Comfort Paye, 53, Ebola survivor, at home.
Alfredo Cáliz
Josephine Karwah lost her mother, father and sister Salomé. Her child was born dead, in the street, on the way to the hospital. No one wanted to help a mother who had contracted Ebola, the lethal virus that claimed the lives of entire families. Sitting in front of the small clinic she now runs in Monrovia, the capital of Liberia, Karwah picks up her phone and opens a WhatApp group. It has 81 members, all of whom suffered from Ebola except for one, a doctor who sometimes offers medical advice. The rest share their pain and sometimes, happiness.
Ten years have passed since the virus decimated their country, but the group remains in contact. The majority of them still experience physical consequences from the disease: pain in their joints, problems with their eyesight.
The group is called All Survivors. Here in Monrovia, the sea is once again playing tricks and has risen up to West Point, the city’s largest shanty town, where the streets are so narrow one has to walk sideways. After it recedes, it leaves a blanket of sand, plastic, and dirt on top of which young children play and slightly older kids prepare fish. It’s Sunday, and there is no market.
In 1970, Liberia was one of the richest countries in Africa. Today, it is one of the poorest and among the most corrupt. Liberia is the only African state that was never ruled by a colonial regime and is the oldest government on the continent, having declared its independence in 1847.
Two of its presidents have been assassinated and it’s undergone two civil wars, the last of which ended in 2003 and left more than 100,000 dead. At least 40,000 minors were forced to become soldiers. Today, 5.4 million people live in the country, where restaurants are run by the Lebanese and highways are built by the Chinese. Tourism is non-existent.
On Transparency International’s corruption perceptions index, Liberia is 145th among the 180 countries analyzed, with 25 out of 100 points. Several studies locate it among the 20 poorest and least-developed nations in the world. Despite a favorable climate and good soil for crop production, it has suffered from food insecurity due to extreme poverty and endemic inefficiency.
It’s been dependent on aid from the United States for years, and has watched Donald Trump’s return to the White House with no small measure of concern. In 2018, during his first presidential term, Trump ended special immigration status for Liberians, giving them a year to leave the country.
The Ebola virus was detected for the first time in 1976 near the Ebola River in the Democratic Republic of the Congo, and led to at least 40 outbreaks. The worst of these started in a village near Conakry, the capital of Guinea, in December 2013 and rapidly spread throughout Liberia and Sierra Leone. The virus killed 11,300 people in Liberia, Sierra Leone, and Guinea, including 500 health professionals. It seemed to disappear in June 2016, leaving behind some 17,000 survivors.
The primary sources of contagion, according to nurse Luis Encinas, were funeral rites, care providers and health centers where there were no adequate protective measures enforced at the beginning of the outbreak, in addition to large gathering places such as markets and churches. “The number of infections multiplied because there were not enough ambulances and potential patients had to be transported in unsafe conditions, such as on motorbikes, that did not allow for safe distancing, or in private vehicles that were not properly disinfected afterwards.
Doctors Without Borders (MSF) sounded the alarm, but international warnings were not issued until many months later, when thousands were already dead,” he adds.
Years of war that preceded the outbreaks had created healthcare deserts in Liberia. A study by the University of Washington revealed that up to 67% of essential primary care in the country evaporated during and immediately following the epidemic. On June 9, 2016, the World Health Organization declared the end of Liberia’s outbreak.
Though the capital had been the worst hit, every one of the country’s 15 counties had registered cases. Thousands survived. Many had sought care in the Ebola treatment center that MSF had built in Monrovia. These are some of their stories.
The Ebola virus was detected for the first time in 1976 near the Ebola River in the Democratic Republic of the Congo, and led to at least 40 outbreaks. The worst of these started in a village near Conakry, the capital of Guinea, in December 2013 and rapidly spread throughout Liberia and Sierra Leone. The virus killed 11,300 people in Liberia, Sierra Leone, and Guinea, including 500 health professionals. It seemed to disappear in June 2016, leaving behind some 17,000 survivors.
The primary sources of contagion, according to nurse Luis Encinas, were funeral rites, care providers and health centers where there were no adequate protective measures enforced at the beginning of the outbreak, in addition to large gathering places such as markets and churches. “The number of infections multiplied because there were not enough ambulances and potential patients had to be transported in unsafe conditions, such as on motorbikes, that did not allow for safe distancing, or in private vehicles that were not properly disinfected afterwards. Doctors Without Borders (MSF) sounded the alarm, but international warnings were not issued until many months later, when thousands were already dead,” he adds.
