Clearing Ebola's Dead In Liberia
Meet the heroes of Monrovia who are trying to stop the disease
Nyilah leads Dead Body Management (DBM) Team 5 in Monrovia, Liberia's capital. In this country, the Ebola virus rages like nowhere else. Over half of the 4,500 people killed by the virus worldwide over the past few months are from Liberia. And those are only the registered cases. The number of unknown cases could be many times higher.
International aid organizations fear the epidemic can no longer be contained. As the cases multiply, the dead have to be removed ever more quickly: Nowhere is the virus more contagious than on a dead body.
His new job has made Nyilah lonely. The taxi drivers he tries to flag down after work keep driving as soon as they smell the dried chlorine solution that sticks to his skin and clothes. His friends have suddenly stopped coming to see him. His girlfriend is keeping him at arm's length. That's the way it is with all so-called Burial Boys, as men like Nyilah are called in Liberia.
Nyilah says he couldn't do anything else. This concerns his country, his people. "We're afraid this virus will get to our families." Somebody has to do the dirty work.
At noon on a recent Saturday, Nyilah is waiting in what was formerly a courtyard of the Ministry of Health and Social Welfare but that is now occupied by the Liberian National Red Cross Society, which coordinates the efforts against Ebola. The Red Cross has 16 teams of 10 people each, groups like Nyilah's, trying to rid the city of infected corpses.
Today, Nyilah is on stand-by duty. Four teams are currently working, and that seems to be enough. In the past few days there haven't been as many dead as there were a couple of weeks ago. Then it was up to 60 a day. Now it's around 30. Still, Ebola continues to spread rapidly. Nearly a third of the official 9,000 West Africans infected by the virus contracted it during the last three weeks.
Nyilah has heard that many of the infected are fleeing the city because they fear they won't be buried in the Liberian tradition. Nyilah and his people take the bodies to the crematorium.
The city has 1.5 million inhabitants who live crowded together, and the city administration has forbidden burials of Ebola victims. In July, when the number of infections rose dramatically, officials designated disposal sites on the city's outskirts where Ebola victims could be buried. Then came the rain, non-stop, softening up the wetlands in particular even further. Shortly afterwards, the papers were publishing photos of bodies that had washed up out of the earth. The city learned something from their mistake. The only problem is that people don't want to burn their dead because it goes against local customs.
The phone rings. A body has been found on a bank of the Du River, and the cause of death is not yet known. That means an Ebola team has to head out. Anyone wishing to bury a dead person needs a document certifying that Ebola was not the cause of death. It currently takes up to a week to get the certificate. The labs process the blood tests of the living first, but in Monrovia's dank heat, bodies can rot within days.
By the time the body collectors clatter down a muddy path to arrive at the riverbank, hundreds have gathered around the body. The team knows what to do. They put up red barrier tape. Four men approach the cadaver, which has already decomposed into several parts, stretch out a black body sack made of thick synthetic material, lay the body inside and hoist it up on their truck.
Ebola has made Nyilah a hero of the death zone. There are a few others like him. A woman preacher for example, a doctor, a young woman on the outskirts of town, a student who patrols a slum. They've been drawn into the fight against the virus. They do what has to be done. Not everybody can — or wants — to see what they do, which sometimes makes their work all the harder.
The Burial Boys took the rap for what happened between June and August. The infection was spreading, the authorities were overwhelmed, there were hardly any international aid organizations. People were calling hospitals asking for help, but the ambulances never arrived. Then when it was too late, the body collectors came.
"You don't give a shit about the living. You only show up when they're dead," people would shout. They threw stones at Nyilah, some brandishing machetes or drawing pistols. What's the use? he would ask himself in such moments. The Liberian government and the Red Cross now have the teams monitored by psychologists. All members meet in the morning at 7:30, two hours before work begins, to eat breakfast together and talk about their experiences.
The job pays around $1,000 a month, which beats what Nyilah was earning fixing computers. But, he says, "for the job we do, it's not a lot." The government wants to halve the amount soon, with funding dependent on an 82-million-euro World Bank emergency fund that pays risk premiums for doctors, nurses and transporters, not only in Liberia but also in Sierra Leone and Guinea, where Ebola has also been killing hundreds for months.
