by Bobby Adair
“Thanks.” Paul tried not to roll his eyes but some things just happen.
Heidi kicked him under the table again.
Chapter 18
Several dozen five-gallon plastic buckets had been found in one of the farm warehouses, distributed around the ward, and placed between the beds and sleeping mats. The patients weren’t allowed to use the outhouses behind the building—new quarantine rules. Not that many of them could have made the walk out behind the hospital anyway. Most couldn’t walk to the interior restroom, which ran off the insufficient supply of water in the hospital’s cistern. So the door to the interior restroom was ordered locked, leaving the patients with one choice for relieving themselves—the buckets.
Carrying two buckets sloshing with reeking human waste, Austin shouldered his way through a door at the back of the dark ward. The buckets came from beside the beds at the back of the room, from among the first of the patients who had been admitted with high fever, headaches, diarrhea, and vomiting. Most of those also had the rash. Hell, most of the patients inside had the rash. It seemed to be spreading across the ward as if it were a disease all its own. Then there were the patients who were bleeding from the eyes, nose, or ears. To Austin, that was the irrevocable sign of hemorrhagic fever—the bleeding.
He crossed the grass behind the hospital and stopped in front of the stinking pit near the tree line. Dumping the buckets, he couldn’t help but notice black tarry lumps in the red and brown liquid. Nearly retching, he quickly stepped away.
“Their organs are breaking down.”
Startled, Austin turned to look.
Nurse Mary-Margaret, with eyes red from lack of sleep and crying, had followed him out. She’d obviously seen what came out of the buckets and turned away to look up at the grayish mists floating through the tops of giant trees up Mt. Elgon’s slopes. At twelve thousand feet the dense forest gave way to bare rock as the mountain reached to touch the sky.
“Breaking down?” Austin asked.
“I started seeing it earlier today.”
“What does it mean?”
“The Ebola virus causes blood to clot,” she replied.
Austin sat the buckets down. “I’m confused. I thought it made you bleed?”
“Early on, the blood clots in the veins. Those clots clump together and clog arteries. When that happens, dead spots form because flesh that can’t get oxygen from the blood dies. This clotting uses up all of the body’s natural coagulants.”
Austin couldn’t help but look down at the residue in his buckets.
“The body starts to slough off the dead flesh. That’s what ends up in the buckets, dead flesh from the esophagus or stomach when it is vomited out. When the lining of the intestines is sloughed off it is—” she hesitated.
Austin glanced at his buckets and looked back at the pit—horrified. “It is Ebola, then.”
Nurse Mary-Margaret nodded, and her face, with her mask pulled down below her chin, was nothing but sadness. “It still makes no sense.”
Austin didn’t know if he wanted to ask. “Why?”
Mary-Margaret replied, “You mean, how did so many get sick so fast?”
It was a rhetorical question. Of course, Austin didn’t know that answer. “Maybe when the doctor from the WHO gets here, he can help.”
“He’s here already. He got here about fifteen minutes ago.”
Austin perked up. “I didn’t see him.”
Nurse Mary-Margaret shook her head. “You’ve been working so hard in here all day. By the way, how are you feeling?”
“Like shit.”
Nurse Mary-Margaret laughed. “I’m not one to use that word, but I might. We all feel bad. We need help here—thank you for pitching in. But how’s your fever?”
“Stable, I guess.” Austin touched the back of his forearm—the part above the glove—to his forehead. “I don’t feel any hotter. I think the work helps. I don’t know.”
“You’ll end up sick if you push yourself too hard.”
“I’m already sick, will it make a difference?”
Mary-Margaret tried to look hopeful. “I wish I could tell you.”
“Then I’ll keep going as long as I can.” Austin looked back into the ward. “You said the doctor from the WHO is here?”
“We’ve set up another ward in the school.”
“Another ward?” And before Austin could think that it was a stupid thing to say, he said, “We’re so crowded in here. We should move some of these patients—”
Mary-Margaret’s old face stretched sadder with a slow shake, and that answered the question.
“There’s no room in the other ward?” Austin asked as though he hadn’t already guessed the answer.
“No.”
“My God.” Austin shook his head. “How many are sick?”
“Three hundred and eleven, at last count.”
“How is that possible?” he asked.
“That’s what we’re trying to find out.”
Austin stepped back so that he could see part of the town around the hospital building. “I wonder how many are sick in their homes, afraid to come for help.”
“We have volunteers out now, checking.”
“Do you think there could be a lot?” Austin asked, shaking his head without meaning to. The hopelessness of the absent, red eyes in the ward was infecting him.
Mary-Margaret said, “There might be more sick people in their homes than here. This isn’t Denver. People here don’t trust hospitals like they do in the states.”
“Jesus.” Austin paused and tried to tamp down the frustration coming out in his tone. “Is everybody in the village going to get it? How many people live in Kapchorwa?”
“Maybe eleven or twelve hundred within a mile of the center of town,” she replied.
“So between the hospital, the school, and any who are in their houses and afraid to come out, how many do you think are infected? Half? More?” Austin didn’t want to believe it.
