How to Ignore a Plague: Escaped Ebola patients, besieged hospitals, and deadly denial in West Africa
By Umaru Fofana
In the doorway of an Ebola isolation facility in Kenema, Sierra Leone, stood a group of 10 or so patients. I could see them from a distance—I’d been advised by the medics not to get too close since I was not wearing protective clothing. They were mostly women, but I also saw two children: a boy and a girl. Ebola was eating him up. I was later told that the boy’s name was Kinnie, and that he was five years old. I shouted across to him, but he was too emaciated and weak to reply.
Inside the isolation wards were dozens of people who had tested positive for the rampaging hemorrhagic fever, including at least five nurses. They had apparently been infected by patients who had not been suspected of carrying the virus. Until recently, health workers didn’t use protective gloves unless they knew they were treating a confirmed case of Ebola—even though the virus is hard to diagnose, easily transmitted through bodily fluids, and Sierra Leone is in the middle of an outbreak that has stricken more than 300 and killed 92. One of the nurses died a few days ago. Her name was Sarah, and she got married last December. She was a few weeks pregnant.
Despite the danger facing these medical workers, they are being blamed for the disease by the public—a public so poorly informed about Ebola that many didn’t know of its existence before the outbreak began.
A few yards from the isolation facility lay the main wards of the Kenema Government Hospital. Many patients there fled after one of the nurses tested positive, headed for who knows where. And a couple of days after I visited, a colleague of mine watched relatives of Ebola patients pelt the hospital itself with stones. Confirmed Ebola cases are quarantined, and the attackers accused the nurses of sorcery and demanded their sick relatives be released to them — if they were dead, they said, they wanted the bodies to bury themselves. Such is the respect and reverence people have for the dead that the way Ebola victims are laid to rest is hard for most to stomach. Medics place them into a bag, and bury them without ceremony in a mass grave. The confrontation became so violent that police used tear gas to disperse the crowds, and have remained in and around the hospital since.
It is amazing—shocking—to see the denial of so many people here. Just 500 yards from the hospital, a group of revelers stood outside a video center (as cinemas are known here), pulling on cigarettes and even sharing the same butt. Backslapping and hugging having just come from the unventilated room. Sweating profusely in the 90-degree heat. There are other such video centers throughout Kenema, all over Sierra Leone. Beneath the veneer of that excitement and camaraderie lies the acrid reality that Ebola is tearing the country apart. The next day, at the Holy Trinity Secondary School, I saw scores of high school kids playing soccer. Some had removed their white uniforms to avoid them getting dirty, and their bodies glistened. The longer they played, the more they sweated, and the more dangerous the game became for them. But they were either oblivious to the dangers of a virus that can kill nine in 10, often by internal bleeding and organ failure, or they did not care.
Kenema hosts the only Ebola-testing laboratory in the country, one of the best in the world, run by the U.S.-based Metabiota and Tulane University. And yet some people here are even questioning the existence of the disease. At a roadside store selling candies and sodas, I talked with a high school student who gave his name only as Konneh. “Ebola is unreal,” he told me. He peeled a banana and guffawed before biting into it. “I have not seen anyone who has suffered from or died of it,” he said as he munched.
There are other conspiracy theories flying fast and thick. My mother fell ill last week, while I was on a short trip abroad. She was vomiting and needed to see a medic, but some of my relatives advised her against going to hospital. They had heard rumors of a desperate attempt to stem the spread of Ebola: patients with signs of the disease, which include symptoms as broad as fever, were being injected with poison by health workers. It was only after my return that I could persuade her to seek treatment.
Three days after the hospital was attacked—and more than a month after the outbreak began—President Ernest Bai Koroma finally ended his curious silence, and addressed the nation. He said that “the national efforts of patriotic citizens from all regions, all political parties and districts must not be derailed by a misguided few.” He added: “Anyone who knowingly harbors an Ebola victim without notifying health authorities is also guilty of an offense and we will ensure that the full penalty of the law is meted out on them.” But he fell short of declaring the disease a public health emergency, which would have put the country’s resources toward the fight, and he has yet to visit any of the areas affected.
Koroma’s slow response recalls the civil war of the 1990s. Like Ebola, it started abroad, in Liberia, and snaked across the border. The army was ill-prepared; war was strange to the soldiers; many ordinary people took it lightly—I dare say, scornfully. It was not until fighting reached Freetown that the government made a serious effort to end it. By then, tens of thousands were dead. With the casualties in neighboring countries, the death toll from the current Ebola outbreak has already topped 500, and figures keep rising every day. No one knows how many more have died outside of health facilities, or are mistakenly being treated for another disease. Médecins Sans Frontières, an aid organization, has described the situation in the region as “out of control.”
People who actually acknowledge the situation are uncertain about what to do now. At my wife’s church—she’s Catholic—the body of Christ as epitomized by bread is now dipped into wine by a glove-wearing priest. Handshakes have been minimized in mosques in this Muslim-dominated country. “It is the hard tradition-breaking sacrifices we have been forced to make,” a Friday worshiper told me. At one restaurant I visited, the owner had placed a bottle of chlorinated water at the door; everyone who entered was asked to wash their hands with it. But the chemical has become hard to find, and the owner of the restaurant told me that the price of chlorine has tripled.
Meanwhile, suspected Ebola patients are doing exactly what public health workers would like them not to do, which is to move around and potentially infect others. Almost 60 have disappeared after testing positive, officials say. “They may have died somewhere after infecting others,” one doctor told me, looking worried. One of the escapees was a man named Mohamed Swarray, who fled Kenema last month for Freetown, the capital, where he went into hiding. Police found him a week or so later, after he was spotted by someone who knew him in Kenema, and who had heard the announcements on local radio calling for information on his whereabouts. By then Swarray had visited a hospital in the capital, and may have infected the nurse who treated him. (The authorities are also on the lookout for his mother with whom he is believed to have escaped.)
I was standing outside the Kenema hospital when a new-looking ambulance raced into the hospital compound, sirens blaring. The driver wound down his window and asked shakily in a local language where the Ebola ward was. I pointed it out, and the driver meandered toward it, dodging the potholes made muddy by the country’s rainy season. I was curious as to how an ambulance in this part of the country could not know where the Ebola ward was, and suspected they must have come from Freetown. Moments later I saw Mohamed Swarray being guided to the isolation ward by a nurse in protective clothing. He looked hopeless and forlorn, as if he were being led to the gallows.