On July 9, Alex Moigboi and Humarr Khan put on PPE and went on rounds through all three of the Ebola wards, tending patients, placing IVs. Late in the day, they exited, decontaminated their gear, and removed it. Afterward, Alex confessed to Khan that he wasn’t feeling well.
Khan then placed the backs of his hands on Alex’s neck—a quick way to check somebody’s temperature. Alex’s neck felt hot and sweaty: he had a fever. It was probably malaria, Khan thought, and he decided to check Alex’s eyes. He pressed his fingertip on one of Alex’s lower eyelids and pulled the eyelid downward, which revealed its wet inner membrane. It was bright red. “Look up,” he said to Alex, holding the eyelid down. When Alex looked upward, the lower white of his eyeball came into view. The white was red and inflamed, the blood vessels bright and swollen. He checked Alex’s other eye and saw the same thing. Alex’s eyes revealed classic signs of malaria. Next, Khan took out his wad of currency, peeled off some bills, and stuffed the money into Alex’s hand: “Take this money and go buy some malaria medicine, and go home and rest for the night.” Alex thanked Khan and headed off to buy the medicine.
CONFESSION
LASSA PROGRAM OFFICE, KENEMA GOVERNMENT HOSPITAL
Late morning, July 10
Later, Khan began thinking about what he’d done. He had acted on instinct, the habits of a doctor working in his outpatient office. “Oh,” he said to himself, “I have touched Alex.” He had gotten Alex’s tear fluid on his fingertips. He had gotten Alex’s sweat on the backs of his hands. He had pressed money into Alex’s damp hand. His hands might have gotten smeared with millions and millions of particles. Had he washed his hands? When had he washed his hands? People touch their own faces and eyes all the time, unconsciously. Had he touched his face or eyes before he washed his hands?
The next day, Khan dropped by the office of Simbirie Jalloh, the program coordinator, and sat down on a wooden chair next to her desk. The chair was a kind of worry chair for everybody in the program, where they poured their troubles out to Simbirie.
“Simbirie, I made a mistake,” Khan said to her. He explained what he’d done with Alex.
Simbirie felt extremely frightened when she heard him describe the incident. She tried to sound calm. “Don’t worry so much, Dr. Khan.”
After a few moments, Khan went off to attend other matters.
That same day, Baindu Kamara, one of the three volunteer nurses who’d assisted Auntie in the failed attempt to save Lucy May, broke with Ebola disease.
The day after that, Alex told Khan that the malaria medicine wasn’t working. Khan advised him to get a blood test for Ebola. Alex did have Ebola; they put him in a private room in the Annexe ward.
After Alex broke with the virus, Khan seemed to get ever more desperate. A tsunami of Ebola cases had started flowing out of Kenema, heading for Freetown, the capital. He dropped by Simbirie’s office again and sat down in her worry chair. “Simbirie, I want our government to quarantine this district.”
She thought he looked incredibly tired.
“People are going out of the district and they’re bringing Ebola into the rest of the country,” he went on.
“Dr. Khan, I’ve been calling the government again and again.” The government wasn’t listening to her, and the $3.50 in hazard pay for the nurses still hadn’t arrived. “I don’t know what I can do,” she said to Khan.
Auntie also dropped by Simbirie Jalloh’s office and sat in the wooden chair. “I am not feeling too well, Simbirie. I am hurting all over my body.”
“Auntie Mbalu, you have to rest,” Simbirie said to her. “You’re tired. You’ve lost your husband. You must give yourself rest.”
“What can I do? People are dying.”
“Auntie Mbalu! You have to rest!”
Auntie walked back up the hill to the Ebola ward.
July 12
Joseph Fair, the scientist who had originally been planning to work with Lisa Hensley setting up a blood-testing lab for Humarr Khan, was now living in Freetown and working as an advisor to Sierra Leone’s Ministry of Health. Fair had begun to worry intensely about Khan, and he decided to visit Kenema and see what he could do to help.
