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Liberia
The Hardest Labor, Clearing Ebola's Dead In Liberia
Meet the Burial Boys of Monrovia, whose role is no less important than medical staff in trying to stop the disease from spreading further.
MONROVIA — During the day, Kollie Nyilah says his work collecting the dead keeps him from losing his mind. Sitting in the truck on the way to homes of reported Ebola victims, Nyilah is surrounded by people he calls his brothers. Three drivers, four porters and two men — the sprayers — who will disinfect the areas where the dead are found with chlorine solution.
Like him, they are all body collectors. They're doing what they've done every day dozens of times in the past weeks, starting with putting on the white protective clothing that Nyilah regularly curses because of the heat. It covers every single pore and keeps away the Ebola virus, but never the sun. They gather up the bodies and take them in special sacks to the crematorium. Every handhold is practiced. This is the daily choreography of death.
There's so much to do, so much to take into account. It takes his mind off all the faces that the lethal virus has stripped of humanity. The faces appear in the evening, during the night, haunting the mind of this gaunt 26-year-old who used to repair mobile phones and computers for a living.
Nyilah leads Dead Body Management (DBM) Team 5 in Monrovia, Liberia's capital. In this country, the Ebola virus rages like nowhere else. Over half of the 4,500 people killed by the virus worldwide over the past few months are from Liberia. And those are only the registered cases. The number of unknown cases could be many times higher.
A lonely job
International aid organizations fear the epidemic can no longer be contained. As the cases multiply, the dead have to be removed ever more quickly: Nowhere is the virus more contagious than on a dead body.
His new job has made Nyilah lonely. The taxi drivers he tries to flag down after work keep driving as soon as they smell the dried chlorine solution that sticks to his skin and clothes. His friends have suddenly stopped coming to see him. His girlfriend is keeping him at arm's length. That's the way it is with all so-called Burial Boys, as men like Nyilah are called in Liberia.
Nyilah says he couldn't do anything else. This concerns his country, his people. "We're afraid this virus will get to our families." Somebody has to do the dirty work.
At noon on a recent Saturday, Nyilah is waiting in what was formerly a courtyard of the Ministry of Health and Social Welfare but that is now occupied by the Liberian National Red Cross Society, which coordinates the efforts against Ebola. The Red Cross has 16 teams of 10 people each, groups like Nyilah's, trying to rid the city of infected corpses.
Today, Nyilah is on stand-by duty. Four teams are currently working, and that seems to be enough. In the past few days there haven't been as many dead as there were a couple of weeks ago. Then it was up to 60 a day. Now it's around 30. Still, Ebola continues to spread rapidly. Nearly a third of the official 9,000 West Africans infected by the virus contracted it during the last three weeks.
Nyilah has heard that many of the infected are fleeing the city because they fear they won't be buried in the Liberian tradition. Nyilah and his people take the bodies to the crematorium.
The city has 1.5 million inhabitants who live crowded together, and the city administration has forbidden burials of Ebola victims. In July, when the number of infections rose dramatically, officials designated disposal sites on the city's outskirts where Ebola victims could be buried. Then came the rain, non-stop, softening up the wetlands in particular even further. Shortly afterwards, the papers were publishing photos of bodies that had washed up out of the earth. The city learned something from their mistake. The only problem is that people don't want to burn their dead because it goes against local customs.
The phone rings. A body has been found on a bank of the Du River, and the cause of death is not yet known. That means an Ebola team has to head out. Anyone wishing to bury a dead person needs a document certifying that Ebola was not the cause of death. It currently takes up to a week to get the certificate. The labs process the blood tests of the living first, but in Monrovia's dank heat, bodies can rot within days.
By the time the body collectors clatter down a muddy path to arrive at the riverbank, hundreds have gathered around the body. The team knows what to do. They put up red barrier tape. Four men approach the cadaver, which has already decomposed into several parts, stretch out a black body sack made of thick synthetic material, lay the body inside and hoist it up on their truck.
Pay cuts
Ebola has made Nyilah a hero of the death zone. There are a few others like him. A woman preacher for example, a doctor, a young woman on the outskirts of town, a student who patrols a slum. They've been drawn into the fight against the virus. They do what has to be done. Not everybody can — or wants — to see what they do, which sometimes makes their work all the harder.
The Burial Boys took the rap for what happened between June and August. The infection was spreading, the authorities were overwhelmed, there were hardly any international aid organizations. People were calling hospitals asking for help, but the ambulances never arrived. Then when it was too late, the body collectors came.
