Monrovia, Liberia – The storm in Liberia began three years ago this summer. The word Ebola had first passed from radio to ear across the country in spring. In June, the disease was no more than an ethereal curiosity, vaguely menacing but thankfully confined to the faraway Guinean jungles and more likely to be the butt of a joke or conspiracy theory in Monrovia than cause for real concern.
But by the same month one devastating year later, nearly 5,000 Liberians had been killed by the disease. Many of them had been unceremoniously cremated at a remote site near a beach, the fragments of their bones dumped into oil drums or buried near pyres hastily set up by the government as part of a euphemistically dubbed “safe burial” programme.
Thousands more survived the disease, leaving foreboding treatment units for empty homes, their lives turned upside down by the loss of loved ones, with aching joints and heartache as the daily price on the ledger of their victory.
Those who encountered Ebola in those frantic months of mid-to-late-2014 share a strange bond: whether they are health workers who faced tragedy every day in the struggle to save lives, survivors who have been confronted with the imperative to move forward despite immeasurable loss, or journalists who found themselves near the heart of the outbreak’s daily nightmares, there is a sense of disquiet at how quickly the storm appeared and then vanished.
Jarring memories that set the course of lives dwell in unvisited corners of the mind, not quite collecting dust but not shared generously either, framed by grief, guilt, and a cocktail of other emotions.
For most Liberians, the outbreak will always be a confusing footnote in the country’s modern history, an unsettling moment best left in the past lest it be conjured back into existence.
But for a few, the disease left deep marks. They will carry their memories of that panicked, terrible time with them forever.
Three years after it began, here are some of their stories.
Dr Jerry Brown
|Dr Jerry Brown operating on a patient in ELWA hospital [Photo courtesy of Dr Brown]|
When the Ebola crisis was at its peak of international news attention, in the autumn of 2014, a typical cable television viewer probably imagined an “Ebola doctor” as a European or American volunteer, moved by compassion and noble impulse to join the response. Without any doubt, there were many doctors who fit that archetype, and they were heroes.
But most of the health workers on the front lines of the response in Liberia were themselves Liberians. Nurses, technicians, and doctors were hit disproportionately by the virus, dying in high numbers, particularly in the early days of the outbreak when nobody was yet sure how to protect themselves. By the time the crisis wound down in the spring of 2015, 288 Liberian health workers were listed by the WHO as “confirmed or probable” Ebola cases.
In the summer of 2014, Dr Jerry Brown was the medical director at the Eternal Love Winning Africa hospital on the outskirts of Monrovia. Known as ELWA hospital, the facility was one of the first to care for Ebola patients. In August 2014, two American missionary doctors who were working there, Kent Brantly and Nancy Writebol, were infected and evacuated to the United States, signalling the start of Ebola’s prominence in news bulletins across the world.
Now, Brown sits behind his desk in the administrative wing of the hospital, which was expanded into a maze of one-storey concrete units and reopened to great fanfare last year. The sound of the generator that powers his wing hums angrily in the background and his blue scrubs frame a face that smiles gently, almost sadly, as he remembers his months as an Ebola fighter.
After the two American doctors and a Liberian nurse fell ill, panic gripped staff members at the hospital and some urged Brown to close the hospital.
“Some of them said, ‘If I get infected I will come to your house and hug your wife,'” he remembers, laughing at the memory of his colleagues’ fury over his decision to keep the emergency room open. But he says that despite the risks, closing the hospital would have led to preventable deaths for routine emergencies, pointing to a ledger with a list of procedures performed that summer. “If I had shut the hospital down, what would have happened to those people?”
By mid-August, the number of cases began to skyrocket in Monrovia, jumping from less than 100 new patients a week through most of July to nearly 300 a week. Doctors Without Borders opened a large treatment unit near ELWA, but the Liberian Ministry of Health asked Dr Brown to set up a parallel unit nearby.
“We said we don’t want any missionary doctors joining our unit,” he recalls. “We will do it as Liberians, as a Liberian staff. We didn’t want any expatriates dying in our unit. If you want to give us support, we will take the supplies, but here we want to take care of patients on our own.”