Fair had first gotten to know Humarr Khan in 2006, when he arrived in Kenema as a graduate student to do research for his dissertation. He got a room at the Catholic Pastoral Center on the outskirts of the city. Soon after he arrived he became sick, and ended up in bed there with a high fever, bleeding from his intestines and throwing up blood. He had also lost the ability to speak except in a faint whisper. A devout Catholic, Fair asked a priest at the center to give him final confession and the last rites. The priest phoned Humarr Khan instead.
Soon afterward, Fair saw a white Mercedes with spinner hubcaps pull up in front of his room, and Khan stepped out. He was wearing his white baseball cap, which gave him a sporty look. He came into the room and examined Fair. “You’ll be fine,” Khan said jovially. Then he left the room for a moment, and forgot to close the door behind him. Fair heard Khan say to somebody, “This guy is dying! I can’t have an expat die on me!”
Khan then returned to Fair’s room and started setting up an IV infusion of antibiotics.
“I think I’m passing,” Fair whispered to Khan. “I need to make confession. Can I do it with you?”
Fiddling with the infusion line, Khan agreed to take Fair’s confession. Fair told Khan about various regretful acts. Khan gave him absolution—he said God would forgive him. Fair also mentioned that he didn’t have a will. Khan got him a piece of paper and a pen. Fair scrawled a few lines. He had no worldly possessions, but he left his body to science, and asked that it be autopsied by a space-suited virologist in a Level 4 hot zone, just in case he’d been killed by something interesting. Khan then signed Fair’s will as a witness. In a fairly short time, however, Khan’s antibiotics began to kick in. Fair recovered nicely, and the two men became close friends and drinking buddies. Fair discovered that Khan was deeply religious, though he was very quiet about it.
Now, after a five-hour drive from Freetown to Kenema, Joseph Fair pulled up by the Ebola ward and started looking for Khan. It was pouring rain, and he couldn’t find him anywhere. Eventually, Fair ended up at the plastic viewing window in the Tent, and he saw Khan working inside. By this time the Tent held around forty Ebola patients. “Dr. Khan was working alone in PPE with only one nurse, also in PPE,” Fair recalled. “There was blood, feces, vomitus, and urine all over the floor.” He didn’t get a chance to speak with Khan.
Joseph Fair also went looking for Auntie, with whom he was very close. He found her in the foyer of the Ebola ward, and they embraced. Fair walked around the outside of the small building. Behind the Ebola ward, outside a back door, he discovered twenty dead bodies lying in the drenching rain. They were uncovered, not in body bags, and the rain was carrying body fluids away from the bodies. The people had died in the ward. The back door was open, and Ebola patients inside the ward could see the bodies lying there.
Fair asked Auntie what was going on.
The hospital had run out of body bags, she told him. “We have no access to body bags throughout the country,” she said. Fair promised to get her some bags. When he returned to Freetown, he arranged for an air shipment of two hundred body bags from Geneva to Humarr Khan and Mbalu Fonnie.
Monday, July 14
Two days later, in midmorning, Simbirie Jalloh was sitting at her desk in the program office trying to decide what to do with herself. She wondered if she should just leave. People were running away, deserting the hospital. Her mother had been calling her and urging her to leave Kenema and come live with her in Freetown. Her mother was terrified she’d catch Ebola, but she had been saying to Simbirie that if Simbirie got sick with Ebola she must come to Freetown anyway, and her mother would care for her. Come to Freetown even if you are changed to stone, her mother had said to her, using a proverb.
Humarr Khan walked into her office and sat in the worry chair. The government of Sierra Leone had just declared him a national hero for leading the fight against Ebola for the nation. Khan didn’t seem particularly happy about this, and he said to Simbirie that the virus was going absolutely out of control. A wave of Ebola was coming out of Kenema and was going to hit Freetown, the capital. Again Khan mentioned quarantine.
“Dr. Khan, I don’t know what I can do.”
Khan had been calling every medical relief organization he could think of, with no results. He also had been thinking about how he had touched Alex Moigboi’s eyes. Alex had tested high positive for Ebola, which meant he was probably going to die. “I don’t think Alex will make it,” Khan said to Simbirie. “If Alex dies, I’m worried for my life.” He took hold of his right arm with his left hand. “I would cut off this arm, Simbirie, if I could save Alex’s life.”