"You don't give a shit about the living. You only show up when they're dead," people would shout. They threw stones at Nyilah, some brandishing machetes or drawing pistols. What's the use? he would ask himself in such moments. The Liberian government and the Red Cross now have the teams monitored by psychologists. All members meet in the morning at 7:30, two hours before work begins, to eat breakfast together and talk about their experiences.
The job pays around $1,000 a month, which beats what Nyilah was earning fixing computers. But, he says, "for the job we do, it's not a lot." The government wants to halve the amount soon, with funding dependent on an 82-million-euro World Bank emergency fund that pays risk premiums for doctors, nurses and transporters, not only in Liberia but also in Sierra Leone and Guinea, where Ebola has also been killing hundreds for months.
With 200 dead health-care colleagues, the prospect of a pay cut makes Nyilah shake his head. A few days ago, Liberian nurses working in isolation wards took to the streets to protest their own round of salary cuts. "They're letting the patients down for a few dollars, sending them to hell," the Minister of Health railed. "We can't spend everything on salaries. We also need medicine."
Nyilah says he's given the matter some thought, and has ruled out a strike. "Somehow we have to get this job done." There's one other Ebola statistic the Burial Boys of Monrovia proudly cite: No one from the team has been infected.
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In Liberia, The Good Faith And Bad Politics Of Ebola
Even as President Sirleaf is criticized by some, one opposition parliament member has decided to donate his own time and money to work directly with those affected by the outbreak.
MONROVIA — Legislator Saah Joseph is an exception. First of all, this 38-year-old opposition party member refuses to join the growing ranks of his political allies criticizing the way Liberian President Ellen Johnson Sirleaf is confronting the deadly Ebola epidemic, which has hit this country hardest.
Second, this parliament member is on the ground every day fighting against the deadly virus at a time when several government ministers have simply fled the country to escape the epidemic that has already killed more than 2,400 Liberians.
"Ebola is a national issue, not a political one," says Joseph, who represents the 13th district of Montserrado (a county that includes the capital, Monrovia). He is a member of the Congress for Democratic Change, the opposition party founded by former soccer player and former presidential candidate George Weah.
Joseph has purchased three second-hand ambulances imported from the U.S. for Ebola patients to be driven to hospitals. That means he actually doubled the number of vehicles that health authorities in Monrovia had at their disposal. Before the crisis, he also created a free school for the poorest families and former child soldiers. "I did all that on my MP salary," he says. "The war had destroyed everything."
The last, gruesome chapter in this country's history in fact left Liberia torn apart in 2003. Moreover, critics say the foreign aid that came into the country since President Sirleaf was first elected in 2006 has been squandered.
Hassan Bility, West Africa regional director at the human rights organization Global Justice and Research Project, says: "There's no trace of it: not in health, nor in education or infrastructure."
Before Ebola
Most of the money now being pledged to help Liberia fight Ebola has not yet actually arrived in the country, but the defiance towards Sirleaf, 2011's Nobel Peace Prize winner, is growing, having begun well before the current Ebola outbreak. "It really started with her reelection in 2011," a foreign diplomat working in Monrovia says. "The level of corruption is ever-increasing. She's placing people close to her in the highest positions, including her son at the head of Liberia's National Security Agency."
Sirleaf is also accused of having waited until the end of July to react to the deadly epidemic that began months earlier, and of taking advantage of it to give herself more executive powers, which she did on Oct. 10.
"She wanted to limit freedom of movement, of speech and of reunion and asked to be able to requisition private properties without compensation," says Moses Acarous Gray, one of the most vocal opponents within the Congress for Democratic Change. "When our rulers have such powers, that's called dictatorship."
On a recent day, MP Joseph said he prefers not to talk politics, but rather focus on an anti-Ebola treatment center managed by the Health Ministry and the World Health Organization. The nurses in this 150-bed hospital, which was overcrowded as soon as it opened in mid-September, were threatening to go on strike if their monthly bonus wasn't raised to $700, from the less than $500 they get now on top of their $200 wages.
To ease their daily expenses, Joseph decides to make one of his buses available to transport them from their homes to this high-risk hospital. This comes on top of the vague promises the government has made about the bonuses. The strike is cancelled. "Everybody does what they can," he says. "But it's true that the people aren't very happy."
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Jihad And Ebola, A Double Threat To The African Miracle
-Analysis-
PARIS — A decade after development began in earnest on the "continent of lions" — the result of vast riches in raw materials, and of Africa embracing globalization — the countries from the northern sub-Saharan Sahel region and large parts of central Africa are facing a double threat.
