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Just Who Is Leading the Fight Against Ebola?

Aid groups are clear — they need people to fight Ebola in West Africa. Yet hardly anyone is sending them.

The Ebola toll is fast approaching 5,000, with 2,400 people dead in the space of a few months, the World Health Organization said Friday. It’s getting worse and not better. Yet aid is not pouring into West Africa.

It mystifies Sophie Delaunay, executive director of the U.S. office of Medecins Sans Frontieres (MSF or Doctors Without Borders). “We know what needs to be done but we don’t know why it’s not being done. It’s incomprehensible to us,” she told NBC News.

Dr. Oliver Johnson of the King's Sierra Leone Partnership at Connaught Hospital in Freetown echoes the sentiment. “The international response to the outbreak remains virtually non-existent, in terms of actual impact on the ground,” Johnson wrote in a plea to international infectious disease specialists. “At Connaught … our isolation unit is full with adult and pediatric cases and we have suspected cases in the waiting area and emergency room that we can't isolate — I don't know how much longer the hospital will be able to stay open in these circumstances.”

“We know what needs to be done but we don’t know why it’s not being done."

The No. 1 need? People.

"The number of new patients is moving far faster than the capacity to manage them. We need to surge at least three to four times to catch up with the outbreaks,” WHO director-general Dr. Margaret Chan said Friday. "The right people, the right specialists, and specialists who are appropriately trained and know how to keep themselves safe."

The lion’s share of the work in Liberia, the hardest-hit country, and much of West Africa has been and is being done by missionaries whose groups had been slogging away for decades through civil wars and disasters to try to minister to the people there.

Saving Dr. Brantly, Part 1

Sept. 6, 201407:52

“The need is so huge and it is getting bigger every day,” said Franklin Graham, president and CEO of the Billy Graham Evangelistic Association and the Christian relief organization Samaritan's Purse. Samaritan’s Purse hit the headlines when missionary physician Dr. Kent Brantly became infected with Ebola, was evacuated from Liberia in a dramatic rescue, and finally walked out of a special isolation unit at Emory University Hospital.

Samaritan’s Purse also aided in the evacuation of Brantly’s colleague Nancy Writebol, who is employed by another Christian missionary aid group, Serving in Mission (SIM) USA.

And Samaritan’s Purse flew Brantly to Nebraska last week to donate blood to use to treat SIM’s volunteer, Dr. Rick Sacra, who also became infected with Liberia.

Why only missionaries? They were already there, working to build up health systems after extended and brutal civil wars in Liberia and Sierra Leone — marked by the forced enlistment of child soldiers and the widespread use of amputation as a tool of terror.

“Many of the doctors not only give their time but they also pay their own expenses."

“I just believe in life that there are people in the ditch along life’s road, and God expects us to stop and help them and not pass them by,” Graham says. Samaritan’s Purse was helping SIM USA rebuild a hospital at the group’s ELWA compound outside Monrovia when Ebola hit earlier this year. It was the only group working in Liberia — even MSF had pulled out.

Graham says Samaritan’s Purse — the group's name comes from the New Testament parable about the good Samaritan who helps an injured stranger when no one else would — has about 420 doctors in various overseas assignments.

“Many of the doctors not only give their time but they also pay their own expenses,” he said in an interview.

Sacra left his duties as a family physician and assistant professor at the University of Massachusetts medical school to travel to Liberia to help.

“Rick went to Liberia at the beginning of August because he could see that the Ebola crisis was setting off a domino effect in the Liberian healthcare system. Not only was there inadequate medical care for those with Ebola disease, but patients with common health problems were not getting treatment,” his wife, Debbie, told a news conference this week.

“Those with high blood pressure would not be filling their prescriptions, those with diabetes would not be able to have their blood tests and parents were going to lose their young children because they had contracted malaria and there would be no place to receive the lifesaving IV drugs they needed,” she added.

“When Rick arrived at the beginning of August, there was not one box of gloves to be purchased in the city of Monrovia, so clinics and hospitals had almost no choice but to close their doors until they could get the supplies they needed. Rick himself had to go all around the city to hardware stores to find boots for the OB and OR staff.”

“They are putting into action what they say they believe."

Of course the care given has a twofold purpose. “Everything we do, we want people to know that there is a God who loves him,” Graham said. Volunteers must sign onto a code of conduct and Brantly was clear that he considered prayer and evangelism part of his duties in Liberia.

“They are putting into action what they say they believe,” said Jeremy Writebol, Community Pastor at Journey the Way in Wichita, Kansas and the son of Nancy and David Writebol.

“I’ll be honest. I wish more Christians would do more things like my parents,” Writebol said in an interview. “I wish humanity in general would step outside of themselves and see the needs of others.”

Not everyone’s motivated by religion in that mission. Dr. Daniel Lucey, an adjunct professor and infectious disease specialist at Georgetown University, is preparing for a six-week tour in Liberia with the strictly non-religious and nonpartisan MSF.

“There’s nothing that compares to this,” said Lucey, a veteran of the early days of the AIDS epidemic, the 2003 epidemic of severe acute respiratory syndrome (SARS) and H5N1 bird flu. International Medical Corps paid for Lucey to go to Sierra Leone in August, although he paid his own expenses to stay for an extra week.

Besides doctors, Lucey said, groups like MSF need people with a range of skills, from water and sanitation engineers to architects. “One person can make a significant contribution,” he said.

David Writebol agrees. He was a non-medical specialist working in Liberia when his wife, Nancy, became infected. After a career in financial software, Writebol turned his skills to organizing and helping with the hospital project in Liberia. He’s also puzzled that the world hasn’t responded to West Africa’s need.

“It’s as though the world didn’t really take note of what was going on in any major fashion until it came home and two Americans were diagnosed, which is kind of a sad thing,” said the man who waited by his wife’s side as she fought the virus.

The United States announced this week it would provide 1,000 beds and spend $10 million to transport 100 health-care workers from other African countries, but there’s no overwhelming airlift of American doctors in the works.

“If you are not ready to take those challenges, you probably are not willing to go.”

Why not? Budget cuts, in part, but also self-interest. "The outbreak does not pose a significant risk to the United States," the Centers for Disease Control and Prevention says on its Ebola website. CDC has sent 70 staffers to the region, mostly to do coordination and education work.

Cuba has committed to send 165 healthcare workers to Sierra Leone in October. There are some smaller groups, like Last Mile Health, with clinics in the region, but they are staffed by small handfuls of people. A group called the Viral Hemorrhagic Fever Consortium had been working on what they thought was a good scale to study and fight Lassa fever in Kenema, Sierra Leone, until Ebola overwhelmed them.

“We're working round-the-clock trying to set up a new unit every 48 hours, but we are the only partner undertaking this work and we simply won't be able to keep up with demand,” Johnson wrote. MSF has 2,000 staff in the region, 10 percent of them foreigners and the rest locally hired.

And when you're relying on goodwill, it takes a special motivation to stay, David Writebol said in an interview. “Liberia is not an easy place.” Electricity and water supplies are uncertain and there’s no healthcare system. “Even our embassy and the diplomatic corps, they’re very concerned about the healthcare infrastructure,” he said.

“If you are not ready to take those challenges, you probably are not willing to go.”

Graham and Delaunay agree — only a large government, such as the United States — can fill the gaps now.

“The problem is bigger than what aid groups like Samaritan’s Purse and SIM and even Doctors Without Borders can deal with,” Graham said. “Once this reached the state of a public health menace, then it needs a response that only government organizations (can provide).”

“This is all we are asking. If a few states get their acts together, their means are much bigger than MSF’s means,” Delaunay added.