Esther and I rode in my SUV with Suliaman, my driver. The CHO drove in his own car with David, and Papa drove the tuk-tuk in the lead of our little caravan. Papa drove as he always did — much too fast, over-confident, with a seemingly blatant disregard for his own fragile mortality.
We roared past the roundabout that marked the intersection with the major highway to Guinea, then Papa took us off the paved road and onto the deeply rutted dirt tracks that led to the market. When my usual driver and I stopped by the market to run errands, he took the road at a crawl. Today, we flew. Esther and I crashed back and forth, slamming against our seatbelts, as Suliaman wrenched at the steering wheel, fighting for control.
The road turned left past a building, and then the entrance to the market came into view.
“Oh, my God,” I whispered.
The road was overflowing with hundreds and hundreds of people.
Ahead of us, I saw Papa turn the tuk-tuk violently to the right, heard him sit on the horn – a long, shrill wail – and accelerate to the entrance. The crowd parted like water, people racing for the side of the road, trampling each other to get out of the way of our three-car caravan. Dust exploded from the ground under their sandals, rising dozens of feet into the air, obscuring our vision.
Suliaman made the turn onto the road after the CHO, and then we were inside the crowd, swallowed by the masses, bodies flinging themselves aside in front of us and crashing together again in our wake. We pulled up abruptly next to the tuk-tuk, next to a man wearing an ‘Ebola Response Team’ t-shirt from the Ministry of Health, waving his hand to flag us down.
I turned in my seat and stared at Suliaman, his tense, frightened gaze meeting mine. “After Esther and I get out, you lock the doors, and get back to the holding center. Get out of the crowd; don’t let anyone stop you. Keep your windows up. And do not let ANYONE try to get into the car.”
“How will you get back?” he asked, clearly worried.
This was part of the plan we had hacked out, deliberately and carefully, while gathering our supplies at the holding center. We had assembled and filled a new chlorine sprayer, since all of our sprayers either stayed in the red zone or in the decon area. We had packed three complete sets of PPE, two lapas, and two large biohazard bags. We planned to don our gear in the street, walk into the market, carry the woman out on the lapas and bags, climb into the tuk-tuk with her, still contaminated, and return immediately to the holding center. We planned to use the ambulance entrance directly into the red zone, drop her off in the ward, and then get safely doffed in our own doffing stations.
The matter of getting safely decontaminated had been the tricky part of planning. Eventually, we realized that with three different teams dealing with ambulances at the holding center, we didn’t have enough staff to bring a decon team out in the field with us. We also wanted to spend the shortest amount of time possible out in the public eye. We knew every move we made would be scrutinized.
In essence, once we got into our suits, we could not safely get out of them until we had picked up our patient and made it back to the holding center, regardless of how long it took.
“Papa will take us and the woman back in the tuk-tuk. Okay?” I asked. He nodded, agreeing with our plan and my instructions for him. I gave him a quick, tight smile, and then opened the car door, stepping out into the chaos.
The crowd saw me and roared. “APATO! APATO! APATO!” Children screamed the word for ‘white person’ or ‘foreigner’ at the top of their lungs, shrieking as I glanced at them. Women pointed and yelled at me in languages I couldn’t understand. Dressed in my scrubs and my tall rubber boots, I turned quickly towards Esther, and we walked to the man in the t-shirt who had stopped our caravan.
He was a surveillance officer for the Ministry, and had been one of the first people to arrive after the woman collapsed and someone called 117, the national Ebola hotline. “She’s been laying there since she fell down, and she hasn’t moved,” he said. “She old; she won’t talk to us. There’s another surveillance officer close to her, keeping the crowd away.”
“Where is she?” I asked, glancing around.
He pointed. “In there.”
She was so deep in the market I couldn’t see her from the street. All I could see were the narrow, twisting paths past individual stalls, each hammered hastily to the next one, made from roughly stripped tree branches, shadowed under the corrugated zinc roofs.
Esther and David and I looked at each other, and started to get dressed. At the main ETU in Port Loko we had tall mirrors to double check our zipper and seams and masks and shields, and an assistant to triple check us again. Here, in a dusty, dirty street, littered with garbage and surrounded by a pulsing, humming crowd inching closer and closer, we had no mirrors, no extra gear, no assistants save each other.
I had been donning and doffing without mirrors for months at the eight remote holding centers I helped at, but Esther and David were new to it. I pulled the yellow hood of my PPE over my head, and immediately the crackling of the plastic mixed with the sounds of the crowd. I was instantly hot, sweating. I finished with my gear, and we all checked each other. We adjusted necklines to close gaps, adjusted face shields to cover every inch of bare skin. We helped David shoulder his sprayer. Then the three of us turned as a team, and walked into the market.
It was instantly cooler without the glare of the sun, but we blinked as our eyes adjusted to the dim light filtering in through the cracks in the zinc above our heads. David walked in front, working the pump of the canister with his left hand, spraying the ground in front of us with the nozzle in his right. This was a useless, wasteful exercise, but with the eyes of hundreds of people on us, we knew that we were on stage. We not only needed to stay safe and help the stricken woman, but we also needed to put on the best show of our lives.
With my peripheral vision severely constricted by my hood and shield, I could just barely catch a glimpse of crowds of people mirroring our progress through the market, walking along a parallel path maybe twenty feet to the left of us. I looked forward again, and saw the top of David’s head come within millimeters of a nail, hammered down through a roof branch, its beveled point left hanging at scalp level.
