The Best American Magazine Writing 2016

by Sid Holt

  So Khan had bent the rules and moved the Ebola-stricken nurse to a private room in the observation wing, normally set aside for those awaiting their diagnostic test results. It was more comfortable and dignified—befitting the nurse’s status, Khan thought, as the most beloved figure at the hospital. Khan and Mbalu Fonnie had been each other’s family for much of the past decade. He called her “mom.” She thought of him as her son, and she took maternal pride in his accomplishments. A round-faced man who had been born poor in a village near Freetown, Khan had become a hero in Kenema, a backwater town of 130,000. As the head of the Lassa fever ward, he had treated more cases of hemorrhagic fever than anyone else in the world, helping thousands of patients recover their health. He attended conferences from New Orleans to Nigeria, published studies in major medical journals, and was soon headed to Harvard on sabbatical to work at the cutting edge of tropical-disease research—mapping the virus genome. But now Khan was facing the greatest challenge of his life.

  “We’re working hard to help you,” he said to Fonnie, his voice muffled behind a face mask. Like the attending nurses, Khan was clad in full protective gear—DuPont Tyvek hooded suit, two pairs of surgical gloves, Wellington boots, and an apron. “You have to hang in there.” An attending nurse complained that the IV fluids weren’t flowing into Fonnie’s veins fast enough, so Khan retrieved a higher pole from which to hang the bag. He showed his chief nurse a get-well card sent by the U.S. ambassador, who had visited the hospital weeks earlier. “We are with you,” it read. “Be strong.” Then Khan turned away, struggling for composure.

  The first Ebola cases in Sierra Leone had been diagnosed in late May, nearly two months before Fonnie’s infection, in Koindu, one hundred miles north of Kenema. Since then the sick and the dying had been flowing into his hospital at an accelerating pace. The death toll had reached several hundred, though nobody knew the exact count; many were dying in isolated villages beyond the reach of health workers. Seventy people filled the wards at Kenema hospital, and more were arriving in ambulances or coming on foot every day. Khan felt let down by the Sierra Leone government, which had all but ignored the outbreak; the minister of health and other officials “were too frightened,” says one U.S. doctor, to travel to Kenema. Khan was sending out e-mails to friends around the world, begging for equipment. Most of the staff had fled—Khan was the only local doctor left—and the handful who had remained behind had begun to die. Four nurses other than Fonnie and one lab technician lay gravely ill in the Ebola wards.

  Nobody understood why so many nurses were getting infected. In the early days of the outbreak, Khan had introduced a rigorous decontamination procedure. After treating patients, staffers were thoroughly sprayed with a 30 percent chlorine solution. They would meticulously remove their personal protective equipment, or PPE—face shields, boots, and outer gloves—wash their hands with a 10 percent chlorine solution, a less abrasive but still effective mixture, and, after pulling off their second pair of gloves, receive a final squirt of Ebola-killing disinfectant. Still, they were falling ill. Some suspected that the problem was not the PPE-removal and cleaning-up process but the PPEs themselves. It was widely believed that Fonnie and three other nurses had picked up the virus at the same time in mid-July while helping another nurse, infected with Ebola, deliver her stillborn baby inside the isolation ward. The birth produced a massive amount of infected blood and other bodily fluids, and colleagues assumed that some viral particles had leaked through the PPEs.

  Khan “was frustrated, distraught, and overwhelmed,” says one Centers for Disease Control scientist. He spent much of his time trying to hold the hospital together. The facility was unguarded, and some patients, believing they weren’t sick, wandered off, escaping into the streets to return home. Crowds had begun to gather outside the hospital gates, bewildered and angry by the deaths of so many people. None could believe that a disease could be killing their loved ones so fast; they assumed there had to be a plot behind it. One peaceful vigil for nurse Fonnie nearly turned violent when a rumor spread that she had died. “Let’s storm the hospital,” somebody yelled, and hundreds surged forward. After the outburst, they directed their rage at Khan. “The doctor is killing people, and these nurses are taking people’s hearts,” they cried. Khan had no choice but to address the crowd himself. He walked out of the hospital and assured them the rumor was false. “I’m putting my own life on the line,” he told them. “My nurses are dead, and I don’t know if I’m already infected or not.”

