MONROVIA, Liberia — Ebola is killing Kona Kupee, who loved her husband too much. Kupee is 36. Her husband, Alosho Mumbah, died of Ebola on Aug. 15. He’d known he was sick for a week — he’d been calling a national hotline, trying to get someone to take him out of his house and into a treatment center — but Kupee didn’t know he had Ebola. He had a fever and vomited and shook violently, but he didn’t bleed. She worried it might be Ebola, especially with all the phone calls, but she told herself it was something else. Had to be. Where would he have gotten Ebola, anyway?
All the while, she took care of him, bathing him and feeding him and cleaning up whatever way the disease ravaged his stomach. She was his wife, after all.
And in ignoring the risks of disease in order to give comfort, she’s not unlike most Liberian women. In fact, the people who see patients and who bag bodies and who respond to calls agree that it’s mostly women who are dying of Ebola in Liberia, and this, they say, is why.
To specialists, Ebola is a deadly but manageable threat. It isn’t contagious until patients show symptoms, and chlorine and ultraviolet light and even a good soaping up will kill it. Avoid the bodily fluids of the sick and you’ll probably avoid Ebola.
But to families losing their loved ones, Ebola is a heartless killer. It demands what most people consider a ruthless response to suffering: distance. Its secret weapon is not the scientific mystery of its seven proteins. It’s love. It’s the human need to show compassion and care, and it’s killing Liberia’s women.
The Ministry of Health says fully 75% of the Ebola deaths it has counted are women, but it doesn’t release disaggregated mortality statistics. But Tolbert Nyenswah, the assistant minister of health who provided the estimate, agrees that whatever the number, women bear the biggest mortality burden of this disease. Culturally, they are expected to do the caretaking. “In this country,” he said, “men are bullshit.”
Slowly, health care workers are getting the equipment they need to touch patients, a head-to-toe uniform called PPE, or personal protective equipment. But there are no plans to issue PPE to mothers and wives and daughters.
It’s hard to imagine a mother tolerating PPE. The goggles and masks obscure the face; the head-to-toe white suit engulfs familiar body language or movement. People in PPE are white plastic strangers.
Dr. Samuel Brisbane, Liberia’s top doctor, wouldn’t have wanted to look like a plastic stranger, either. He was the chief medical officer at the country’s teaching and referral hospital, the man in charge of the place where students learned and patients ended up if things went really, really bad. He was a man of prominence and authority, things that are respected here with more reverence than, say, the States, where Brisbane’s wife and children live.
But Brisbane wasn’t just a man of stature. He was a man who’d stayed through the civil war, a man who could handle crises, who could do things — and sometimes the only man who could do many things the hospital needed.
“He was the most senior, the most experienced,” said Dr. Wvannie Scott-McDonald, the general administrator and CEO at the John F. Kennedy Memorial Hospital in Monrovia, where Brisbane worked. “This is the one person who did intubation, who did CPR, who did shocks [defibrillation]. He was there — with all that contact. He was the hero in that area.”
He was, simply, the best. When Dr. Brisbane was alive, no one could touch him. And when Dr. Brisbane died, no one could touch him.
He contracted Ebola from a patient who went into cardiac arrest. Ebola, a rare but deadly virus raging now in three West African countries, spreads through bodily fluids. But this patient didn’t have any of Ebola’s usual symptoms, McDonald said: No fever. No vomiting or diarrhea. No bleeding. No reason to suit up.
So when the man’s heart stopped, Brisbane went in without the full protective gear health workers touching Ebola patients should wear. He did CPR. He ventilated him. He hooked him up to the usual series of tubes and wires. “And that’s what happened,” McDonald said, tearing up, as she described the last case Brisbane worked on.
When Brisbane’s colleagues went to his funeral, they couldn’t touch each other, either. Brisbane’s patient was the first Ebola case in their hospital, and he had taken down Liberia’s untouchable doctor. Their grief was enormous, but their fear was greater.
