KENEMA
Monday, May 26
Nine hours later, Humarr Khan was standing in front of a window in the Library. The room was packed with staff of the Lassa research program. The air in the room was thick with warmth and anxiety. “Guys,” Khan said, “Ebola is with us.” He explained that two Ebola patients were in the hospital already. They were Satta K. and Victoria Yilliah; both women were now lying in beds in the Lassa ward, desperately sick. The Lassa virus surveillance team, he said, should prepare a group of vehicles and set off for Koindu immediately, the small town in the Makona Triangle where Mamie Lebbie, the first confirmed Ebola case in Sierra Leone, was lying in a bed in the local clinic. Get her and bring her back to the Lassa ward to get her isolated, and search the area for more Ebola cases, he instructed the surveillance team.
As Khan was issuing these instructions, a woman in the room started crying. Her name was Veronica Jattu Koroma, and she was the assistant supervisor of the Lassa ward—Auntie’s deputy.
Khan spoke to her sharply in Krio. “Wetin make you de cry, Veronica? Why are you crying?”
“I am crying,” she said to the room, “because I myself have gone through the arms of Lassa fever, and I know that Ebola is worse.” Like the other nurses in the Lassa ward, she was a survivor of Lassa hemorrhagic fever. Her illness had been dreadful, and she had fallen into a coma and nearly died. As she had started to recover, she had gone bald. Lassa virus had killed the roots of her hair. She also fell into a serious depression. Years later, her depression had lifted and much of her hair had grown back, but she wore a wig to cover up the damage. “Ebola is more virulent,” she said to her colleagues.
Khan wasn’t sympathetic. He reminded her that she, like everybody else in the room, was a medical officer with a job to do. The Kenema Lassa program had the nation’s only medical unit that could handle Ebola patients. Everyone in the room was an employee of the national government. “The Ministry of Health is looking at us,” he said.
After the meeting, Veronica Koroma walked up the hill to the Lassa ward to start the day’s work. In a few minutes, she would be coming face-to-face with Ebola patients for the first time in her life. She had never seen the disease, and she was very afraid. At the entrance to the ward she met her boss, Mbalu Fonnie. “Oh Auntie, I’m so afraid and so scared,” she said, and started crying again.
Fonnie looked grave. “Veronica, why cry? Why pour tears? We have to put on our PPE and get to work on our patients.” The two women went inside the cargo container next to the Lassa ward. It was the staging area for the ward. There, they donned whole-body Tyvek biohazard suits with hoods, HEPA breathing masks, eye shields, double gloves, rubber boots, and rubber aprons. Then the two women crossed the open space and went through the entry door into the hot zone, the narrow corridor lined with cubicles. From that moment on, what had been the national Lassa ward would be the national Ebola ward.
* * *
—
After the staff meeting, Humarr Khan dropped by the cargo-container office of Nadia Wauquier, the French scientist, to talk about the test results. While they were talking, he asked her if she could spare a cigarette. Khan then closed the door—he didn’t want anybody to see him smoking—and continued discussing the blood tests. Suddenly Khan clapped his hand to his forehead. “Oh, shit!”
“What?” she asked
“Shit! The stool cups!”
The motorbike courier, after dropping off the tube of blood from the clinic, had delivered several cups of feces to a government lab in Freetown, to be tested for cholera. But the patient had Ebola. “Those cups are hot!” Khan exclaimed.
It was the world’s hottest shit. They burst into morbid laughter, they couldn’t help themselves, but it was a dangerous situation. Khan would have to call the Freetown lab and warn the workers not to open those cups, and to sterilize them.
But wait—how could a cup full of Ebola shit be sterilized? Nadia and Khan began discussing the problem. Should the cups be burned in an incinerator? The feces would spill into the fire, producing smoke. Could someone catch the virus by breathing shit smoke? They realized that nobody had any idea whether Ebola shit smoke was a biohazard. Khan called the Freetown lab and told them to burn the cups and to absolutely stay away from the smoke.