  Seeing Khan, exhausted and alone, the people quieted down and wandered back to their huts in the bush and jungle-covered hills.

  • • •

  In October I flew on Brussels Airlines to Sierra Leone, a former British colony about the size of West Virginia, sandwiched between Liberia and Guinea on the tropical west coast of Africa. The Ebola outbreak was then in its sixth month, and it showed no signs of letting up. (By late December, the number of confirmed cases reached nearly seven thousand; more than two thousand people have died. Only neighboring Liberia has reported higher numbers.) The outbreak had swept across the country with terrifying force, leaving a trail of corpses and eerily empty villages. And yet Khan’s story—a story that explains so much about the bravery of the first responders and how health officials, through ignorance, fear, and willful neglect, mishandled the situation—had gone largely unreported.

  The plane was packed with returning Sierra Leoneans, Western doctors, and public health officials, and the atmosphere was hushed. I had covered more than a dozen wars, revolutions, and coups—including two trips to Sierra Leone in the midst of its devastating rebel war in the 1990s—but I had never faced anything so unsettling. On the ground, the fear was palpable. People had stopped shaking hands, and chlorinated water taps stood at the entrance to every building I entered. Outside Connaught Hospital, a crumbling facility in Central Freetown, I watched as a man stumbled out of a taxi, collapsed, and died in front of the entrance. Men in biohazard suits appeared moments later and sprayed down the vehicle; pedestrians hung back, horrified.

  Khan knew the risks better than almost anyone else in the world. Born in Mahera, a village of muddy roads across an estuary from Freetown, to a schoolmaster, he and his nine brothers and sisters grew up under firm rules. The elder Khan was a “strict disciplinarian,” recalls Humarr’s older brother C. Ray, who used a switch on his children and insisted they be held back a year if they finished below the top five in their class. But the rules weren’t without purpose. The Khans often offered to board poor children who lived too far away to walk to the school every day. “His father was intent on making sure that all kids could attend school,” says one of Khan’s close friends. “The mother would make clothes for all those needy families who didn’t have any. Every week, they would invite some individual from the community to have dinner with them—someone very poor or someone with medical problems.”

  Khan, a bright boy with a mischievous streak, often tarried on the way to and from school to pluck mangoes from neighbors’ gardens. By the time he was ten, he had started spending much of his time on weekends and after school down the street, wandering the grounds of Bai Bureh Memorial Hospital, a fifty-bed private clinic founded by a wealthy German French transplant and her husband, a Sierra Leonean obstetrician-gynecologist. The clinic drew expectant mothers and other patients from around the country—Siaka Stevens, Sierra Leone’s president, came here to be treated for malaria. Some camped out overnight in the Khan family living room while awaiting treatment. “Squazu [Khan’s nickname] wanted to know, ‘Who is this person who is so important that people stay overnight to see him?’” remembered Khan’s nephew “Alaska” Kargbo. Khan befriended the physicians’ three children. As his friends played football, he was making toy stethoscopes out of string and a sink stopper and examining his brothers and sisters. “The surgeon became his role model,” says Alaska. “He started asking the man’s kids, when he was thirteen, fourteen, ‘How do I become a doctor?’ They told him,
‘You have to study science.’”

  At St. Francis secondary school—one of the best in the country for science—Khan led the debating team, read the news at assemblies, and tutored his schoolmates after hours in math, chemistry, and biology. He had so little money that his fellow students took turns buying him lunch at the “kukeri” shops that sold cheap meals of rice, cassava, and potatoes. His obsession with medicine was evident. One day he came across the report of a Western physician who had contracted Lassa fever and died. He told classmates: “I want to be that guy. I want to cure Lassa fever.”

  Khan graduated at the top of his class in 1993, and went on to medical school outside Freetown, where he started to date an attractive young nursing student named Assie. He had known Assie since junior high, but as the two grew closer, he fathered two children with two different women. “He was young, and he went out to sow his oats,” says his brother C. Ray.

