Obituary

Remembering health workers who died from Ebola in 2014

Andrew Green @_andrew_green

www.thelancet.com Vol 384 December 20/27, 2014

Lead consultant and endocrinologist at First Consultants Medical Center in Lagos, Nigeria. She was born in Lagos on Oct 27, 1956, and died there, aged 57 years, on Aug 19, 2014. Ameyo Adadevoh has been called the woman who saved a nation. In July, 2014, a traveller from Liberia collapsed on arrival at Lagos airport and was brought to the family clinic, First Consultants Medical Center, where Adadevoh worked. The patient was initially given a diagnosis of malaria, which Adadevoh questioned when she saw him the next day. She ordered an Ebola test and, despite the patient’s insistence, barred him from leaving the clinic until the result came back. It was positive. In the process of caring for the patient, who would die a few days after arriving in Nigeria, Adadevoh also contracted the virus. She was isolated and, despite treatment, died a few weeks later. But, with her quick thinking and steely resolve, she helped arrest the disease’s spread in Nigeria— Africa’s most populous country. 2 months after her death, the country was declared Ebola-free. Adadevoh’s actions in this instance were characteristic of the fearlessness she brought to her work, said Adaora Igonoh, a Medical Officer at First Consultants Medical Center. “When she believed in something, she stood her ground.” It is one of the many accolades

Adadevoh garnered across a career of more than 30 years. She earned a degree in medicine and surgery from the University of Lagos and then worked at the institution’s teaching hospital from 1983 to 1991, first as a resident and later a consultant. After completing a fellowship in endocrinology in the UK at Hammersmith Hospital, Imperial College London, Adadevoh returned to Lagos and the First Consultants Medical Center. She worked there for the next 21 years. Her patients remember Adadevoh as a committed physician. Online tributes are full of memories of her smile, her attention to detail, and her willingness to help, whatever the hour. “Dr Adadevoh gave her life to save Nigeria from a plague”, Igonoh said. “She could have acted differently and perhaps she would be alive today. But I doubt she would have been able to live with herself if she did.”

Samuel Muhumuza Mutoro

Courtesy of Mutooro Philip

Ameyo Stella Adadevoh

Courtesy of Niniola Soleye

The Ebola outbreak in west Africa has had a devastating effect on health workers in the three countries most affected by the virus. Of the nearly 17 000 cases of Ebola virus disease in Guinea, Liberia, and Sierra Leone, at least 600 have been among health-care providers. More than half of them have died. The outbreak has also claimed the lives of doctors, nurses, and technicians from Mali, Nigeria, Spain, and the USA. The risk of death from Ebola has not been limited to the teams who staff Ebola treatment and care centres, since infected patients travel to any health centre or clinic they can reach. The outbreak has left health workers across all three countries at risk of infection. Many of the doctors who have died in Liberia and Sierra Leone were not directly involved in the response, but simply providing routine health care, often to underserved populations. There will be lasting consequences in the affected countries. Officials lament that the Ebola outbreak has reversed gains in health-care provision in Liberia and Sierra Leone, both of which are still emerging from civil wars. “During the early stage of the outbreak, everything, especially the health system, was immensely hit in different areas”, said Saye Dahn Baawo, the Liberian Ministry of Health’s Assistant Minister for Curative Services. He pointed to declines in health indicators such as immunisation rates as health facilities closed and health workers fell sick or left their posts. Guinea’s Government has even requested that doctors come out of retirement to shore up the country’s response. Each country has lost doctors who also worked as medical teachers; their deaths are a loss to the next generation of health workers. The individuals featured here are just some of the health professionals who died from Ebola in 2014. We pay tribute to their contribution.

