As Ebola deaths rise in Monrovia, dark omens and religious prophecies abound that disease heralds the ‘End of the World’

September 2014 – AFRICA – All around Monrovia, there are portents and prophecies. The number of suspected probable and confirmed cases of Ebola throughout the whole of Liberia has risen to more than 3,000, with over one third occurring in the capital, according to figures from the country’s Ministry of Health. Predictions of infections and deaths in the broader West African region, ranging from 20,000 cases to hundreds of thousands, have been offered by international experts and virologists. On the ground in Monrovia, needs are growing by the day, even the hour. The infection last week of a foreign nurse with MSF meant that the organization’s 160-bed treatment center was unable to accept patients for two days, according to MSF press officer Sophie-Jane Madden. It has since reopened. Other centers are full, yet every day, ill people show up in taxis and ambulances at the gates of treatment centers. When they are not accepted inside, many go back to their communities, where they could continue to pose a risk to their families and neighbors. Redemption, which saw its first cases of Ebola months ago, has become a potent symbol of crisis and the near-collapse of Liberia’s health-care system. Esther Kesselly, described by her colleagues as a “diligent, caring, and hardworking nurse,” died in the emergency ward in late May. A Ugandan doctor, Samuel Mutoro who treated Kesselly also contracted the virus and became the first doctor in Liberia to die from Ebola.  Earlier this month, the Redemption staff came to work to find all of the wards boarded up, with only the outpatient department remaining open. The pediatrics, obstetrics and gynecology, surgical, and emergency wards are now filled with beds for suspected Ebola cases.

The establishment of other treatment units, however, has been slow moving. They must be built with utmost care, ensuring that waste disposal is executed properly and that water and drainage does not contaminate neighboring communities. Monrovia’s torrential rains during the wet season, which stretches for five months and makes many roads impassable, has been hindering construction, according to Jean Pierre Veyrenche, who is overseeing the building of treatment units for the WHO. Outside a large, long-unfinished building, the construction of which came to a standstill with the onset of the civil war in 1989, yellow earthmovers stand parked in the rain. At the end of the war in 2003, displaced people cooked, showered, slept, and traded between the black moldy walls of this windowless structure. The Chinese once proposed making it into a new ministerial complex. Now there is a plan to set up tents outside of the building, with 100 beds — another frontline in the Ebola crisis. Veyrenche, however, said it will be at least a month before this unit opens. Constructing the sites is not the only hurdle. “Finding foreign medical teams to come has been a challenge,” said Roar Bakke Sorensen, the spokesperson for WHO in Liberia. Complicating matters, health workers promised hazard pay in August have yet to be paid. 

Amid the chaos of ambulances roaring, family members waiting, and people dying in and near Ebola treatment units, there is a paradoxical sense that Monrovia has come to a standstill. The plush, maroon-carpeted amphitheaters of Capitol Hill, where senators and legislators usually sit in dark wood chairs behind lecterns, were empty on Tuesday. The political center had been closed after James K. Morlu, the deputy sergeant at arms, was suspected to have died of Ebola at Redemption. The halls were disinfected with chlorine spray. Many other government buildings in downtown Monrovia and along Tubman Boulevard, the city’s main thoroughfare, are largely empty, with non-essential staff sent home. The clicking of black shoes and roar of children departing school each afternoon is gone; classrooms stand empty, unlikely to be filled until next year. John F. Kennedy Memorial Hospital, the nation’s largest hospital, is desolate and quiet, now filled with a jumble of plastic chairs, stacked beds, and abandoned hazmat suits. Many health workers are frightened to come to in, for fear that a patient might arrive with Ebola. Patients with other ailments are being turned away. The hospital’s morgue is empty. In the kitchen on Thursday, a worker placed a few food trays on a trolley. There were only seven patients to attend to in the whole facility.

The same day, at an Ebola treatment unit run by the Ministry of Health that has taken over the JFK cholera ward, a thin, middle-aged man hung out the window of an ambulance as though he was about to vomit. Four other people were in the shadows of the ambulance’s tinted windows; the vehicle could have been mistaken for an ordinary car. The man had come from Kakata, a town in Margibi County, over an hour away. Those transporting him were from a hospital that last month lost almost half of its staff members, according to workers from the facility. With only a few ambulances or vehicles serving as such in each county and treatment centers few and far between, rural health workers must drive for miles with suspected patients across muddy, potholed roads. -FP