by Sid Holt
On July 29, the health minister called C. Ray Khan with good news: His brother’s white blood cell count had risen overnight, and he was nearing the level considered safe for air evacuation. But while his body was fighting the virus, he was now unable to stand without help, and he had near-constant bloody diarrhea. “He asked me to help him change his Pampers,” recalls Sankoh-Yela, “then he asked me to take him out for fresh air.” Sankoh-Yela, with the help of doctors, lay Khan down on pillows in the outdoor area in front of the tent. Around two p.m., Khan asked Sankoh-Yela to prop him up in a seated position. “Dr. Khan, I am tired, I am also sick, I think I must leave you now,” Sankoh-Yela told him.
“Yela, are you leaving me?’ Khan asked.
“Yes, I am running away from you now, I need to rest,” he said and returned to the ward.
Minutes later, lying in his bed, Sankoh-Yela heard a shout from outside. It was another nurse from Kenema, holding vigil for Khan.
A few minutes later, C. Ray Khan received another call from the minister of health. “Your brother passed away,” she told him. “We have to let the plane go.”
• • •
Khan was a test case. Every high-profile instance of infection that came after him went completely differently. In late July, Dr. Kent Brantly, an American physician-missionary in Monrovia, Liberia, fell sick with Ebola and, as Khan lay dying, the National Institutes of Health arranged a shipment of the three vials of ZMapp from Kailahun to his treatment center. As Brantly rested in quarantine, nine days after showing the first symptoms, a single dose was injected into his bloodstream. Within an hour, Brantly’s breathing improved and a rash that had covered his body faded. Hours later he boarded a Phoenix Air Gulfstream jet contracted by the U.S. State Department and fitted with an “aeromedical biological containment system,” a collapsible plastic tent designed to house a single patient. From his isolation room at Emory University Hospital in Georgia, Brantly told the assembled media that “God leads to unexpected places.”
Brantly’s colleague in Liberia, Nancy Writebol, contracted Ebola around the same time. She received the last two vials of the drug from Kailahun, and, on August 6, she was able to board the same Phoenix air ambulance and return to the United States, where she quickly recovered. During the same frantic period, the Spanish government sent a specially equipped Airbus A310 medical jet to Liberia to evacuate an infected missionary, Father Miguel Pajares, to Madrid. Pajares was also given ZMapp, but he died in a hospital a week after his evacuation, one of two Ebola patients treated with ZMapp who did not survive. (The other was a Liberian doctor.)
The fifth Ebola patient to be treated with ZMapp was Will Pooley, the British nurse at the Ebola ward in Kenema. The 50–50 odds of contracting the virus he had given himself did not work out in his favor. He believes he got the virus from an eighteen-month-old infant whose parents had died of the disease but who had initially tested negative; the nurse had begun changing its diapers, and the child developed Ebola symptoms while Pooley was caring for it.
“I thought I would go to Kailahun, and that scared me, because Khan had died there,” Pooley recounted one evening over a beer in a bar in Freetown. “But it also occurred to me that I wouldn’t have to go on the ward at Kenema.” Instead Pooley traveled in an ambulance with a police escort to Lungi Airport, where he was put on a Royal Air Force air ambulance to London, and was given one of the world’s last remaining doses of ZMapp. “I had a really high fever and the shits, and then I started to recover,” he says. When we met, Pooley had been back in Sierra Leone for a week; he was working in the “suspect ward” at Con-naught Hospital in Freetown, treating sick patients who were waiting for the results of their Ebola tests. The difference this time was that Pooley had almost certainly developed an immunity to the virus because of his previous exposure. “The doctors aren’t 100 percent sure, but it’s probable,” he says. Pooley believes that ZMapp cured him, and probably could have cured Khan as well. Medical experts aren’t so sure. “If the question is, ‘Did ZMapp do this?’ The answer is that we just don’t know,” says Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. “People who are in much less sophisticated medical-care conditions in West Africa are recovering 50 percent of the time.”