Surgeon at Redemption Hospital in New Kru Town, Liberia. He was born in Uganda’s Kasese district on Aug 24, 1969, and died in Monrovia, Liberia, on July 1, 2014, aged 44 years. At Mbarara University of Science and Technology, in southwestern Uganda, Samuel Muhumuza Mutoro studied medicine, later returning to specialise in surgery. But the lesson that underpinned his time at Mbarara University, 2201

Obituary

Samuel Brisbane Chief of the Emergency Room of the John F Kennedy Medical Center in Monrovia, Liberia. Born in Bomi County, Liberia, on July 29, 1939, he died in Monrovia on July 26, 2014, aged 74 years. 2202

Samuel Brisbane was well past retirement age and most of his large brood of children were settled in the USA, far from him. But colleagues said they could not imagine him ever leaving the Liberian medical community that he had led for so many decades. “He refused to retire from hospital work even though he was advanced in age”, David Okiror said on behalf of his medical colleagues at the John F Kennedy (JFK) Medical Center. It was typical of Brisbane’s career. Even during the two civil wars that rocked the country, Brisbane never left his country. He completed his medical studies in Germany before returning to practise in Liberia. Brisbane worked for a time as medical adviser for former President Charles Taylor and also as a general medical practitioner. For most of that time he was working at the hospital on the Firestone company’s plantation outside Monrovia. After the fighting ended, he helped set up the JFK Medical Center, the only academic referral hospital in Liberia. Benetta Collins Andrews, a Resident Student in Paediatrics, said Brisbane “was very passionate of whatever he was involved in”. That was a lot. He was the hospital’s Chief Medical Officer for 2 years and served on the hospital management and advisory board. Brisbane also helped with the training of interns and residents. There are few doctors active in Liberia who didn’t learn something from him. For Celina Zayzay, who now works at Monrovia’s James Davis Jr Memorial Hospital, it was how to read an electrocardiogram test. Brisbane helped Tesser Utam, a Resident in JFK Medical Center’s intensive care unit, practise inserting chest tubes. Finda MayahToto, a Resident Physician, said Brisbane viewed all interactions as possible lessons, because he “was committed to teaching”. Brisbane, who outside of medicine was a successful coffee farmer, contracted Ebola in the course of treating patients. During his illness, he told the doctors who were treating him,

“When we find ourselves in the middle of the sea and there are rough waves, we should not give up. We should fight on to the end.” He died on the anniversary of Liberia’s independence.

Abraham Borbor

Courtesy of Dr Saye Dahn Baawo

his friends and colleagues said, was to always be selfless. “There’s a strong aspect of community-based medical education at Mbarara”, said Stephen Ataro Ayella, Mutoro’s friend and fellow Mbarara medical alumnus. “Graduates that come out have a stronger liking to work in those underserved communities”, he said. Ayella said that was what motivated Mutoro to take a job in Liberia after he completed his surgical training 3 years ago. The country had been devastated by two civil wars and WHO was recruiting doctors from the region to support Liberia’s collapsed health-care system. Mutoro signed up for a surgery position at Redemption Hospital in a Monrovia suburb. He didn’t take the job for the salary. “If you look for a specialist, like a surgeon, he could earn that same money in Uganda”, Ayella said. “But there is a need to go and fill the gap.” Mutoro stayed on through the emergence of Ebola in the capital city, transitioning from surgeon to primary health-care provider. Ayella said his friend was well prepared, having fought outbreaks of measles and diarrhoeal diseases during his time in Mbarara. Mutoro’s wife told a Ugandan newspaper she believes he might have been infected after volunteering to treat a nurse with Ebola at his hospital. A few weeks after his death, during celebrations marking Liberia’s July 26 independence anniversary, President Ellen Johnson Sirleaf singled Mutoro out for praise for “his collaborative and selfless service to the Liberian people”. She promised, “He would be remembered as a true international servant, who exhibited competence and intelligence at the highest echelon of his profession.”

Internal medicine physician and Deputy Chief Medical Officer at John F Kennedy Medical Center in Monrovia, Liberia. Born on April 27, 1960, in Lofa County in northern Liberia, he died on Aug 25, 2014, in Monrovia, aged 54 years. Liberia’s health system was ravaged by two civil wars in the past three decades. By the time the second conflict ended in 2003, Liberia had only about 50 doctors left. As the country started to rebuild, those physicians who remained were responsible not just for treating patients, but also for training the next generation of health workers. That is where Abraham Borbor shone. In addition to his job as Deputy Chief Medical Officer at Liberia’s JFK Medical Center, Borbor—who ran the internal medicine department—was responsible for the education of residents and interns. And he was “exceptionally good” at it, said Steven Hatch, an infectious disease specialist from the USA who helped train internal medicine residents at the centre last year. “Borbor had the gift of being able to motivate others and get them excited about the practice of medicine.” Colleagues remember how Borbor’s students were willing to work hard

