11 June 2017

Liberia: Return to Liberia - Life After Surviving Ebola

Photo: IRIN
Momorie, an Ebola burial worker on the left standing in the grave, lowers an elderly women’s body at a local cemetery.

Three years after the 2014 Ebola outbreak that killed more than 11,000 people, African countries are still struggling with the virus and its effects.

The virus is currently spreading in the Democratic Republic of Congo in an area next to the Ebola River where the virus was first discovered in 1976.

Forty-one years on, there is still no cure, vaccines are still being developed, and people continue to die.

In 2014, a global and unprecedented outbreak set the world in a panic. The highly contagious virus spread from a young boy living in a small village in rural Guinea to across the region and beyond - killing 11,000 people.

Poorly equipped and understaffed, medical workers across Guinea, Liberia and Sierra Leone turned down infected patients. When it reached the densely populated Liberian capital Monrovia, it took epic proportions.

Still, over 17,000 people contracted the virus and survived, but Ebola continues to haunt them.

Talk to Al Jazeera looks back at the 2014 crisis and meets those that have survived Ebola; men, women and children that played a crucial role in bringing the outbreak to an end.

'Patient zero' and the 2014 Ebola crisis

It all started in December 2013, deep in the forest of Guinea.

Scientists call him "patient zero" - the first human to get Ebola in West Africa. For Etienne Oumouna, it's is Emile, his two-year-old son who used to love playing football.

Scientists suspect Emile got the virus by touching an Ebola-infected bat in the forest. Children in Guinea hunt and eat bats.

Emile passed Ebola to his mother, who passed it on to his sister, who passed it on to his grandmother and so on - until more than 29,000 people - mostly in West Africa - were infected.

The outbreak was out of control, and Margaret Chan, the former director-general of the World Heath Organization (WHO), called it "the largest and the most severe Ebola complexes ever seen in the nearly 40-year history of the disease."

Affected countries took drastic measures, including closing borders and using the military to impose quarantine over entire neighbourhoods.

The Liberian capital, Monrovia, was on the brink of widespread unrest and the government declared a state of emergency.

The scale of the epidemic was too much to handle for Doctors without Border, also known as MSF, who in the summer of 2014 considered pulling out of Liberia all together, seeing the danger for their staff and the epidemic spreading fast. So, for the first time in MSF's history, it called on the military to intervene and the United States sent 3,000 troops to affected countries.

It took another year and a half to get the outbreak under control - not before Ebola killed 11,000 people and infected 29,000 others.

'A dead body is more dangerous than one alive'

Now the MSF clinics have closed, the soldiers are gone, the dead are buried, and only the survivors remain.

Disco Hill is a site where thousands of Ebola victims have been laid to rest - a tribute to those who have fallen battling the virus.

In times of Ebola, a dead body is more dangerous than one alive because it's five times more contagious. To tackle this, medical staff initially refused to hand over those that died in the treatment centres. Instead, the dead were cremated in isolation.

This was seen as dehumanising, creating an uproar among Liberians. And so the Liberian state opened Disco Hill cemetery, a place for safe Ebola burials, in an attempt to build trust between health workers and the population.

Naomi Tagebert survived Ebola and became a body collector in 2014. Her job was to convince families to hand over the bodies of the deceased, so they could have a safe burial.

When you got a call in the morning telling you there is a body to be picked up, tell me what went through your mind?

It was like a reminder of challenges every day. The problem was coming back and it was not getting better. That was what we thought.

Every morning, we had to make our way to assemble somewhere and get ready for the communities and the treatment centres. Things went wrong and we were hurt every day. Things were tough.

Those were challenges but there was a lot of grief than we thought. We saw our brothers been carried away every day; our sisters and neighbours and all that. It was tough.

How many bodies did you bring to Disco Hill?

Tagebert: We started to bring bodies here late in 2014, in December. I can't tell you the number of bodies, but maybe around 500.

