John Fankhauser, a missionary doctor, is as scared of Ebola as anybody else. But that hasn't stopped him from tending to patients during the outbreak. He sees the Ebola crisis as an important moment in his personal relationship with God.

"I have a very keen awareness of the risks and the need to be extremely careful, but I also feel very called to what I'm doing," says Fankhauser, 52, from Ventura, Calif. "I feel very confident that this is where God wants me right now."

And so he is on duty at the ELWA missionary hospital in Monrovia, Liberia. According to ELWA's mission statement, its primary purpose is "to propagate the Gospel, disciple believers, minister to human needs, and partner with churches to build the Kingdom of God."

When the Ebola crisis started to spiral out of control last summer, missionaries at ELWA and elsewhere in the region stepped forward to try to help. This was in marked contrast to the way much of the rest of the world reacted. Up until late last year, finding volunteers willing to treat Ebola patients was incredibly difficult. With the exception of Doctors Without Borders, international aid groups moved at a glacial pace. The World Health Organization deferred to weak local governments to tackle the terrifying disease. Even the U.S. military response was predicated on the idea that American troops would not be directly providing care to people affected by the virus.

Public health experts say if there had been enough trained medical professionals on the ground early enough, the outbreak probably wouldn't have mushroomed the way it did. The outbreak might even have been snuffed out months ago.

Despite lacking experience with Ebola, missionaries entered the fray.

Fankhauser's colleagues, Nancy Writebol and Kent Brantly, were the first two Americans infected with Ebola during this outbreak. They were both medevac'd back to the U.S. and survived.

Another missionary doctor from Maryland, Martin Salia, died in November after treating Ebola patients in his native Sierra Leone. Throughout the region, more than 800 health care workers have been killed by the virus, according to the World Health Organization.

As the health systems in Liberia, Guinea and Sierra Leone collapsed, many aid agencies couldn't find staff willing to confront the deadly outbreak. Doctors and nurses from evangelical groups, however, toiled away, tending to patients at several key Ebola treatment centers.

"I really have a great deal of respect for other organizations that are not faith-based," Fankhauser says. But he says the missionary response is fundamentally different. "It reflects our faith in a way that has meaning to people. It's not just words. In our actions we demonstrate the kind of love that our faith is based on."

They care for patients who are suffering from a horrific and dehumanizing disease. They tend to the dying. They offer hope to people who've been shunned. At one point, when there was nowhere else to house to Ebola patients, the missionaries converted their hospital chapel in to an Ebola ward.

Local religious groups have also been key players in the response to Ebola. In Liberia, the government turned to churches and mosques early on to try to spread the word about Ebola prevention.

Dr. Fankhauser addresses worshippers at a service in Monrovia.

Dr. Fankhauser addresses worshippers at a service in Monrovia.

Courtesy of Bethany Fankhauser

Outside observers agree that the missionaries and religious groups have been indispensable, in West Africa and elsewhere. Tom Kirsch, who runs the Center for Refugee and Disaster Response at Johns Hopkins University in Baltimore, says religious groups have become major players in international aid. In some cases, he says, they tie their humanitarian and evangelical work closely together. They talk to aid recipients about the Gospel. Prayer and assistance go hand in hand. Then again, other faith-based relief agencies don't mention religion at all.

"It totally depends on the group," Kirsch says. "And the groups vary. There are groups like Catholic Relief Services, which is a massive organization in hundreds of countries, to very small churches that run single missions in countries."

And in such a large field, there are effective groups — and groups that don't provide much assistance.

"In any disaster there are many groups and well-meaning people who feel it's their job to go out and help."

So they just show up. Which doesn't always work out so well.

"In a disaster, particularly in an event like Ebola where things are so dangerous," Kirsch says, "you have to be very careful and you have to come prepared for a unique and difficult environment."

Aid groups that tend to have the biggest impact are the ones that were established in an area before a crisis hits. The SIM missionaries at the ELWA hospital in Liberia are a perfect example. They're already connected to the community. They often have buildings and vehicles that they can redeploy for relief purposes.