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Obituary

Courtesy of Dr Saye Dahn Baawo

John Taban Dada

Gynaecologist and surgeon who was Medical Director of Monrovia’s Redemption Hospital and taught www.thelancet.com Vol 384 December 20/27, 2014

postgraduate medical education at the Liberia College of Physicians and Surgeons in Monrovia. He was born in Koboko, Uganda, on Dec 27, 1958, and died in Monrovia, Liberia, on Oct 9, 2014, aged 55 years. Tony Walter Onena, a Ugandan currently consulting for WHO’s Ebola response in Liberia, went to primary school with John Taban Dada. He remembered a “clever boy”, who actually took over the lessons when a pregnant teacher went into labour. Onena lost touch with Dada for decades, only to recently discover he had been working in Liberia. They did not have a chance to meet before Dada became sick with Ebola. Since his classmate’s death, Onena said people across Monrovia “still talk about him. That he was a very kind man who devoted his time to save the lives of the Liberians”. None of his colleagues are really sure when or why Dada ended up in Liberia. They remember the Ugandan-born gynaecologist and surgeon, who took Liberian citizenship, as just always being around, committed to improving the health-care system in his adopted country. Saye Dahn Baawo, the Liberian Ministry of Health’s Assistant Minister for Curative Services, attended the University of Liberia’s A M Dogliotti College of Medicine with Dada. Baawo recalls how “many who were nonLiberians went away, but he chose to remain with those he had known and who have become a part of his life.” Over the years Dada developed a reputation both as a skilled surgeon, but also as a rigorous, but encouraging, educator. Paul T Whesseh, who is currently a Resident in Obstetrics and Gynaecology at the Liberia College of Physicians and Surgeons (LCPS) in Monrovia, studied under Dada. During his first 6-month rotation, Whesseh said, “We all depended on his vast experience and mentorship”. The two would go on to collaborate on campaigns to surgically repair obstetric fistulae. Although resources for the work were scarce, Dada was “never complaining,

but improvising so that the work can be done”, Whesseh said. In addition to teaching at LCPS, Dada worked as the Medical Director of Monrovia’s Redemption Hospital from 2008 to 2013. He had recently moved to the JFK Medical Center, Liberia’s largest hospital. He also served as a consultant for People Associated for People’s Assistance, an organisation helping improve the country’s HIV service provision. “All those who experienced his warmth, commitment, and hard work are still in shock” over his death, Whesseh said. “We don’t want to believe it has happened.”

AbdelFadeel Mohammed Basheer

Courtesy of Awadallah Arbab

under his guidance because he was equally as demanding of himself. “He believed that one could always be what he wanted to be so long as focus was maintained”, said physician Saybeh M Vanyanbah, a Resident Student in Surgery. Borbor had worked as a trader to support himself through his undergraduate years at Cuttington University in Suacoco, Liberia, and then through medical studies at the A M Dogliotti College of Medicine at the University of Liberia, where he graduated with honours in radiology. After he became ill, Borbor was one of the first people to receive the experimental Ebola drug ZMapp. His doctors reported that he initially seemed to respond positively to the treatment before his health rapidly deteriorated. Hatch said his loss is incalculable. “Once the Ebola crisis abates…I have no idea who will fill his shoes, and how young medical student graduates will have someone perform that alchemy that will turn them into physicians.” Borbor’s medical colleague Roseda Marshall, who worked on the same floor as him at JFK Medical Center, said as a tribute, “we will strive to carry on the commitment and dedication of improving the quality of the health-care delivery system in Liberia”.

Medical Laboratory Technician with the UN in Liberia. Born in El Obeid, Sudan, on Jan 1, 1958, he died in Leipzig, Germany, after being flown there for treatment, on Oct 14, 2014, aged 56 years. AbdelFadeel Mohammed Basheer seemed to always be in motion, his colleagues said. His work as a Medical Laboratory Technician at the United Nations Mission in Liberia (UNMIL) kept him perpetually busy running medical tests and writing up results. It was “like he was doing two jobs”, said his friend Awadallah Arbab, a Sanitation Engineer with UNMIL. For months he had been trying to get back to Sudan to see his family, but “nobody could replace him”, Arbab said. “It was always cancelled.” The trip home was finally 2203