Large numbers of dying people spread across a desert refugee camp was an easy thing to depersonalize when seen from the perspective of a couch in an air-conditioned room on the other side of the world. Dying people who could be smelled, who could be touched, whose tears flowed out of empty eyes—close enough to wipe away with your own hand—that kind of dying was real in a way that few people have the misfortune to understand. And all around, people were dying—the ones Austin could see and many more that he couldn’t.
He asked, “How is it possible that so many could contract it so fast?”
“We don’t know.” Mary-Margaret shook her head. She looked defeated. “That’s why Dr. Littlefield thought at first it might be typhoid.”
Austin looked down at the bucket to make his point. “But now we know that’s not true.”
Nodding on autopilot, Mary-Margaret softly confirmed, “We know that’s not true.”
Austin squatted to stretch his legs—in a way—to get closer to the ground, so when he passed out and fell over it would hurt less. “So, somewhere between sixty and ninety percent of all of those people are going to die?”
“Depending on which strain of Ebola this is.”
Austin thought about all the people he’d seen on the streets, everyone he’d talked to, and those he’d befriended since coming to Kapchorwa—most of them were going to die. And not just die, but gruesomely waste away as their bodies painfully disintegrated from within. He looked at his gloved hands as though he might see something there—evidence that he was alive, or evidence that he might stay that way. “I don’t know.”
Mary-Margaret turned to Austin, confused. “What? What don’t you know?”
“I think I’m numb.” Austin shook his head slowly as he spoke. “I never expected anything like this. I feel like I just need to keep moving, you know. I’m afraid to stop.”
He thought about when he’d been sitting on the plane at Denver International Airport prior to take off. He’d been excited about coming to Africa. It was the g
randest adventure he could imagine. But it wasn’t just that. He felt a passion to make a difference in the world. He didn’t harbor any illusions about making it better for everyone. Those kinds of thoughts were idealistic silliness. Austin’s aspirations were much simpler. He wanted to make the world better for someone, or maybe several people. So when he stood in front of his class of a dozen kids in the free school and felt the enthusiasm they had for learning, he knew he was helping them—if only just a little—toward a better life. In some ways, those days were among the best of his life. He was happy. He was making a difference.
But just as life in America has a way of killing the soul with vapid pleasures, life in Africa broke the heart through random brutality. Austin closed his eyes and choked back a tear as he saw a parade of smiling faces of those who lived in the village. Many of those people were in the clinic, and he had been carrying out buckets of their fluids all day. Their eyes were desperate with pain. They knew they were dying. Few of them had any hope.
Ebola was that kind of killer. Through its deadly reputation, it killed hope first. Without hope, victims only wanted the suffering to end. They gave up. And in lingering moments of consciousness, they stared at the ceiling or the dying person in the cot next to them. Some cried. But most were past tears.
Austin couldn’t think about it anymore. He needed to get moving. No matter how much he hurt, the work helped. “I’m running out of bleach to clean these.”
“We’re running out of everything.” And that was the end of Mary-Margaret’s hope. She put her face in her hands to catch her flowing tears.
Staring at her didn’t seem awkward. In weeks past he’d have turned away, distracted himself with a misplaced comment on something unrelated, random, and maybe even funny. But that’s what people he knew back at school did. Back in that sterile, painless world, emotions were hidden—something for keeping behind bedroom doors or in darkened rooms. Emotions were shameful things that were only put on display in books and movies, when fictional characters with imaginary problems had the right to cry, making moviegoers feel their pain so thoroughly that they cried, too.
But painful in America? How bad was that really? Losing a boyfriend? Getting a parking ticket? Missing out on a job? A long line at Starbucks? Getting behind on a credit card payment?
Pain in Africa was getting thrown off of a roof for the sin of being an orphan. It was being castrated in the street and left to bleed out. It was standing in a ward, stinking of death, watching every familiar face lose its smile, lose its hope, bleed its tears, convulse, and die.
Chapter 19
Dr. Littlefield walked across the deserted dirt street, still groggy from his insufficient nap. Wind from a coming thunderstorm kicked up a red dust that blew down the road. Littlefield shielded his eyes as he noticed a truck parked near the hospital entrance. Had help finally arrived?
He mounted the steps and just as he landed a foot on the porch, a tall man in full protective gear opened the door and came out of the hospital. “Dr. Littlefield?” He had a thick Italian accent.
“Yes.” Littlefield glanced down at his own inadequate bundle of protective gear—a surgical mask, goggles, gloves, rubber boots, and a plastic apron.
“I’m Dr. Dante Giovanni. I sent the girl to wake you.”
“Thank you for coming, Doctor.”
“You’re an imbecile.” Dr. Giovanni sounded like a father who’d lost all his patience with a child who didn’t want to learn. “You are going to kill everyone in this town.”
Dr. Littlefield’s immediate impulse was to lash back, but he didn’t have the energy for it. Too many twenty-hour days had worn all the fight out of him.