Whether they're faith-based or not, Kirsch says, these long-term players are the ones that really make a difference on the ground.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Transcript

ARUN RATH, HOST:

For many doctors and nurses fighting Ebola, what keeps them going is their faith. In fact, the first two American's infected with the virus were missionaries working at an Evangelical Hospital in Liberia. The Ebola crisis has highlighted the work of missionaries in West Africa because while many other aid agencies struggle to find staff willing to confront the deadly outbreak, Christian doctors and nurses tended to patients in overcrowded Ebola wards. NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: In August, there was an incredibly dark moment in Liberia when the Ebola crisis was spreading so fast and seemed to be so uncontrollable that nearly every health clinic in Monrovia shut down. But the ELWA Missionary Hospital on the outskirts of the capital stayed open.

JOHN FANKHAUSER: We were the first Ebola unit in Monrovia. We turned our chapel into a six-bed Ebola unit, so that was the ELWA one.

BEAUBIEN: John Fankhauser is a missionary with SIM which runs the ELWA hospital. ELWA stands for Eternal Love Winning Africa, but most people now just call it E-L-W-A, or ELWA. It's been operating in Liberia for five decades. According to its mission statement, the purpose of ELWA is to propagate the gospel, disciple believers, minister to human needs and partner with churches to build the kingdom of God. Take Ebola patients into the chapel is not explicitly in that statement, but that's what they did. Fankhauser respects the work of other secular aid agencies in West Africa, but he says what he and other missionaries are doing during this Ebola outbreak is special...

FANKHAUSER: ...In that it reflects our faith in a way that has meaning to people. It's not just words, but in our actions, we demonstrate the kind of love that our faith is based on.

BEAUBIEN: In this outbreak, recruiting aid workers has been a huge challenge, and convincing people to risk their lives to treat Ebola patients continues to be difficult. After other natural disasters - the 2013 typhoon in the Philippines or the 2010 Haitian earthquake - aid workers flooded into the affected countries to help. But with the Ebola, that didn't happen. Missionaries were one of the few groups ready and willing to go. Bruce Steffes, the head of the Pan-Africa Academy of Surgeons, which trains missionary doctors, says missionaries aren't necessary braver than anyone else.

BRUCE STEFFES: They're still humans. They still have all the same fears and so forth. But because of the very strong sense of calling and a sense that this is what their God wishes them to do, I think they are able to corral those fears.

BEAUBIEN: During this outbreak, it hasn't just been international evangelical groups that have been involved with the crisis. In Liberia, the government turned to local churches and mosques very early on to try to spread the word about Ebola prevention. Tom Kirsch, who runs the Center for Refugee and Disaster Response at Johns Hopkins University in Baltimore, says religious groups are increasingly important players in international aid. He says some tie their humanitarian and evangelical work together, others don't mention religion at all.

TOM KIRSCH: It's totally dependent on the group and, again, the groups vary from - there's groups like Catholic Relief Services, which is a massive organization and hundreds of countries around the world, to very small local churches that run single missions in countries. So it's very widespread differences.

BEAUBIEN: And some are more effective than others.

KIRSCH: In any disaster, there are any many groups and many well-meaning people who feel that it's their job to go out and to go help.

BEAUBIEN: And so they just show up.

KIRSCH: In a disaster, particularly an event like Ebola, where things are so dangerous, it's just - you have to be very careful in those settings. And you have to come prepared for a very unique and difficult environment.

BEAUBIEN: Kirsch says the aid groups that tend to have the biggest impact are the ones that were established in an area before a crisis hits. The SIM missionaries at the ELWA Hospital in Liberia are a perfect example. They're already connected to the local community. They often have buildings and vehicles that they can redeploy for relief purposes. And whether they're faith-based or not, Kirsch says these are the ones that really make a difference on the ground. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.

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