6 January 2016

Liberia: Josiah Kormie, Pharmacist - "Love for Medicine Keeps You Working in a Crisis"


Josiah Kormie is a pharmacist in Liberia's West Point slum. Born in Grand Kru county, he had a career as a pastor and then studied pharmacology in Monrovia before opening his one-man pharmacy in 2002. Ebola Deeply spoke with him about why he chose to keep working, despite the risks, at the height of the Ebola outbreak.

How did you respond in the initial weeks and months of the Ebola outbreak in West Point?

Pharmacists were told to take precautions. We were told not to touch anybody. But we were also told not to go out, so for me, I looked at the situation and I decided that, rather than sitting at home waiting for the thing to be over, I would serve the community. At first, I wore gloves, goggles and long-sleeved T-shirts - later, a colleague gave me a box of personal protective equipment (PPE).

This place was packed during the Ebola time. It was full to capacity, because it was the only pharmacy that was open. Some people waited outside. I got tired, but that's the job.

I triaged every patient for Ebola, but other illnesses did not stop during that time. There was a need to keep treating patients for malaria and to prescribe other medications. People used to come here to seek paracetamol, bandages and other tablets for fever. I would look at them and ask about their symptoms. If they didn't have symptoms that concerned me, I would prescribe the drugs they needed. For instance, if they were not vomiting or toileting, I would take that to be ordinary fever or malaria. I would usually prescribe artesunate-amodiaquine for malaria, and explain to the patients how to take it.

At least four pharmacists died in Monrovia during the Ebola outbreak. How did you address the risks?

I'm a humanitarian. I'm a health practitioner. Once I'm able to work, it is my duty to serve the public. Now I'm 68, age is not in my favor, so I can't travel much. But I'm still working actively, because I'm willing to help the community. So there was no question of me not helping.

I experienced one patient who turned out to have Ebola. A lady came and said she had typhoid. During the heat of Ebola, it was very hard to get a lab test, but this lady managed to get a test for typhoid, which came back positive. She insisted she did not have the symptoms of Ebola. Still, I was not satisfied. I looked at her condition and I was very skeptical. At that time, there were very few places accepting Ebola patients: the Ebola treatment units (ETUs) were full. And it was very hard to get a test for Ebola, so I did what I could. I prescribed medication for typhoid, and I told the lady's husband that if, after three days, there was no improvement in her condition, they should come back.

What happened next?

Three days later, the husband called me. He said, "As we speak, I am in the ELWA ETU." His wife had died. It turned out that the husband had been concealing information. He confessed that his wife had been passing blood. I was so angry. I had been very careful not to touch her, because of my skepticism, but I had been at risk.

I isolated myself inside my store for two weeks. I was sure I had taken all the precautions, but I didn't want to put anyone else at risk. I was alone here, to see whether something happened. I was not really afraid, because I know that Ebola cannot jump on you. If you handle the patient with bare hands, or if the patient vomits on you, you might catch it. But I hadn't done those things. I isolated myself for public safety. Nothing happened to me, but the lady died, her husband died, and their three children died. That was how things went on.

Did patients come back, after you emerged from self-quarantine?

Well, because people didn't see me for two weeks, they thought something had happened to me. I said, "No, I know what I'm doing." A colleague brought me a box of PPE, and I made sure the chlorine dispenser was regularly filled up. And then I continued working.

Other pharmacies closed. Why did you stay open?

Some pharmacist friends died. They were careless. My neighbor, right here, across the street, was one of them. An Ebola patient was inside his store, although we didn't know the diagnosis at the time. After he treated the patient, he came to my store and washed his hands at the chlorine bucket. But that wasn't enough. That's what happened to him.

Nobody forced me to keep working. I did it because of my passion, my love for the work. You can be the number-one clever person in the community, but if you don't have love for medicine, you cannot work in a crisis. You have to be strong, and you should know what to do if something bad happens. Ebola was here, but I knew what I was doing, so I was not feeling fear. I wore PPE that a colleague gave me. The virus could not jump on me.

Now, after the outbreak is over, what do you think Liberia's health system needs?

We, as Liberians, don't care enough about health. Even Liberian doctors often aspire to work overseas or do other work. Some of them aspire to go into politics. Some of them are looking for money. They don't all have passion for their jobs. Health work is not just for money and respect - we should all be humanitarians and put patients, and the health system, first. That's what happened here. Our people don't want to take care of people. In this country, we don't care enough about poor people. That needs to change.

We need to encourage people. Look, we're taking medical cases from here to Ghana for operations. We're taking health workers to Ghana and Nigeria for training. Liberia is an older country than Ghana. The best way to address this is to bring trainers here and keep our health workers in the country. For the cost of transport and accommodation overseas, you can do thorough training sessions here. If you take health workers away from here for training, they will then want scholarships and they will go away. Sometimes, they won't come back. That's the problem that Liberia has.


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