The unit, known as ELWA2, was set up to care for 60 patients, but was quickly housing upwards of 100, with some lying on mats on the floor. Doctors Without Borders had suspended the administration of intravenous rehydration, citing concerns over staff safety, but Brown’s unit continued to provide IV fluids to patients, sometimes directly into their jugular vein in a difficult procedure that carried the risk of infection for his staff. When he saw a colleague, another doctor, lying on a stretcher in a pool of blood, his staff began to bathe patients in their beds.
“I said, the depression will kill these people. If [the protective equipment] we are wearing will protect us from the fluids, can anybody give me a reason why we can’t give patients bed baths?”
For months, he and his team worked between 12 and 15 hours a day, seven days a week.
“What motivated my staff and myself to work harder was that every time we saw someone survive, it was a kind of jubilation. We felt that we had achieved some kind of victory,” he says.
Sometimes, when I look at the things I did, I ask myself why was I so foolish? … I think I was just moved by my quest to see someone live
Of the first 49 patients that Brown and his staff treated in July and August, only one survived. But by September, the survival rate at his unit was as high as 45 percent. At night, he would pore over medical journals, hoping to glean any insight into how he might push it higher.
Finally, in February, after months in which he worked for as many as 12 hours a day in the unit, cases in Liberia had declined enough that Dr Brown felt it was time for him to leave.
“Sometimes, when I look at the things I did, I ask myself why was I so foolish? What was the force driving me to do this?” he says.
“I think I was just moved by my quest to see someone live.”
Now, Brown is back as the medical director and general surgeon at ELWA hospital, performing a variety of procedures for the low-income patients who visit the hospital.
The building where he fought Ebola has reverted back to its intended purpose of laundromat and cafeteria. He has tried to eat there only once. “I began to imagine things that happened there, people dying, and I just walked away,” he says.
Brown says he is surprised by how quickly the three years since the crisis have passed by, but that his experience treating Ebola patients changed him forever.
“It made me more humble. Life as a whole is nothing to brag about. It can just go away at any time. I can’t say I’m a doctor and brag about it, because anything can happen at any time. It made me less afraid of death.”
The ambulance driver
|Foday Gallah [Ashoka Mukpo/Al Jazeera]|
During the peak of the crisis, the sound of sirens was pervasive in Monrovia. Ambulances would screech along the main highways on their way to overcrowded treatment centres where they would often have to wait for hours for the patients they were carrying to be admitted.
The most ubiquitously visible ambulances were adorned with the picture and name of a local politician, Representative Saah Joseph, who had raised funds from abroad to purchase two used ambulances.
Foday Gallah, a stocky 38-year-old with a booming laugh and broad smile was one of the drivers selected by Joseph to work in the ambulances in the months before the outbreak. Gallah was a nursing student at the time with ambitions of becoming a doctor.
Now, amid the clink of silverware in an upscale hotel dining room near a pristine Liberian beach, Gallah remembers a time far removed from the peace and luxury that surrounds him.
I feel a lot of pride that I was able to help people in the midst of fear while others were running away
In the early spring of 2014, after the first few cases had put health officials in the country on edge, a few colleagues of Gallah’s had been sent to northern Liberia to receive training on how to deal with Ebola patients. “When they came back they said, Foday, what we saw, you have to be careful. It might just enter Monrovia,” he says.
By summer, their prediction had come true, and along with the other drivers, Gallah began responding to dozens of calls every day across Monrovia.
“We stopped responding to normal cases because, by then, doctors and nurses were running away,” he says. “We couldn’t blame them because nobody understood the virus and they were running for their lives. But people needed to fill in the gaps so the country could be safe.”
As cases mounted, the calls became more frequent and panicked. Sometimes, he would respond only to find hostile family members who refused to believe that their relatives were sick with Ebola. Other times, his patients would die in the ambulance en route to the treatment unit. The stress began to take its toll on him.
“It was terrible, but as a leader, you had to brave the storm. Because if I had shown discouragement and fear, [the other workers] wouldn’t be brave, so I had to muster the courage. But the fear was in me,” he remembers.
Gallah’s private telephone number became a direct line for scared relatives looking for someone to pick up sick family members and his life became a haze of manic journeys weaving through traffic across town. “I never had what they call night,” he says. “In fact, at night, the calls would triple.”
