Risk Is Right, Says Ebola Survivor and Missionary Nancy Writebol

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Staff writer, desiringGod.org

Nancy Writebol, 59, would prefer to be known simply as a Christian, wife, mother to two grown boys, and grandmother. But after an adventurous few months, she’s now known to the world as a brave missionary, Ebola survivor, and success story of medical evacuation. Having been featured on every major television news outlet and in every major newspaper, those who recognize her in public approach her with gratitude for her courage, or they draw back, as if the Ebola virus still lingers in her presence.

Along with her husband of 40 years, David, she was serving as a missionary in Monrovia, Liberia, before the Ebola outbreak. They served in a hospital that would become a frontline defense against the disease.

Among her duties, Nancy helped to dress doctors and nurses into their biohazard suits (PPEs) before they entered the Ebola isolation unit. The work is messy and dangerous, so the protocol is strict: Doctors and nurses in scrubs put on boots, Tyvek suits, surgical masks over their face, goggles over their eyes, Tyvek hoods, double gloves duct taped in place, and heavy rubber aprons over the top of it all. The process takes about twenty minutes, usually longer.

But even before all these coverings, there’s the matter of hydration. All the layers exacerbate the heat. Doctors talk about the sound of sweat sloshing in gloves as they work in the isolation unit, working from the patients least likely to have Ebola to the worst cases to avoid cross contamination.

But as any missionary knows, there’s an urgent spiritual side to ministry in a hot zone, and that side of the story often goes untold. Nancy agreed to share her story with desiringGod.org and give details she has not offered elsewhere, provided we excused her frequent flood of tears amidst the descriptions. The memories she shared with us are fresh and vivid. And they are raw. The faces of the dead and the families of the suffering are all so real for her, as is the darkness she experienced in her own battle against the world’s most feared disease.

This is the eyewitness account of the Ebola outbreak in Monrovia, the densely populated capital city of Liberia, from one who not only experienced it, but suffered the fury of the disease for herself, and who did not waiver from trusting the sovereign goodness of God over it all.

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Nancy, you and David were missionaries in Ecuador for years, and then Zambia, and then traveled to Liberia in August of 2013. Ebola wasn’t on your minds at that time. By March of this year, however, Ebola started to spread in Guinea. At what point did your work in Monrovia begin to center on Ebola?

I think the first reported case of Ebola came in December of 2013 in Guinea, but there was not really any large outbreak. By March of this year, talk increased because the numbers of Ebola in Foya, a town in the northern part of Liberia, was increasingly growing. There was a great concern that it would travel from the border down to Monrovia, a drive that takes eight to ten hours over rough roads. So we knew that the possibility was that it could come to our city, and even more quickly through air travel.

So in March we discussed the possibility, and one of our partnering doctors, Debbie Eisenhut, had a passion for getting ready for Ebola cases. She decided that we should not just sit and wait for an outbreak, but prepare for it before it was an issue.

We converted the chapel of the hospital into an isolation unit with six beds. David was part of that work. We could talk to patients through the chapel windows. We put up a triage tent. And then we waited, and waited, and waited. Standard procedure is to wait 21 days. If you go that long without any cases, they consider the region safe from a major outbreak. If you go another 21 days without any cases, then you are considered Ebola clear and free.

At the end of 42 days, the government hospital in Monrovia, John F. Kennedy Medical Center (JFK), put away all of their isolation units. They put it all back in the box. On day 44, the ministry of health called us and said they received Ebola patients at JFK, but because they had put away their unit, they were sending them to us.

That’s how our first patients arrived — three patients in the back of an ambulance. One was a child who ultimately did not have Ebola. The other was a woman in her forties who did. And the third was an older man, the uncle of the woman. He died in the ambulance ride between JFK and our hospital. The woman died a few days later.

Then we went one day without any patients. From that point on, we always had patients, and as the patients increased, it became evident that six beds were insufficient. Our partners, Serving in Mission (SIM) and Samaritan’s Purse, decided we needed a larger isolation unit. Samaritan’s Purse had been building a hospital on our campus for SIM. The new hospital kitchen and laundry building was complete, and it was decided to convert it into a 20-bed isolation unit.

We moved into the unit on July 20, and immediately had eleven patients. By the end of that next week, we were totally full. From June 11 to July 20, of the many Ebola patients we cared for, only one survived.

