Thomas Eric Duncan had recently been working for a shipping company in Monrovia. Before traveling to the United States to visit family, he had tried to help his landlord’s nineteen-year-old daughter, Marthalene Williams, get to a hospital. Williams was soon expecting a baby and assumed her convulsions stemmed from pregnancy complications. Duncan and Williams crisscrossed the city by taxi in search of care, but, with the epidemic raging, they were turned away from three facilities for lack of space. Duncan helped carry her back to her family home, where she died of Ebola within hours.
A few days after arriving in Dallas, Duncan went to the emergency room complaining of “abdominal pain, dizziness, nausea, and headache.” While the nurse who treated him noted that Duncan had recently arrived from Africa, this information was not highlighted to Duncan’s doctor, who ended up discharging him. Two days later, when his condition worsened, he was rushed by ambulance back to the hospital. His blood tested positive for Ebola, and he died a week later. Texas health officials announced that at least fifty people whom Duncan had interacted with in the United States were at risk of contracting Ebola.
The news coverage quickly became saturated by sensationalized fear. “What’s that?” Fox News host Jeanine Pirro seethed. “You don’t want people to panic? You don’t want us to panic? How about, I don’t want us to die!” CNN ran an onscreen graphic asking whether Ebola was “The ISIS of biological agents?” while another Fox host, Eric Bolling, mused, “We have a border that is so porous, Ebola or ISIS or Ebola on the backs of ISIS could come through.” In less than two days, Twitter mentions of the virus increased from 100 per minute to over 6,000 per minute.40 And when two of the Texas health workers who cared for Duncan—Nina Pham and Amber Vinson—tested positive for Ebola, the public concern exploded into something approaching hysteria.
A teacher in Maine was placed on a three-week leave of absence because she had visited Dallas for a conference. A passenger who vomited on a flight from Dallas to Chicago was sequestered in the bathroom until the plane landed. A middle school principal in Mississippi was asked to stay home after parents learned that he had traveled to Zambia—a country on the other side of the continent from the affected region.
The approaching midterm elections in November fed into the fearmongering and political posturing, with Republican members of Congress compounding the turmoil by demanding a government-imposed travel ban. House Speaker John Boehner encouraged the idea, and several Democrats facing tough reelection fights also offered their support. Some of Obama’s longtime critics, seeming to tap into the racist conspiracies suggesting the President was not fully American, accused him of prioritizing the lives of Africans over those of the American people.
As sensible as it may have sounded to try to contain the spread of Ebola by keeping travelers from West Africa out of America, the travel ban Obama’s critics proposed would almost surely have made the problem worse. Such a ban would likely have had a dramatic chilling effect on travel to the countries where the infections were happening—but it would not have prevented the daily influx into our country of US citizens and permanent residents returning from West Africa, who could not have been legally barred from returning home.* Moreover, the experts in our government believed a ban was not even likely to prevent noncitizens from traveling to the United States. Rather, many would instead go to Canada or Mexico first and then seek to enter over one of our land borders.
With public pressure mounting, President Obama named Ron Klain, a skilled government operator with deep political connections across the country, as his Ebola “czar.” Klain instructed the CDC to funnel travelers from the region through five major US airports, where he posted public health officials to conduct intensive screening of new arrivals. “We’ve got to bring the fever down,” Obama said repeatedly in our internal meetings, which he was now personally chairing several times a week.
Less presidentially, I wrote in my journal on October 17th: “Our ability to lead the world turns on our ability to prevent a full freak-out at home.”
Although we made our case everywhere, from media interviews to congressional testimony, we were not persuading people. An ABC News/Washington Post poll taken the week of October 20th found that 70 percent of Americans supported blocking entry for all people who had been in the Ebola-affected countries. A CBS News poll from the same time period showed that an even greater percentage of people—80 percent—favored mandatory quarantines for American citizens returning from West Africa, regardless of whether they showed any Ebola symptoms.
Against this backdrop, my speechwriter Nik suggested that I travel to the three Ebola-affected countries in West Africa.
LEAVING NEW YORK in the midst of our lobbying efforts had never occurred to me, but I immediately embraced Nik’s idea and asked my staff to see if the White House would provide a government plane for a trip. While I still saw my primary role to be helping gin up resources from other countries, I thought my advocacy would be more credible if I could draw on what I had personally seen. A trip would also enable me to bring journalists to the sites we visited, and their stories could demonstrate to the American public that by following proper precautions, one would not contract Ebola. And, ever a believer in a worm’s eye view of a crisis, I would be able to get a firsthand sense of what the US and UN needed to do differently going forward, informing my recommendations to the President and secretary-general.
USAID’s highly trained Disaster Assistance Response Team was playing a major role in coordinating the American response, so I reached out to USAID administrator Raj Shah for a gut-check. He encouraged me to go. “Our partners are toiling in complete isolation over there,” he said. “It will be a big morale boost.”
The main skepticism I heard came from an unsurprising source: Cass hated the idea and for the first time, Declan was old enough to offer reinforcement.
Having just entered kindergarten at the UN International School (UNIS), Declan must have heard someone talking about the epidemic. “Mommy are you going where the Bola is?” he asked me a couple days before I was scheduled to depart. I nodded, but promised I would stay safe.