In August, Gallah received a call to pick up a few members of a family that had fallen ill. A few days later, he returned to the same house to pick up the rest of the family, who had also begun to show symptoms. En route to the ambulance, a young boy he was cradling in his arms vomited onto his protective equipment.
Less than a week later, Gallah decided to take his first day off in weeks. Midway through the day, while helping to disinfect a neighbour’s house, he began to feel feverish and experience pains in his joints.
“I couldn’t even stand, so I knew,” he says.
Gallah’s colleagues drove him to the Doctors Without Borders treatment unit. “All the doctors and nurses knew me,” he remembers. “They were so downhearted, they just came in looking at me in sorrow.”
For two weeks, Gallah fought the disease. Patients lying beside him died in front of his eyes, but he remained resolute, drinking juices that Joseph sent to him and steeling himself against the pain.
Finally, he received the news that he would survive.
When he returned home, Gallah was too weak to ride in the ambulance, but he began taking calls again, helping to direct his colleagues towards urgent cases.
At first, some of his neighbours avoided him and refused to shake his hand out of fear that he might still be carrying the virus.
“I was ashamed to go around people,” he says. “Sometimes, I would just sit around by myself and cry. But once I cried it out, I’d feel okay.”
Slowly, the stigma subsided, and his community began to embrace him again. “It was a turning point for me,” he recalls. “If my family and community can accept me, I can get over it.”
Gallah struggled with joint pains and fatigue for months after being discharged, but he says that as time passed, he’s come to terms with what he went through.
“The first time I drove by the [Doctors Without Borders] unit, I cried. But now it’s normal, I just pass it by or go there for meetings,” he says. “Life has to go on.”
“I feel a lot of pride that I was able to help people in the midst of fear while others were running away. I feel proud that God was able to use me to help somebody.”
Gallah is frustrated at what he feels is the Liberian government’s neglect of health workers and survivors, and the country’s eagerness to quickly move on as soon as the death toll fell.
“It happened, and I saw it,” he says. “I felt it. I lived with it.”
|Dominic Kollie, Kakata [Ashoka Mukpo/Al Jazeera]|
I first met Dominic Kollie in September 2014. Kollie had contracted and survived Ebola a month earlier. A gaunt 22-year-old, he had lost 24 members of his family before being hired by Doctors Without Borders to work as a psychosocial counsellor for sick patients in the unit.
When we met again in February 2015, he was broken. He spoke mournfully of his family, with tears streaming down his face. He had been particularly close to his mother, and her loss had hit him hard. He told me that his life felt like an “empty room”.
Now, Kollie is nearly unrecognisable. He has put on what looks like 20 pounds of muscle and cuts an imposing figure in his camouflage Armed Forces of Liberia uniform. Just a year after being discharged from treatment, he was accepted as an army recruit. Speeding in and out of a choked Monrovia thoroughfare in a worn Toyota Corolla and blaring its horn at slow-moving taxis, he speaks in the clipped tones of a soldier. Kollie has carved out a new life for himself, and his resilience shows.
When Kollie entered boot camp in September 2015, he was still struggling with the joint and muscle pains common to most survivors.
“It was a bit hard for me,” he says, “But I kept pushing until my body adjusted. Nothing was easy for me but I just had to fight it.”
I lost a lot of people, and saw myself standing alone … Why must such a thing happen to me? But you can never ask God why
His drill sergeants told him ahead of basic training that they couldn’t give him special treatment, but he said he didn’t want it anyway. Occasionally, though, he was given extra rations to help his body regain its strength.
Once, during training another recruit tried to bully him, calling him a “second-hand human” because he had been an Ebola patient.
“He kept saying it to provoke me, so I kept asking, I ain’t got strength, right? I ain’t got strength? Pop,” he says, smiling at the memory of punching his rival in the mouth.
Military Police officers forced the two to apologise to one another, and a few days later the other recruit approached him privately. “He said, ‘I just realised the hardships you went through, I just felt it was a joke.’ And he hugged me,” Kollie recalls, saying that the two went on to become friends.
After completing basic training, Kollie chose to become a medic, following a passion for medicine that he says he developed during his time working with Doctors Without Borders.
When Kollie graduated from a training module, he called another survivor, Helene Henry, to attend the ceremony. Henry had been a patient at the Doctors Without Borders unit where he was a counsellor. Nine of her family members had died there, including her husband.