Obituary

For a longer Obituary of Sheik Humarr Khan see Lancet 2014; 384: 740

Courtesy of Scotland family

Thomas Scotland

A recent graduate of the University of Liberia’s A M Dogliotti College of Medicine, he was completing 2204

a medical internship when he volunteered to help with the country’s Ebola response. He died in Monrovia, Liberia, on Oct 18, 2014. Christal Da-Thong only met Thomas Scotland once, but it was memorable. A team from Da-Thong’s organisation, ActionAid, had gone to deliver food and clothes to patients who had recovered from Ebola infections and were being discharged from the JFK Medical Center in Monrovia, Liberia. Before the supplies were distributed, Scotland organised a small ceremony for the survivors. Knowing that they were likely to face stigma when they returned to their homes, Da-Thong said, “He wanted to encourage people. He was telling them not to let anyone put you down.” Da-Thong said she was struck that he would take the time out of his gruelling schedule to do this. “He showed a humanitarian spirit”, she said. “He cared about people as more than patients.” Scotland was determined to be a doctor. He paid his way through the University of Liberia’s College of Science and Technology and, later, the university’s A M Dogliotti College of Medicine, by working as a security officer. He “worked on security detail at night and attended school in the morning with little time to sleep”, remembered Abraham Tumbey, who became friends with Scotland during their undergraduate years studying biology and chemistry together. After finishing medical school in 2013, Scotland moved to Tappita, in north central Liberia, to start an internship at Jackson Fiah Doe Memorial Regional Referral Hospital. But as Ebola began to take its toll on the country’s medical profession, Tumbey said his friend decided he could be of more use in Monrovia. He returned to the capital and volunteered at the Ebola treatment unit being run out of JFK Medical Center. Shortly after he started at the treatment unit, Scotland took to Facebook to describe what he was seeing. In the post, he writes of parents too weak to care for sick children,

people bleeding freely in their beds and on the floor, and of seeing as many as five bodies removed each day from the unit. He ends by declaring the outbreak a call “for clinicians to step forward” and “demonstrate compassion and empathy in caring for the ill and dying fathers, mothers, brothers, sisters, sons, and daughters”.

Sheik Humarr Khan

Dr Pardis Sabeti

approved and Basheer packed his bags. But before he could go, he started to show symptoms of Ebola virus disease. His colleagues suspect he might have contracted the virus doing laboratory work for another UNMIL employee who was unknowingly infected. Although he was evacuated to Germany’s Klinikum St Georg, Basheer never recovered. Basheer started his career in Sudan’s Ministry of Health, before taking a laboratory position in the now ended UN Mission in Sudan. He was also in charge of hygiene and sanitation there. In Sudan, he volunteered for the Sudan National AIDS Program and served on the faculty of the University of Kordofan, teaching classes in practical haematology and immunology. In 2011, he joined UNMIL. Arbab said after living in Liberia for so long, Basheer understood how difficult it was for new arrivals in the country to be away from their families. He would go out of his way to make them feel welcome, letting them stay at his house for weeks until they found their own places. Despite his workload, he would also get people together to play music in the evenings. He was “always wanting to interact with people”, Arbab said. Even after he became sick, he called his friends from his self-imposed quarantine to assure them he would recover and to tell them not to worry.

Expert in the clinical care of viral haemorrhagic fevers. Born in Lungi, Sierra Leone, on March 6, 1975, he died in Kailahun, Sierra Leone, on July 29, 2014, aged 39 years. When Sierra Leone President Ernest Bai Koroma asked Sheik Humarr Khan to help lead the country’s Ebola response, he was an obvious choice. Since 2005, Khan had served as the Physician-in-Charge of the Kenema Government Hospital’s Lassa Fever Programme. “He was one of very few doctors in Sierra Leone and one of the only doctors dedicated to the care of viral haemorrhagic fever patients”, said Kristian Andersen, a postdoctoral researcher in Harvard University’s Department of Organismic and Evolutionary Biology and the Broad Institute. The Institute and Khan’s programme are part of the Viral Hemorrhagic Fever Consortium. Khan studied medicine and surgery at the University of Sierra Leone’s College of Medicine and Allied Health Sciences. After he had established his career,