“I’ve only been here a half hour, and I can already see this is Ebola—or maybe Marburg—if you’re lucky. And what have you done? Your nurses wear plastic aprons they’ve been reusing for days. They clean the aprons in a common bucket instead of burning them. They are not protected from this outbreak. You’re going to kill them and yourself. You don’t have a containment area. You let people walk out of the hospital and into the street, carrying the virus with them. You’ve made this whole town a hot zone. How can you be a doctor in this country and not have the good sense to take the proper steps to contain this?”
Dr. Giovanni was on the edge of the porch by then, Littlefield having backed down a few steps in the face of the scolding.
But Giovanni’s rebuke found a quick end. “Have you nothing to say for yourself?”
“Yes. Are you ready to listen?” Littlefield replied.
“Of course.” It sounded like a platitude.
“I’ll skip right over the part where I tell you I’ve been on the radio, and you’re the first person to show up.” Littlefield retreated down the last few steps and put himself on level ground. The Italian could come down and talk to him face-to-face.
Dr. Giovanni proceeded down the steps and took up a position on the dirt road in front of Littlefield, towering over him anyway. “I came to investigate as fast as I could.”
“When were you told to come?” Littlefield was not impressed, and his tone made that very clear.
“Yesterday morning?”
“Why so long?”
“West Africa.” That was the simple answer, and both Littlefield and Giovanni knew that. West Africa was experiencing the largest Ebola outbreak in history, and it was accelerating. “Whoever is not there is running around the rest of Africa chasing rumors of more outbreaks. Most of them are just fear.”
Littlefield nodded to the hospital. “But this one isn’t, is it?”
“No. But if you know it’s Ebola, why haven’t you taken the steps to contain the disease?”
Dr. Littlefield laughed harshly. “It’s so easy to judge, isn’t it?”
Dr. Giovanni took a moment to pull himself back from the edge of losing his temper. “Tell me, then. What happened here?”
“As far as containment goes, well, you can see the outbreak is bad. It’s already everywhere in the town.”
“When did it start?”
Littlefield did some mental math. “People started showing up with symptoms a week ago.”
Dr. Giovanni asked, “How many?”
“A lot more than there should have been for a normal outbreak. Nearly two dozen that first day.” The fog of missed sleep clouded his memory.
“Twenty-four?”
“Yes.” Littlefield looked down, nodding for emphasis. “Twice that number, the next. On the third day, when I started pleading for help, we had around a hundred. That is a lot for a town this size.”
“And you’re the only doctor?”
Littlefield gestured down the street. “This is not a large town. Even so, maybe a hundred thousand live in the district. There are two other small clinics in the area, but this is the only one that passes for a hospital. There were two of us, but Dr. Ruhindi is inside. He fainted last night. He has the virus, and can’t even stand now. Two of our nurses went to Sierra Leone two months ago to help. Some of the college students teaching at the free school volunteered to help. All but one is sick. We have Nurse Mary-Margaret and a couple of girls from the town who help us.”
“When did you first suspect Ebola?”
Littlefield thought for a moment. “The third day. Before that, patients had the usual headaches, fever, nausea, and diarrhea that accompany just about any common outbreak. However, this outbreak was so widespread and sudden, I initially suspected typhoid. I drew blood samples and sent them to the lab in Kampala.”
“What came back?”
“Nothing.”
Putting the pieces of the puzzle together, Giovanni replied, “You didn’t receive the results?”
“I’m still waiting.”
“You may not ever get the results. Rumors of Ebola and fear of the disease have caused the government to blockade the roads in most of the eastern districts.”
“Great.” Dr. Littlefield stepped over to lean against the side of the porch’s foundation, and put hims
elf under the shade of the roof that slanted out in front of it. “On the third day, maybe twenty of the people who’d come in over the previous days with other symptoms came back with blood-red eyes. Others followed. The rashes started showing up, and that’s when I knew.”
“But all at once? How do you explain it?”
Dr. Littlefield shook his head. “It didn’t make any sense. You obviously see that, too. Ebola has a death chain. Usually you can trace it back one person at a time. Perhaps a man comes in with symptoms, but you know he got it from his wife, who was in two weeks ago, who got it from their child, who contracted the disease a week or two before. And maybe that child got it from a childhood friend. Ebola is a nightmare—a slow-motion nightmare that grows through personal contact. It thrives in this culture because they feel a social need to touch. They even touch the bare skin of the dead in their funeral rituals.”
“Not that different than us in the West,” Dr. Giovanni said.
“I guess not.” Dr. Littlefield took a moment to collect his thoughts and get himself back on track. “We didn’t have a death chain here. That’s the reason I didn’t even suspect Ebola at first.”
“Because it exploded across the population rather than growing in it?” Dr. Giovanni asked.
“Yes. That’s exactly what happened. It exploded for no apparent reason. People were getting infected by the dozens, with no apparent link. Of course, that was at first. By now, everybody in town who didn’t flee is in some stage of the disease. The hospital is overflowing.” Dr. Littlefield pointed to a cluster of three rectangular buildings a short distance across the mountain slope. “The school buildings are full.”
“Everybody is infected?”
“I don’t know that for sure.” Dr. Littlefield pointed down the road in both directions. “Two days ago I walked through town and tried to get people to come out of their houses and talk to me.”