She says that, at first, she didn’t want to talk to Kollie, who had long hair and stubble. “I was afraid because he had bushy hair. I was thinking, ‘Oh, Ebola catching zokos and all?'” (“Zoko” being the term for criminal in “colloqua”, Liberia’s hybrid English dialect.) Kollie assured her he wouldn’t hurt her, encouraging her to eat and take her medicine.
After being discharged from the unit, Henry, now 32, was wracked with grief over the loss of her husband, mother, brothers and sisters. In those early days, before survivor support groups had coalesced to provide a forum for the living to share their anguish over what they’d lost and to help one another cope with the post-Ebola syndrome many faced, she struggled with debilitating depression.
“It was difficult for me to the point where I wanted to kill myself,” she says.
When Kollie invited her to attend his graduation in late 2015, she decided to take him up on his offer. After the ceremony, when he mentioned that he had a week off she invited him to spend it with her.
|Dominic Kollie and Helene Henry, Kakata [Ashoka Mukpo/Al Jazeera]|
Now, Henry is pregnant with Kollie’s child, and the two have built a house together in Kakata, a city about an hour’s drive north of Monrovia.
Kollie describes his mother as an imposing figure who pampered him and, after her death, he was abruptly forced to take full responsibility for himself. “Life was difficult for me,” he says. “But when I see myself now, I feel pride as a young man to have taken such a bold stand in life.”
At times, though, he is still overcome by sadness over his lost family. “I lost a lot of people, and saw myself standing alone,” he says with a faraway look in his eyes. “Why must such a thing happen to me? But you can never ask God why.”
While Henry has embraced her new life with Kollie, she says she too still struggles with the memory of her husband.
“Sometimes, I just go into my room by myself and sing,” she says. “I tried to feel that this has passed and I can continue my life, but I still find it difficult.”
“It changed me in the sense that the things I used to do, I’m not doing them anymore. The people I used to be with, I’m not with them anymore. So, it’s like starting my entire life over.”
The body collector
|Garmai Sumo in southwest Philadelphia [Ashoka Mukpo/Al Jazeera]|
Thousands of miles away from the rain-soaked streets of Monrovia, Garmai Sumo sits on the couch in her brother’s small home in a working-class neighbourhood of southwest Philadelphia.
It’s the eve of her 31st birthday, and Sumo, a slight-framed young woman with a broad smile and penetrating gaze, is sipping on a glass of apple juice while she chats with her older brother, Wisdom Zio, 45, a mental health worker who moonlights as a reverend for a congregation of the West African immigrants who live in their neighbourhood.
For one year, beginning in June 2014, Sumo worked on a “body team” – one of the Red Cross units that was tasked with collecting samples from corpses that were suspected of having died from Ebola.
In August 2014, when the Liberian government decreed that anyone who died in Monrovia would be cremated rather than buried, the teams were given the thankless, brutal job of retrieving bodies from their homes.
“Sometimes, you’d go in the house and the whole family would be dead. But the younger ones would be there, crying, hungry. So, I’d give money to go buy food for them. That helped me, positively, because I was there for them, and they wouldn’t die of starvation,” she says.
Everyone left me. Only my son, my mom, and God stayed with me
Sumo volunteered for the team early in the outbreak. She was working as a nurse in a ward for tuberculosis patients when she walked into the office of a senior health official and proclaimed her intention to join the response.
“He said, ‘Sit down, you’re too small. Why are you going to kill yourself?'” she remembers. “I said, ‘No, I will fight.'”
Sumo was the only woman on her team, a tight-knit group that found solace in dark humour, bonding during the long months they spent travelling across Monrovia, gathering the dead for the crematorium pyres.
For Liberians, burying dead relatives is a sacrosanct ritual, and the concept of cremation was as alien as it was sacrilegious. Sometimes, grieving relatives threw rocks at Sumo and her team, or threatened them with machetes.
By August, they were picking up dozens of corpses every day, sleeping in the 10-wheel flatbed truck at night when they couldn’t make it home.
“Bodies, bodies, bodies. Every day,” she says. “Not just one, not two, not 10, not 15. Increasing every day. Like, what is going on?”
When Sumo talks about her memories of the crisis, her facial muscles tighten and she purses her lips. She grips one hand with the other in her lap, and at times her voice wavers.