10:30 a.m., May 26
After smoking a cigarette with Nadia, Khan returned to the Lassa ward to meet with Auntie and discuss the clinical care of the two Ebola patients, Ms. Victoria Yilliah (who’d had the hemorrhagic miscarriage and the D&C), and Ms. Satta K. Satta K. had three children, two teenage boys and a young girl. They were sitting on a bench in Khan’s outpatient waiting area, under the palm-frond shade, next to the Lassa ward, waiting for news of their mother. A thunderstorm came in, and Satta’s children ended up in Khan’s cargo-container office, sheltering from the rain and talking with him. They refused to accept the idea that Ebola was real or that their mother had the disease. Khan couldn’t change their minds about this, and eventually he brought Satta’s children to Nadia Wauquier’s cargo-container lab to show them how the blood test worked. Nadia displayed their mother’s results on a computer screen and explained how the test was done.
Satta’s children listened attentively. They were bright kids. They told Khan that they wanted their mother’s blood sent to a second laboratory in order to cross-check the results. Nadia later wrote in her journal:
They seemed to be quite educated. I told them that…the only option would be to send it [their mother’s blood sample] abroad, whether Europe or the US. I assured them they would get the same result. Then they started asking more moving questions such as “what are the chances of survival?” “is there a cure or a vaccine?” I looked at Khan to see if he would help me but he shook his head and told me to go on and answer. Telling children that their mother has an 80% risk of dying is not an easy thing. They took it fairly well….They thanked me sincerely for talking with them and moved out under the rain. I saw them again a few minutes later, outside. The young girl was crying.
Their mother died four days later, in the Ebola ward.
* * *
—
While Nadia was explaining Ebola to Satta K.’s children, the surveillance team was traveling into the Makona Triangle in a group of three 4x4 vehicles that included a bush ambulance. The vehicles were loaded with biohazard protection equipment. After hours of driving over mud-slogged roads, the team arrived at Koindu, the town where Mamie Lebbie, the laboratory-confirmed Ebola patient, was lying in a bed in the town’s clinic.
It was Michael Gbakie’s job to get the team dressed properly and to make sure they made no mistakes when they were inside the clinic and exposed to an Ebola patient.
First the team met with a group of Kissi chiefs—who have a lot of political power—and described Ebola to them, and explained what the team was doing. Michael speaks four languages—English, Krio, Mende, and Kono—but he doesn’t speak Kissi. Nobody on the team spoke Kissi except for the ambulance driver, a Kissi man named Sahr Nyokor, who helped translate. Afterward, the team parked their vehicles near the clinic, a small, one-story building with yellow stucco walls.
The clinic was a hot zone. Inside there was one person who definitely had Ebola, and there might be other people in the building with Ebola, as well. Every interior surface of the building could have Ebola particles on it—walls, floors, beds, medical tools, toilets. As is normal in African medical care units, there would be family members in the building taking care of loved ones. The family members might be very protective of the patients. Any of the family members could have Ebola, too.
The team members began staging their gear. This was their first deployment into an Ebola-contaminated area, and they were keyed up. Michael supervised as they put on whole-body Tyvek suits, HEPA breathing masks, eye shields, double gloves, and rubber boots. Michael instructed the drivers to stay close to the vehicles. The drivers include
d the Kissi man, Sahr Nyokor. Then Michael and the others entered the building, which was now, they knew, a nest of Zaire Ebola, the red queen of the filoviruses.
VIOLENCE
KOINDU
2 p.m., May 26
As Michael Gbakie and his partners entered the clinic they scoped the layout of the place. There were four small ward rooms in the clinic, and the rooms were full of patients. The team found the Ebola patient, Mamie Lebbie, lying in a bed—a woman in her thirties, deathly ill, being cared for by anxious relatives, including her husband. The team asked the family to stop giving her care and not to touch her. They began exploring the clinic more carefully, examining patients, and to their surprise they discovered eight more patients who were showing symptoms of Ebola disease. Strangely, all of the suspected Ebola patients were women.
