KENEMA (Sierra Leone) - The best defence against despair is to keep working.

Many times, that choice was far from obvious: Ms Josephine Sellu lost 15 of her nurses to Ebola in rapid succession and thought about quitting herself.

She did not.

Ms Sellu, the deputy nurse matron, is a rare survivor who never stopped toiling at the government hospital here, Sierra Leone's biggest Ebola death trap during the dark months of June and July.

Hers is a select club, consisting of perhaps three women from the original Ebola nursing staff who did not become infected, who watched their colleagues die and who are still carrying on.

"There is a need for me to be around," said Ms Sellu, 42, who oversees the Ebola nurses. "I am a senior. All the junior nurses look up to me." If she leaves, she said, "the whole thing would collapse".

The other nurses call her Mummy and she resembles a field marshal in light-brown medical scrubs, charging forward, exhorting nurses to return to duty, inspecting food for patients, doing a dance for once-infected co-workers who survived, and barking orders from the head-to-toe suit that protects her from her patients.

In the campaign against the Ebola virus, which is sweeping across parts of West Africa in an epidemic worse than all previous outbreaks of the disease combined, the front line is stitched together by people like Ms Sellu: doctors and nurses who give their lives to treat patients who will probably die; janitors who clean up lethal pools of vomit and waste so that beleaguered health centres can stay open; drivers who venture into villages overcome by illness to retrieve patients; body handlers charged with the dangerous task of keeping highly infectious corpses from sickening others.

Their sacrifices are evident from the statistics alone. At least 129 health workers have died fighting the disease, according to the World Health Organisation.

But while many workers have fled, leaving already shaky health systems in shambles, many new recruits have signed up willingly - often for little or no pay, and sometimes giving up their homes, communities and even families in the process.

"If I don't volunteer, who can do this work?" asked Mr Kandeh Kamara, one of about 20 young men doing one of the dirtiest jobs in the campaign: finding and burying corpses across eastern Sierra Leone.

But after he started working, his family said, he was no longer welcome in his village. Mr Kamara's uncle, the family patriarch, told him never to come back. At first, he stayed with a friend, but the man's wife was afraid and kicked him out, too.

Ms Sellu faced a similar predicament. At the height of the Ebola deaths last month, her two teenage children and her family in the capital, Freetown, urged her to stop.

The remaining nurses at the hospital staged a revolt. One morning, 40 of them appeared outside the door of her home in Kenema, yelling, "If one of us dies again, prepare yourself to die!"

Frightened, her children warned her: "They have come for you. Mummy, don't go there again."

Ms Sellu disobeyed all of them. "I was sneaking in at the end of the day," she said.

Thanks to international help in recent weeks, confidence among the nurses in the Kenema hospital has been restored. A more rigorous system for screening, filtering and holding Ebola patients has been instituted. But outside the hospital, they continue to face stigma.

Some of Ms Sellu's staff spoke of husbands abandoning them and neighbours shunning them.

One nurse told of returning home to find her belongings in suitcases on the sidewalk and her spouse warning her to stay away.

The epidemic goes on. International aid workers said the official figures - an estimated 2,615 cases and 1,427 deaths in Guinea, Liberia, Nigeria and Sierra Leone - are almost certainly much lower than the real number of infections and deaths.

Ms Sellu finds some reason for optimism, though. She has seen the flood of Ebola patients diminish. And she and her nurses are no longer alone in the fight.

"Some went, but we stayed," said nurse Nancy Yoko. "We have kept coming. We never left."

NEW YORK TIMES