In the Company of Men

by Véronique Tadjo

  The whole country was profoundly shaken. For the first time, Ebola was no longer anonymous. It had a well-known face. A young doctor commenting on this on the radio explained that the impact of this death reached far beyond our national borders. He discussed the enormous disparities regarding access to treatment and talked about the indifference and institutional inertia that reigned in the Department of Health. In a Western country, a senior politician made the following statement: “Globalization brings us closer to our African fellow citizens, while the media have the opposite effect. Another alienating factor is our widespread indifference toward the terrible crisis into which these countries have been plunged. Any active involvement, be it at the international, national, community, or even personal level, seems to stop at the borders, at the barriers everyone’s putting up.”

  We needed our doctor’s courage so much! We needed his example so much! He wasn’t the only one who died that way.

  We, survivors of the epidemic, suffer in silence. We carry invisible, painful scars. We want to lead normal lives, but the stigma of the virus keeps us apart from other people. In my village, my family home was burned down; all that’s left of it is dry wood and ashes.

  The other day it rained. That made me happy. Rain, finally. I went outside so that the rain would touch my body. So that every drop would clean my face and tell me that rebirth was still possible.

  IX

  It’s not the uniform that makes the man; it’s circumstances that reveal his noble heart.

  I’m a prefect, in charge of the outreach teams that are currently visiting my part of the country. Their brief is to explain at length. They give detailed information about the illness: its mode of transmission, the risks, the available treatments. They must stress the need for people to go straight to a treatment center at the first sign of symptoms. In certain cases, people will be placed under quarantine. The teams have to go over the strict safety regulations again and again.

  Science alone is not enough to bring the virus under control. We need so much more than that. We need to reduce the level of ignorance. The tension. The fear. Human beings are not just vectors of infection. All that callousness is contraindicated. All that cold, scientific reasoning just undermines our efforts.

  That’s why I keep telling my teams that they have to practice the art of persuasion. They must convince people that they should stop visiting the sick, and that dropping in on patients’ families and friends to support them in their ordeal is now out of the question.

  The sick woman is slumped in her armchair. Her clothes are creased, her braids undone. She looks bad, and her hands are trembling. There are a lot of people milling around. Young girls are busy in the kitchen, cooking porridge. In one of the corners of the house, children are playing. The boy is her son, and the little girl belongs to the neighbors. She’s only eighteen months old and wanders around among the adults, holding on to them. The sick woman’s husband is in the bedroom. He’s not well either. His sisters, come to take care of the household, are cleaning the house. No one knows that the disease has staked out its territory and will gain ground at great speed. Before much time passes, not many of these visitors will be left alive. But from time immemorial, solidarity has been expressed in this way. It was like that in the villages, and also in the working-class neighborhoods in the town. “If I help you out today, you’ll lend me a hand tomorrow”—that makes them stronger, and it’s how they were brought up. Rejoicing together, weeping together. You show compassion, give some money for medicine, or bring along a few soft drinks. It’s the gesture that counts.

  My outreach units are tasked with explaining that this way of life has to end, that shaking hands, touching, embracing one another are no longer allowed. Instead, you have to keep your distance from other people, stay at home, and wash your hands with disinfectant before entering a public space.

  The teams emphasize that, even if a person doesn’t show any suspicious signs, he or she may already be infected. And, as soon as they get sick, they remain contagious for several weeks—including after their death. As a matter of fact, the corpse is more dangerous than anything else. Above all, don’t touch it. Ebola kills a very high percentage of those afflicted, and there’s no medication that can change that!

  In order to reassure the population, the outreach units also say that this virus is not new. The doctors know a lot about it, such as the way it spreads, or the protective measures one needs to take against it. They know you can’t catch it just by breathing, which is good news.

  The outreach teams have to exercise patience. They need to find the right words. Because when people are afraid, they will act irrationally. The contradictory claims and rumors going around about Ebola create a lot of uncertainty in peoples’ minds. The rate at which it spreads, its virulence, that’s all too much to grasp, and very hard to accept. Sometimes it’s just easier to lie to yourself. It’s easier simply to disbelieve the evidence before your eyes, in your own village, in your own neighborhood. Despite the public notices, many prefer to hide the sick, or even, if the threat becomes real, to die with them. What’s the point, they say, it was a losing game right from the start. The most vulnerable members of society, women and children, have to bow to the decrees of the elders. They’re excluded from the discussions, and thus they have no inkling of the dangers lying in wait for them.

  The outreach teams have to strike the right note.

  I also send other units to the remote areas, in four-wheel-drive vehicles donated by a humanitarian organization. The units distribute kits for protecting the whole family and for disinfecting the house. Whenever one of these teams approaches a village where Ebola cases have been reported, the members are well aware of the risks they’re taking. They arrive wearing heavy rubber boots and dressed in the official uniform. They avoid touching anything. They keep their distance. And while handing out color brochures that explain the virus and its modes of transmission, they keep their hands protected with gloves. Sometimes people just shrug when they’re told to stop eating bushmeat. “That doesn’t make sense,” they reply. “How are we going to feed ourselves now?”