In the beginning, we did cremation and not burial because we never had the site like this to do normal burial.

When you went inside someone's home and you saw the body, and you took it away from their family. What would you tell those people?

Tagebert: We would tell them that this person has died and we have to pick up the body. Some would resist that the body is not going and then we had to test swap the body, to know whether it was Ebola positive or not.

After that, we would pick up the body and disinfect their home. There were challenges. People would refuse not to pick the body and many days we were pursued. But we had to do it. It was for the safety of those who were still alive and not the person who had died.

What was the most challenging body that you had to pick up?

Tagebert: There was this day precisely in September 2014; we went to pick a body from around the Paynesville Belt, Monrovia. It was a lady who had died, leaving her seven children behind.

I was the team leader, and when I got there, her husband was crying. He was really crying and he never wanted the body to leave. We talked to him that we had to take the body away because nobody would help him; nobody would assist in any way to bury her, so we had to take the body away and the children were crying.

I felt so emotional and I started crying. I couldn't work the whole day. I was imagining my sister, a mother who has left all of her children and has to be buried. By then, we were not doing burials. We had to bring her to the cremation site for her to be burned and that was hard. That day was a serious day for me.

' This place is not good for a living being'

Fear of Ebola has spread faster than the virus itself. Many children orphaned by Ebola are being shunned by their communities over fears they may bring the disease back with them. So many Liberians that have survived, hide it. Dominic Kollie explains that people still fear he could be contagious.

In 2014, Kollie had already lost his entire family from Ebola at Ebola Treatment Unit (ETU), and so his grandmother tried to dissuade him from going back for treatment, fearing he would die.

But Kollie made his way to the ETU, hoping to get treated, but instead, he was refused at admission. Shaking, sick with Ebola, he refused to return home, fearing he could infect others.

So, he spent the night alone, under a tree, sheltered from the rain, outside the ETU.

Dominic Kollie: I got it from my cousin whose father died of the virus. They were all affected but I used to care for them. I took them from one hospital to another.

I experienced fever; then after two days, my eyes began to turn red ... I said to myself that I can't stay in here because I will affect others in the house. So, it will be better I go to the ETU. It will be better to die in the ETU instead of home and infect other people.

[At the ETU] they said, "You need to get back home. You remember how many persons you brought here and they all died. This place is not good for a living being. You need to get back home. If you don't have money I will give you five dollars. Go and buy some medication and take, and if there is no improvement after three days, you can come back."

Whilst in that process, in less than three to four minutes, I threw up right in front of him. So, I decided to stay out here until the following morning ...

I went at the back to urinate and that's when I saw my mum's body. It was lying outside of the morgue. It was lying outside in the body bag with the name written on the head. I stood up and then broke down. When I went back into the ETU [after two days waiting outside for admission], I was unconscious for days.

American citizen: Different treatment

American photographer Ashoka Mukpo came down with the Ebola virus while working in Liberia. He was treated in the same Ebola Treatment Unit, just weeks apart from Kollie.

Ashoka Mukpo: I just felt that ache kind of thing like, I would say, when you start to feel like you have the flu. You know, there is that moment, you're ... I'm kind of sick.

There is nothing else it could be. I have had malaria numerous times, and the fever does not come out stronger like that, it's a little bit slower, you feel a little a much more a sense of achiness, this was just a really sudden onslaught of fever.

Where did you get it from?

Mukpo: I think it was just a fluke. That's my best guess. I think somebody touched a surface and I went and touched it, and maybe smoked a cigarette before I had a chance to chlorinate my hands or something escaped the chlorine. But the truth is, I don't know and I am very frustrated about that.

What happened at the ETU?

Mukpo: I came at dawn. I came so early that there was nobody else waiting for admittance.

The first thing that happened is that an MSF doctor who had seen me filming in the area first ran out and he was kind of furious.

He was like, "What are you doing in this area?" You know, he was angry at me for being in an area that I wasn't supposed to be. And, I was like, no I am supposed to be here. And I think he kind of like figured it out. He said "I am really sorry. Step back."