“David, watch your head!” I hissed frantically. He responded perfectly. He didn’t twist his head, or question my command. He just dropped his head, and ducked. The three of us froze for a moment. Catching a nail on the head would end our rescue mission instantaneously — it would breach our gear, tear our skin, and leave us terribly vulnerable to Ebola, never mind a whopping case of tetanus. My coworkers at the Government Hospital routinely tried to save rigid, gasping children dying of a dog bite.
I took a deep breath. “You ok, David?”
“Yes,” he said, calmly.
“Stay low, guys,” I said, and we moved forward again.
We followed the narrow path for forty or fifty feet, and then heard a call coming from our right. “Here! She is here, here!” We turned, and thirty feet to our right, we saw her.
She had collapsed on the near side of a two-foot wall that led to a concrete platform, a more permanent part of the market. The platform was a writhing mass of onlookers, pushing and shoving for a better view, lulled into a sense of security by the tiny wall between themselves and her. She lay on her back, a black-and-red lapa tied around her waist, saturated with diarrhea. She was impossibly thin, frail, and very old.
David turned and led us towards her. The crowd saw him and started to scream, the same phrase, over and over again, like a chant.
“What are they saying?” I asked Esther.
“They want us to spray her,” she replied.
“With the chlorine?!?” I asked, aghast.
“Jesus fucking Christ,” I muttered, and Esther and I stepped from behind David, and started to approach her. Esther called to her in Temne. The woman opened her eyes, turned her head, and saw us.
Terrified, she rolled to her stomach, pushed herself shakily to her feet, and tried to get away.
The angry, frightened roar of the crowd was deafening.
“No, no!” yelled Esther, and lunged forward, grabbing her firmly by the wrist. The woman gave a half-hearted tug in return, and then abruptly capitulated.
Suddenly, just like that, in the space of a breath, it was over.
In that moment when the woman rose to her feet, I realized immediately that she didn’t have Ebola. I had no proof save for the hundreds of Ebola patients I had treated in the past three months – she just didn’t have ‘the look.’ She was clearly unwell, perhaps with fulminant tuberculosis or AIDS, but I knew, somehow, that it wasn’t Ebola making her sick. In any case it was irrelevant; our plan didn’t and couldn’t change, and we were a long way from the holding center.
Esther and I helped the woman into a clean lapa, and David sprayed her soiled lapa and the ground where she’d lain with gallons of chlorine.
“Aren’t you going to take that garbage with you?” called the surveillance team member, the one who had called us over to her.
“No,” I shouted back through my mask and shield, one of my hands holding firmly onto my patient. “We need to get her back to the holding center. I need you to call the command center and get a decontamination team out here to clean this up.” Let the command center do some goddamn work today, I thought, uncharitably.
He nodded and pulled out his phone. With Esther holding one arm and myself holding the other, we turned the woman and walked her back along the path we’d taken, this time with David behind us, spraying the ground where we walked. I was drenched in sweat inside my suit, my bandana under my PPE plastered to my skull over my wet hair, my socks inside my boots squishing unpleasantly with every step.
As we walked towards the daylight of the road, we saw Papa standing there next to the tuk-tuk, wearing a vague approximation of PPE, all the layers backwards and reversed. I had neither the time nor the inclination to debate proper infection control with him, and so I said nothing, but steered my patient well clear of him, just in case.
Papa saw us, turned to the back door of the tuk-tuk, and wrenched it open — and it fell off its rusted hinges into his hands. Startled, he stood there stupidly for a moment, holding the dismembered door. Then he turned, and tried to slide the door into the back compartment, where we’d be sitting with the patient.
“Papa, leave it!” I yelled, coming ever closer.
“But I must–” he started.
“PAPA, LEAVE THE FUCKING DOOR IN THE ROAD,” I roared.
He dropped the door.
We walked back into the blinding sunlight for a fraction of a second, and then Esther jumped into the back of the tuk-tuk, tugging the woman in with her. We sat her on a long narrow bench, her legs stretched in front of her. Esther sat behind her back, hanging on to her shoulders. I wedged myself between the bench and the opposite wall, one hand on Esther’s knees, and one hand firmly clamped to David’s shoulder. David was tall enough that he was able to plant his back against one side of the tiny compartment, and his feet against the other.
We were wedged into a box that was barely four feet wide and five feet long, with one bench, no seatbelts, and no back door.
Papa jumped into the drivers’s seat, and started the engine.
“Papa, go SLOWLY,” I yelled.
“OK!” he yelled back, and floored it.
I remember looking out the open rear door of the tuk-tuk as the market disappeared into the distance again, the sudden reappearance of asphalt under our tires, the white-knuckled grip I kept on David’s shoulder, as though my own puny strength would be enough to keep him from being tossed out onto the road.
I glanced up and saw Suliaman following us closely in my SUV — he had waited in the car, windows up, doors locked, the entire time I was inside the market, watching for me, making sure I made it back out. He stayed right on our tail, his eyes clearly focused on the four of us crammed into the back of the tuk-tuk.
I turned my head from the back, and looked at Esther. She had her arms around the exhausted, debilitated woman, acting as her seatbelt and support.
We couldn’t see each other’s noses or mouths through the heavy white N-95 masks we wore under our shields. But when she met my gaze, I smiled, and she saw it in my eyes.
And with her own eyes, she smiled at me in return.
~ ~ ~