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Obituary

Modupeh John Horatio Cole Physician Specialist in Connaught Hospital, Freetown, Sierra Leone. Born on May 18, 1958, in Freetown, Sierra Leone, he died in Kailahun, Sierra Leone, on Aug 13, 2014, aged 56 years. Modupeh Cole loved everything about being a doctor. Koyie Henry Mansaray, who grew up with Cole, remembered thinking his friend, who had an aptitude for science, would probably end up becoming a teacher. Cole had other ideas. He never talked much about his plans, but when he entered Fourah Bay College in Freetown to pursue a degree in pure and applied sciences, Mansaray realised his friend had other ambitions. Cole went on to complete a medical degree and do postgraduate work in internal medicine at Volgograd State Medical University in what was then the Soviet Union. Cole would continue broadening his expertise throughout his career in a range of areas, including clinical pharmacology, clinical administration, public health, and HIV. “His work became far more important to him than anything else”, Mansaray said. Colleagues remember Cole’s www.thelancet.com Vol 384 December 20/27, 2014

intellectual curiosity prompting him to take difficult assignments in some of the most remote parts of the country. That included stints at the Kamakwie Wesleyan Hospital and the Rogbane Community Health Clinic, both in the country’s north. But the job wasn’t purely a cerebral exercise to Cole, Mansaray said. With “his love for humanity and generosity”, the doctor also delighted in treating patients. In 2004, he moved back to the capital, Freetown, to work at Connaught, the country’s leading referral hospital. The many responsibilities he took on there reflected his different interests: providing both inpatient and outpatient care, a lengthy period in the intensive care unit, training interns and residents, and doing research. Cole apparently contracted Ebola from a patient at Connaught. He was transferred to a treatment centre run by Médecins Sans Frontières in northeastern Sierra Leone, where he died. He was “a very unassuming person and he led a very simple life”, Mansaray said. But when it came to his patients, “he was untiring in giving them courage and hope”.

Olivet Buck

PRIME–Partnerships in International Medical Education

he would return to the college as an associate lecturer. After graduation, he took a post as a Medical Officer at the national Directorate of Disease Prevention and Control in the Ministry of Health and Sanitation in Freetown. He moved to the Lassa Fever Programme after his predecessor, Aniru Conteh, contracted the disease and died. “He was aware of the dangers of his work”, Andersen said, “but selflessly worked around the clock to ensure that patients received the best possible standard of care”. Khan is credited with saving more than 100 lives in the months he spent treating patients before becoming infected himself. Koroma declared Khan a national hero after he died. The Sierra Leone Government plans to name a new viral haemorrhagic centre in Kenema in his honour.

The Medical Superintendent of Lumley Government Hospital, Freetown, Sierra Leone. Born on Dec 28, 1954, in Freetown, she died there on Sept 13, 2014, aged 59 years. Medicine was Olivet Buck’s second career. For 20 years she was a science

teacher working primarily at Annie Walsh Memorial School, a girls secondary school in Freetown. Her husband, Reverend Jenner Buck, said his wife had always been interested in a career as a doctor. They discussed it often in the years after they were married. Eventually, when the University of Sierra Leone’s College of Medicine and Allied Health Sciences opened, Olivet Buck decided to apply. After graduating in medicine in 2000, Buck went on to work at the Lumley Government Hospital, which her husband described as overcrowded and underfunded. She was one of only two doctors. But despite “the problems in the hospital, she was very committed. She enjoyed being a doctor”, he said. Her phone rang constantly even after her shift ended, as other health workers called to get her advice on their cases. Jenner Buck believes his wife became infected with Ebola because she continued to treat patients despite a shortage of protective gear. She refused to turn people away. Her illness sparked controversy when WHO turned down the Sierra Leone Government’s request to have Buck evacuated to Germany for treatment. WHO officials said they could only assist people they had deployed to Sierra Leone. Since her death from Ebola, tributes from her former students have sprung up online. Many of the women write that they continue to draw inspiration from the teacher who decided to go to medical school even as she was raising three children. Buck never completely abandoned her first career. During her time at Lumley Government Hospital, she was also the lead tutor in Sierra Leone for PRIME— Partnerships in International Medical Education. Buck was also an executive member of the Sierra Leone Medical and Dental Council and the secretary of the Christian Medical Association of Health Workers. Ron Rhodes, who worked with Buck as a senior PRIME tutor, said, “All were inspired by her clear commitment, drive, honesty, and deep, deep Christian beliefs. That she 2205