In the aftermath of Khan’s death, many of those involved in the decision making have been reluctant to talk about what they know. “Unfortunately I cannot comment on this matter at this time. Is that okay?” Miatta Kargbo repeated robotically at least fifteen times when I pressed her on the phone after she had been fired from her post as Sierra Leone’s minister of health. Doctors Without Borders, invoking patient-doctor privilege, refused to answer any questions about Khan’s condition while in their care, or even to explain why a patient who is walking and talking can, as Khan did, rapidly deteriorate and die. (Studies have attributed sudden death to shock and organ failure caused by fluid loss, and a sudden onset of arrhythmia.) According to Doctors Without Borders, the determining factor in denying Khan ZMapp was “clinical”—the belief that Khan’s condition had deteriorated to the point that ZMapp probably could not have helped him. But that doesn’t explain why Khan was up and about, talking coherently and eating well for his first few days in the treatment center.
Doctors Without Borders also denied that it played any role in the “management” of the plan to evacuate Khan or the final decision to abort the flight. This contradicted what C. Ray Khan had been told by the minister of health. “Things aren’t adding up,” he said in a phone conversation from Mahera. “Somebody isn’t telling us the truth.” Khan’s brother Alhajie remains angry that an African was denied treatment with the experimental drug while two white Americans became the first to be given ZMapp, and distrusts Doctors Without Borders’s account of what happened. The decision, he says, “looks political.” One medical professional who was involved in the conference calls told me that Doctors Without Borders “was being very paternalistic,” entirely cutting Khan out of the decision-making process. “It’s not that they didn’t want to do what was best for Khan,” the medical professional says, but the organization allowed the perception to take root that “it was about color.”
• • •
Khan was buried in a hastily dug grave in a weedy field behind the Kenema Government Hospital, next to the new, unfinished Lassa fever research center. The minister of health attended the ceremony, but many other government officials were afraid to come, and Khan’s immediate family stayed away. “He died like a brave soldier defending his country,” I was told by Victor Willoughby, Khan’s mentor, who himself died of Ebola in December. During my visit to Kenema, a nurse from the Ebola unit took me behind the compound to show me the grave. It was a desolate place, a slab of marble-tiled concrete standing alone in a field of dirt and weeds. There were no markings on the tomb, which was already crumbling, and the only indication of who was buried there were three black flags drooping from wooden posts, left by different departments at the hospital. “The district health-management team extend their condolence to the family and friends of Sheik Humarr Khan,” one read, “who suddenly left us when we needed him most.”
On my last afternoon in Sierra Leone, I took the ferry to meet Khan’s family in Mahera, where the doctor’s love of medicine had first taken hold. I was met by his brother C. Ray, and together we drove to a low-slung yellow house a few blocks from the sea. The family’s ninety-eight-year-old patriarch sat on the porch, draped in a brown traditional gown and Muslim skullcap, still as a statue, acknowledging my presence with a trembling lip. His wife, who is eighty-six, sat beside him, clad in a richly patterned peacock-blue gown and maroon headscarf. She shook my hand and managed a soft “hello.” I tried to engage them in conversation but made little headway, except when C. Ray prodded his mother about the corporal punishment that she had sometimes meted out to young Humarr when he misbehaved.
“I whipped him six times with a small, thin cane on his butt,” she said.
“It was
more like twelve times,” C. Ray interjected.
The old woman nodded. “He was a very nice boy,” she murmured. “A quiet boy.”
C. Ray brought out a folder filled with family photographs—a portrait of his grandfather in the British colonial police force in the early 1930s, Khan posing in front of his car a decade ago: with a grin so wide he seems to be laughing at a joke between him and the photographer. After a time, I excused myself to catch my flight home to Europe, and the elder Khan finally mumbled something. “My father wants to pray for you,” C. Ray said. Khan raised his hands and chanted a prayer in Arabic in a raspy whisper, which C. Ray translated: “Take this son of America home, safely. Guide him well.”