Thinking about Khan’s many exposures to the virus, Simbirie started to cry.
Khan got a stern look. “No’r cry, Simbirie,” he said in Krio. Don’t cry. He switched to English. “When something is really bad, you just do what you can do.”
She kept on crying.
He softened. “No’r cry all de time, Simbirie.”
Something in his manner frightened her. He was sitting stiffly on the edge of the chair, a few inches away from her desk. No part of his body was touching her desk. He wasn’t reaching out his hand to comfort her. He didn’t seem to want to touch her or touch anything that was connected to her. Abruptly he stood up and walked out of her office.
Simbirie Jalloh stayed at her desk, in tears. Why had he sat that way in the chair? Why did he not want to touch her desk? Where had he gone? She decided to try to find him.
THE SMOKING PLACE
KENEMA GOVERNMENT HOSPITAL
Late morning, Monday, July 14
Simbirie Jalloh ran up the hill to the Ebola ward, but he wasn’t there. She looked into his cargo-container office, and he wasn’t there, either. He could be in the general wards, she thought, and so she hurried around the wards, but she couldn’t find him anywhere. She was starting to panic. Then it occurred to her that he might have hidden himself, and she ran down the hill along the dirt road to the construction site of the new Lassa ward, and she looked behind the cargo container. There she found Khan, sitting on his plastic chair and drinking a bottle of Sprite.
“Are you all right, Dr. Khan?”
He warned her to stay back from him. “I must keep my distance from you, Simbirie. I don’t know if I’m infected or not. We don’t know who the next person will be.”
She started crying again.
“Now no’r cry all de time, Simbirie.” He was holding the soda and looking at the concrete structures and an expanse of lush weeds, green in the rains. “This world is full of mystery,” he said. “When you are strong and healthy you do your part to help. And if you fade away, the next man will do his part.”
“Let’s pray, Dr. Khan.”
Khan put down the soda and stood up. Keeping well apart from each other, they raised their hands up in front of their chests, palms turned to the sky, and prayed.
He sat down. She urged him to stop getting near Ebola patients.
“Who else will care for these people? You must do the job and pray.” He sipped his Sprite. “You are getting too exhausted.”
“I am not exhausted.”
He thought she should let her mother take care of her. “Go to you mama na Freetown and go stay fo two weeks.”
She refused.
He gave her a slight smile. “Doctor’s orders. Two weeks of rest.”
Simbirie left Khan sitting on his chair and walked back to her office. The next day she left for Freetown and moved in with her mother. She felt like a coward who had run away from a battle. Even worse, she had deserted her boss, left him alone, sitting on a chair in a corner of the hospital, and he was in a fight that might claim his life.
About the same time, Monday, July 14
The British WHO doctor Tim O’Dempsey had been working at the Kenema hospital, doing whatever he could to help in the Ebola wards. Sometime in the middle of the day he found Auntie lying on top of the table in the nurses’ private room, resting, as she sometimes did. This time, though, there was an IV pole next to the table, and Fonnie’s brother Mohamed Yillah was watching over an infusion line that ran into Fonnie’s arm. He was infusing her with a malaria drug.
O’Dempsey was alarmed. He went out and found Dan Bausch and told him what Auntie was doing. Bausch hurried to the nurses’ room. Keeping his distance from her, he gently suggested she should get a blood test for Ebola.
Auntie agreed. Bausch told her he’d do it immediately. He put on gloves and drew blood from her arm. Then he carried the blood tube down to the Hot Lab and handed it through the door to the people inside.
While Bausch was at the Hot Lab, Lina Moses walked into the nurses’ room wanting to talk with Fonnie, and she saw Fonnie lying on the table with the IV in her arm and her brother Yillah watching the infusion. She took Yillah aside. “What’s going on with her?”
“She’s in for a blood test,” Yillah answered.
A wave of dizziness hit Moses. This couldn’t be happening. Not Auntie Mbalu. Her next thought was about Auntie’s brother. He’d been driving her around on his motorbike. And he had just placed an infusion needle in her arm, exposing himself to her blood. “Are you protecting yourself?” she asked Yillah quietly.