  In 1991, a rebel movement called the Revolutionary United Front coalesced in the eastern corner of the country, near Liberia, vowing to bring down an authoritarian and corrupt government. The insurgents, many of them children, killed and hacked off the limbs of thousands of civilians. Like many, Khan fled to neighboring Guinea. In 1997, he made a perilous boat journey down the coast after leading student demonstrations against the military coup and eluding a warrant for his arrest. He remained in exile for months. After returning, he was again driven out when rebels marched into Freetown, killing and mutilating hundreds. In 1999, Khan and his whole family fled to Conakry, Guinea’s capital, where his siblings—many of whom had already relocated to the United States—tried to persuade Khan to do the same. Khan was unmoved. “Everyone is saying Sierra Leone is lost,” he told his family. “But I’m going back to Freetown.” He caught a flight back days after British troops drove the rebels out of the capital and encouraged his nephew, who dreamed of moving to the United States, to join him. “He told me, ‘America, America, America. You’re going to wash dishes, do odd jobs. You are wasting your time, Alaska. Come home.’” Alaska did as his uncle asked.

  In the ruins of the capital, amid a traumatized population and a shattered infrastructure, Khan went to work. He practiced at a local government hospital and also became a visiting doctor in Kenema, a town 190 miles to the east. Since the 1970s, Kenema had maintained Sierra Leone’s only treatment center for Lassa fever, one of the biggest killers in eastern Sierra Leone. Like Ebola, Lassa is transmitted by animals—rodents, in this case—and attacks almost every tissue in the human body, beginning with the sinus membrane, intestine, lungs, and urinary system, before devastating the vascular system. The end result is remarkably similar to Ebola: Internal bleeding and high fever kill up to 70 percent of Lassa patients who become sick enough to seek medical attention.

  In 2004, the director of Kenema’s Lassa fever program, Dr. Aniru Conteh, died after pricking himself with a needle while drawing blood from an infected patient. Khan saw an opportunity: he applied for the post and was quickly hired.

  “I’m on my way to Kenema,” he told his nephew. “I’m leaving tomorrow.”

  His family begged him not to take the job.

  “But the last doctor died,” Alaska replied. “Don’t you know how dangerous it is?”

  Khan was undaunted. “They need me there,” he said.

  • • •

  The 190-mile stretch of highway between Freetown and Kenema has become one of the main transmission routes of the current Ebola outbreak. During the last week of October, when I made the journey in a four-wheel-drive vehicle with a driver and a translator, we were stopped en route at twenty “Ebola checkpoints,” rudimentary roadblocks manned by police, soldiers, and government health workers. At each one, my translator and I were ordered out of the car for a temperature check and a hand washing at a chlorinated water tap. (For reasons that nobody understood, the driver was exempted from the ritual.)

  Kenema, a decrepit tropical backwater, has been battered by the twin African scourges of war and disease. Smoke rose over jungle-covered hills in the distance, once a sanctuary for rebels. Just inside the front gate of Kenema Government Hospital, dozens of people sat listlessly on plastic chairs beneath a tarpaulin, possibly infected with Ebola, awaiting admission to a larger observation tent in the “red zone.” I observed from about fifty feet away as a man collapsed beside the guard booth and lay face down in the gravel, his chest heaving. A small boy, probably his grandson, squatted beside him. “Can you hear me?” a Red Cross official asked, to no response.

  When Khan arrived in Kenema in 2005, driving a beat-up sedan, the hospital was in a far different state. Tulane University had recently set up a state-of-the-art lab to test for Lassa fever, which meant that samples no longer had to be sent overseas. Researchers could diagnose the illness on the spot and get patients started on the right treatment. (A major scientific study had found that treating Lassa fever victims with the antiviral drug Ribavirin during the first week of symptoms pushed the cure rate to 95 percent.) Khan worked closely with the lab, which grew viral proteins from a single strand of RNA and cultured human antibodies. He also tended to patients and opened a private practice. “He liked to joke, and he was always advising you to further your education,” says nurse Issa French. Khan often lingered with patients, asking about their families, their jobs, their aspirations; his enthusiasm struck his colleagues. “He always wanted to talk about his latest cases,” said Robert Garry of Tulane University, who worked closely with Khan. “Poisonoussnake bites, vitamin deficiencies, seeing stuff that he had learned about in medical school [in clinical situations] fascinated him.”

