patients.   The problems of preventing spread of this deadly disease in an impoverished community are a daily reality to this small team of Seventh-day Adventist health care workers.  As a massive and expensive foreign aid campaign slowly begins to respond to this crisis, Dr. Appel offers a very insightful analysis of what is wrong and what could be right from the donors and governments belatedly rushing in to “help.”  These deeply insightful comments were written by Dr. Appel  from Monrovia, Liberia  Monday, September 15, 2014.  Adventist Today feel his opinions deserve to be considered by all donor organizations, and his article is reproduced here with Dr. Appel’s permission:

I don’t mean to be critical—

by Dr. James Appel

I don’t mean to be critical.  I can’t really know what’s going on.  I’m just a simple family doctor working in a hospital.  I’m not really even taking care of Ebola patients.  How could I know why Liberia is losing the fight against Ebola? 
I haven’t sat on any NGO (non-governmental organization) committees or listened to the WHO (World Health Organization) discussions or to what the CDC (Centers for Disease Control) has to say.  I’m just ignorant.
But I’m going to give my opinion anyway.

Losing a fight

Liberia is losing the fight against Ebola because they are depending on NGOs and an influx of Western money instead of traditional ways of dealing with epidemics.  The first few Ebola epidemics were in remote villages where the villages touched by Ebola were self-quarantined according to ancient traditions of dealing with plagues.  No one went in and out, and the surrounding communities brought them food.  The caregivers washed themselves and their clothes rapidly and frequently after each contact with the patient, just using simple soap and water.  Very few ever got sick, and the disease was controlled in a few months.


Here in Liberia, everyone is excited about the millions of US dollars being poured in to “fight Ebola,” and everyone wants a piece of the pie.  A certain NGO out in rural Liberia quarantined a village, claiming they’d tested and found three cases. They applied for and received US$ 250,000 to fight Ebola in this village.  They brought in a few sacks of rice and some chlorine.  The villagers mobbed the trucks and carried off the plunder.  And, miracle of miracles, not a single person died in the village. 
Great effort at treating and controlling Ebola?  Or pretending there’s Ebola in order to pocket some easy cash?  I’ve never heard of a 0% fatality rate for Ebola, but you make the call.

Dozens of Land Cruisers

NGO’s spending hundreds of thousands of dollars to level earth with heavy equipment over a month in order to build tent cities capable of isolating and treating Ebola, but then not even giving them IV fluids or food, so that the Ebola patients sneak out of the tents and cross the street looking for food. 
Dozens if not hundreds of US$70,000 Land Cruisers are taking foreigners around town to hotels, bars, clubs, and fancy guest houses so they can feel comfortable while they fight Ebola, and yet they can’t even collect the dead bodies that could expose so many more! 
We’ve had bodies left for up to three days.  Others have stayed in the open for up to five days before being collected.  Patients are often turned away from the Ebola centers, and some have even refused to take anyone who doesn’t come in an ambulance.  How many of the poor in West Point slum can afford an ambulance, even if there were enough available to take them?


Low-Tech Solutions

I propose the following solution.  I got the idea from a seasoned MSF doctor named Cameron.  (MSF is Médecins Sans Frontières, or Doctors Without Borders.)
There are two reasons people call the Ebola hotline: they have a dead body they suspect of Ebola, or they have a live patient they suspect of Ebola.
If there’s a dead body, the hotline should alert some local drivers with old beat-up pickup trucks, and the first one to the site gets the body.  Of course, they will be given full protective gear.  If they bring the body in within 3 hours of the call they get US$50; if they bring it in within 6 hours of the call they get US$40; if within 12 hours, US$30; if within 24 hours, US$20; if after 24 hours, US$10.  If after 48 hours, US$5.  This will motivate people to quickly get the bodies and bring them in to be tested and buried appropriately, with minimal chance for contact and spread.
If it’s a live patient suspected of Ebola, a taxi can be called and for a few dollars take a nurse or lab tech out to the site in full protective gear.  They will draw blood for Ebola testing, take the address and contact info, give the family a box filled with gowns, gloves, masks, rubber boots, bottles of chlorine, antibiotics, anti-malarials, oral rehydration salts and anti-vomiting medications.  They will contact the community leaders, who will ensure that the family is not only quarantined in their compound, but also provided with food and water.

Local economy

All this could be done for a fraction of the current funds being used, and would be more effective, because the patients would all get the individual care that only a family member can give, including adequate food.  It would also be more effective because you’d be using local methods and using the money to invest in the local economy instead of paying the high costs of plane tickets, salaries, living expenses, transportation costs, etc., of foreign aid workers.

Working alongside

I’m not saying that there shouldn’t be foreigners involved.  I’m just saying that the foreigners should be working alongside the Liberians, helping them to find a solution to the Ebola problem, not trying to impose Western ideas that obviously aren’t working.  Foreigners should not be bringing in a lot of money that is spent on things that will just make the Liberians envious and want to share in the spoils of aid money.
Sorry for speaking my mind so frankly, but sometimes I just can’t seem to hold it all in, whether people like it or not.

(Please like or share this article, especially if you have contacts in the donor community responding to the Ebola crisis.  Donations to Adventist Health International to support Dr. Seton and her staff can be made at )