He didn’t answer. But she saw a look in his eyes, and it told her everything. He had Ebola, too. He had caught it from his sister.
They put Auntie in the private room in the Annexe ward where Alex Moigboi was dying. He was Auntie’s senior Ebola nurse, and now they were dying together. Auntie’s brother Yillah stationed himself in their room and began giving them nursing care, doing everything he could to try to help his sister and Alex get through Ebola alive. He didn’t bother to wear any sort of biohazard protection when he cared for them. He didn’t need any protection from Ebola now.
CALLER I.D.
MONROVIA, LIBERIA
Next day, Tuesday, July 15
Lisa Hensley worked a twelve-hour day in the Liberian National Reference Lab at the former chimpanzee station. She stayed in her space suit almost all of the time, working in the negative-pressure hot zone, testing samples of blood using the PCR machine that could detect the genetic code of Ebola. In late morning she exited from the hot zone and stepped into a tub of bleach water, took off her boots, then used a pump sprayer to spray her suit with bleach, and took off her suit. Underneath she wore blue cotton surgical scrubs, surgical gloves, and socks. She stepped into her loafers, then went into a room that had a balcony that looked over the metal roofs of the chimpanzee enclosures. It was raining, and the rain was hammering on the metal chimp houses, making a lot of noise.
She ate some peanut butter crackers and drank some bottled water. That was lunch. She made some calls on her government phone, and then suited up and went back into the lab, and worked until she couldn’t stand up anymore. She was working with an Army colleague named Randal Schoepp. There were times when she or Schoepp had to exit from the hot lab due to gastrointestinal issues, a common thing in Africa. Every time she felt a little sick, Hensley wondered, faintly, if this was an amplification of Ebola.
The virus was hitting Monrovia hard. All of the city’s hospitals were filling up with Ebola patients, and the medical system in the city had become almost nonexistent. A blood sample came into the lab that had been taken from a pregnant woman who was in a distressed childbirth. She was lying on the sidewalk outside the main city hospital of Monrovia, bleeding from her birth canal. The doctors wouldn’t admit her because she appeared to have Ebola, and a pregnant woman with Ebola who is hemorrhaging is an extreme danger to medical staff. Hensley knew that the woman and her baby needed i
mmediate medical attention. She tested the woman’s blood sample immediately—but the process took two hours. The result came up: The woman didn’t have Ebola. She could be admitted; she and her baby could be saved. But by the time she got the results back to the hospital, the woman and her baby had died on the sidewalk.
At night, a U.S. Embassy car took Hensley and Schoepp to their hotel on the beach. The streets felt unsafe; civil order was beginning to break down. At the hotel, Hensley would eat something and then, just before she went to bed, she would call home on Skype. Her parents were taking care of James, and he would be eating supper. She would chat with him over supper, then talk with her parents. Her father, Mike Hensley, had begun to worry about her. He didn’t say anything to her about his worry, not a word, but he was a research scientist who had worked to develop drugs for HIV. He had been watching reports of the outbreak and talking with Lisa at least once a day. From her reports he could see that things were going to get much worse in Monrovia. This Ebola outbreak had just begun, in his opinion, and Lisa was in the center of the storm. He knew his daughter very well. He thought she was likely to disregard her safety as she tried to help people. He said nothing about his fears to Lisa or to Lisa’s mother, Karen.
KENEMA HOSPITAL
6 a.m., Saturday, July 19
Auntie declined rapidly. Eventually she was moved out of the private room in the Annexe ward and into the Ebola ward. She ended up lying in the cot in the nook at the back of the ward where Nurse Lucy May had died. Nurse Alex remained by himself in the private room.
At dawn on Saturday morning, a nurse entered Alex’s room and found that he had died during the night, alone in the room. There was nobody available to put the body in a biohazard bag, so it was left lying on the bed.
At about nine that morning, Simbirie Jalloh, who was living at her mother’s house in Freetown, called Humarr Khan. He didn’t answer. This was unusual. He had caller I.D., and he always answered her when she called.
Crisis in the Red Zone Page 25