The sight of government medical officers in moon suits walking around the clinic frightened the patients and their families. Speaking Krio through his HEPA mask, Michael explained to Ms. Lebbie and her family that she had a disease called Ebola. It was very dangerous and could spread to other people, he said. He wanted to bring Ms. Lebbie to the government hospital in Kenema, where she could get treatment and could be isolated so she wouldn’t spread the disease to other people. He had no legal power to force her to get into the ambulance. As a patient she had freedom of choice.
Ms. Lebbie, however, was too sick to make a decision. It was up to her family to decide. Her husband was in favor of moving her to the Kenema hospital, but her relatives objected. “The relatives raised their eyebrows at that idea,” Michael recalled later. “They made references to the MSF [Médecins Sans Frontières/Doctors Without Borders] treatment center in Guinea. They said in Guinea people had been taken to the treatment center and it was the end for them.”
Michael and the team decided to stay in their hazmat suits and try to reason with the family. They stayed for almost four hours, discussing the matter with Ms. Lebbie’s relatives, but the relatives remained firm: She was to stay in the clinic.
Remember our earlier example in suburban Massachusetts. If you were visiting your sick mother at Newton-Wellesley Hospital, and a team of federal officers wearing moon suits suddenly entered your mother’s hospital room and announced that an extreme virus had gotten into your mother and they needed to take her away to a government facility, you might have some questions about this. You might, in fact, start screaming.
As the discussions over Mamie Lebbie dragged on, a crowd began gathering outside the clinic, and rumors and text messages started flying around the villages in the area. As the crowd grew larger, Michael and the team began hearing the commotion. They could see people moving around outside the clinic’s windows. The crowd was speaking in Kissi. Mixed in among them were many young men.
The drivers stayed close to their vehicles. Sahr Nyokor, the Kissi driver, understood what people were saying, and it scared him. He went over to a window in the clinic and began waving to Michael Gbakie, who went to the window and opened it a crack.
The youths, Nyokor told him, were planning to attack the team. They were going to burn the vehicles, so the team couldn’t escape, and then they were going to move in on the team and try to hurt or kill them.
Gbakie rushed back to his team and told them to make a crash exit from the building, right now, get out of your gear, don’t do decontamination procedure. Still wearing their moon suits, they ran out the front door and found themselves facing a group of hostile young men holding rocks in their hands. They were close to the vehicles, and had cut off the team’s means of escape.
The team ripped off their masks and tore off their suits, and kicked their rubber boots off their feet. The drivers moved away from the vehicles and got in among the team members. Gbakie and his co-leader, an epidemiologist named Lansana Kanneh, exchanged quick words. They decided that their best chance was to try to reach the town’s police station. It was four hundred yards away. They would have to run in their socks, having rid themselves of their biohazard boots.
As the young men closed in, the team broke out. They sprinted toward the police station, keeping together, and it turned into a desperate, four-hundred-yard dash. The young men went after them, hurling rocks. The rocks were the size of apples and came in on skull-fracturing trajectories. The team members, looking over their shoulders and dodging the rocks, made it to the police station and flew in through the door, gasping, while the crowd pulled up just outside. None of the team members had been hit.
The police officers seemed strangely unaware of the riot. Michael and the team told the police they wanted to file a report on the violent assault they’d just experienced. They also said they were afraid their vehicles were about to be burned. The police officers gave them a paper form to fill out stating the details of the incident, location, time, and so forth.
Michael filled out the report. But then the team couldn’t leave the police station, because the young men were still around. Night fell, hours passed. They looked out into the darkness and wondered if they were going to see bursts of flame, their vehicles being torched. They heard motorbike engines sputtering through town.