Years of war that preceded the outbreaks had created healthcare deserts in Liberia. A study by the University of Washington revealed that up to 67% of essential primary care in the country evaporated during and immediately following the epidemic. On June 9, 2016, the World Health Organization declared the end of Liberia’s outbreak.
Though the capital had been the worst hit, every one of the country’s 15 counties had registered cases. Thousands survived. Many had sought care in the Ebola treatment center that MSF had built in Monrovia. These are some of their stories.
Karwah breaks down in tears. There has been so much pain, too many ugly stares. Like Salomé, she is a nurse and runs the clinic their parents founded before they died, Karwah’s Memorial Healthcare Center. On a press tour in Amsterdam during which she shared what had happened to her, she received treatment for her eye problems, but she says she continues to lose more of her vision every day.
“The stigma continues. Recently I attended a wedding and someone recorded me. You can hear in the video how they refer to me as the Ebola nurse,” she says. Josephine and Salomé’s parents are not here, in this small cemetery on the highway to the airport. Like the rest of those who died during the hardest months of the Ebola epidemic, they were cremated. Facing criticism, U.S. agencies bought property on which to bury the dead.
Today, their parents’ ashes are there, mixed with those of hundreds of others, along with the corpses of those who were able to be buried. A few miles away at Karwah’s parents’ clinic, a pregnant woman waits to be attended.
It’s noon and the sun bakes the building’s aging walls. On them hang posters with recommendations about how to fight Covid and avoid another disease, Lassa fever. Not a single poster addresses Ebola.
Karwah breaks down in tears. There has been so much pain, too many ugly stares. Like Salomé, she is a nurse and runs the clinic their parents founded before they died, Karwah’s Memorial Healthcare Center. On a press tour in Amsterdam during which she shared what had happened to her, she received treatment for her eye problems, but she says she continues to lose more of her vision every day.
“The stigma continues. Recently I attended a wedding and someone recorded me. You can hear in the video how they refer to me as the Ebola nurse,” she says.
Josephine and Salomé’s parents are not here, in this small cemetery on the highway to the airport. Like the rest of those who died during the hardest months of the Ebola epidemic, they were cremated. Facing criticism, U.S. agencies bought property on which to bury the dead.
Today, their parents’ ashes are there, mixed with those of hundreds of others, along with the corpses of those who were able to be buried. A few miles away at Karwah’s parents’ clinic, a pregnant woman waits to be attended. It’s noon and the sun bakes the building’s aging walls.
On them hang posters with recommendations about how to fight Covid and avoid another disease, Lassa fever. Not a single poster addresses Ebola.
Benetta Coleman takes Paracetamol to treat the intense headaches she suffers after having Ebola — when she can find someone to pay for the medicine. Being cured was supposed to mean she could start over, but things haven’t been going well. The 34-year-old earns just $1 a day selling water and ice in the streets of Monrovia. She cares for her eight-year-old daughter, Francia, who is her greatest treasure and whose father is a married man who tried to convince Coleman to get an abortion, and who has never wanted to help them. “They had told me that it was very probable that I wouldn’t be able to have children, so when I became pregnant, I was absolutely sure that I wanted to have my daughter,” she says.
What was it like starting over? “I had lost 15 members of my family to the virus. Soon after I was cured, Atena, an MSF worker, offered me a job. For a few months I worked at Elwa-3 as a social assistant. With the money they paid me, I bought property, but when Ebola was in its final days, MSF handed the center over to the government and I was left without a job or money to develop the land,” Coleman says. Today, she has just one sister, who helps her survive. “Around here,” she says, “no one knows I’m an Ebola survivor.”
She’s one of many patients who had to move because of stigma. Prevail covered her medical expenses for six months. Now Coleman’s main issue is money, as it is for the majority of survivors.
The United Nations’ Human Development Index, which measures countries’ progress, has found that Liberians have one of the worst qualities of life in the world: 83.8% of the population lives under the poverty line, which is set at wages of $1.25 a day.
“Becoming a mother after the epidemic is the best thing that has happened to me in 10 years,” she says. “My only wish is for someone to help me provide a future for my daughter. I can only put her into school when I get some money.”