Obituary

Courtesy of Joseph Kamara

Godfrey George

Medical Superintendent at Kambia Government Hospital in northwestern Sierra Leone. Born in Freetown, Sierra Leone, on July 9, 1960, he died there on Nov 3, 2014, aged 54 years. Godfrey George freely admitted that Ebola scared him. The 27-year veteran health officer served as the Case Manager for Kambia’s local Ebola taskforce, alongside his work supervising the area’s hospital. The rural community is located in northwestern Sierra Leone near the country’s porous border with Guinea, where the Ebola outbreak started. At taskforce meetings, George made it clear “he was a man who was not comfortable”, said fellow taskforce member Joseph Kamara, the Kambia Project Officer for an international education charity, Children in Crisis. When taskforce members chided him for being worried, “he responded, ‘Yes, I should be afraid, because it is deadly.’” He was particularly concerned about how dangerous the disease might be in a rural setting where it is difficult for health workers to reach people and convince them to take precautions. George knew it would be nearly impossible to convince people not to touch a sick child, spouse, or parent. Still, Kamara said, despite his personal misgivings, George was committed to “change the minds and hearts 2206

of people”, and to continue caring for patients who arrived at Kambia Government Hospital—the main health institution in the area. Officials suspect he contracted the virus from one of those patients. Once diagnosed, George was transported to Freetown for treatment, but never recovered. Officials and friends said this willing ness to set aside personal worries and serve Sierra Leoneans was typical of George’s career. He received an undergraduate degree in chemistry at Freetown’s Fourah Bay College, before studying medicine and surgery at the University of Lagos in Nigeria. He worked for several years in Lagos after graduating. Upon his return to Sierra Leone, he took a number of positions, including stints in the surgical unit at Freetown’s Connaught Hospital and as medical superintendent at Bo Government Hospital in south central Sierra Leone. Kamara said George’s frequent movements resulted from a government with limited resources desperately trying to shore up gaps in its health system. George, he said, “was always willing to go where he was needed”.

Martin Maada Salia

United Methodist News Service

sacrificed her life in order to serve others was entirely compatible with the person we had come to know.”

Surgeon and Chief Medical Officer of the Kissy United Methodist Hospital in Freetown, Sierra Leone. Born in Kenema, Sierra Leone, on Sept 6, 1970, he died on Nov 17, 2014, in Omaha, NE, USA, aged 44 years. Nearly 3 years ago, Martin Salia was recruited to work at the United

Methodist Hospital in Kissy, an impoverished suburb of Freetown in Sierra Leone. Although he was a naturalised American citizen and his family remained in the USA, Salia told United Methodist Communications in an April interview, “I took this job, not because I want to, but I firmly believe that it was a calling and that God wanted me to”. He “proved himself as a committed and dedicated professional health practitioner, who was more interested in the wellbeing of his patients than in the money he received from them”, said Sierra Leone’s United Methodist Bishop John K Yambasu. Salia received degrees in medicine and surgery from the University of Sierra Leone’s College of Medicine and Allied Health Sciences. He went on to graduate from the Pan-African Academy of Christian Surgeons. Before joining Kissy United Methodist Hospital, Salia worked at the Banso Baptist Hospital in Cameroon, at Tenwek and Kijabe hospitals in Kenya, and at the United Brethren Church Hospital in his native Sierra Leone. It’s unclear how Salia contracted Ebola, since his hospital did not have a treatment facility for the disease. His colleagues have speculated he might have unknowingly come into contact with an Ebola patient while assisting at other clinics, part of his commitment to provide “needed medical services to the population at a time when Ebola was ruining livelihoods, health, and other social facets of society”, Yambasu said. Salia started to display symptoms in early November, but an initial test came back negative. Nearly a week later, a second test confirmed Salia had the virus. He was flown to the USA and cared for at the Nebraska Medical Center, one of four US hospitals with specialised facilities to treat the disease. There he received the experimental Ebola drug, ZMapp, as well as plasma from a patient who had survived. But the doctors caring for him said the disease was already too advanced and he did not respond to treatment.

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Remembering health workers who died from Ebola in 2014.

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