With 200 dead health-care colleagues, the prospect of a pay cut makes Nyilah shake his head. A few days ago, Liberian nurses working in isolation wards took to the streets to protest their own round of salary cuts. "They're letting the patients down for a few dollars, sending them to hell," the Minister of Health railed. "We can't spend everything on salaries. We also need medicine."
Nyilah says he's given the matter some thought, and has ruled out a strike. "Somehow we have to get this job done." There's one other Ebola statistic the Burial Boys of Monrovia proudly cite: No one from the team has been infected.
On the outskirts of the city of Monrovia, a hefty woman in a bright red dress stands under a sink tin roof while shouting a powerful sermon into a microphone. Favor Ha-wa Masom Andersson, a strong-voiced prophetess, is conducting her Sunday service. She knows everyone in Moses Blah’s town, 15 kilometers from Monrovia. She has her own radio show. People still come to see and listen to her. One hundred and fifty believers have come today. However, many of the white plastic chairs, which serve as pews, have become empty recently. Ebola has not spared the believers. This is also a problem for Favor Hawa Ma-som Andersson.
At both entrances sit tubs filled with a chlorine solution for everyone to wash their hands. This has become a rule in all public buildings in Liberia. No one holds his fellow believer's hands during a prayer or when singing a gospel song anymore. The cup from which everyone used to drink has been banned from the service, as has the bush meat worshippers used to cook together. Both are seen as carriers of the virus.
“Ebola will not kill you. Your time has not come. Ebola will not kill you.” Andersson shouts, competing with the humming of a generator, and also against the powerless-ness. ((should this next bit be part of a quote?)) God allows this disease to destroy their women, children and friends. God has also allowed a whole group of priests to declare that Ebola is a punishment for sins committed. They proclaim that life according to biblical principles is the only protection. One of these priests showed his congregation a very ill patient during a service. This priest said the man was possessed by demons and laid his hands upon him. When this man coughed up blood the priest declared that this is a sure sign that the demons are leaving his body.
Mother Favor, as Andersson is called, no longer solely relies on heavenly commandments. She uses a cloth to cover her microphone, which others also touch. She tou-ches nobody. She knows exactly where this disease cau-ses the most devastation. Thus, before the serice she calls on the few strangers to introduce themselves. Her only wish is that her husband would also do as she is doing.
Elijah Nyumah Andersson is also God’s servant. He has a louder voice than his wife and says he trusts God more than she does. He holds the hand of an elderly woman for a long time during the service and touches someone else’s shoulders when talking about a parable Jesus used. Later on he mentions that he knows these two people very well. They live according to Christian principles. He is of view that this serves as sufficient protection against this plague. A plastic basket is used for the collection. Elijah Andersson receives each note followed by a handshake and lets it fall into the basket.
Nearby, the foundations of a new church are visible. But nothing has been built since the beginning of the epidemic. The congregation is numb. Many people have lost their jobs, and even the civil servants are being paid irregularly. The Liberian economy will fall this year, after growing by 10 percent in 2013.
Mother Favor is considering buying an infra- red ther-mometer, like the kind used at airports. Anyone with a temperature of 37.5 degrees Celsius may not enter the country. This temperature reading could be consistent with uncomplicated influenza, but is also consistent with the first symptoms of Ebola. When these symptoms surface, the virus becomes contagious.
Mother Favor says she told her priests months ago not to lay their hands on their believers' heads. She also says this in her radio and TV shows. She says that Jesus has the highest regard for the health of his followers, and that He ((I left this capitalized, but this really depends on your publication's style -- perhaps it should be "he")) places it higher than that of religious traditions. Her colleagues in the Pentecostal Church have made this part and parcel of their convictions. Sadly, her husband has not. He will have to rethink his ways very soon. The different church deno-minations support the burial ban in Monrovia. As soon as the epidemic, is over a central monument will be erected for the victims of this epidemic. Mother Favor approves of this.
The Interfaith Council of Liberia, which is a group of the most important Christian and Muslim Congregations in the country, introduced a practice that priests attend services in congregations other than their own. They have to report to the council if dangerous messages are spread. Even the Muslim minority, who have problems with the burial ban, are compelled to adhere to it. In September a well -known imam ordered his students to touch the body of a deceased a last time, to say farewell as their traditions prescribed. This imam and eight of his students died. Mother Favor also approves of strict rules.
