IS EBOLA THE BEGINNING OF THE END OF THE WORLD?

Dispatch

Is Ebola the Beginning of the End of the World?

As deaths rise in Monrovia and the sick cluster in gutters outside overcrowded treatment centers, many people are turning to God for answers -- and salvation.

   BY Clair MacDougall

   SEPTEMBER 22, 2014

MONROVIA, Liberia — Dr. Mohammed Sankoh, the medical director of Redemption Hospital, stole a few moments before meeting with his staff to sketch out a sermon in cursive in a blue spiral notebook. Sinking forward into his small frame, he furrowed his brow, bowed his head, and read Corinthians 13 aloud from his small, brown King James Bible.

"If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but do not have love, I am nothing," Sankoh recited under gold-rimmed glasses.

In addition to working at Redemption, Sankoh is a part-time preacher at Philadelphia Church here in Monrovia. But his two roles intertwine these days, as he seeks understanding in a crisis of unprecedented, horrible proportions: the Ebola outbreak. A holding center has taken over the main wards of his hospital, housing suspected patients before they are tested and released, or transferred to a treatment center. The disease has already claimed nine Redemption staff members.

All around Monrovia, there are portents and prophecies. The number of suspected probable and confirmed cases of Ebola throughout the whole of Liberia has risen to more than 3,000, with more than one-third occurring in the capital, according to figures from the country's Ministry of Health. Predictions of infections and deaths in the broader West African region, ranging from 20,000 cases to hundreds of thousands, have been offered by international experts and virologists.

But amid these prophecies, there are also signs of love. Outside Redemption, near a faded, red metal door, exhausted relatives wait in the September rain. In their hands are plastic bags full of clean clothes, bread and biscuits, and mobile phones and minutes so they can monitor the condition of their family members. They ambush health workers in white hazmat suits to get whispers of information about those inside Redemption.

Last Wednesday, Roosevelt Sargeoh, a 52-year-old teacher from a suburb in Monrovia called Battery Factory, sat near the front of a small bar directly opposite the red door. Since September 14, Sargeoh had been arriving at 6 a.m. and waiting until 10 p.m. for word about his son Exson, a patient inside. Exson, 22, a student in his final year of high school, who had dreams of being an engineer, became ill the previous week. He was vomiting, his stomach hurt, and he couldn't go to the toilet or eat. Sargeoh was concerned about keeping him in the house with his wife and seven other children, so he chartered a taxi and took Exson from hospital to hospital. (There are eight hospitals and many small clinics in the city.) No one would accept him. As his son lay outstretched in the back seat of the yellow station wagon, Sargeoh knew he would possibly die. Finally a doctor told Sargeoh to take Exson to Redemption.

The staff at the holding unit instructed Sargeoh to leave his son in a sitting area, a wide gutter, outside the front entrance. Exson lay down and waited for two and a half hours before he stumbled inside. His father watched him go.

"I said goodbye in sorrow and tears," Sargeoh explained, but not with words.

Waiting outside of Redemption, Sargeoh held a small, black, rectangular bag containing a mobile phone he hoped to give to his son and hand sanitizer for himself. Sargeoh was dressed in a baseball cap, with long sleeves and closed shoes, measures he thought would protect him from Ebola.

Late that evening he learned of Exson's death. His son's was among 70 bodies removed from the holding ward at Redemption last week, according to supervisor Sam Tarplah. "People come in seriously sick, and there is nothing you can do about it. You reach here, you drop, and die," Tarplah said.

Monrovia is racing against time to prepare beds to deal with its current caseload of people infected with Ebola. The World Health Organization (WHO) and Doctors Without Borders, also known as Médecins Sans Frontières (MSF), have been calling for 1,000 beds to be created, but there are now only around 400. Before long, as cases increase, the city will need many, many more. Sankoh's job, in other words, will only get harder -- and more people like Sargeoh, hoping for salvation, will lose their loved ones.

When asked how he makes sense of the crisis, Sankoh again turned to religion. "All of us will die," he said. "We are all strangers passing through."

***

Last Tuesday, after a meeting with the Centers for Disease Control and Prevention, U.S. President Barack Obama described the outbreak as "out of control" and said it could lead to a "potential threat to global security if these countries break down, if their economies break down, if people panic." Obama called the situation a "national security priority" and announced the establishment of a military command center in Monrovia. He also pledged $500 million in funding from the Department of Defense to fight the disease. He promised to send 3,000 military troops (who are not intended to come into contact with patients), to construct 17 Ebola treatment units with 100 beds, and to train 500 health workers per week. The U.S. Agency for International Development (USAID) will also distribute 400,000 protective kits with sanitizer and gloves (Liberia is a focus of this plan).

Echoing Obama on Thursday, the U.N. Security Council declared Ebola a "threat to world security" that could undermine peace and security in affected nations. It said it is creating an "emergency U.N. mission" that will work with the World Health Organization (WHO).

Both announcements came just over two weeks after MSF President Joanne Liu called for U.N. member states to deploy civilian and military medical teams in Ebola-affected nations. They also came after Liberian President Ellen Johnson Sirleaf's office sent desperate letters to world leaders, pleading for help. (In an address broadcast over national radio and television last week, Johnson Sirleaf thanked Obama and members of the U.S. Congress who support the action plan, but she also stressed the need to "strengthen our health care system in the long term.")

Jeremy Youde, a political scientist focused on global health at the University of Minnesota Duluth, says the announcement of U.S. deployment points to a positive shift in the attention being paid to Ebola, but it should have come four or five months ago. "How quickly can they mobilize?" Youde asks. "You look back at the plan the World Health Organization released back in August, and one of the issues that came up there was the WHO doesn't have those resources or those personnel on its own. So it has this great plan but it has to spend a month, or six to eight weeks, trying to get other people to come on board with it. Is this [Obama's plan] the kind of thing that will happen next week, or will it take three to four weeks to go through an appropriation process?"

