The Seattle Times Jerry Large column

Aug. 07--Dr. Elinor Graham and her friend, Dr. Roseda Marshall, are two remarkable doctors united by their concern for the well-being of the Liberian people. In recent weeks they have been gathering medical supplies and raising awareness about Liberia among Americans.

Liberia is one of several West African countries struggling to contain an Ebola outbreak that has taken almost 900 lives so far. And it is one of the three most affected countries, along with Sierra Leone and Guinea, none of which is equipped to combat what is already the most deadly outbreak of Ebola ever recorded.

Marshall, who is Liberian, and Graham, an American who lives in Southeast Seattle, have spent years trying to improve medical care in Liberia because even when there is no crisis, too many Liberians die for lack of proper medical care, sanitation or clean water.

Watching the outbreak unfold from Seattle, Graham is concerned with how Americans see Liberians. Liberians run the gamut from good to bad, like we do, and mostly they are ordinary people facing challenges it may be hard for Americans to understand. Right now, she said, they need our empathy.

Many people in Seattle are helping. My colleague Sandi Doughton has reported on local research in search of a cure. The Bill & Melinda Gates Foundation made a grant of $1 million on July 18, to the U.S. Fund for UNICEF in response to the outbreak. A spokesman for the foundation told Doughton the money will support UNICEF efforts to provide critical medical and hygiene supplies, strengthen coordination among those engaged in outbreak response and get vital information to affected and at-risk communities.

Graham and I talked at her home about Liberia and about the work she and Marshall do. Graham is constantly talking to people in Liberia and told me that during the initial impact, "Virtually every morning I was crying."

Graham is a pediatrician who taught at the University of Washington and practiced at Harborview Medical Center until she retired in 2008. She went to Liberia in the spring of 2009 after accepting an invitation through a program of the Yale University School of Medicine, and she's gone back once or twice each year since. She was last there in December, and she plans to return this December.

At first, she was seeing patients and trying to help organize health-care systems, but her work there now is mostly about helping make it possible for Liberia to educate more medical specialists. That first year, she said, "I was the only pediatrician in the country." There are others now, including two recently trained Liberians.

There is also Marshall, who worked for 25 years as a pediatrician in Baltimore before retiring after her husband's death and returning to Liberia in 2011. She hasn't rested since.

Marshall oversees an orphanage she founded, and serves as head of pediatrics at the A.M. Dogliotti School of Medicine and as president of the Liberia College of Physicians and Surgeons, which she helped found to train specialists.

She and Graham said Liberia trains doctors, but if those doctors want to become specialists, they have to leave the country for training, and, as is often the case in developing nations, many decide not to come back but to opt for a better life abroad. Many choose the U.S., which has shared history with Liberia.

In the 1820s, the American Colonization Society (and other organizations) began sending formerly enslaved people to the area that became Liberia. The land was already contested by several indigenous groups of people, but they all were dominated by the well-armed newcomers who essentially re-created the plantation society they were accustomed to with themselves at the top this time.

The Americo-Liberians were overthrown in the first civil war, in 1980. The new repressive government was overthrown by another; then, that government was overthrown. In 2005, Liberia became a true democracy, and now, only a few years into the beginnings of recovery, it has been struck by the deadliest virus we know.

Three civil wars in quick succession left the country without the kind of infrastructure needed to cope with the challenge Ebola presents. Even things we take for granted, such as gloves for doctors, are always in short supply. Both women are working to get more medical supplies to the country.

Brave Liberian health-care workers have died because they didn't have proper protective gear. They risk their lives even thought there is no life insurance or a program like Social Security for their own families.

Marshall comes to the U.S. every summer to visit her family, (one of her daughters is a physician in California), but this year she's working to generate support for the fight against Ebola.

In a speech at Johns Hopkins University on Tuesday, she said, "This disease is a disease of poverty. It's a disease of lack of education. It's a disease of mistrust or lack of trust. It's a disease of poor health infrastructure."

Those circumstances prevent the country from quickly containing Ebola. She is trying to address all of them in her work, training doctors, working to inform the public and improve the infrastructure. And she's stayed on in the U.S. to find money and supplies to plug holes while the work toward self-sufficiency continues.

The work she and Graham do toward sustainable infrastructure and education is part of the long-term solution. "We need sustainability," Marshall told me in a phone conversation. "We have to rise to the occasion. We don't want at the end of this to go back to zero."

Graham and Marshall noted the increasing Chinese investments in Liberia, and she said expatriates are investing, too. This week's White House summit with African leaders is a recognition (a long time coming, Marshall notes) that the world is changing.

It's important for Americans to see both the struggles and the potential of countries such as Liberia and, through our votes and voices and choices, to support their work toward self-development.

Jerry Large's column appears Monday and Thursday. Reach him at 206-464-3346 or jlarge@seattletimes.com

Information in this article, originally published August 07, 2014 was corrected August 07, 2014 A previous version of this story incorrectly stated that Guinea Bissau was among the three countries most affected by an Ebola outbreak.

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