The New York Times recently featured an ambulance nurse in Monrovia named Gordon Kamara, tasked with driving and collecting bodies — the sick and dead. He said, “There are patients all over. The first thing I do, I give them courage. I tell them, ‘Don’t be afraid.’ They feel fear. I see it in their eyes. I’m tired of seeing people getting sick. I don’t rest, even when I go to bed. Sometimes, I see them in my dreams. We have only three treatment centers in Monrovia. It is insufficient. I feel hopeless.” There’s a video showing a young woman getting into the back of the ambulance, and she is trembling, presumably from fear. In America, the Center for Disease Control (CDC) is telling everyone to not fear, and rightly so. But in a hot zone, like Monrovia, how palpable is the fear?

The fear is very real. When patients came into the isolation unit, they knew there was a great possibility they were coming here to die. And part of the reason why is that patients were coming to us so late. When you get sick, first it feels like you have malaria. You feel like you might have typhoid. And so people stayed at home until they were at the end of the disease. And so we had patients coming to us so sick, and too late, for the supportive care to really be of great benefit to them.

Even in my own experience, I felt the progression of the disease going through my body. After watching those patients die, I knew when I saw the symptoms in my body that I was close to death.

So going back to your question — the fear. Part of it is the fear of the unknown. People don’t know how they are going to be taken care of. People know that when they go into an isolation unit, they are not going to see their family, because their family is too afraid to put on PPEs and to come into the unit. We never had one family member come into our isolation unit, even though we told them we would dress them and they could go in and see their family member. They chose instead to stand outside and be able to talk to their family members through the windows.

Speaking of the fear, what do you tell citizens in the U.S.? And my response is always that we need to have a respectful fear of Ebola, but we need not panic into hysteria. Early detection is the key to survival. And I think that’s why we are seeing more and more patients in Liberia surviving. But there’s still a huge fear in Liberia, and in the States. Here at home, David and I have been in multiple churches where people have been physically afraid of us, and afraid to approach us.

Back in Monrovia, did you meet the patients coming off the ambulance?

Sometimes. I was not the attending doctor, of course, but I often stood with the doctors and nurses as the ambulances arrived. Ambulances could only come so far into our hospital area, and then they would put the patients on a stretcher and we had to walk around the back of our hospital, outside. I would carry a sprayer, sterilizing the ground as we walked. But I would follow them or go before them. Ambulances would come in the middle of the night, and sometimes I would walk in front of the stretcher with a flashlight to light the way.

So there were many times, when receiving ambulances or with people walking up to our triage tent, that you could see the fear in people’s eyes and their family members’ eyes. They would look at us and just not know what was to come in the days ahead.

Everyone sees Ebola and wants to stop the disease from spreading physically. But more important is the urgent care for souls nearing the brink of eternity. What spiritual care takes place inside the isolation unit at ELWA (Eternal Love Winning Africa)?

Our doctors and nurses would pray with family members. Many times, I felt that was part of my ministry, to pray with the family members who were standing on the outside the hospital.

It was almost impossible to know where the patients stood spiritually. So many times because people were coming to us so very late in the progression of the disease, they couldn’t communicate with our doctors and nurses. But every single time the doctors and nurses dressed before entering the isolation unit, we prayed. As a team, as they went in, we prayed that God would give them wisdom, and that the patients would at least sense that we were the hands and feet of Christ.

As for spiritual care, I saw Dr. Kent Brantly kneel beside the bed of a woman in her fifties who was dying. Her daughter had just died that morning in the same isolation unit right across from her. Another daughter of hers had recently died in another isolation unit. I remember Kent kneeled beside the bed of this mother, in his PPE suit, praying with her, holding her hand, and then he sang a hymn to her. She turned to him and expressed her gratitude for his care and concern for her. The woman died two days later.

Your work focused outside the isolation unit. You cared for families of those infected. Which stories stand out to you now as you look back?

Well again, for fear, a lot of people stayed away from the hospital. We had one little twelve-year-old boy in our unit, and hardly anybody ever came to see him. We brought a children’s Bible for him to read. One of the hygienists spent time reading to the boy, and had the opportunity to lead that little boy to faith in Jesus. He spent many days in the isolation unit before being released. Dr. Brantly would kick a soccer ball with him. His sister visited him once or twice. We all had a concern for him when he returned to a family that had been deeply affected by Ebola.

For those families that did come, they came maybe two or three people at a time. One time several nurses were admitted into our isolation unit from another hospital. Their hospital did not have any PPEs, and so their health care workers were infected, and we took their infected nurses. I remember one father who came to talk to his daughter every day. One day he brought her his Bible and asked if we could bring it to his daughter, one of the infected nurses. I would stand many times with her dad at the window, and many times prayed with him. I often thought of what this would be like, my daddy standing outside talking with me through a window.

It was raw to watch people die like this. There came a time at the end, before patients lost their lives, when they knew they were at the end. Many patients died the same way. They would sit up, cough, groan in pain, and then they would just fall back and pass into eternity.

What happens to the bodies next? Where do they go?

