The body was safely buried a few weeks ago. The burial team was called, arrived at the holding center more than an hour away from us, sprayed the body and the body bag with chlorine, placed the body into the bag, zipped it up, sprayed it again with chlorine, and then transported it to a cemetery. It was sprayed again with chlorine, and buried six feet deep.
A few days later the body was un-buried, and taken away into the forest.
– – –
I wonder about the person or persons doing the digging.
It is the darkest hour of the night. There is some light from a half moon, but not much. Because what you are doing is illegal, you have no torches, no lanterns, nothing to alert anyone that you are taking the body of your family member back. You are driven by grief, because the loss is so new, so painful. They took them away to the holding center, and you never saw their face again.
You are driven by a cultural imperative that is so deeply ingrained into your soul that you barely question your actions. This was done wrong. To be sprayed with chlorine, dumped into a white plastic bag, dumped into a hole in the ground in an impersonal graveyard? Wrong. The body must be washed by the hands of the people who loved them. The body must be embraced by the others in the family, the community, a chance for everyone to celebrate a life well lived and a spirit that will be missed. To complete a ritual that is immutable, almost sacred.
But, I wonder, maybe, as the shovelfuls of dirt are tossed to the side, and you feel the sweat drip down your face, your back, as the hole in which you stand gets deeper, four feet, five feet, maybe there is a small part of you that knows this is wrong. And maybe you are driven by fear.
– – –
Seven days after the body went missing, the ambulances started to arrive.
Now assigned to the field team, I was not at the ETU as the wave arrived. But around the dinner table each night, my colleagues shared their stories, and so I share them here.
– – –
We pulled him out of the ambulance, and thought he was dead. Then he opened his eyes and looked at us. The triage nurse asked only the most basic questions – where are you from? What village? What is the phone number of your family? How long have you been sick?
“Five days,” comes the answer, weak and thready.
“Five days!” exclaims one of the expat nurses. “Why the hell did he wait so long to call the ambulance?”
Though the statement was mostly rhetorical, the triage nurse assumes that the expat nurse wants her to ask the patient that question, and so she does, bluntly. And to our horror, he answers.
“I did call. I called every day for four days. And every day they said they were coming.”
And then his eyes rolled back in his head, and he started to seize. We placed him on the cot in triage, and someone in the green zone went to draw up IM diazepam.
He died two hours later.
We walked into the Confirmed Ward, and we walked into a nightmare. Patients collapsed on the floor, sometimes with their arm above their head where the IV tubing hooked to the wall had stubbornly refused to let go. Pools of vomit around their faces, their lapas around their waists soaked with diarrhea.
We picked one woman up, placed her back on the bed, and she immediately tried to roll off, delirious and uncomfortable and frightened. So we gave up, and pulled all the mattresses off the beds, and shoved all the metal bed frames to the side. One by one we picked them up off the concrete floor, and placed them on a mattress. We cleaned them, sat them up, held a cup to their lips, poured ORS into their mouths, trying to get them to drink. We hung litre after litre after litre of D5/LR, all of which had been laboriously mixed by hand in the nurses station before we entered.
We ran out of lapas, then we ran out of adult diapers. Then we ran out of washcloths or any sort of rags to use for cleaning. So we tore up our last sheet and used that, and then we pilfered from the stash of clothing for infants, and used their tiny onesies and jammie pants as wipes.
Two hours later we finished caring for the last person in the ward, and needed to get out of the red zone. On our way out of the ward, we noticed that the first patient we had helped was already dead.
The pediatric team sat in their ward, trying not to lose any more children. Day after day after day they watched tiny body bags being carried to the morgue.
One nurse sat with a twelve-year-old boy, sitting him up and letting him lean against his Tyvek-covered arm, encouraging him to drink ORS, to take liquid paracetamol for his 41*C fever. The boy drank, sips at a time, took the medicine, looked at the nurse, smiled a little.
Another nurse sat on a bed, a three-year-old girl cradled in her arms. She had a little ORS and now seemed to doze, comfortable and soothed being held and rocked slowly to sleep.
The first nurse stepped away from the boy, washed his hands, went over to chart all the medications he’d given — ceftriaxone, artesunate, flagyl, D5/LR, paracetamol, zinc. He heard a cough, and turned around.
The little girl coughed once more. The nurse holding her reflexively tightened her grip, knowing somewhere deep within that now was the moment that this child would fall away, no matter how hard she tried to hold on to her.
A final cough, and she died in the nurses arms.
They placed her on the bed and covered her body with a lapa. Grief-stricken, they turned together back towards the boy. Under the sheet, his body lay with the stillness that only comes in the absence of breath.
– – –
They came too late, that was the problem. They all waited at home, hoping that this was just malaria. Nobody wanted to admit that the body had been infected with ebola, nobody wanted to admit that by washing and embracing the body and following the edicts of a culture that they had chosen their own day to die.
When they finally arrived, one ambulance after another, when they named their village and in doing so implicated themselves as being part of the funeral party, they did so with a strange mixture of fear, shame, and regret. All the things that make you so uncomfortable inside your own skin, all those emotions that you hate to reveal to another person, all of it made them wait and wait and wait until finally their disease was more uncomfortable than the guilt, and they came in.
And by then it is almost always too late. Sometimes we can catch you if we deploy our safety net early, on the first or second day of the fever, on the first or second day of the stomach pain or the bodyaches. If we get fluids and medications in you from the moment you arrive, you’ve got a chance. By the fifth day, your chance has plummeted to nearly zero.
More than twenty patients presented to our ETU having either participated in the funeral rites or having touched someone who had.
Nearly eighty percent of them died.
– – –
So now we stand back with our scientific, western eyes and assign blame. Why didn’t they listen to the public service announcements? Why didn’t they respect the safe burial and grieve in a different way?
Why did they choose to do something so risky?
Allow me to stand behind a young mother in Sierra Leone. Let me stand behind her as she watches a small, wheezing, blue Peugeot trundle down the dirt road towards her remote village. Inside are two nuns, a box of lollipops, and a small cooler with vaccines.
Let me stand behind her as she says, thank God they’re here. Someone will vaccinate my son. He will not die in agony of measles, or mumps, or rubella, or diptheria, or pertussis. He will not die of tetanus when he steps barefoot on a sharp rock.
Let me stand behind her as she watches an American mother, armed with opinions from lunatics on the internet, take her own son out of the pediatricians office with no bandaids on his arms or legs.
Let the mother from Sierra Leone say, Why doesn’t she listen to the public service announcements? Why did she not try to protect her son?
Why did she choose to do something so risky?