  Kenema was still recovering from the rebel war, but Khan enjoyed the clean air and the slow pace. He found his way to The Capitol, a Lebanese-owned hotel and restaurant, which had hummus and tabbouleh on the menu, a murky swimming pool in the asphalt courtyard, and a flat-screen TV that played European football matches. After work he liked to sit in a wicker chair on the second-floor veranda, order a Maltina, and cheer on AC Milan, his favorite team. Peter Kaima, a bartender at The Capitol who would later become Khan’s assistant, first met the doctor during the televised UEFA Champions League final in May 2005, shortly after his arrival in town. “When AC Milan scored a goal, he ran outside, took off his shirt, and was waving it and shouting in the street,” Kaima recalls. “I asked people, ‘Who is this man?’ And somebody said, ‘That man is a doctor.’”

  A year after his arrival, Khan married Assie in a Freetown mosque, according to Muslim tradition (while Khan wasn’t particularly religious, he did pray in mosque most Fridays). Khan’s brothers and sisters used the occasion to pressure Humarr to make a fresh start. “I told him he should move to the U.S.A.,” says his brother Sahid, who had settled in Philadelphia in 1992. “I wanted him to make more money. All he had to do was pass the U.S. medical boards.” Assie wanted much the same: to begin a new life with her husband in England. Instead, the couple settled into a long-distance relationship. Assie visited Kenema once a year, staying for a month; Khan would stop in England on his way to occasional lectures and conferences in the United States.

  The distance wore on the young couple. Peter Kaima remembered fierce arguments between them at Khan’s bungalow in Kenema. “He would always say, ‘I need to stay here and work with my people,’” Kaima recalls. Assie sent Humarr letters expressing her frustrations and, finally, asked him for a divorce. “She wrote, ‘It seems that you are married to your job. I cannot compete with it,’” says his older brother Alhajie.

  Without Assie, Khan devoted himself further to his work. His efforts were recognized in 2013 when Kenema was included in a newly established, international consortium of medical schools and labs focusing on hemorrhagic fevers. The group won two multi-million-dollar grants from the National Institutes of Health, money that would allow Khan and his team to focus on sequencing the genetic code of a broad range of infectious tropical diseases, including Ebola—an essential step in the development of diagnostics and vaccines. I
n early May 2014, Khan met with Garry of Tulane University, Dr. Pardis Sabeti of Harvard University, and other members of the consortium outside Lagos to inaugurate a $10 million initiative. Khan was buoyant. The U.S. Navy had recently approved funding for a new Lassa fever ward at Kenema Government Hospital to replace the sweltering concrete shed with a new, forty-eight-bed ward—doubling capacity. In the evenings, Sabeti, Garry, Khan, and other members of the consortium would gather in a hotel suite near the university, discussing their plans to train a new generation of African researchers and doctors. “He was always the last one to fall asleep,” says Sabeti. “He wanted to talk all night about the things we could do together.”

  Amid the good cheer, however, came disturbing news. In March, Guinea had notified the World Health Organization that it had confirmed a number of cases of Ebola—the first time the virus had ever appeared in that part of the continent. Then, just as quickly, the disease appeared to recede. “We dodged a bullet,” Garry thought. Still, he told Khan he should be prepared when he returned to Kenema. “It could be a month, a year, or two years,” Garry said. “But Ebola is going to come.”

  Unbeknownst to the doctors, deep in the rolling hills and diamond mines of eastern Sierra Leone, in a district called Kailahun, a traditional village healer had begun claiming that she had the power to cure the mysterious disease. Dozens of the desperately sick traveled from Guinea through the bush to visit the medicine woman’s home, where she reportedly treated them by applying herbal remedies, draping snakes over their bodies, and uttering incantations.

  Within weeks, the healer herself became infected and died.

  On May 23, a pregnant woman who had attended the healer’s funeral arrived to Kenema hospital, suffering from a severe hemorrhagic fever. Nurses initially assumed that she had Lassa. But the head of the Kenema laboratory performed the diagnostic test and it turned up negative. Khan understood the implications immediately. “Okay,” he said, “then she has got Ebola.” On May 24, the lab director tested the sample of a desperately ill woman from Kailahun along with the pregnant woman’s blood and that of another woman who knew the healer. All three proved positive for Ebola. On May 25, the World Health Organization was notified that Ebola had spread to Sierra Leone.