“When I dare to be powerful, to use my strength in the service of my vision, then it becomes less and less important whether I am afraid.”
– Audre Lorde
Early March, 2015. Sierra Leone.
The first ambulance arrived to my holding center in the Northern District around two in the afternoon. Four or five of my staff stepped into their heavy yellow plastic suits, intolerably hot underneath a blazing March sun. The man they pulled from the back of the ambulance almost certainly had Ebola; he was emaciated, weak, pale and wan from fluid loss.
Our holding center had been empty for several days; cases were plummeting across the country and West Africa as a whole. I’d come to the northern district alone that day; my data collection folk were working in our main district, and the physician that always worked with me was taking a day off. I’d even sent my regular driver off to Freetown to see his wife and traveled north with a new, much younger driver, always smiling, always impeccably polite, shy and quiet.
Half of the Nigerian team from the African Union that served as the clinical leadership for the holding center was gone, taking a sabbatical in Freetown as well. It had been so quiet, so empty, and they’d worked ceaselessly for months. Until that ambulance arrived, unannounced and unexpectedly, I’d spent the day sitting outside in the shade in our tiki-bar-style veranda, chatting idly with the Sierra Leonean staff, listening to the sun blister and bake the world around us.
The staff in the red zone finished their intake, and gently escorted the ailing man into the ‘wet’ ward, IV fluids running. The sprayer soaked the inside of the ambulance with chlorine, slammed the back doors shut, sprayed them one last time, and called to the driver to head out. The sprayer turned, sweaty and exhausted from carrying a full chlorine tank on his back in the heat, and headed towards the path to the doffing area.
“Wait!” called one of the nurses in the green zone. We looked down the road into the distance, saw the approaching dust cloud, heard the roar of the engine of yet another ambulance. “They de come.”
“What the hell?” I said, irritated. This was the second unannounced ambulance of the day. The command center of the district was usually much better about letting us know when patients would be arriving; today’s radio silence was disconcerting.
The sprayer turned back towards triage and picked up his tank of chlorine yet again. A second team of clinicians headed to the donning station. The ambulance backed into the driveway, its tires crossing into the red zone. The sprayer sprayed the back doors, and opened them. A mother and child emerged blinking into the afternoon heat. The clinicians headed into the red zone.
I turned over my right shoulder, away from the triage area, looking to the front of the holding center fence. A figure stood there in front of a vehicle I didn’t recognize, surrounded by several members of my staff. They were waving me over.
The figure turned out to be Papa, an ambulance driver for the district that we knew well, albeit more for his gregarious personality and the thick gold chains he wore around his neck, rather than for his safety as a driver. He was standing in front of the oldest, strangest-looking tuk-tuk I’d ever seen. A three-wheeled motorized tricycle, the back was an enclosed white box with double rear doors, and a big blue snowflake painted on the side.
A snowflake. In Sierra Leone. I blinked to make sure I wasn’t hallucinating in the heat.
Papa nodded to me. “There is a sick woman at the market. We need to go get her.”
I gaped at him for a moment. “Why didn’t someone call for an ambulance?”
“They’re all out.”
“What do you mean they’re all out?”
He pointed to the ambulance still in our driveway, being sprayed down. “That one’s here. There’s one decontaminating at the command center.” That would be the one that had brought the first, very ill man just half an hour earlier.
“And the third?” I asked. Our district, covering more than 1,200 square miles, with a population of over 300,000 people, sitting on the porous, Ebola-ridden border with Guinea, had exactly three ambulances.
“They’re on their way here from Malal.”
“With a patient?” I asked, horrified.
“I think three,” he replied, evenly.
Yet another ambulance incoming with no warning, no time to ready ourselves, call for food for our patients, get medications mixed, or call for additional staff from the main ETU in Port Loko.
“Are you FUCKING kidding me?” I yelled, my hands flying to the top of my head in disbelief.
I was not known in the United States for either my calm temper or appropriate language, and Sierra Leone had only exacerbated the problem. My driver, after three months of hauling me around, was now also swearing like an American sailor after a night in a bar.
