When Ebola Comes
JDJ during better days
Only the faded JDJ and Redemption signs and the rare but perfectly cast foot print in the dusty waiting areas give hint of the hundreds of people who used to gather here. Monrovia’s biggest hospitals are now closed. Augustine tells me that the number of patients at JDJ and Redemption began dwindling long ago.
“There is much misunderstanding,” Augustine said, “besides, few doctors and nurses come to work for fear of the Ebola virus. Those who came to fulfill their duties got sick or died. There is no one to care for patients anyway.”
Augustine’s descriptions of a place and people well known to me elicit both confusion and resolve. I think of Augustine trying to study in his small one bedroom rental using a car battery to charge his computer and cell phone. Famatta trying to single handedly hold the IRC health program together both as administrator and program manager. Daniel and Princess trying to get beyond their shyness and diabetes as young teens. Van trying to build up his five-cuisine beach side restaurant before his lease runs out. Taps trying to manage his new baby and sputtering car service while still finding time to play Sunday basketball at Paynesville Park. I say Augustine, Famatta, Daniel, Princess, Van and Taps are “trying” because in Liberia, the words “can” and “will” are never used independently. If you ask a Liberian if they will be able to deliver a project on time, they will say, yes, I will try. If you ask a mother if her sick infant is getting better, she will say he is trying. But can you do it, you will ask. Will you do what you say, holding in your exasperation. And you will get back, God willing, yes, a cross and maybe a look towards the sky.
Rudimentary Liberian Health Care Infrastructure
This is the country now at the center of the world’s Ebola epidemic. After decades of mostly violent manmade insults, Liberians don’t predispose that they are much in control of anything, let alone a virus with a 90% kill rate. Liberians are proud and resilient and will certainly “try” to fight Ebola, but they will be unable to do so without substantial, organized and smart external inputs. I say this because in 2011-2012 when I lived and worked in Liberia, JDJ and Redemption already averaged 42 and 33 child deaths a month. Each hospital already averaged one maternal death a month. The country’s maternal mortality rate was 400 times that of the United States. 15 in 100 Liberian children did not live to celebrate their 5th birthday. In other words, the death toll from in Ebola in Liberia, which currently stands at 768, pales in comparison to the numbers that die from malaria, pneumonia, sepsis and post-partum bleeding each day. These numbers are likely to worsen with the widespread hospital closures. If you can’t put in an IV under sterile conditions or pay health workers enough and on time, how to you treat a patient coughing and bleeding from his mouth and eyes?
We side on the dramatic of the moment at cost of the realities of the day-to-day. I myself am torn when asked to return to West Africa to help with the medical response, which admittedly has been too long in coming. I ask myself why I can’t triage large scary problems across different work responsibilities like I do in the emergency room or pediatric ward. Does it make sense to build quality care systems in Indonesia for infants when there is Ebola in Liberia? I ask myself why I am scared for my own life dealing with only the idea of risk when 4 million Liberian risk their lives simply by waking up each day.
Through all this of course, Augustine continues to care for our patients with diabetes.
“We meet at JDJ,” he says, “it is quite convenient.”
“Is it safe?” I ask?
“It is safe because no one is there,” he says, “or as long as none of them get Ebola,” Augustine gives a short laugh.
“Not funny,” I say
“Oh,” he says, shifting. “Daniel and Princess are doing well.”
Diabetes patients including Daniel and Princess with coolers to store insulin
If I didn’t know Daniel and Princess, I would think that the picture Augustine just sent me depicted two adolescent who were exactly not well. But three years ago, Daniel and Princess were dying from severe complications of uncontrolled diabetes. On each of their discharges , I had the preposterous decision of personally buying them insulin or letting them die at home having just used enormous public resources to save them. Now the Pfeizer corporation provides them with all the medicine and testing equipment they need. Four years ago Daniel and Princess were not going to school because their guardians were scared that they might get sick away from home. Besides, money was tight. Now both Daniel and Princess have completed four additional years of school with above average marks from funds donated to this website. I suspect Daniel and Princess are suffering from kwashiorkor but at least they do not have marasmus. I can’t figure out why their bellies are so large despite multiple rounds of deworming and attempts at protein-rich food. I am not trying to pretend there is progress when there isn’t. Things for Daniel and Princess are only slightly above average. But I am saying that our efforts are buying time for medical technology to advance beyond three-times-a-day dirty insulin shots and for the Liberian education system to actually increase one’s chance of getting a job. Daniel and Princess are remarkable individuals who deserve this.
Daniel’s grandfather wrote me a letter. In this letter, he thanks me when he shouldn’t for help that I can no longer directly give. Within his generous remarks it is easy to miss the fact that he tries to give Daniel away to me for hopes of a better life. I cannot imagine such desperation and love
Letter from Daniel's legal guardian and grandfather