   On the ground in Monrovia, needs are growing by the day, even the hour.

On the ground in Monrovia, needs are growing by the day, even the hour. The infection last week of a foreign nurse with MSF meant that the organization's 160-bed treatment center was unable to accept patients for two days, according to MSF press officer Sophie-Jane Madden. It has since reopened. Other centers are full, yet every day, ill people show up in taxis and ambulances at the gates of treatment centers. When they are not accepted inside, many go back to their communities, where they could continue to pose a risk to their families and neighbors.

Redemption, which saw its first cases of Ebola months ago, has become a potent symbol of crisis and the near-collapse of Liberia's health care system. Esther Kesselly, described by her colleagues as a "diligent, caring, and hardworking nurse," died in the emergency ward in late May. A Ugandan doctor, Samuel Mutoro, who treated Kesselly, also contracted the virus and became the first doctor in Liberia to die from Ebola.

Earlier this month, the Redemption staff came to work to find all of the wards boarded up, with only the outpatient department remaining open. The pediatrics, obstetrics and gynecology, surgical, and emergency wards are now filled with beds for suspected Ebola cases. The holding ward will close when there are enough beds in treatment centers, says Assistant Minister of Health Tolbert Nyenswah. (On Sunday, Island Clinic, a facility with 120 beds, opened nearby. Ambulances have slowly started moving patients from Redemption. At the opening ceremony, Minister of Finance Amara Konneh thanked people for their pledges of support, but urged them to turn their "commitment into cash.")

The establishment of other treatment units, however, has been slow moving. They must be built with utmost care, ensuring that waste disposal is executed properly and that water and drainage does not contaminate neighboring communities. Monrovia's torrential rains during the wet season, which stretches for five months and makes many roads impassable, has been hindering construction, according to Jean-Pierre Veyrenche, who is overseeing the building of treatment units for the WHO.

Outside a large, long-unfinished building, the construction of which came to a standstill with the onset of the civil war in 1989, yellow earthmovers stand parked in the rain. At the end of the war in 2003, displaced people cooked, showered, slept, and traded between the black, moldy walls of this windowless structure. The Chinese once proposed making it into a new ministerial complex. Now there is a plan to set up tents outside of the building, with 100 beds -- another front line in the Ebola crisis. Veyrenche, however, said it will be at least a month before this unit opens.

Constructing the sites is not the only hurdle. "Finding foreign medical teams to come has been a challenge," said Roar Bakke Sorensen, the spokesperson for WHO in Liberia. Complicating matters, health workers promised hazard pay in August have yet to be paid.

***

   Amid the chaos of ambulances roaring, family members waiting, and people dying in and near Ebola treatment units, there is a paradoxical sense that Monrovia has come to a standstill.

Amid the chaos of ambulances roaring, family members waiting, and people dying in and near Ebola treatment units, there is a paradoxical sense that Monrovia has come to a standstill. The plush, maroon-carpeted amphitheaters of Capitol Hill, where senators and legislators usually sit in dark wood chairs behind lecterns, were empty on Tuesday. The political center had been closed after James K. Morlu, the deputy sergeant at arms, was suspected to have died of Ebola at Redemption. The halls were disinfected with chlorine spray. Many other government buildings in downtown Monrovia and along Tubman Boulevard, the city's main thoroughfare, are largely empty, with nonessential staff sent home. The clicking of black shoes and roar of children departing school each afternoon is gone; classrooms stand empty, unlikely to be filled until next year.

John F. Kennedy Memorial Hospital, the nation's largest hospital, is desolate and quiet, now filled with a jumble of plastic chairs, stacked beds, and abandoned hazmat suits. Many health workers are frightened to come to in, for fear that a patient might arrive with Ebola. Patients with other ailments are being turned away. The hospital's morgue is empty. In the kitchen on Thursday, a worker placed a few food trays on a trolley. There were only seven patients to attend to in the whole facility.

The same day, at an Ebola treatment unit run by the Ministry of Health that has taken over the JFK cholera ward, a thin, middle-aged man hung out the window of an ambulance as though he was about to vomit. Four other people were in the shadows of the ambulance's tinted windows; the vehicle could have been mistaken for an ordinary car. The man had come from Kakata, a town in Margibi County, over an hour away. Those transporting him were from a hospital that last month lost almost half of its staff members, according to workers from the facility. With only a few ambulances or vehicles serving as such in each county and treatment centers few and far between, rural health workers must drive for miles with suspected patients across muddy, potholed roads.

Nearby people gathered to read the Daily Talk, a famous chalkboard on which the latest local news is written. All of the news was about Ebola. The headline "Killer Bean Ebola" underscored a picture of a strange wormlike creature with a skull-and-crossbones head, holding an arrow in one hand and a dagger in another. "I was created in the image of Satan to destroy life and property on earth," words under the drawing read. In the lower left-hand corner was a photograph of an Ebola survivor whose blood, the board claimed, could be used to treat patients.

At the Ebola treatment center, a fire billowed, burning used hazmat suits and waste, as people headed to their homes before the nightly curfew imposed by the government.

Sankoh believes Ebola is a sign of the end of times, which, according to Luke in the Bible, would be marked by earthquakes and pestilences. Others similarly believe that only God can explain the outbreak: In front of Redemption, a 13-year-old girl named Esther Cooper, whose mother, father, and 5-month-old brother had recently died from Ebola, lay on the ground in a pink T-shirt next to an elderly woman trying to stay conscious.

"I feel terrible, but there is nothing I can do," said Cyrus Williams, the girl's uncle. "I hope God will restore her. Everything is with God."

Ashoka Mukpo