“How do you know?” he asked, adding: “Those other people thought they would be safe too.”
I explained how I would not do anything dangerous, but he kept pressing, saying, “Mommy, I’m certain you will bring back Bola.” I had never before heard him use the word “certain,” which I found jarring.
Fear continued to spread as my team made final preparations for the trip. On October 23rd, a New York doctor named Craig Spencer was diagnosed with the virus after returning from an MSF mission in Guinea. When the news broke, Spencer’s cell phone rang off the hook as his former patients called to see if they could help.
Spencer had covered a lot of ground during the week between his return and his diagnosis. He had walked the High Line in Chelsea, eaten at a popular restaurant in Greenwich Village, and gone bowling in Williamsburg. Even more terrifying to New Yorkers, he had taken an Uber and ridden the subway. A tightly packed city with millions of people had its first Ebola case—the plotline of a horror film come to life.
As fear reigned during this period, politicians’ reactions varied widely. New York City mayor Bill de Blasio rode the subway and dined with his wife at the restaurant where Spencer had eaten to show they were safe. Conversely, New York governor Andrew Cuomo joined New Jersey governor Chris Christie in announcing that their states would quarantine any person who had worked to combat Ebola in West Africa. It did not matter whether they showed symptoms or not—for twenty-one days, they would be wards of the state. That same day, immigration officials at Newark airport detained Kaci Hickox, who had been working with MSF in Sierra Leone, even though she tested negative for Ebola.
The combination of adding three extra weeks to health workers’ time away from work—and the additional state-sponsored stigma—seemed sure to reduce the number of American doctors and nurses willing to travel to the region, weakening the response at just th
e time when we needed a huge surge in trained personnel. Prior to the outbreak, Liberia had just one doctor for every 100,000 people. (By comparison, the US then had around 257 doctors per 100,000.)
The day of Hickox’s confinement, Susan Rice, who had done a masterful job pushing the administration to be aggressive in our Ebola response, telephoned to urge me to consider calling off my trip. Acknowledging that she was calling more in her capacity as my friend than as National Security Advisor, she urged me to think about my responsibility to my kids. I said I had of course thought about my family, but I was confident in the safety protocols and felt it was essential to show that our collective domestic panic was misplaced.
She continued to press me. “Think about it, Sam,” she said. “What if something goes wrong? Can you imagine what would happen to our larger effort if a member of the President’s cabinet had to be quarantined?”
Susan was highlighting a problem I had not sufficiently considered. The political sands were shifting beneath our feet. While we were abroad, Cuomo, the governor of the state where my team and I lived, could conceivably make further changes to New York’s rules and declare that even individuals who had no physical contact with Ebola patients would be isolated upon return, just for visiting West Africa.
Cass, meanwhile, remained opposed to the trip. “There is nothing you can accomplish by going that you can’t accomplish by staying home,” he said. The problem with Cass’s counsel was that he had made similar arguments regarding every previous trip I had taken. Because I wanted to go, I sought advice from others.
I reached out to Klain, who was supportive. He reminded me that Terry McAuliffe, the governor of Virginia, was keeping Dulles Airport open and free of quarantine restrictions. I once again called Raj, the USAID administrator, and pressed him on the question of risk. “Look, you are not going to be touching Ebola patients,” he said. “But of course it is risky.” When he had traveled to Guinea a few weeks before, he recalled listening to his interpreter translating and suddenly thinking, “Wait, as he is speaking inches from me, microscopic specks of his saliva could be entering my ear right now. This is not good!” Still, he urged me not to cancel.
I also called my mother, who had gotten educated on Ebola since her initial negative reaction. She now offered unflinching encouragement, ending our call by saying, “I wish I could come.” With her vote of confidence, I resolved to go ahead.
I gathered the small USUN team accompanying me, whose physical safety was my responsibility, and delivered the spookiest sermon they had ever heard. “You could forget that you must not shake anyone’s hand,” I said. “And, if you shake someone’s hand who has Ebola and a tiny cut, and you have the same, you could get Ebola.” Unaccustomed to offering this form of apocalyptic leadership, I echoed Susan’s concerns as my team looked at me gravely. “I want to make sure that each of you has thought through the risks you are taking,” I said. “It is absolutely not too late for any of us—or all of us—to back out. Are you sure you still want to go?”
Hillary, my longtime aide and friend, was the first to speak. “We should go. We will be incredibly careful, and our visit can make a difference.” Each of the other members of my team affirmed what Hillary had said. “ ‘Freedom from fear,’ right?” said one, citing one of FDR’s “Four Freedoms,” which I often drew upon.
Before leaving, Declan and I made our peace about the trip. He was then in a phase of acute empathy. At times it took absurd form, such as eating the last remaining chicken finger even though he was full, “so the chicken finger won’t be left all alone.” I told him that, because there was at least a chance I could help people who were really sick, I had to go. He came into my bedroom the morning our team departed and said, in a very grown-up voice, “The people in Africa are really lucky that you are going to the Bola place to try to help. I’m proud of you, Mommy.”