Every event where people are within one meter from each other is deemed to be a risk. Therefore, huge gathe-rings of any nature are prohibited. It has been months since there have been any soccer games in Liberia. The clumsy ((do you mean "old"" Or do you mean "makeshift"?) TV sets on which the latest illegally downloaded Hollywood films were shown have disap-peared from the sides of the road in central Monrovia. They are strictly forbidden. Liberia’s president, Ellen Johnson Sirleaf, who is a practicing Christian, now also wants to prohibit church services. Parliament is busy debating this.
However, Mother Favor disagrees. “ If people cannot pray together, what hope do they have left?” Dr. Jerry Brown has removed his protective clothes now only has on jeans and a shirt as he stands in front of isolation ward Elwa-2 in Monrovia. He looks at his watch; he is waiting for a 4x4 vehicle before his next appointment, an emergency meeting with other doctors of the city. Brown, 44 years old, a short man with short hair and a moustache, is accusto-med to coping with shortages and making the best of them.
Until a few months ago he was a surgeon at a different hospital, where most of his work involved resetting bones after car crashes. Now he is the head of a special ward for patients with Ebola. This is one of the only six isolation wards in Liberia. Brown and his staff have too little money, too little time, too little medication.
They have to discard a part of their protective clothing after it has been worn only once. They have to see to it that the mattresses and bedding of each patient are burned. It is very difficult for health practitioners like him to accept that no medication for Ebola is available. Stock of experimental and unapproved Ebola medication has been exhausted worldwide. Brown experiments with vitamin supplements. He heard about a country doctor in the western parts of the country who cured Ebola patients with medication for Aids. Another used cancer medication. Experts say that the use of both these types of medication makes no sense.
So Brown ensures that his patients are given ample flu-ids with a mineral solution of up to 12 liters a day. He says it has helped that sanitation issues have been sorted and eventually secured. During the early weeks, nurses had to cart off patients' waste in buckets. He lost two elderly doc-tors to Ebola, colleagues he could not help. He is still suf-fering. “ I knew them for decades. One was my lecturer at university,” Brown says. “I tried everything.” Despite this loss, he stood at the bedside of the next Ebola victim at 8h30 the next morning. He left the hospital at 21h00 as he does everyday. There is no time to mourn.
There have been a few successes, which Brown is ela-ted about. At the start of the epidemic, a crew of men cal-led the "Burial Boys," would come to the wards to find very few survivors. Many of these early vicrims were only brought to the hospital in later stages of the disease. And in those early days, the center struggled with issues of hygiene and nutrition. THat appears to be turning around. In September, every second patient survived - and that figure is rising. “We have learned a lot!” says Brown. He says that the international help for Liberia could bring even more change if it is intensified. He also believes that Ebola could possibly be stopped quicker than predicted.
Brown knows he takes a lot of risks. His wife tried to for-bid him from working in the isolation ward. She begged him not to, as so many doctors and nursing staff -- about 200 in all -- had died in the preceding months. Dr. Brown remained silent. He did not have the heart to tell her no. For a week, he let her believe that he was still working as a surgeon. He confessed only when she asked him why his shirts were so faded and why he reeked of chlorine. The disinfectants not only eradicated the Ebola virus, but also bled the colour from his clothes.
“I just have to help,” he said. His wife understood. This time both remained silent. They have an agreement: he isn't allowed to hug his children. He has to change his clothes, shoes and socks in the garage, even though at work he wears medical protective clothing in the isolation ward. He leaves that gear at work when he goes home.
Isn’t he afraid? “ No,” says Brown, without hesitation. ‘As soon as one understands the transmission paths of the disease, it is possible to effectively protect oneself.” The minute he walks into the treatment area, not even one centimeter of his skin is exposed. He wears a white full body suit, mask, elbow-length gloves and a hood which only leaves an opening for his eyes. Those are covered with protective glasses, which look like diving goggles. This protects him when a patient vomits or coughs on him. Brown says that he concentrates on the survivors. Every single one motivates him afresh.
But he knows that there are still many problems. The vi-rus is raging in many parts of the country which difficult for international aid organisations to reach. Even in Monrovia, there is no guarantee that the sick will receive the best help. Brown still has a few beds available. However the isolation ward of Doctors Without Borders is totally over-run. No more patients are being admitted. There are only four more isolation wards. Five more are being built and six are still being planned -- but no one has been found to manage them. Each nurse who contracts Ebola scares away aid organisations and volunteers. This happened to Brown in August after two health practitioners became infected and aid organisation “Samaritan’s Purse” withdrew from nursing. Brown and his staff kept going as well as they could.
