Health workers reported for duty at Liberia's hospitals on Monday, largely defying calls for a strike that could have further hampered the country's ability to respond to the worst Ebola outbreak in history.
Nurses and other health workers - though not doctors - had threatened to strike if they did not receive the higher hazard pay they had been promised by the government. That would have made the already difficult care of Ebola patients even harder, since the bulk of the staff at clinics and hospitals is made of up of nurses, physician assistants and community health workers.
Underscoring how overwhelmed the health system is, one patient in Liberia's capital complained Monday about a lack of food and water.
"Since this morning we have not eaten any food, there is no water, no medicine. We are dying," Junior Flomo, a patient at John F. Kennedy Memorial Medical Center in Monrovia, told The Associated Press by phone.
The outbreak has also reduced access to health care even for other diseases because many hospitals and clinics have shut, often because their staff are afraid to come to work or are not sufficiently trained to handle a patient with Ebola if one arrives.
In Guinea, a private clinic which served much of the city's elite, including many expatriates, stopped accepting new patients this weekend after a woman there showed symptoms of Ebola. The woman never went past the lobby of the clinic, a statement from the medical center in the capital Conakry said Monday, and the area she was in has been disinfected and sealed off.
Patients that were already inside the clinic are still being cared for but are at no risk, the statement said, since they never had any contact with the woman.
Doctors Without Borders is following up with anyone the woman came into contact with. She is now being treated for Ebola at a hospital, the statement said.
The Ebola outbreak that was first identified in March in Guinea has hammered Guinea, Liberia and Sierra Leone. Around 8,400 people are believed to have caught the disease. Liberia has recorded the highest death toll with more than 2,300 deaths linked to the virus.
Health care workers in West Africa are particularly vulnerable, working in overcrowded wards, often without proper protective gear and not enough staff. About 400 health care workers have become infected in this outbreak, nearly half of those in Liberia. But despite that, many kept on working.
"Considering the situation in which we find ourselves we don't think strike is the way forward," said Dr. Jerry Brown, head of ELWA2, a treatment center on the outskirts of Monrovia. "Because if we strike now, more and more patients will remain in the communities. And as more and more patients remain in the communities, there will be more new cases and there will be a setback."
"Things are back to normal, and we are working," said Dr. Atai Omoruto, a Ugandan doctor heading up an Ebola treatment center at Island Clinic in the western suburbs of Monrovia, Liberia's capital. She said all nurses and physician assistants were at work.
Other hospitals also said all their employees were at work. But at one government hospital in Tubmanburg, 60 kilometers (40 miles) from the capital, only some nurses and physician's assistants were reporting to work Monday, said Dr. Gobee Logan, the doctor in charge there.
George Williams of the Health Workers Association, which represents 10,000 health workers, including about 1,000 who work on Ebola wards, accused the government of pressuring people to go back to work.
Information Minister Lewis Brown said the government had simply asked health workers to go to work since it is in the national interest.
It was unclear if the health workers have been offered higher hazard pay, as they were demanding.
Liberia initially agreed to pay $700 per month in hazard pay to health workers, including nurses and physician assistants, on top of monthly salaries of about $200 or $300. But the government has since lowered that bonus to $435 per month, saying it can't afford the higher rate because the epidemic and efforts to contain it have expanded so much.
Doctors receive at least $825 in monthly hazard pay, and their salaries are more than double most other health workers.
The hardest hit countries of Liberia, Sierra Leone and Guinea had too few health workers even before the outbreak began, and infections among health workers have only further hampered their ability to respond.