Health
MONROVIA, Liberia – Michel Boima lay on a thin mattress on the concrete floor as dim blue light reflected from the walls and tarpaulins covered the brick windows. Asked whether he thought his condition would improve, Michel looked up and said, “No treatment.” Aside from water and food, he had received no medical attention or medication since arriving early that morning.
Michel was one of 18 patients in this school turned temporary holding center for suspected Ebola patients in West Point, a poor neighborhood in the Liberian capital. His father, Fallah Boima, a wiry farmer, paced outside the building as motorbikes zoomed past. The veins on Fallah’s forehead were sharp with worry. He said he was uncertain what to do and what would happen to his son.
Five days earlier, on Aug. 9, Michel, a 19-year-old motorbike driver in Monrovia, had ridden to his father’s town in the bush and reported stomach pain. Soon, Michel was suffering from constant diarrhea and a high fever and had stopped eating. As his condition worsened, Fallah isolated his son in a room in his house and took care not to touch him. He knew his son could be infected with Ebola, the deadly hemorrhagic fever that has killed at least 712 across West Africa and likely infected 2,127 people, according to the World Health Organization (WHO). In Liberia alone, there have been 413 deaths and 786 probable, confirmed or suspected cases, although the WHO says the actual number may be much higher.
Initially skeptical of the Ebola threat and resistant to the government’s public health warnings, Liberians in Monrovia are beginning to take the disease seriously and seek treatment. But they face major hurdles in accessing ambulances, reaching the Ebola hotline set up by the government to aid people who may be infected and finding facilities that will take them. Most of the nation’s clinics and hospitals have closed because many health care workers have died from the virus and others are afraid to return to work.
Aid groups and the government have started to set up treatment centers solely for people who may be infected with Ebola. But the facilities have been overwhelmed, and new ones are slow to open. The Liberian government announced last week that an Ebola facility with 20 beds would be established at John Fitzgerald Kennedy Medical Center, Monrovia’s main hospital. But Dr. Billy Johnson, the hospital’s chief medical officer, said he did not know about the announcement and had seen no signs of such a facility. The aid group Doctors Without Borders is in the process of opening a treatment center with 120 beds on the outskirts of Monrovia. But construction has been delayed because of resistance from residents who live nearby. The West Point holding center, set up last week, was the first of what the government said would be three quarantine centers in the city.
Then on Saturday, two days after Michel arrived at the West Point center, it was ransacked. Angry protesters accused the government of failing to inform them that an Ebola facility would open in their neighborhood. They freed patients and looted the building when officials from the Ministry of Health brought in supplies, mosquito nets and bedspreads.
The protesters surrounded Miatta Flowers, commissioner of West Point, who was forced to barricade herself in her office. “They say Ebola is not here and that I brought Ebola here and the Ebola center in West Point,” Flowers said. “Ebola is here, and they are dying.”
By Sunday, the center was empty, its blue iron gates shut. Some of the patients reportedly escaped; it’s unclear what happened to others. Community members are currently searching for them.
The treatment options for people who may have the disease are scant. Like other relatives of suspected Ebola sufferers, Fallah struggled to find help for Michel. “The very day he reached to me, I start calling for ambulance. I called over four, five days, and they can only answer me, but no one came,” he said.
Four days later, Fallah took Michel in a shared taxi to Redemption Hospital in New Kru Town, a Monrovia slum. The skeleton hospital staff sent Michel to the emergency room. There were only five patients in the hospital, all of them suspected Ebola patients, according to Fallah. “No one was catering to them,” Fallah said. “The doctor in emergency stood far from him.”
On Thursday, Michel was transferred to the makeshift holding ward in West Point because the main treatment center on the outskirts of Monrovia was packed. Built to accommodate 45, it held almost twice that number. People waiting to be admitted sat or lay on the grass outside, some with small children. Inside, patients slept on thin mattresses on the floor, according to Nathaniel Povillie, the emergency coordinator at the Ministry of Health. One person with extensive knowledge of the center’s operations said the facility was so crowded that patients who may not have Ebola when they arrive could become infected as they awaited a diagnosis.
“We don’t have room, and you don’t know whether everyone who comes in has Ebola,” the senior staff member at the center said. “One person can come in with one condition and pick up the virus.”
By Saturday afternoon, Michel was dead.
Others don’t make it to treatment centers in time. Health workers on Thursday pulled the body of 25-year-old Jefferson Gbolee out of the front seat of a car outside the main treatment center on the outskirts of Monrovia and packed it into a body bag. Gbolee’s mother, Finda Gbolee, and aunt had taken him in a taxi from the town of Mount Barclay. Finda Gbolee said she called an ambulance at 5 a.m. “We begged one taxi driver. The taxi broke down. We got another one,” she said amid tears. “The boy was fighting. We tried to carry him to a different hospital, and on the highway he died. Police made them turn back to the hospital.”
At the West Point holding center on Thursday, Finda Zanobo, a 30-year-old mother, stood wearing a grubby white polo shirt and surrounded by six small children. Two little boys looked scared, while the others played, unaware of the meaning or significance of their surroundings. Zanobo said she was their only living adult caregiver.
“The people bring me here because they say all my family finished, all my family dying, dying,” she said. “They say I come here and they take test for me.” She recounted rolling days of death: On Monday her mother died. On Tuesday the little boys’ father and mother died. On Wednesday her husband died.
On Friday, after days of waiting for Ebola test results and an ill nephew, Saah, to be given treatment, Zanobo said that she wanted to leave but that the health workers wouldn’t let her. As night fell, she huddled with the children in her care on two mattresses next to a cheap portable light.
Saah, who had been coughing and experiencing diarrhea all night, lay on the edge of a school bench turned on its side. He wore only a jacket because he had soiled his clothes. Zanobo had separated him from the other children to make sure he didn’t infect them if he had Ebola. She took one of her lapa scarves and placed it over Saah.
On Saturday, when the holding center was ransacked, Zanobo fled along with other patients. Their whereabouts are unknown. The mattresses were stolen and could be infected and they are said to be floating around in the community.
Shortly after the raid on the holding center, Daniel Dahn, a tall man with deep bags under his eyes, remained inside a dark room in the building with his four daughters. The family voluntarily went to the center when his wife became ill, he said. She has since died. The family stayed in the building as members of the community looted, Dahn said. “We are frightened,” he said. “Nobody giving us medicine.”
While the center remains closed, Assistant Health Minister Tolbert Nyenswah said on Monday that discussions with the community are ongoing.
Said Solomon George, who represents West Point in the national legislature, “We are waiting for the government to re-establish the center. It should be established by force if necessary. It is a state of emergency. Many people will die if we don’t do it.”
Update: At a meeting on Tuesday between Ministry of Health officials and representatives of West Point, the community agreed to allow the holding center to reopen if it served only local residents. Also, the new Ebola treatment center at the John F. Kennedy Medical center opened on Sunday.
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