Muhammed Sherif’s pregnant sister died because of ebola. Only she didn’t have ebola.
34 year old Fatuma Fofana had already given birth to five children, so when an unexpected pain filled her swollen belly, she knew something wasn’t right.
Concerned Sheriff took Fofana to the closest clinic. They refused her entry. Pregnancy is a bloody ordeal, and they were afraid she had ebola, the rare and deadly plague that has made its way to the capitals of three West African countries.
Fofana did not have ebola, but that wasn’t the point. She was refused entry by three more clinics, and by the time she was admitted into a fourth, it was too late. Fofana’s baby was dead inside her womb, and the clinic was unimaginably ill-equipped to handle it.
The best the clinic could do was give Sheriff the telephone numbers of a few doctors. He called and called, he was even willing to line their pockets generously for a home visit to treat his sister. He had collected close to $400 – a small fortune in Liberia.
Little good did it do. Not one of the doctors he called even picked up the phone.
According to Sheriff, “the money they could charge, we could make it available. But no one would do the job. They couldn’t come, even for the money.” And so his older sister, along with her unborn child, died.
Fofana is not an isolated case – she is far from the only expecting mother to be lost in the panic that has gripped the ebola-striken Liberia. Less than a week ago a pregnant woman in Monrovia died from being unable to find a clinic to help her complicated labour. A few days before, a woman died from a miscarriage for the same reason.
In fact this is the story told by the families of many who have lost loved ones from diabetes, malaria, typhoid, and other preventable diseases simply because they were refused treatment.
This is the single biggest outbreak of ebola, and the first ever in West Africa – and Liberia is caught right in the middle. Ebola first erupted in the rural north of the country in April, raising alarm that died down soon after. It then appeared in Monrovia, where local and international officials have been unable to contain its spread. Recent figures from the World Health Organisation report 786 cases and 143 deaths in Liberia alone, and over 2000 other cases and 1000 deaths in the wider Western states of Africa.
This must be terrifying. The deadly virus is spread via body fluids, has no cure, and kills you in a number of weeks. Even so, many Liberians continue to deny its existence and resist health care workers. For some, Ebola is sorcery. Others think it’s a government scheme to make money. Many can’t seem to conjugate what they hear and what they see: Bleeding from every orifice is a graphic symptom of the disease, but not everyone who contracts it and dies bleeds, so relatives decide it must’ve been something else.
Denial, or claims of sorcery, are common in ebola outbreaks – anthropologists document similar stories when the virus appeared in both the Congo in 2003 and in Uganda in 2000. But again, ebola has never before touched West Africa, and that is important to remember when thinking about Liberia. This is a country sceptical of its political elite and already ravaged by civil war. For many, the fear and paranoia are the most real parts of ebola.
This all comes to together in Liberia. And that’s precisely why ebola can kill you even when you don’t have it. Fear of the disease overshadows these needs. Time and time again, health care workers echo the sentiment of “you don’t know who is who.”
So it becomes safer to not help anyone.
Ellen Johnson Sirleaf, the Liberian President, foresaw this issue. “The epidemic is having a chilling effect on the overall health care delivery,” said Sirleaf, after declaring a state of emergency. “Out of fear of being infected with the disease, health care practitioners are afraid to accept new patients, especially in community clinics all across the country. Consequently, many common diseases which are especially prevalent during the rainy season, such as malaria, typhoid, and common cold, are going untreated and may lead to unnecessary and preventable deaths.”
Notice that she overlooked pregnancy in that statement. The country has one of the highest rates of maternal mortality in the world. Giving birth is incredibly risky, even when you can count of the clinic doors being open.
West Point is a densely populated informal neighbourhood, or slum, in Monrovia that has become a hot zone for ebola. The maternity ward in West Point remains open for time being. In a normal week, the clinic might see the birth of 10 to 15 babies, but since the outbreak, the number has dropped to one to two.
Comfort Tapeh, a nurse who has worked at the clinic for over ten years, explains why. “People won’t go to the hospital, the clinic. They say that when you go to the hospital, the nurses kill you. I tell them, ‘So who’s killing the nurses?’”
So far, at least 36 health care workers have died from ebola, and many clinics have had to shut their doors. Only recently have the two main hospitals in the city of Monrovia re-opened, and everyone is struggling to find basic supplies.
Another West Point nurse, Fatou Sheriff, has heard even more depressing rumours. “They say the health care workers are working with the world organisations to bring in money, and then they are all eating the money.”
Fear even gets to those who actually make it to the clinic. Recently a woman who came to the clinic in labour had spiked a fever, but resisted any medication. Her husband also refused any attempts to medicate her and took her home. According to the nurse on duty that night, Jemimah Karbo,“She will die. With a fever like that, she will definitely die. Maybe the baby too.”
According to Sheriff, even successful home births are risky – there is little accountability on the tools used, and it is quite possible to contract HIV.
West Point maternity ward makes up part of a larger hospital, and sometimes sees patients with red eyes, a sign of ebola, come in to seek help. These patients are immediately turned away.
“We are afraid,” says Karbo. “If I had the money to sustain my family for six months, I would go home.”
This is because the equipment available to the nurses in insufficient, with nothing protecting their cotton-polyester scrubs. Karbo doesn’t trust it: “when someone vomits on me, what’s going to happen? It’s going to go through.”
President of the Liberia Midwifery Association, Lucy Barh says these feelings are common, “That’s why some of the clinics are closed — fear, fear, fear. There’s no protective equipment, and the lives of those health care workers are threatened.”
Barh practises in the maternity ward of Redemption Hospital – a hospital that was closed when Fatuma Fofana went there to seek help. The clinic had been shut down after a pregnant woman, possibly ebola infected, died in late July. According to Barh, the community blamed the Redemption health care workers for her death and attacked the hospital.
“They said the hospital killed her, and they stormed the hospital,” says Barh. “The police had to come to our rescue. Then we had to close the hospital for two weeks.”
Redemption re-opened following the pleas from a youth leader for a functioning health facility. The much-reduced staff are now delivering an average of five bavies a week, a very low number for a clinic that usually saw the delivery of 300 babies a month.
Sheriff, whose sister died, sees the closure of these clinics are a betrayal. “We never imagined they could close the clinics, the small community clinics,” says Sheriff. The order to shut the government hospitals, he said, “scares the other community [clinics, which think] ‘If they closed, what are we doing?’”
“It deprives us of our rights,” he said. “You have a pregnant woman who died just because she couldn’t be treated.”