Over the past few weeks, panic over Ebola has replaced months of indifference and carelessness. At the same time, the spectacular ISIS advances in Iraq have shed a worrying light on the violence of armed Islamist groups in Africa.
What does this double crisis in Africa tell us? First of all, the arc of current health and security problems covers weak states. The threats are hitting hardest those that are struggling to face the rebellions and those — led by Liberia and Sierra Leone — in which authorities lack resources and the ability to organize a minimal quarantine to slow the spread of the virus.
The strong economic growth of Liberia and Sierra Leone over the last few years hasn't been enough for the countries to make up for decades of underdevelopment — not just in health care, but also in education, an essential factor in the evolution of cultural habits and social behaviors. Because it is wealthier and more organized, Senegal has fared much better.
But the dramatic events in these regions are telling us something else too, namely that "it's ridiculous to consider Africa as a single country. Would we say that of Europe?" asks Thierry Vircoulon, director of the Central Africa project at the International Crisis Group. There is a world of difference between the isolated countries of the Sahel or Central African Republic, and dynamic countries such as Nigeria, Kenya, Ethiopia or Zambia.
The economic question
Is the durability of the African growth miracle in question? Nobody wants to underestimate the risks that the crises carry for the continent. Some say that the effects of Ebola on the worst-hit countries are "more severe than a coup d’état." Their growth prospects, very encouraging until now, have already been revised down, and there are fears that the epidemic might create a diversion for victims of other diseases such as malaria.
The French Development Agency expects a "spillover effect on the budgets of neighboring countries that are taking precautionary measures." In Senegal, for example, "the shock could be irreversible if tourists leave," says Diery Seck, director of the Center for Research on Political Economy (CREPOL) in Dakar. He is also worried by the absence of a common risk management strategy and health coordination inside the Economic Community Of West African States, one of the best integrated organizations in Africa.
Meanwhile, World Bank officials believe that the "panic reaction fed by the fear of contagion" represents the real danger, more than the direct cost of Ebola.
But all experts are cautious about the risks on African development. "The growth of African economies is happening in an extremely chaotic context," explains Jean-Michel Severino, former CEO of the French Development Agency. "The growth of around 5% for the last 10 years will remain significant, but it will be fickle and will vary from country to country, insufficient to quickly bring the populations out of poverty and end political volatility without new structural changes. This will take a long time, and there's still work to be done."
Over and over again, experts point to Africa's great capacity for "resilience." After all, it has been living for decades with the ravages of HIV and virtually forever with malaria, which kills close to 600,000 Africans each year. What's more, Africa now has solid systems in place to combat these problems.
African economies have benefitted form debt write-offs, and they enjoy good trading conditions for their raw materials. They are also more diversified, fed as they are by an ever-growing global demand and an urban middle class that creates new markets. "Investors differ from one country to another, which minimizes the risks of contagion," says Patrick Raleigh, associate director at Standard & Poor’s.
Politically, "the risk of conflicts in Africa is today weaker than it was 20 years ago," says Philippe Hugon, research director at the Institute of International and Strategic Relations in Paris.
And despite undeniable shortcomings, the countries' foundations have been spectacularly shaken up over the last decade in terms of democracy, fallen dictatorships and varying governances, says Pierre Jacquemot, also a researcher at the Institute of International and Strategic Relations.
Philippe Lévêque, director of the NGO Care France, holds a relatively optimistic view: Although Ebola "undermines the social and economic bases of the affected communities," it should not affect the rest of the continent.
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Liberia
Christophe Châtelot
Coalition Of Inaction: Outrage On The Ebola Front Line In Liberia
MONROVIA— "Welcome to hell." There is no cynicism and no irony in the voice of the young French volunteer from Médecins sans frontières (Doctors without Borders). The deep rings of fatigue under his eyes tell the same tale.
This "hell" is Elwa in Monrovia, the capital of Liberia. Elwa is the largest treatment center ever set up by the French NGO to fight an epidemic, a camp of big white tents where its staff is trying desperately to fight Ebola, the terribly contagious virus that causes often fatal hemorrhagic fevers and has already killed more than 2,000 people in west Africa, over half of them in Liberia.
Dealing with death is not even the hardest part for the young volunteer. What haunts him is that for three days through the chain link and padlocks of Elwa’s high gate he has been sending infected people to die elsewhere, because the center is too crowded.
"There is nothing worse for us, both humanly and hygienically, because we don’t cut the chain of contamination," says a discouraged Laurence Sailly, emergency coordinator of Doctors without Borders Belgium, the branch of the French NGO with the most expertise in the fight against Ebola. "We are swamped but we have to keep the center under control for both the people who work there and the patients. So we refuse people. It’s awful."