Hours later, the town seemed to have cooled off. They returned to their vehicles, which were undamaged. During the hours when the team had been holed up, however, all nine of the sick women with Ebola symptoms had disappeared from the clinic, including Mamie Lebbie. Their beds were now empty.
What had happened was this: People had phones, people had motorbikes, and news had spread fast. The families of the sick women had organized a rescue. It takes about twenty minutes to drive by motorbike from villages near the Makona River to Koindu. Under cover of darkness, people riding motorbikes had come out of the villages and converged on the clinic, and had gotten their loved ones out. They put the nine Ebola-infected women on the backs of the motorbikes and carried them to safety, to be hidden in the villages or taken across the river to Guinea. Mamie Lebbie—it was later learned—was carried on the back of a motorbike to a river crossing, and was taken into Guinea. (Weeks later, she surfaced alive, and eventually gave some interviews to local news media—she was an Ebola survivor.)
The team couldn’t spend the night in Koindu, the town had gotten too dangerous, so they drove to a larger, safer town and spent the night there. The next day they returned to the area around Koindu and began driving through the nearby villages, asking questions, looking for the nine women who’d been spirited out of the clinic. They were also looking for more people with signs of Ebola. Local people were reluctant to talk with them. And the villagers were clearly hiding the suspected Ebola patients.
KENEMA
8 p.m., May 27
After the team was on its way back to Kenema, Michael Gbakie called his wife, Zaiinab. He told her he was safe and that he’d be home from the patrol—the expedition—in time for a late supper. The children would eat early because they had school the next morning. The vehicles entered the hospital compound and pulled up next to the Lassa program office. Michael went into his office and unzipped his travel bag and dropped off some papers. He was exhausted. He took an L.L.Bean sweatshirt off a hook on the wall and put it on, to ward off the nighttime chill. On the wall of his office, over his desk, there was a large map of eastern Sierra Leone, dotted with hundreds of villages. He often consulted the map when he was tracking cases of Lassa fever. Right now, the map dotted with villages did not make him feel easy. Ebola was out there somewhere, but it was going to be very hard to find. He slung his zipper bag over his shoulder, put on his helmet, and went outdoors and started his motorbike.
He wove his way around mud puddles, feeling the damp, clean air blowing over his face. The nights of the rainy season were beautiful, cool, and thunderstormy. His route took him past small houses crowded together, made of concrete blocks, separated by lumpy dirt streets. Many of the houses were dark, except for an occasional fluorescent bulb throwing a greenish glare. Inside t
he houses parents were cleaning up after supper or going to sleep, having already put their children to bed.
Years earlier, a civil war, called the Blood Diamond War, had devastated Kenema and the surrounding country. Marauding soldiers with automatic weapons had shot many citizens, had cut off their hands and feet with machetes, and had forced them to work in the diamond fields under threat of execution. The reason was diamonds. Control of the diamond fields equaled control of the nation of Sierra Leone. The war had ended and things were better now, but he often reflected that life in Kenema was not easy. It could be difficult to explain to his international colleagues what it felt like to raise a family in Kenema. He began following a road that runs alongside the dirt airstrip of the abandoned Kenema Airport. No planes had landed on it in many years.
He turned onto a dirt track that led to a group of houses that had been built on the end of the abandoned airstrip. He parked next to his house, a modest, spotlessly clean stucco structure painted yellow, with glass windows and a new metal roof. He and Zaiinab were raising two sets of children. Their own children were teenagers and young adults. They were also raising Michael’s brother’s children, who were youngsters. The sound of Michael’s motorbike attracted the kids, and they came hurrying out of the house. He was an affectionate father. As he stopped the bike, the children gathered around him, expecting hugs.
“How de patrol? How de patrol?” the kids asked.
“I tell God thanks it was not so bad,” he said. “No’r touch me”—don’t touch me—he said firmly to the children.
Crisis in the Red Zone Page 12