  The outreach teams know not to respond to mockery. In every village throughout the region, they spend entire days talking to the people and making them understand that these measures won’t last forever, but only until this terrible disease disappears. The people aren’t convinced. They say, “You’re telling us that if we get sick, we need to go to an Ebola clinic right away. But at the same time, you yourselves also tell us that there’s no treatment. So what is it you’re actually trying to say?”

  In this ruthless war against Ebola, words are very powerful weapons. Or at any rate, that’s what I’d like to believe. But there are still many problems to be dealt with. Why is it that, in the middle of such an epidemic, hundreds of public health officials feel they must clamor for indemnity payments and threaten to go on strike? They want financial compensation for the risks they’re taking; they want assurance that their families will be looked after in the event that they die from Ebola. I have personally promised that I’ll try to move heaven and earth for them.

  It’s true that a lot of money is changing hands in these critical times. It would have been better if the international community hadn’t publicly announced how much money has been donated for humanitarian aid. The amounts sound like colossal sums, but that creates a false idea of the situation. The economy is collapsing. Economic activity has come to a halt. Trade with neighboring countries has stopped, the borders are closed, infrastructure projects have been postponed. Most airline companies have canceled their flights. The tourists have all gone, and the schools and universities are closed. Shops and markets are deserted. Farmers have stopped tending their fields. Normal, everyday illnesses are ignored, medicines have run out. All medical treatments for other health conditions have been suspended overnight. If someone collapses in the street from a heart attack, nobody will go ne
ar him. He’s left there unaided until an ambulance comes and takes him to an Ebola center, which is the very place where he shouldn’t be. Pregnant women can’t find anywhere to give birth.

  Ebola! Ebola! Ebola!

  And yet, for the first few months, the epidemic was underestimated. Fundraising efforts were slow. Instead of inspiring compassion and support, the increased media coverage caused the opposite reaction: self-preservation and withdrawal.

  Infectious disease experts were well aware that the Ebola virus existed, but they thought it would behave as usual. They expected a very localized outbreak that would be over once it had claimed a few dozen victims. Since the virus was identified in 1976, hadn’t there been something like twenty outbreaks, but hadn’t they all been relatively mild? Only as time went by did they realize how wrong they were. The virus had changed tactics. It had left the forest and moved into the urban areas, where population density and mobility were much greater. When they saw what was happening, the local NGOs rang the alarm bells: we need to act fast! They were shocked by the lack of reaction, claiming that if this crisis had struck any other region on the globe, it would have been dealt with differently.

  But it was already too late—the epidemic was out of control. The virus was on the move in three different countries, and threatened to travel even farther afield. And it was at that moment that the first cases of infection were reported in the West. The media were going mad; the international community was in turmoil. A Spanish priest who became infected at an Ebola treatment center was repatriated in a hurry. He died of the virus in Spain. Some months later, another missionary died in a hospital in Madrid, having passed on the virus to one of the assistant nurses who had cared for him. At the same time, an African traveler fell ill in the United States and died just a few days after his arrival, having infected two nurses. The apprehension reached a fever pitch when the Americans found out that the second nurse, after treating the patient, had taken a plane. The public health authorities were now forced to trace the 132 passengers who had traveled with her and who had to be put under observation. The world was now fully aware of the extent of the danger. Just how far was this epidemic going to spread? How long would it last? The possibility of a globalized Ebola outbreak was fostering panic.

  The countries of the West realized how vulnerable they were. Health checks at the point of arrival for all flights coming from the affected geographical areas were put in place at most airports. And there were checks at departure too. Travelers had their temperature taken, there were forms to fill in, suspect passengers were placed in isolation.

  Right then, what we most urgently needed was money! International aid was doubled, then tripled. Quadrupled. Western heads of state decided to hold a summit. Its goal was to develop a plan of action to bring the crisis under control. The UN Security Council set up an emergency committee exclusively dedicated to the fight against Ebola. The organization demanded that its member states “dramatically accelerate and expand their financial and material support.”

  The result was mobilization on every continent, with the participation of numerous sectors of the economy, both public and private. Billions of dollars were said to be in play. But there was still a lack of funds, and the virus continued to spread. Experts declared: “The epidemic has left us far behind; it’s making headway much faster than we are, and it’s about to win the race…”

  The American president now proposed a much more aggressive response: war! Military troops were deployed. The other countries followed, particularly France and Great Britain. The soldiers were trained in combat, skilled in confronting an invisible, highly dangerous enemy, capable of exercising crowd control and securing high-risk zones. They had to transport equipment and construct new treatment centers. They were responsible for the recruitment of staff and the intensive training of health workers. It was a massive offensive. A fierce onslaught that required sharing strategic and medical information among all the participating countries.

