Kadiatu Barry was dying in her home in Monrovia, Liberia, with her daughter nearby as a local aid worker called 4455 for the country's Ebola hotline.
Five days later, Ms. Barry's ride arrived: a makeshift coroner's truck. Her final days and fate are emblematic of why West Africa's Ebola crisis is forcing a major reconsideration of how the world handles public-health emergencies.
Eight months after the deadly epidemic began in a forested corner of Guinea, there still aren't enough doctors, nurses, and epidemiologists to keep it from spinning out of control. The World Health Organization said Thursday that more than 40% of the 3,069 cases reported since the outbreak began in December 2013 have occurred in the past 21 days. At least 1,552 people have died. The WHO says more than 20,000 people could be infected before the outbreak can be brought under control.
The rapid expansion of the Ebola epidemic sends a shrill wake-up call to the global health community and the governments that often provide aid in crises—because so far the nations with the funds and medical resources to help deal with this scourge have offered only a trickle of aid. The lackluster response has compounded the pain and suffering the countries and their people are going through.
"Ebola is moving at the speed of sound and the aid organizations are moving at the speed of a snail," said James DorborJallah, the national coordinator of Liberia's Ebola Task Force. He pulled out a piece of notebook paper labeled "BLEAK!!"
It was the government's forecast of the monthly death toll. "Hundreds now," he said. "By October, we're talking about thousands."
WHO has steered the global health community in bringing major outbreaks under control, such as SARS in 2003 and the H1N1 flu pandemic in 2009. Some officials involved in the Ebola response say overcoming the outbreak, which has prompted economic hardship and social unrest in addition to disease, will require the sort of large cadres of foreign aid workers and disaster-assistance experts that dealt with disaster zones such as the tsunami in Southeast Asiaand the Haiti and Kashmir earthquakes.
In a road map released Thursday, the WHO called for a scale-up of medical staff, hospital beds, laboratories and other services to reverse the epidemic within three months and end it within six to nine months. The United Nations public-health agency estimated the effort would cost $490 million, to be funded by national governments, some U.N. agencies and other partners.
Aid experts say that will involve government organizations that are used to managing disasters rather than just nongovernmental and health-focused groups.
"We have learned an uncomfortable lesson over the past six months," said Brice de le Vingne, director of the operational center in Brussels for Doctors Without Borders, the nonprofit organization that is leading the international effort to isolate and treat Ebola patients. "None of the organizations in the most affected countries—the U.N., WHO, local governments, NGOs [including Doctors Without Borders]—currently have the proper setup to respond at the scale necessary to make a serious impact on the spread of the outbreak."
The stricken nations are starting to draw help from some unusual actors. The U.S. Office of Foreign Disaster Assistance, part of the Agency for International Development, normally delivers humanitarian aid following typhoons, drought and conflict. But this month it deployed a team to the region and airlifted 16 tons of protective medical clothing, plastic sheeting and other supplies. It is working with U.N. agencies to add several hundred treatment beds in Liberia and to train additional staff, said Jeremy Konyndyk, the OFDA director, on a stopover Thursday as he returned from a trip to Liberia.
"We would not typically get involved in an infectious disease outbreak," he said. But "this is all hands on deck."
Mr. de le Vingne says the aid effort is now in a dangerous race against time. "We need a much stronger mobilization to help with the situation in Monrovia," he said. "We are late."
How late became agonizing clear in the case of Ms. Barry, the Liberian woman who died of Ebola days ago.
Amos Constant, a health worker, found Ms. Barry too gravely ill to move when he dropped by her house as he made the rounds this past Saturday in West Point, a densely packed neighborhood of 75,000, looking for sick people.
Days earlier, the government had grown so fed up with residents here denying the presence of Ebola that soldiers took neon-colored string and simply roped off the neighborhood of tin roof homes.
He called the Ebola hotline to summon an ambulance. On the other end of the line was one of 90 operators who handle some 3,000 calls a day, supervisors say. "The calls are constantly coming," said one agent, switching from one line to the next.
If the call is about a sick person, the phone bank asks for an ambulance to be dispatched, the agent said. If the person is dead, they request a coroner's truck.
Mr. Constant followed up by phone for days: "It rings and rings."
Monrovia, a city of more than one million people, has only six ambulances. And even when one comes, there is often nowhere to go. The only Ebola treatment center, run by Doctors Without Borders, has 120 beds, and they have been consistently full.
At least 1,000 hospital beds are needed in Monrovia to isolate Ebola patients, said Mr. de le Vingne Doctors Without Borders, which is trying to expand its existing treatment center and train more personnel to staff it.
A coroner's truck isn't any easier to summon. There are also only six coroner's trucks, and though Ebola-infected bodies should be cremated, the only crematorium in the country belongs to Liberia's Hindu community. It can't handle the daily overflow of dozens of corpses, said Mr. Jallah, the national coordinator.
"People are dying faster than we can dispose of the bodies," he said.
Back in quarantined West Point, Ebola is sparking another health crisis: hunger. The World Food Program is distributing food, although not enough to go around. George Doe, a former soccer player now tasked with passing out rice and beans, said Thursday he has only enough for about 20% of the people in his zone. All over West Point, crowds follow foreigners, begging for food and hand sanitizer.
Pharmacies are out of medicine at the height of malaria season. Shelves at FFF Medical Supplies are bare, excluding a variety of condoms, cough syrups and vitamins.
On the streets, sick people are a common sight: "This man is in a bad condition," said a young boy, walking an older guy by the hand, looking for help. "Excuse me!" shouted another boy, pointing at a man lying on a step. "He is very ill."
Health workers are overwhelmed at the only clinic left open in West Point. On Thursday morning, a woman was throwing up on the floor of the clinic—infecting the ground if, as nurses believe, she has Ebola.
Nearby, Amadu Jalloh was hunched over. For three days now, nurses said they've told him to go to the testing center next door to have his blood sampled for Ebola.
On Thursday morning, he finally worked up the courage. When he got to the testing center, though, the only five workers on duty were too busy spraying down the corpses of the last pair of people to show up.
Mr. Jalloh sat outside for 45 minutes, waiting for them to open the gate. Eventually, his father arrived, took him by the hand, and led him back through the crowded neighborhood.
Minutes later, a health worker opened the gate and shrugged off Mr. Jalloh's disappearance. "It was beyond our focus," said Gideon Klehkleh.
Ms. Barry, who was in her 20s, never made it that far. She raised a daughter in the sandy alleyway where she cooked the porridge she sold by the road. On Sunday, she died.
On Thursday afternoon, a truck finally arrived, and carried her away.
Nobody knows where her husband is. He vanished into the city, carrying the little girl and probably, health workers say, the virus.