BY THIS POINT, more than 10,000 people in West Africa had confirmed or likely cases of Ebola, and some 4,900 people had died.* The physical manifestations of the disease—fever, vomiting, diarrhea, bleeding, and intense pain—had left victims dying on roadsides and in overcrowded clinics. I expected the trip to be as unsettling as any I had ever taken. Instead, I found it to be a stunning tribute to American ingenuity and, above all, to the resiliency of the people of West Africa.
When announcing our stepped-up response, President Obama had assured the American public that all US personnel being deployed to the region would abide by strict protocols to ensure that they did not contract the virus. My delegation took a number of precautions—traveling with a physician, checking our temperatures regularly, giving elbow-bumps as greetings instead of handshakes, and not entering the Ebola Treatment Units we visited.*
The US commanding officer in Liberia, US Army Major General Gary Volesky, flew our delegation by helicopter from near Monrovia to Bong County, where we met US Navy technicians who had just set up an Ebola testing lab. Previously, blood samples had needed to be taken by motorcycle on often-impassable roads to the only lab in the country, which was located in Monrovia. The samples were sometimes lost in transit, and the testing queue was long. People far away from the capital, like those in the area we were visiting, usually did not get results back for at least five days. While they waited to hear whether they had Ebola, they were often kept quarantined with other Ebola patients, increasing the risk that those who did not actually have the virus would end up contracting it anyway.
At a nearby Ebola Treatment Unit, we heard that the US lab was already having a huge effect. Now that test results were provided within five hours, beds were freed up for actual Ebola patients and the infected were swiftly isolated so they did not transmit the virus. Equally important, the ability to begin early treatment was dramatically increasing survival rates.Once these recovery stories finally began to make their way back to rural communities, terrified citizens with Ebola symptoms began to come forward, suddenly hopeful that their lives could be saved. As Albert Camus wrote in The Plague, “It could be said that once the faintest stirring of hope became possible, the dominion of plague was ended.”
In Sierra Leone, we visited Freetown’s new Ebola response call center. The CDC had identified safe burial as the sine qua non of ending the epidemic, so it was heartening to learn that a robust public information campaign had finally begun spreading word among the city’s residents to call 117 when a sick person had died. I could see that the message was getting through. On the wall of the call center was a map of Freetown. The Sierra Leonean volunteers were using red pins to mark the locations where deaths had been reported. When a team retrieved and buried a body, the red pin was replaced with a blue one. A week before, the Sierra Leoneans told us, only 30 percent of bodies were being collected and safely buried within twenty-four hours. By the time we visited—in no small part due to the infusion of British military and civilian experts and other international support—98 percent of reported bodies were being buried within a day. On the map, we saw a single red pin surrounded by a sea of blue pins. The practice had not yet been scaled in districts outside the capital, but they had developed proof of concept.
At training centers run by the United States in Liberia and by the United Kingdom in Sierra Leone, we saw young people lining up to volunteer. I stopped a number of them, asking what was motivating them to take part in the Ebola response. With the economy in complete free fall and unemployment surging, for some it was the lure of a day’s wages. But for most, it was the simple desire to help. As one young man in Sierra Leone told me, “If we leave our brothers and sisters to die, who knows, it might be us next. It is a point of duty.”
Were it not for the staff and security I had around me, I would have felt like I was back in Bosnia, notebook in hand, asking questions and hoping that I could convey these inspiring stories to someone important. Now, thankfully, I would be able to report what I witnessed directly to the President of the United States.
One of our biggest concerns was one that had inhibited the r
esponse from the start: stigma. I met one twenty-four-year-old survivor in Guinea, a high school teacher named Fanta Oulen Camara, who told me she had lived three lives: before Ebola, in the hell of her infection, and since recovering. She said her post-Ebola life was harder than when she was battling death. Her friends had stopped talking to her, and she felt so alone that she had even considered returning to the Ebola treatment center to see if she could live there.
Back in Washington, Obama had done what he could to fight the stigma, inviting Texas nurse Nina Pham to the Oval Office after she was released from the hospital, and giving her an effusive embrace. I had taken to describing the photo of the scene as “the hug heard around the world” because everyone from Camara to Liberian president Ellen Johnson Sirleaf had mentioned how much it meant to them. “Our countries need to be hugged like Nina Pham,” Johnson Sirleaf told me.
Before heading home, I visited with Jackson Niamah, the Liberian health worker who had spoken so movingly by video to the Security Council about his people’s devastating plight. He was now so confident and cheerful that I hardly believed he was the same person we had heard from the previous month. Because the United States and other countries were furiously building Ebola Treatment Units across Liberia, he told me his MSF clinic could finally care for all those who arrived seeking medical attention.
As I left our meeting and reflected on all that we had witnessed, I began to believe that we would succeed in ending the Ebola epidemic—if fear (channeled through Congress) did not interfere with the US-led response.
AS IT HAPPENED, on the day we departed West Africa, President Obama decided to convene the national security cabinet to determine whether to succumb to congressional calls for a travel ban. I would join the Situation Room meeting from the plane by secure videoconference.
The Education of an Idealist Page 48