A few weeks ag,o Brown woke up in the middle of the night. He was drenched in sweat. The first thought that went through his head was, 'these are the first symptoms.' Instantly he was alert. His wife turned over in her sleep and put her arm over his upper body. Panicking, he pushed it away. “ What’s the matter?” she asked, shocked. He remained silent. He had dreaded this moment so many times. When he regained his senses, he saw the ventilator, which he had not put directly in front of the bed as usual, but had left at the other end of the room. He took the thermometer. It read 37 degrees Celsius. No indication of a raised temperature. It was merely a bad dream.
Bill Harris vividly remembers the days during August, the anxiety, and the fear. The army blocked off the section in the area where he lives, in the middle of the night. Soldiers blocked the only main road which one could use to leave and enter West Point. The road across the ocean was also closed. The navy forced small fishing boats, which had gone out to sea, back to the beach. A rumour spread that dozens of Ebola cases had broken out in West Point, a huge slum in Monrovia.
The government started to panic. West Point was closed off. Even night watchmen, who returned from work the next morning, were not permitted to return to their families. More than one hundred thousand people live in very confined area. Four out of five of them have less than a dollar a day to live from. The air is stuffier than in the rest of the overcrowded city. The smell of rotting refuse mixes with the stench of human secretions. The inhabitants make a living from retail dealing. They move all over Monrovia. People from the rural areas who come to find employment in the city see this area as an important port.
“ Those days were terrible, people were scared,” said Harris. Hardly any groceries were delivered to West Point. “ Prices of rice and water shot up sky high because dealers could not move into or out of West Point.” In reality it was a false alarm as in actual fact there were less cases in West Point than in other parts of the city. Eleven days later the army ended the blockade.
Harris, who is 24 years old, is sporty and speaks English well, walks through the narrow alleys of West Point. He has been living here since the day he was born and he loves nature. Before the universities were closed due to the Ebola crisis he was studying forestry. Unlike him, hardly any of his neighbours can read or write. This is one of the reasons why West Point became a place for mighty conspiracy theories. There is no other place in the country where distrust against the authorities is as prominent. Some of the people were convinced that Ebola was an invention by the government. It was a trick to enable government to inconspicuously collect bodies and then to sell their organs. Unrest became the order of the day and two inhabitants were killed. Nobody knows exactly how many people died as a result of Ebola in West Point. The government only discloses the deaths in each province. The reason being that many strangers from other communities, in Monrovia, are viewed with suspicion and often even pushed away. Especially if they come from areas, which are known for the fact many emerging Ebola cases are the order of the day.
“ Since West Point was blockaded we are considered to be Ebola carriers and in other parts of the city we are avoided. ” says Harris. He however knows how dangerous such a situation in fact could be. Not only for himself but also for his family. The epidemic could escalate vigorously any time. “ We have to do what we can - it is our duty.” He has found a way to be of help. Harris wears a light blue golf shirt, which all volunteers for Unicef Children’s Fund wear.
They started moving through West Point in pairs weeks ago. Young adults, at the forefront of the war against Ebola. They move from shack to shack, knocking on doors and start discussions about Ebola, a thousand times a day. Those that do not believe that Ebola exists are decreasing in number. They do not want to talk to any of the government officials, but they do listen to youngsters from the neighbourhood.
Harris faces a difficult task, which has no instant result. However initiatives such as “A Life “ have become indispensable in Liberia. The youth have posted hundreds of posters on the walls of the main streets. They have slogans such as: “ Ebola is here and it kills”, printed, on them. Often the messages are graphic: small images, that vomit, have a high fever and a bad headache or bleed- possible symptoms of the deadly disease. Those that cannot read understand.
Ebola is almost the only topic spoken about by radio presenters. Even the songs played deal with the disease. People may disrespect politicians but they do not feel the same about songwriters, such as Judie Andy. Andy’s current gospel song “Ebola is real” is known countrywide. It sounds like a children’s song but is actually for adults. “ There is no cure/But it can be prevented/Ebola, Ebola- together we stand/ Speak to everyone about Ebola ”. Almost all renowned artists have recorded such songs. Peaceful Gospel songs sometimes even absurd happy sounding Reggae songs.