As the number of Ebola deaths escalated, there were too few burial teams to handle the bodies. The Ministry of Health made the decision that burial teams would be hired to collect the bodies. But there was a shortage of body bags, and our doctors were forced to wrap the bodies in plastic sheets. At one point, we had to wait many days for the burial team to come and pick up bodies, because they were so overwhelmed with the numbers of dead. So the bodies had to be collected and held by us onsite.

This all brought tension to families. At first, burial teams would come and pick up the body, take it to where the family wanted the body to be buried, and the family could be present there. But as the numbers ramped up, they just couldn’t do that. The government decided on cremation, which is just not done in Liberia, so the government is having issues with angry families.

Depending upon where the body was, families would come to the triage tent, to the makeshift morgue tent, or to the door of the isolation unit. At all times, the family member was not permitted to touch the body. Through breeze-block windows of the chapel, we would open the plastic to where they could see the face, and identify their loved one. Then they were wrapped again, and then the burial team would take the body.

You were diagnosed with Ebola on July 26, and Dr. Brantly, your friend and fellow worker, was diagnosed the same day. What was it like to get this news, and how did you face this deadly disease as a Christian?

They had done the Ebola test that morning, and I didn’t think so much about it. Dr. Debbie kept saying she didn’t think I had Ebola. I didn’t have all the symptoms. Maybe it was just malaria, and all I needed was a quinine drip. Sometimes that happens. So I wasn’t really concerned. I never really felt at risk.

Debbie came to our door that night as Dave and I were just sitting down to dinner. She joined us. We had dinner, and I still wasn’t feeling good, but David and Debbie left, went to a meeting, and came back in about 20 minutes. David walked into our bedroom where I was laying down. He said, “Nancy, I need to talk to you. I have some hard things I need to tell you.” Then he proceeded to tell me that Kent had Ebola. And Kent and his wife Amber are not only colleagues, but good friends. And so when David told me that Kent had Ebola my heart sank. And then David said, “And Nancy, so do you.” And he reached out to take me into his arms, to comfort me, and I put my hands up, saying, “don’t,” and pushed him back and reminded him of how serious this was.

All I could think about was Debbie being in the house that evening, and David and I sharing our home and bed over the four days I had a fever.

David and I walked out of the bedroom and were met in the living room by our friends from SIM, Debbie and a doctor named John, and another doctor from the Samaritan’s Purse team. And they just kept saying, Nancy, we are so sorry. We are so sorry.

And all of us knew. We knew. We had seen with our own eyes what Ebola does to people’s bodies. And all I can tell you is that somehow God gave me this great sense of peace. And I looked at all of them and said, “It is going to be okay. It is going to be okay.”

I had no clue whether I would live or die. I knew the chances were bad. I knew that among Ebola survivors, there were none over the age of 60.

We knew it was going to be hard, but we had peace. I felt for David, who now had to call his parents, my mom, and our boys. And from that moment on, he could not come into our home unless he was in PPE. They isolated me in our home. That evening the doctors left to go get all the supplies that we needed. I went back to bed. Alone.

Nights were the hardest. That was when I had the nightmares. One night I remember picking up the telephone and calling Dave and saying, David, I need help. And David said, Nancy, what is wrong? And I couldn’t tell him exactly what was wrong. Even in those really dark hours, the Lord started to bring Scripture to my mind. I was laying in bed one night, in the dark, and he brought to my mind Psalm 23:4: “Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; Thy rod and thy staff they comfort me” (King James Version).

One night, when I felt especially alone, I awoke with a terrible nightmare, and God brought John 10:28–29 to mind, where Jesus said, “I give them eternal life, and they will never perish, and no one will snatch them out of my hand. My Father, who has given them to me, is greater than all, and no one is able to snatch them out of the Father’s hand.” And I rested in the fact that even though it was a dark period, God still gave peace, and he used his word to minister to my heart.

These were very dark days in Liberia. Our team felt the darkness of a spiritual battle. Kent and I were battling for our lives. And it rained and rained and rained. Even Liberians from Monrovia said they had never seen rain like this before. [As the wettest capital city in the world, Monrovia averages 200 inches of annual rainfall.]

During this time, I never saw the sun. It was just dark — isolation and darkness. One woman said at the time the ocean waves were black, and seemed angry. We saw flooding in places we had never seen the ocean come.

Through it all, my husband cared for me like Christ loved the church, a picture of what you read about in Ephesians 5. David came inside the house in PPE many days to read Scripture to me. The doctors read from devotionals. God used his word. God used people. He ministered to us all in ways that were amazing, not only spiritually through his word and through people, but physically he ministered in practical ways, too.

