Outside a run-down elementary school in West Point, Liberia, health workers stand silent and stiff under a balcony as the night darkens. Their spare supply of white hazmat suits, latex gloves and chlorine has been stolen, along with food for 21 patients who were being quarantined inside.
Just an hour earlier, locals had burst through the gates and looted the facility. Patients suspected of having Ebola were “liberated” — the mob took their bedding and mattresses out with them. Now the staff are waiting for the police to escort them to safety. They eventually depart, unharmed, but they are forced to leave a patient’s dead body behind.
The school was supposed to be a holding center so that those infected by the virus could be quarantined in the community before they came into contact with others. The main treatment center was so choked that one healthcare worker said he feared people coming in without the virus might end up infected. However, the initiative collapsed after just 48 hours. At least three people died inside — they did not receive medical treatment during their final hours.
West Point, Monrovia’s largest seaside slum, serves as a microcosm for the fear and confusion that is gripping the wider community. The Ebola epidemic has claimed 1,400 lives and infected more than 2,000 across three countries — Liberia, Sierra Leone and Guinea — in just five months.
Since the outbreak in Guinea began, many who live in the region have been deeply confused about what Ebola is and how to prevent it. Resistance and denial run high. There are reports that about 150 bodies have been secretly buried under Monrovia’s sands, in contravention of the government’s ban on burials.
Ebola is transmitted through bodily fluids, and the corpses of those infected can remain virulent for months after death if not treated with chlorine and sealed off with plastic. Yet local culture is a challenge in communities where world events are seen through the prism of religious fatalism and superstition.
Variations of the same rumor circulate the region: that drinking-water wells are being poisoned by the government to cash in on the international aid meant for addressing the crisis. It has stoked an existing paranoia that the lives of ordinary Africans are expendable. Sierra Leone lost its leading Ebola doctor, Sheik Umar Khan, last month, along with numerous health workers.
It was only after the infection of two US non-governmental organization staff, Kent Brantly and Nancy Writebol, who were working in an isolation center in Monrovia run by Samaritan’s Purse, “that the world sat up and paid attention,” according to Ken Isaacs, one of the organization’s vice presidents.
An exodus by foreign aid workers is also triggering feelings of wartime abandonment as NGOs fret about their insurance and image.
“It’s as though people have just woken up and realized that this is not Club Med,” one expatriate said bitterly, before he was unwillingly evacuated.
While aid has been pledged by the government, borders have been closed, communities quarantined and non-essential staff at ministries sent home. The crisis has again brought into sharp focus Liberia’s deep class divisions, between those who are mobile and free to fly to other countries when crisis hits and those who are forced to remain dormant and weather the storm.;
“Now you have the battlefront all over,” says Jefferson Sibley, a doctor at Phebe Hospital, where the lives of five nurses and a physician’s assistant were claimed by the virus. “The good thing about the war was you heard the gun sounds, you could hear a group of people shooting somewhere coming and you could run and take cover, but Ebola is not like that. You never know where it is coming from or who is bringing it to you.”
DOCTOR
Grazia Caleo, Sierra Leone:
I do not allow myself to feel fear in the field.
I focus on sticking to procedures. Slowly, but surely I have built up confidence working at the Medecins Sans Frontieres treatment center in Kailahun, although I’m always aware how important it is not to get overconfident, because that can lead to mistakes. Long shifts and tiredness are a dangerous combination.
To begin with, the villagers were not receptive to us, but they are starting to trust that we are there to help. We have invited heads of villages to the treatment center to see for themselves the work we are doing — they can understand why we need to isolate patients now, instead of villagers being taken away for treatment and mysteriously never making it back.
It has been challenging: You see people dying and there is only so much you can do to help. As a doctor and a human being, that can be difficult to take. An ambulance arrived late one night carrying a mother and her seven-year-old daughter. They had been on an 11-hour journey to the treatment center, but sadly, when they got to us, the mother had already passed away, leaving the little girl in the back of the ambulance with her mother’s body. She was so traumatized and ill that she could not tell us what her name was or what village she was from. She died a few days later.
However, I have also seen some miracles: People I thought were goners have got better and walked out — 17 in the five weeks I was there. With Ebola you can never really tell how it will work out for those who come for treatment early on. It is different for those in the advanced stages — they are so thin, consumed by the virus.
I do not disengage from my emotions to cope. Seeing people expose themselves [to Ebola] in order to look after family members, knowing the risks, is very humbling. It is quite something to see older children in the high-risk unit instinctively look after the younger ones even though they’re not related. Being in Sierra Leone has taught me about the human spirit. We’re much more resilient than we think we are.
MOURNER
Stephen Kpoto, Liberia:
The problems I am encountering now are too big for me. I have not really slept since my father, brother and sister were admitted to the West Point treatment center in Monrovia a week ago.
I brought them here by taxi as the Ebola Response Team never came when we called them. My family were all so weak: my brother Abraham and sister Nancy are only 13 and 12 years old and could not really see what was happening to them, but I could and so could my father.
It started with my stepmother falling ill three weeks ago — she began vomiting and toileting too much. This was not long after her own mother had died of similar symptoms. It is part of our custom for a family member to wash the deceased’s body in preparation for burial, and that is what she did for her mother. She then started to feel unwell. We took her to a pharmacy, where they gave her medicine for malaria and typhoid and asked us to leave.
Before long, her eyes started turning red; her face changed. We called the Ebola hotline and a health worker came, but they did not have space for her at the treatment center and there was no ambulance to carry her anyway. She died a few days later.