The people, also in West Point understand what they are dealing with. Despite this knowledge not everyone adheres to the preventative measures. People have to get to their work and the market. And so many Liberians squash in to the mini busses where they desperately try to keep at a distance from their fellow passengers. Or they opt for the cheaper motorbike taxis. Sometimes 4 people sit on it all cramped together. A daily scene in Africa. Nowadays, it however has a different meaning. The Aid organization “Doctors Without Borders “ in the mean time advises not to use public taxis. In August, during the time the virus spread rapidly, the twelve ambulances of the city with millions of inhabitants could only fetch a fraction of the patients suspected of contracting the disease. Out of pure desperation relatives used taxis to transport the deceased. Since then taxi drivers strikingly often became ill. Apart from medical practitioners and nurses no other career commiserates about so many infected colleagues.
Bill Harris survived the civil war as a child. He was 13 years old when the war ended and he missed many years of schooling. During that time he swore that he would do everything to avoid his country from experiencing a similar tragedy.
Fatu Kekula sits in front of a house painted in blue. Chickens run around, the water well is situated 50 meters from the settlement. There is no electricity. A board hangs on the entrance door. “Jesus” is written on it. This house has become the arena of a miracle.
It was on a Monday during August when she received the diagnoses: Ebola. Her father would die, soon, thought Fatu Kekula. Then her mother had a high fever, as well as her sister and a cousin who lived with them. Most of the hospitals were closed after more than a hundred nurses were infected. There were hardly any isolation wards, which separated the dying from the rest of ill and injured patients in the whole country. The Ebola virus was threatening to eradicate her whole family and Fatu Kekula did not know what to do. Where could she go to with her sister, mother, her father, her cousin? The closest hospital had no more available beds. For many days Fatu Kekula searched for another place where they could be treated. She found none. So she decided to do it herself. She was no doctor but an aspiring nursing sister. She had trained for three years and only had to do her year of practical training. Unfortunately the training centre, she went to was closed just as all schools had been. She had no other choice.
Fatu gets up and enters the stone hut and shortly thereafter leaves it with large rubbish bags, a raincoat, socks and gumboots. That was her protective gear and as it seems also her life insurance. For two weeks Fatu would put plastic bags over her socks and bind them together before she went to her patients. She used another bag to cover her hair. Then she would add the raincoat and layer four pairs of gloves onto her hands. She also had a facemask to cover her face. She laid down a few rules, which would become important. Her father, her mother, her sister and her cousin had to move to her parent’s bedroom where there was a bath. The neighbours were not allowed to come close to the stone hut at all. She had to remain strong irrespective of what would happen. If she dared loose her courage she would lose her patients.
She virtually nursed them for 24 hours a day. “ I often could not sleep longer than 15 minutes at a time,” she says. “I often cried.” Her parents, her sister and cousin soon could no longer keep in solids, a typical development of the disease. It often starts with fever and gastro intestinal problems and in the end hemorrhaging and organ failure cause death. Fatu bought fruit juice on masse to ensure they take in some calories.
It was the time when Liberia closed hospitals by the dozen. The” Mareidi Country Ebola response Center” in close proximity, which was a simple brick building, was also closed suddenly. It was closed in the beginning of August when 14 employees died from Ebola within a few weeks. It remained closed for a month. Thousands of people, in towns before Monrovia had no access to medical care.
Since September it is open again. The beds were incinerated, the walls re-painted, 200 surviving nursing sisters were trained. No employee has since fallen ill. Additionally the amount of Ebola cases has fallen slightly. During September every day ten more patients were tested positively for Ebola, lately only one or two are. A patient’s destiny is decided within a few weeks.
It was the beginning of August when Ebola moved into the blue stone hut. It was the end of August when her parents and her sister started to eat. They went for tests at a clinic. The result: negative-Ebola conquered. She could not save her cousin, Alfred, who died just as the average two out of three patients did since this epidemic broke out. Fatu Kekula, sits on a white plastic chair in front of the house, her sister, mother and father sit outside. Moses, a boy, ten years old also sits there. His parents were victims of Ebola. The family has adopted him. Fatu looks at her cell phone nervously from time to time. She has to leave soon. She moves from door to door in the towns around Monrovia. She wants to tell people who have to nurse their relatives and who do not have protective gear how she managed. She now knows it can be done.