When it opened on August 18, Elwa had 120 beds. That number was soon increased to 160, then 400. This is a first for Doctors without Borders, which took over the treatment center after the departure of the evangelical American NGO Samaritan's Purse at the beginning of August. Elsewhere in town there are 80 other places managed by the Liberian Ministry of Health, in this country still ravaged by the last civil war that ended in 2003. Local doctors and nurses are paying a heavy cost in the fight against Ebola: 152 health professionals have been infected in Liberia, 79 of whom have died, according to the World Health Organization.
But all of this is not enough for Monrovia and its population of some one million people, many of them crammed into squalid slums transformed into viral powder kegs. "We would need 1,000 beds now to fight against this epidemic, the like of which has never been seen before, and Liberian authorities would have to call for help from the outside," says Sailly.
In Elwa’s muddy alleys indignation is mounting. "Where are the other big NGOs so ready to show up when there are humanitarian disasters? They’re afraid of the epidemic and are hiding behind their lack of expertise," says one volunteer, adding that the larger UN agencies move very slowly.
"It’s a coalition of inaction, it’s shocking," says Christopher Stokes, director general of Doctors without Borders Belgium.
A family story
The situation has become so critical that Doctors without Borders has called on American military health services and its logistics. Washington, which sent aircraft carriers, GIs and helicopters to the rescue in Haiti when it was ravaged by earthquake in 2010, is looking into the matter.
"International organizations and various countries have promised tens of millions of dollars as well as equipment to implement the World Health Organization’s emergency plan, but who’s going to coordinate all this?" Stokes says angrily.
Kitchen staff provide food to Ebola patients in Sierra Leone.(Photo - P.K. Lee, MSF)
Meanwhile, Doctors without Borders has stretched to the point of importing a crematorium that can burn over 100 bodies a day. "Normally that’s not out job," Stokes adds.
Still, time is short. On Monday, under sweltering sun in this muggy rain season the frail silhouette of a woman delirious with fever is curled up on the cinderblocks in the shade of the fence surrounding Elwa. Passersby eye her with looks ranging from disquiet to indifference. Indeed in Monrovia lately, a dead body or a person in agony are not such a rare sight. From the other side of the fence the sick woman’s daughter has received a sanitary protection kit: a little white plastic box that contains chlorine, gloves, an apron and a mask to limit contamination. The girl is gathering water bottles discarded by other contaminated people.
How many other contaminated people lie in agony in family compounds, ostracized by their neighbors? How many Ebola orphans are wandering the streets? Nobody can say with certitude.
"The figures have been underestimated so we can’t make projections," says Pierre Rollin, a specialist in hemorrhagic fevers at the American Center for Disease Control and Prevention.
The figures put forth: 10,000 dead, 20,000 by the end of the year? "We’re not seeing the light at the end of the tunnel," Rollin, an Ebola specialist admits. "Previous Ebola epidemics were on a human scale. This is a real natural catastrophe. We cannot explain why there are so many new cases being registered in such a short period of time."
And the meter is running. "On average every case is in contact with ten people and generates 2.4 new cases," Rollin explains. The result is that none of Liberia’s 15 counties — including those bordering on Ivory Coast — has been spared by the epidemic, which probably began in December with one case in neighboring Guinea.
In this region people and hence the virus weave in and out of forested frontiers where the state is nonexistent. Funeral rites are as much a transmitter of the disease as are bodily fluids.
In Monrovia, the authorities have plastered the city with posters that read "Ebola is real." For those who are not illiterate, the message is on every street corner. "Ebola exists," concedes Abdu Aziz Kromah, a student met in one of the muddy alleys of West Point, a slum in Monrovia where a quarantine has just been lifted.
Finda Fallah can bear witness to the reality, which now also includes some hope. On Saturday this young woman of 30 emerged healed from the Elwa center with two of her children, aged three and six, and her young sister of 15. They are now immune to Ebola. But the virus killed her mother, husband, one of her children, a sister, and nephews and nieces, eight people in all with whom they shared a single sordid room in West Point transformed into an Ebola incubator dirtied by blood diarrhea and vomit.
When we saw her the next day, Fallah managed a smile. But she’ll sleep outdoors this night. The roof she used to sleep under is already occupied by others following a visit from the disinfection service. "People don’t come near us, the pharmacist refused to serve me," she says.
"Cured, you say?" says another local, Abdu Aziz Kromah, keeping a skeptical distance. Fallah responds: "That’s what Doctors without Borders said? Well, maybe. But we don’t believe the government."
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