My community has been scared by the illness in my family. We are still waiting for the response teams to come and spray the house with chlorine solution to kill the virus. I bought some chloride and Dettol and plastic sheeting, but I am afraid to do it myself.
I have not been back there, as I do not want to become sick. My father had already lost hope in the treatment center. He felt abandoned by our relatives, and it is true: Everybody is too afraid to be near us. Nobody has come round to see me. My friends are afraid. I spoke to my father on the telephone last week and he said that his condition was not improving; Abraham was OK although he could not speak properly; and my sister Nancy was helpless. I just heard that my father has now died.
I am trying not to be afraid. When you find yourself in the midst of something awful, you have got to be brave. I have nobody to help me now. I just have to wait and see if I get through the three-week incubation period without showing symptoms. I am observing myself. I feel I am too young to die. I have so many things I have to do.
NURSE
Sylvanos B Karimun, Sierra Leone:
I have been a local nurse for four years, but I decided to join the work at the treatment center in Kailahun in June this year. I felt it was my duty to come and care for the sick, for the people that no one wanted to look after. I and the other national staff — who are from Sierra Leone — were scared to begin with as we did not know what to expect and whether it would be safe for us, but I trust what we are doing here now.
I see four to seven new patients a day. They come in on a stretcher and we have to run blood tests on them immediately to see if they test positive for Ebola, but also any other underlying illnesses they may be harboring: HIV, malaria, or any other viruses we need to treat them for.
It is important to boost a patient’s immune system as quickly as possible to give them a chance to fight the Ebola. We then treat them with high-dose vitamins, we keep them hydrated and we look after them — washing them and making them feel as comfortable as possible.
I found this difficult to begin with because I was afraid — but I am not any more.
My family and community worry about me getting sick, but I feel safe here and they are beginning to understand the job I am doing. We follow strict protocols, meaning that I am very unlikely to fall ill. Seeing people I know from my community come in on a stretcher is very hard. These are people I have known a long time and now they are possibly ill with Ebola. Yet I make sure I look after them like any other patient.
The community around here is slowly realizing that Ebola is not a made-up virus — that people are really ill and that the NGOs and Western medical staff are here to help. It will take time for everyone to accept this, but I am hoping that a cure or a vaccine is found before too long — and that this crisis will not last for ever.
SANITATION SPECIALIST
Cokie van der Velde, Liberia:
I was working in the Congo, but when the Ebola outbreak happened, I was sent to work in Guinea and eventually Liberia. There were only a few people diagnosed with the virus when I arrived, but by the time I was leaving — only four weeks later — the situation had become dire. The day I left, there were two dead bodies in the street and our isolation unit was overfull. We have beds for 20 but there were 25 in there, with more patients arriving all the time.
It is my job to make sure infection is kept under control — to train people in how to wear the Personal Protection Equipment (PPE) and teach the protocol for getting in and out of high-risk areas in the treatment centers. I also deal with the dead bodies, training the burial teams in how to dispose of them.
It is physically demanding work. The PPE is completely waterproof, so there is no chance of evaporation and therefore no chance of cooling down. The scrub suit I wear underneath gets completely soaked with sweat — it looks like somebody has thrown a bucket of water over me and I can pour the sweat out of my boots.
Due to the heat, we have to be very careful that we do not faint inside the high-risk units. I have to time it perfectly, working as long as I can without actually fainting — the longest I have lasted is an hour and a half, when I am not doing highly physical work. If I am moving adult bodies, or cleaning blood from the floor, I will last an hour, but no more.
I have slowly got used to being around the bodies. The smell is not too bad as I am always wearing a face mask. It is not easy, especially when children are involved, but I try to do it with as much respect for the deceased as I can. We used to seal the body bags and never open them again as part of our protocol, but we have had to change that because people became very suspicious of us. There were rumors going around at one stage that we were harvesting organs.
Families of the deceased need to have the opportunity to see their loved ones and to say goodbye. We bring the body to the fence we have had to put up and show them the deceased’s face. For an adult, I place flowers beside them, and if it is a child, some toys. It helps the families deal with what they’re seeing somehow, I hope.
SURVIVOR
Harrison Sakela, Liberia:
I kept hearing the word “Ebola” but I had not seen what the illness could do to a human body until my mother got sick. She had traveled to a funeral in Sierra Leone and met someone who had it. I was teaching a class, like any normal day, when I was told that she was unwell, so I went to see her in Sierra Leone and it was obvious that something was very wrong.
I decided to treat her myself: I bought some medicine and a drip. I spent about three days trying to help her, but she was not responding. At the last stage, she would not look people in the face. She was toileting every two to three minutes. She refused to eat. It took her two weeks to die.
Within a week of coming back from Sierra Leone, I began feeling very weak. My head was hurting and I had a fever. I was not even able to cross the road. A Samaritan’s Purse health facility worker saw me and asked me to come to the center. I agreed straight away and tested positive for Ebola that day. I had severe diarrhea and was very weak, but I never vomited blood like others had. A week later they tested my blood. It came back negative for Ebola and they discharged me. I came out and I am all right. Now I am the Ebola ambassador.
I have lost five family members to Ebola: my mother, father, sister, niece and my niece’s daughter. I have no one now, so I have decided to stay on at the treatment center and work here as a security guard.
Most people in my community are ready to accept me again, although some people are saying that the Liberian government is giving me money to say that Ebola is real. Ebola is real. I have experienced it. The people of west Africa need to stop denying it exists.
Source: Taipei Times - 2014/08/25
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