“When we went to bury Dr. Brisbane, we were all frightened. We couldn’t even comfort one another,” McDonald said. “To care is to comfort, to console. Ebola has taken away our comfort. It has taken away our humanity.”
If your husband or daughter or brother gets sick, the only way to protect yourself is not to touch them. If they die, you leave the house, call a body-removal team, and wait for the person you care most about in the world to be wrapped in what looks like a trash bag and slid into the bed of a pickup truck.
“We’re used to bathing our bodies. We’re used to burying. We’re used to hugging,” said Sayday Williamson Taylor, a psychiatrist who volunteers with a national Ebola hotline. “When you’re told not to … it’s like we’re being denied the chance to give a mother, a child, that last love. This person has been part of you forever.
“And it’s hard for the sick. You have to say, ‘I love you, but I can’t touch you.’ You have to do that for the people you are leaving behind,” Williamson Taylor said.
The morning he died, Mumbah called his two children around him. He said some last words, and then he pulled them into his arms for a last hug. Kupee doesn’t say if he called to her, or kissed her. The morning he died, she cried thinking about it, and three days later, she shivered too violently with fever to say much at all.
Mumbah did have Ebola (a post-mortem test confirmed it), and he probably contracted it from a relative who died in Lofa County, where the outbreak began and has surged in recent weeks. Mumbah had gone with his brother to help with the burial, a ritual that includes washing the body, because that is what you do to show your love and respect for the dead.
But then Mumbah’s brother got sick and died. And then Mumbah did too. And now Kupee is in a Doctors Without Borders treatment ward, and her children are being monitored. Here, chances aren’t great: 54% of people who have gotten Ebola in Liberia have died of it.
The desire to keep the disease a secret is easy to understand for Liberians like Lucy Barh, a midwife at Redemption Hospital. Her colleague, a nurse, did the same thing: She cared for a sick relative, and that care gave her the disease. But she didn’t want to die isolated, with people too afraid to visit or bring food or water.
“She said, ‘I have typhoid,’” Barh said. When the treatment didn’t work, she said it might be malaria. By the time her Ebola symptoms were unquestionable — “the red eyes, rashes all over her skin” — it was too late. She died three hours later.
“Those people who cared for her, they gave her medicine. They took her pee pee. All without wearing gloves,” she says, her voice equal tones frustration and disbelief. (Gloves are precious in Liberia, and until Ebola hit the hospitals, they were saved for the cases that really seemed to really need them.)
Four other health workers who cared for their colleague contracted Ebola and died. Redemption closed for two weeks, not just to decontaminate, but to grieve.
Ebola relies on our weakness for compassion and comfort to survive, and as it successfully moves from one grief-stricken host to the next, it erodes another invisible bond between Liberians: trust.
“Were we suspicious of each other?” Barh said, echoing the question incredulously. “Yes-o! We were all afraid — to work, to work together.”
Williamson Taylor says Ebola’s unspoken but palpable erosion of trust is harder than the country’s infamously brutal civil war, from 1996–2003. “This is not people shooting. We don’t know who may have Ebola. We don’t know anything about it.”
McDonald, of JFK Hospital, said her staff went through similar trauma after Brisbane’s death. Even though he hadn’t kept the disease a secret, his death made clear that it isn’t only anonymous patients who bring the risk of disease to the hospital. It could be the people you work with, people you have trusted to understand your instincts and have your back in the ordinary medical crises any hospital sees every day.
So they closed the hospital and re-evaluted the way they provide care. Some changes are simple — now everyone wears gloves all the time — and others, an outsider would never see. Today, McDonald doesn’t pat a colleague on the back to recognize good work or grab a hand in solidarity after a joyful moment.
“I don’t like what [Ebola] has done to me as a person. I came to do this job because of my humanity, and now, something like this —” she said, stopping to fight tears. “It’s difficult. You get angry, and you don’t know why. You don’t even know who you’re getting angry on.”