  The idea was that the military was needed to beat the virus into retreat. However, if I, as someone on the ground, were asked to make a comment, I would address the international community. I’d tell them that fear can provoke a strong reaction, which will in turn free up enormous resources and placate public opinion. But the outcome will not necessarily be the best in the long run. True solidarity is meant to be durable. And in that respect, if I may offer the international community a further piece of advice, I would ask them to investigate how the aid payments were managed. Have the infrastructure rehabilitation projects actually been implemented? Has staff training been effective? Are we better prepared if disaster strikes again, or has everything fallen into oblivion already, crowded out by the thick bustle of our days?

  X

  When the specter of death sows discord among humans, don’t look away.

  It was during my stint as a volunteer abroad, working for an NGO at a treatment center in a remote region, that I became infected with the Ebola virus. I was immediately transferred to the capital, where a medical team was waiting for me. Preparations were made for my repatriation. I was placed in a transparent plastic tent, under negative air pressure and strict security: a kind of mobile isolation chamber. An airplane specially equipped with an “Aeromedical Biological Containment System,” used for patients with highly contagious diseases, stood at the back of the runway. Once my tent had been set up, the plane took off. And with me was a whole medical team. The journey home was long; it gave me a chance to look back on my life. My desire to go to Africa, and my wish to serve in a country where so much remains to be done. I’d found a humanity there that made me question my outlook on life. It also made me more humble. But lying in that bubble, I couldn’t stop thinking of the inferno I had just left behind.

  On landing, an ambulance, forming a convoy with a number of other vehicles, took me to a hospital with a special wing for infectious diseases. Dressed in a protective suit, and helped by one of my attendants, I entered the building. I was very lucky. Most relief organizations refuse to take on patients as contagious as I was. Is it acceptable to repatriate someone who’s extremely likely to infect the people around him? If so, under what conditions? And if not, how do you justify such a refusal, and do you think that from then on, even a single volunteer would still be prepared to risk his life?

  The diagnosis was shocking: severe organ failure. I was admitted to the reanimation ward.

  Several weeks later, from my isolation chamber, I made the following televised declaration: “To all those who are lending me support and have sent me good wishes for my recovery, I would like to say that I’m receiving the best treatment possible. I’m steadily getting stronger. I’ve had the privilege of working in Africa for many years. When the Ebola outbreak was made public, I wanted to be involved in the fight against this dreadful virus. I’ve seen devastation and death. I still remember each face and every name. Thank you for your prayers. May God help us in these times of great uncertainty.”

  I left the hospital officially cured, after more than a month in intensive care combined with an experimental treatment. The press conference that was held on the occasion attracted a large number of journalists. I had my wife and children by my side.

  Science had won!

  Several months went by without incident. But then, one day, I started feeling unwell again, and I had to return to the hospital where I had been admitted the first time. The doctors discovered that Ebola had not been completely eradicated from my body. The test results showed that the virus had lodged itself in my left eye. Before I had the disease, my iris had been blue, but afterwards it turned green. Ebola had gone into hiding where no one would expect to find it. Inside an organ that my immune system could not easily access.

  It was news to me that such sequelae were quite common among Ebola survivors. Secondary effects include backache, tendonitis, a crawling sensation in the legs, eye inflammations potentially leading to bli
ndness, extreme fatigue, and cognitive difficulties. Ebola manages to hide in the joints, the spinal cord, the testicles, the sperm, and possibly also in vaginal secretions. This means that humans, too, have become reservoirs for the virus! So far, nobody knows whether this will pass or whether we are in this for the long term.

  The history of Ebola is punctuated with speculations, questionings, incomplete answers, and a whole lot of theories.

  I had already been evacuated when quarantine was adopted as a general strategy in the country I had just left. Never could I have imagined that the day would come when men, women, and children would be treated like lepers and kept incarcerated by force in their own homes.

  On government order, policemen and soldiers in combat uniform were blocking off entrance and exit doors. The slum-dwellers woke up with a start. They’d just learned that they were locked in, imprisoned, exiled. Strictly forbidden to go beyond the boundaries of the shantytown where they’d spent their entire lives. A wretched place with open sewers, a nauseating stench, and garbage that had piled up for years, because no one had bothered to remove it. Illegal electricity connections, with cables trailing on the ground. Community wells, where the women would go and fetch water in large plastic tubs, metal containers, and buckets that they kept inside their shacks. Overcrowded schools, where the kids had to squeeze onto rickety benches set in front of shabby old blackboards. Teachers who were overwhelmed by the enormity of their task. Not a single hospital far and wide, only run-down dispensaries and private clinics, eager to cash in on bogus cures. Women walked from compound to compound bearing trays on their heads, trays loaded with pills and tablets for sale, medications that were either expired or of questionable provenance.