I went through the screening portion of leading up to the test, so I was going to get one MSF doctor and a couple of local Liberian nurses. They just asked me a couple of questions about my appetite, about my symptoms, and I could really tell based on the reaction of the doctor as I gave answers to the questions that he was asking ... that it wasn't looking good.

Probably the second full day when I was in the Ebola treatment unit I was told that a jet was going to come to pick me up [and evacuate to the US].

At any point did you feel uncomfortable with the fact that as an American, as someone who is white, you had better treatment than people here in West Africa?

Mukpo: Yes, absolutely. I mean that's a tough question to answer, because, on one hand, I can't say that I feel upset that I was given the treatment that I needed to survive.

I think it's more of the feeling that it's not right ... It's not so much that I feel guilty about the privilege that I have. I think it's more, I feel troubled that others don't have the same opportunity that I have.

I definitely think it's not right that Liberians had to kind of suffer with the really difficult conditions and limited options of treatment that they had.

'Ebola united Liberians'

Fifty doctors for 4.5 million people. Liberia could not afford to lose any more medical staff to the virus. And so when Dr Philip Ireland fell sick contracting Ebola while treating patients, he left the hospital and went home in isolation.

Dr Philip Ireland: At that time Monrovia was a twilight zone. It was a very crazy place. You had ambulances running up and down, and the available ETUs were cramped, packed, and so I didn't have a place to go.

So you asked your family members, your wife, your children and everybody else in the house to leave the premises? Who was taking care of you?

Ireland: Well, everybody didn't leave because my mother refused to leave. She wouldn't leave. And she would be the one who would stay with me, treat me, and a few other colleagues who could come every day to take care of me. So, she stayed at home. She remained there until I went to the Ebola Treatment Unit.

So what precautions did your mother take in order to care for you?

Ireland: She used makeshift personal protective gear - a rain coat, a plastic glove that the women use to do their hair. She had her own chlorine tub that she stepped into and stepped out of when she came after seeing me.

And, she would take a chlorine bath every time she saw me. And there was minimum touching of spills, so she was very careful.

You survived Ebola and thankfully no relative of yours, no one in the family, got the virus. How has the virus changed your life?

Ireland: I have been in that position before and I know how it feels like so I am doing everything I can to better my patient's condition the best way I know how. So, that's one of the things.

The other thing is, what I learned from this experience is that if you have anything to do in life, do it quickly, put your best into it, because you don't have time. I was this close, and I'm taking every bit of my time on earth very, very seriously.

So, those are some of the things that happened when I came out.

In this hospital where you work there is still some research going on to find new ways to treat Ebola. But the outbreak is over. Is it still affecting Liberians?

Ireland: This epidemic in 2014 brought Liberians closer together than I had ever seen in my entire life. Actually, it was a beautiful thing to watch, where you had Liberians who were opposed to each other probably politically and along tribal lines. Everybody came together because you had one thing that was about to take out the entire country, and everybody united under one umbrella and fought it off.

One of the things that I really think is that if we get that mindset about everything like education, healthcare and agriculture, we will do very well. That's one of the reasons I am still here.

The virus changed customs and society

Dr Ireland continues to work on researching Ebola. Survivors suffer from neurological pains and aches which doctors are still trying to understand. In some, the Ebola viral load is still found in semen, so the virus is also sexually transmitted. Three years after the deadly outbreak, the virus continues to affect people's lives.

After overcoming a decade-long civil war and a major Ebola outbreak, Liberians are still in shock. The virus has changed customs and society. People are more cautious to shake hands or hug, or even attend funerals.

But Ebola has also united Liberians and brought greater trust into the health system, which is finally seen as the government priority. So, Ebola has strengthened Liberians, now better equipped than ever to deal with another outbreak.

And it is those lessons learned that health workers are now using to deal with new Ebola cases in the Democratic Republic of Congo.

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