As we walked to my taxi, C. Ray gazed at me intently. “When the minister of health called me about my brother, and told me that he had passed away, I said to myself, ‘Oh, wait a minute, how am I going to tell my parents?’” He had decided to take them into their bedroom, where he asked them to sit down. “I have some bad news for you about your son,” he said. “Do you remember that you didn’t want him to go work in the Lassa fever program because of what had happened to the other doctor? Okay, well, he got sick from Ebola, and he died.’”
C. Ray braced himself for the worst. He had expected that his mother and father would collapse. He imagined having to call an ambulance and rushing with them to the hospital emergency room. Instead, they sat perfectly still, saying nothing. Then they raised their hands together toward the ceiling and began to pray.
“Thank you for what you’ve done for Humarr. For what you’ve done for us,” they said. “You are the only one who gives life and takes life, so who are we to cry?”
C. Ray was flabbergasted.
His father looked at him: “Nobody cries in this house,” he said. “We should all give thanks to God.”
New York Times Magazine
FINALIST—REPORTING
In the last five years the United States has deported hundreds of thousands undocumented aliens. Even at a time when immigration is the subject of red-hot argument, their fate still has the power to shock. “Purgatory” describes the experience of Kelvin Villanueva, who was sent back to Honduras—where gang-related violence is commonplace—after being stopped near his home in Kansas City for a broken taillight. The Ellie judges described this story as “thoroughly original” and praised Luke Mogelson for his “resourceful and at times dangerous fact-gathering.” Mogelson’s article “The Dream Boat” won the National Magazine Award for Reporting for the New York Times Magazine in 2014. Another of his stories, “The River Martyrs,” was a finalist in Reporting the same year. His first collection of fiction, These Heroic, Happy Dead, was published in April 2016.
Luke Mogelson
Purgatory
Kelvin Villanueva was almost home one night last June when a policeman stopped him for a broken taillight. From his truck, he could see his longtime girlfriend, Suelen Bueno, waiting for him behind the glass door of their apartment. She often did that when he worked late. Villanueva supervised a small team of Hondurans—like him, undocumented migrants—who did finish carpentry on construction projects throughout Kansas City. It was normal for them to put in twelve-to-fourteen-hour days. During his fifteen years in the United States, he had never been pulled over. Still, Bueno worried. The threat of deportation did not subside with time. You just had more to lose.
Before Bueno reached them, the officer had arrested Villanueva. After being transferred to Immigration and Customs Enforcement, he spent the next four months circuiting a nexus of prisons and detention centers. Mostly, he was in a Missouri county jail that held Americans accused of felonies. Fights frequently broke out between the black and Latino inmates. Villanueva kept to himself, rarely leaving his bunk, passing the weeks by reading and drawing. He called Bueno and their children every day. When they met seven years earlier, at an adult-league soccer game, Bueno already had a young son and daughter; she and Villanueva had since had another one of each together. Villanueva didn’t differentiate. He’d always treated Bueno’s first two children as his own. Now, when the kids asked when he would be back, Villanueva told them, “Soon.”
Bueno, who was also undocumented, could not visit Villanueva during his incarceration. Instead, she borrowed enough money to hire an immigration lawyer, who filed an asylum claim on Villanueva’s behalf. Before his hearing with an immigration judge, Villanueva was interviewed by an asylum officer, whose job it was to determine whether he possessed a “credible fear” of persecution in Honduras—would he be at risk of harm because of his race, religion, social group, or politics? The officer’s analysis would inform the judge’s decision on whether to suspend or proceed with Villanueva’s deportation. When Villanueva spoke with the officer—from prison, by telephone, via a translator—she began by asking him why he came to the United States in the first place.
“To live and work,” Villanueva told her, “because in my country it is very difficult.”