“I felt she was too much involved,” Zio says. “When I first heard she was into it, I literally cried. I felt she’d taken on a suicide mission.”
Sumo’s son Jeremiah, then eight years old, was ostracised in their neighbourhood. Other residents would refuse to allow him to touch the shared water pump at the local well. Tearing up, she says that her friends refused to socialise with her. Some of her neighbours accused her of taking part in a plot to steal parts from the bodies for magic rituals.
“Everyone left me. Only my son, my mom and God stayed with me,” she says.
As the crisis wound down, Sumo returned to her job treating tuberculosis patients. She told people that she was happy for her life to return to normal, but increasingly she felt weighed down by what she’d seen and experienced.
By the end of 2016, Sumo had begun to exhibit symptoms of post-traumatic stress disorder, lapsing into dark moods that would last for days. In January of this year, her brother arranged for her to visit the US, hoping to find mental health treatment for her.
Now in Philadelphia, Sumo is still grappling with the psychological impact of the time she spent working with the burial team. Zio says that he’ll often find her alone on the couch, curled up into a ball and crying. But Sumo isn’t an American citizen, and he hasn’t been able to find affordable insurance for her to see a specialist.
She says that her worst moments come when she thinks about the orphaned children she saw, crying alone in the homes where their parents lay dead, with neighbours too afraid to take them in or bring them food.
“When I’m experiencing that mood, I don’t like to go around anybody. It’s like you see a vision, like a movie that you watched before and you imagine it,” she says softly, looking down at her hands.
Sometimes, Sumo says she dreams that she’s back in Liberia, trapped in a house where a child sits next to its mother’s body, begging her for water.
In a flash, Sumo can transform back into the character that most journalists who met her during the crisis remember, flashing a magnetic smile and laughing deeply at a sly joke she makes about her companions in the room. She’s most animated when she talks about the charity she’d like to set up in Liberia to assist Ebola orphans.
But she says that if she could go back in time, she would stop herself from volunteering to work with the team that day.
“I would grab myself by the arm,” she says. “Because you’re going to sacrifice yourself, and at the end of the day they’ll tell you that you aren’t insured, you didn’t sign any legal document. So why are you going there, for what reason?”
|Mosoka Fallah, Monrovia [Ashoka Mukpo/Al Jazeera]|
If there is one name that anyone touched by Ebola in Liberia knows, it’s Mosoka Fallah. Beloved by survivors, health workers, and journalists alike, Fallah is a gregarious, warm figure whose compassion and intelligence earned him accolades for helping to end Liberia’s outbreak months ahead of Sierra Leone and Guinea.
Fallah has been invited to speak across the world about the Liberian Ebola response, and he says there’s one constant in every presentation he makes.
Every time he starts to speak about Ebola, he cries.
Fallah was raised in West Point, an infamous slum that occupies a peninsula in the centre of downtown Monrovia which hosted the most dangerous moment of Liberia’s outbreak – when the crisis threatened to spill over from medical to political.
The human suffering changed me. When people say you did a great job, I just say that I was trying to help my people
A Harvard graduate, Fallah was hired by French charity Action Contre le Faim in the early summer of 2014 to carry out contact tracing for what was then a minor outbreak.
“In July, a Ministry of Health representative asked me, ‘How long will it be before this is under control?’ I said, ‘Give me two weeks,'” he remembers, laughing.
By August, Fallah was working 100 hours a week, supervising contact tracing across Monrovia with his small team of health workers. As the outbreak grew in severity, he noticed that some members of his team were reluctant to go into infected communities, preferring to arrange day-long meetings.
“I said, ‘Gentlemen, Ebola is not won in a meeting. Ebola is won in the field,'” he says, “But if I had to demand those guys to put themselves at risk, I had to be there too.”
In West Point, a community leader tipped him off about secret burials being carried out by residents who were mistrustful of the government and he realised that the disease had entered the densely populated neighbourhood.
“I called [a Health Ministry official] and said the worst has happened. West Point has Ebola,” he says.
By mid-August, the government was running out of places to house Ebola patients and their contacts. A mob in West Point attacked a holding facility that had been set up in the heart of the slum, releasing patients and looting the building. Fallah explains that residents were angry that patients were being brought in from outside of West Point, violating promises made by the government when the centre was opened.