At night, when I was alone, I would lay my head on the pillow and pray: Lord, I don’t know whether I am going to make it through the night or not, but I know one thing — I will either wake in the morning here, or I will wake in your presence. And he gave me the assurance that this was true.

When you look back and reflect, do you think you got Ebola by accident, or do you consider it part of God’s good plan for Nancy Writebol?

There are no accidents in God’s economy.

I believed God was going to use it, and is using it. I was chosen for this. I don’t understand it — but how much of God’s will do we really understand? I mean, when you consider who God is, how can our finite minds even begin to understand what an awesome God we have and what he is doing in this world?

God is good. He was good before I got Ebola. He was good when I had Ebola. Whether he would have taken my life, or healed my body — in either case, he would have been good.

“God is good. He was good before I got Ebola. He was good when I had Ebola. Whether he would have taken my life, or healed my body — in either case, he would have been good.”

How important was your getting Ebola in bringing the outbreak to the attention of Western nations?

Kent and I getting Ebola was important. Since March, specialists in epidemiology were telling the world that we needed to get ready for this. People were not listening. Popular opinion seemed to be that Ebola would not spread to a city. It had always been out in the bush, confined to small regions, so many people didn’t worry. It took two Americans contracting Ebola for the world to wake up.

You attended Bethlehem Baptist Church many years ago and met John Piper, and you’ve read his books over the years, including Don’t Waste Your Life. I was surprised to hear you’re now reading Risk Is Right. Did I hear that correctly?

Yes, that’s right. I’m struck by what he writes in the first chapter: “There are a thousand ways to magnify Christ in life and death. None should be scorned. All are important” (page 15). And I think that goes back to the last question, Did this raise my level of awareness and is God using it? And I say yes to that.

Then he goes on to say, “But none makes the worth of Christ shine more brightly than sacrificial love for other people in the name of Jesus. If Christ is so valuable that the hope of his immediate and eternal fellowship after death frees us from the self-serving fear of dying and enables us to lay down our lives for the good of others, such love magnifies the glory of Christ like nothing else in the world.”

That says it for us. We went to Liberia not knowing that we were going to be working with Ebola. But we went, first of all, because of our love for Christ and then, second of all, because of our love for the world and others.

One day recently, I was struggling with being forced back to the States in all this, and I prayed, “Lord, you know our hearts for the world. You know our hearts for missions, and I don’t really comprehend what you are doing right now.” And it was a day that a German film-writer videoed us and our story. And when he got through, he mentioned that the film was going to be translated. So I asked what languages, and he explained German, French, English, Spanish, and even Arabic. It was like the Lord was saying, “Nancy, I know how much you love the people of the world and where your heart is. I will be the translator for your story. You don’t even have to learn a new language.” God is so much bigger than our boxes, and so often we limit him to what our finite minds think he can or cannot do.

You have critics. Ann Coulter said your risk was wrong — that it was a waste. Missionaries do more good caring for the manifold needs inside America, she said. What would you say to her?

Well, she’s wrong. We were sad to read that, but encouraged and thankful when Pastor John took up his pen to rebut her and Donald Trump in his poem. That was amazing.

In the foreword to Risk Is Right, David Platt writes, “In view of God’s great glory above us and in light of the world’s great need around us, retreat is unquestionably wrong.” And that’s where my husband and I stand.

People have asked us, What do you think about our military guys going in? What do you think about other health care workers going in? I still think that retreat is wrong, and I don’t think that we should be sloppy in our protocols and how we take care of people and ourselves. I think that is very important. But to just turn away and put our backs to the world is wrong.

Finally, what would you say to an aspiring missionary who is weighing the risk — not sure if the risk is right or wrong for them? They feel called to go to a people where persecution, or violence, or disease is a real risk. You’ve been into the heart of darkness, and your convictions nearly cost you your life. What would you say to this aspiring missionary?

First, the one question we must all answer is this: How does my life bring the most glory to God? It’s not about us; it is about him, his glory, and the spread of the gospel. For the good of souls and for the glory of our Savior, such risk is most assuredly right.

People have asked if we are going back to Liberia. My answer is not right now. But every time we talk to our friends back in Liberia, and every time I read a news article, my heart is drawn back. The needs are real. The need for the gospel is real.

So I think if I were to speak to a young missionary, I would tell them they need to ask themselves, Is God enough? Most assuredly, he must be enough for them before they go. And let me be the first to tell you, even when you are in the darkest struggle of your life, God will be enough for you. Once the question of eternal life is settled, then we are free to suffer for the sake of the gospel. This is what Paul meant when he said, “for me to live is Christ and to die is gain” (Philippians 1:21).

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“Even when you are in the darkest struggle of your life, God will be enough for you.”