“Difficult” might have been an understatement. Honduras is among the poorest and most violent countries in Latin America, and Villanueva’s hometown, San Pedro Sula, has ranked as the city with the highest homicide rate in the world for the last four years. (In 2014, 1,319 of its 769,025 residents were murdered.) Much of the bloodshed is gang-related. During the 1980s, waves of refugees fled civil conflicts in El Salvador, Guatemala, and Nicaragua, many settling in Los Angeles, where street gangs were proliferating. Among Central Americans, two dominant organizations established a vicious rivalry: the Mara Salvatrucha, or MS13, and the 18th Street Gang. When tough-on-crime legislation during the 1990s generated mass deportations, thousands of California gang members were sent back to developing countries ill equipped to receive them. In feeble, corrupt states like Honduras, the MS-13 and the 18th Street Gang flourished, brokering alliances not only with politicians, prison authorities, and the police but also with Mexican and South American drug cartels. The narcotics trade fueled the war between the two groups with unprecedented access to weaponry and cash. In San Pedro Sula, as in many other places throughout the region, resources plus impunity equaled more murder, torture, and rape.
For Villanueva, whose father was an alcoholic and regularly beat his mother, the violence continued at home. After his mother absconded to a different town, Villanueva and his three younger siblings were raised by their grandmother, aunts, and uncles. These relatives were very religious—one uncle was the pastor of a small evangelical church, another directed its youth group—and very poor. To contribute, Villanueva dropped out of school when he was twelve and started working. When he was sixteen, an uncle who lived in Kansas City offered to lend him the money to pay a coyote, or guide, who could usher him across the United States border. He also promised Villanueva a job in a glass factory, fabricating window panes, when he arrived. Villanueva’s family in San Pedro Sula encouraged him to go. Members of the 18th Street Gang had begun pressuring him to join their ranks, and on one occasion they had jumped him for refusing.
“How do you know they were from the 18th Street Gang?” the asylum officer asked during the interview, after Villanueva described the incident.
“They had tattoos with the number on their faces and hands,” he said, “and the walls of their houses are marked with the number.”
Villanueva later described the torture and murder of the uncle who directed the youth group at his family’s church. In 2013, the uncle disappeared after complaining to the police about the 18th Street Gang harassing the group members. A few days later, his body turned up in the Chamelecón River covered with puncture wounds, which investigators deemed to have been inflicted by an ice pick.
“How do you know the gang is connected to the police?” the asylum officer asked.
“Everybody knows that in my country,” Villanueva said.
“Your attorney submitted an article that indicates the police captured a leader of the 18th Street Gang,” the officer pointed out. “If the gangs are working with the police, why woul
d the police arrest their leaders?”
“They arrest people so the community thinks they’re doing something. But then they’re out of jail in a week or two.”
“Why are they released after a week or two?”
“This is the question that all of the good people of Honduras ask.”
“Is there anything else that you’re afraid of in Honduras?”
“No. Just losing my life.”
Although the officer found Villanueva credible, she did not consider him eligible for asylum; the immigration judge agreed. Villanueva was sent to Louisiana, where he was loaded onto a plane with more than a hundred other Hondurans. They wore manacles on their wrists and ankles, and their hands were shackled to chains around their waists. Armed guards accompanied them. Midway through the flight, bologna sandwiches and cookies were distributed. They were packaged individually, the sandwiches and cookies. Most of the handcuffed men and women found it easiest to tear the plastic with their teeth.
• • •
On the outskirts of San Pedro Sula, Ramón Villeda Morales International Airport receives planeloads of Hondurans like Villanueva several times a week. The deportees are unshackled and disembark on the tarmac. They are herded to a processing center, where their belongings are returned to them. Outside the center, family members and girlfriends loiter in the shade, expectantly watching the door. They perk up each time it opens and another deportee emerges. Taxi drivers offer special rates. Money changers wave stacks of Honduran lempiras, buying American dollars. People speak emotionally on phones.