The Liberian government responded by quarantining the neighbourhood and stationing police and army units at the entrances. The decision ended disastrously, with troops firing into a rioting crowd, killing a teenage boy.
Fallah understood that the forceful strategy the government had taken in West Point was backfiring, and he negotiated a plan with community leaders in the neighbourhood to recruit local youth to serve as deputised case finders for the Ministry of Health.
“West Point was a blessing in disguise for us,” he says. “It sent a shockwave into us that we didn’t want to militarise the response anymore. That was very good for us, and actually, the idea of community engagement for Ebola started in the midst of that situation.”
The approach was a success, enabling cooperation between residents of West Point and health officials who had previously been unable to find hidden Ebola cases. The approach was subsequently scaled up across the city. Within a few months, the case rate in Monrovia declined dramatically, and the outbreak began to fizzle out.
While young, sharply dressed Liberian health officials knock on his office door, then sheepishly back away when faced by his hard glare, Fallah says his humanitarian streak was born during Liberia’s civil war. In 2003, during a period of heavy fighting in Monrovia, he worked with Doctors Without Borders, treating civilians who were wounded by gunfire and stray mortar rounds.
“All my life, I’ve been around great, selfless people, and I think it rubbed off on me,” he says, dabbing his face with a tissue as he tears up.
When the outbreak ended, Fallah was hired to supervise a study on Ebola survivors, which helped force a breakthrough on the development of a vaccine. Across the country, there is not a survivor who does not know Fallah, and even the cremation team speaks kindly of him.
“[The outbreak] changed me,” he says. “The human suffering changed me. When people say you did a great job, I just say that I was trying to help my people. I saw the house burning and I wanted to [put the fire out]. There are thousands who deserve to be honoured, who struggled to see the outbreak end.”
|Ashoka Mukpo, second from right, with a group of survivors from Doctors Without Borders, Monrovia, 2015 [Photo courtesy of Ashoka Mukpo]|
At the height of Liberia’s Ebola outbreak, which captivated the world and, for a brief moment, became a powerful vector for the fears that citizens of wealthy nations project towards the rest of the world, reinforcing a view of poorer countries as dangerous, nasty places, I assumed the ignominious mantle of being the only Western journalist to come down with the virus.
It was a calamitous event for myself and my family, but the luck of owning a US passport meant that after a brief, disorienting period during which my public identity was reduced to the cable news-friendly blurb of “Ebola survivor”, I could continue my life without the crushing weight of grief and poverty faced by many of those with whom I share antibodies upon receiving their certificates of good health.
Still, for months after my bout with the illness, I had trouble walking up stairs, struggled with joint pains, and was taught a lesson in just how intertwined our minds are with our bodies. As someone who was used to being active and pushing my limits professionally, it was not easy to experience the weakness and physical toll that Ebola inflicts on the body.
At one point, while interviewing Foday Gallah, he made a comment that resonated deeply with my own experience. “It felt like my identity couldn’t be anything other than a survivor. I was just a survivor,” he said. In some ways the attention the illness brought me was more overwhelming than the disease itself, something I try to remember every time I’ve interviewed someone since then.
In some ways the attention the illness brought me was more overwhelming than the disease itself
For reporters who work in dangerous places, it seems reassuring to believe that one is entirely in control of their own safety rather than subject to fate or luck. But to this day, I still don’t know where or when I was exposed to the virus.
Just 48 hours before I was diagnosed, I was at a table with a reporter who had worked in conflict zones across the world. I asked him how he stayed safe. He thought about it for a moment, and said, “You just play the odds”.
Needless to say, that comment entered my mind more than once in the subsequent weeks. I made the choice to enter a dangerous situation and experienced the consequences of that decision. Like most of the people in this article, I would almost certainly make the same decision again.
Many survivors I’ve met since my illness had it much worse than me. But what we all have in common – and what bonds us all – is that none of us have a choice but to move on. Life simply continues to unfold.
But for 11,325 people in West Africa, that privilege was not granted. There are no gravestones to remember those who were burned on the pyres. As time moves on, the distant footnote of Ebola will feel less and less tangible to most Liberians, but those who saw it up close will always remember.
Source: Al Jazeera