Papa just looked at me with a calm, bland expression.
I gestured irritably to the tuk-tuk. “What the fuck is this?”
He glanced at it, and then back at me, as though I were a very small, stupid child. “It’s a water truck.”
“You’re telling me that there’s a sick woman at the market, we have no ambulance available, and that you need someone to come with you, in a WATER TRUCK, to go get her and bring her back here to the holding center?”
He looked at me proudly. I was clearly getting less stupid by the moment. “Yes. Can we go now?”
“No!” I said, disbelievingly. “My staff isn’t trained to work in the field. We have no way to decontaminate out there. We’re not supposed to leave the holding center!” That final edict had come directly from my employer, a large American NGO. They were willing to accept the liability for putting Americans to work in the ETUs, where the environment was at least somewhat controlled. But to send American, Nigerian, and national staff outside the blue-tarp fence into the field? Way too risky. Way too dangerous. Absolutely not.
Now Papa looked anxious, almost afraid. “Yes, you must!”
“No way,” I said again.
He took a step towards me, pressing his hands against each other nervously. “Martha, you must! It is market day.”
And I stopped cold.
Market day in a town on a major crossroad on the way to Guinea. The stick-and-tin shops of the market would be jammed with a thousand people, jostling each other, buying, selling, yelling. To see a woman collapse next to you, to be unable to get away from her fast enough, to be the first one to scream Ebola! in terror amidst the crowd…
I met Papa’s gaze. His eyes pleaded with mine. “She is all…” he gestured uncomfortably to his own pants. “…wet.”
The whole picture suddenly, quietly, clicked into place in my brain. A roaring mass of people. A woman, still, alone, unconscious, lying in a pool of her own excrement. The palpable terror of someone sick in public in the middle of an Ebola outbreak.
Jesus Christ, I thought quietly to myself. They’ll kill her out of fear.
“I need half an hour to get everything ready,” I told him. “And then we’ll go get her.”
~ ~ ~
I walked quickly back over to triage. My lead Nigerian nurse, known with both affection and awe as ‘Mother,’ was there, filling out paperwork. She was short, wide, and was the boss of all of us. If Mother wanted something done, we all did it without question.
“Mother, there’s a woman who’s collapsed in the market. There aren’t any more ambulances to send. I’m going to take a few people and go get her with Papa.”
She put her papers down immediately. “I’m coming with you,” she said.
I shook my head. “We’ve got a third ambulance coming in from Malal, three people inside. I’m sure they’ll arrive while we’re out. I need you here to help manage that one.”
She eyed me cautiously. “Be very, VERY careful.”
I nodded, and walked over to where my national staff were sitting. “I have a big favor to ask you,” I said to the group. “There is a woman sick in the market. There is no one else but us left to go get her. I am going to go with Papa to try to help and bring her back here.”
Eyebrows lifted all around at this news. I did so much financial, logistical, and administrative work that I almost never entered the red zone anymore; I doubted any of them had ever seen me in PPE.
“I need a sprayer and another nurse to come with me.”
A young sprayer named David raised his hand immediately. “I’ll go.”
Esther, a slender, fine-boned nurse around my own age, stood up. “You’re not going without me.”
I glanced over at our CHO. He had listened to the entire discussion with Papa. He was well-known in the community; he had worked as an anesthesiologist in the local Government Hospital before the outbreak. “Will you come, too? Help keep the crowd away from us and her?” I asked, the first fine thread of fear entering my voice.
We all knew the story of the nine International Red Cross workers murdered in Guinea nearly six months ago. Killed while doing Ebola surveillance work, their bodies stuffed down a well. I had seen video at the command center of another incident, a village in our district, the surveillance team running for their trucks as villagers armed with sticks and rocks rushed towards them from the jungle.
And even so, I knew I had to go. There was literally no one else in the district to help this woman. And I wouldn’t risk the health and safety of my staff if I wasn’t willing to risk my own first.
He smiled at me, and that small thread unknotted itself. “You know I will.” He rose from his chair. “Let’s go get ready.”
~ ~ ~