By JEFFREY GETTLEMAN DEC. 20, 2014
FREETOWN, Sierra Leone — NOT even 30 minutes away from the little house where I watched a girl die from Ebola sat the clinic she had been so desperate to reach. It was a modest compound, of simple rooms lined with iron cots. I didn’t see any blinking computer screens or machines that beeped. It looked more like a high school nurse’s office than an I.C.U.
In one room, nurses were quietly putting pills on little squares of paper.
“What are those?” I asked.
“That’s medicine for Ebola patients,” explained a Sierra Leonean doctor.
I checked the boxes: acetaminophen, ciprofloxacin, some oral rehydration salts — all available at the smallest pharmacies, even here. I was stunned.
“That’s it?” I asked.
“Yeah,” the doctor said. “That’s it. Maybe an IV for the really bad cases.”
I’ve covered a lot of disasters in Africa — famines, civil wars, warlords on the rampage, all the nasty things that many people associate with the poorest continent on earth. We’re used to seeing shots of Africans dead on a red dirt road with a white United Nations helicopter chugging above.
Maybe Ebola looks like that from a distance. But up close it’s different. What I learned this past month reporting in Sierra Leone is that this is one crisis that should be relatively easy to solve.
Ebola, however much some of its symptoms conjure up a horror film, is usually shockingly simple to treat. The virus is swift and ruthless, hideous and creepy, causing some patients to have bloody vomit, bloody diarrhea or even — in severe cases — bloody eyeballs. Ebola is one of the handful of viruses than can trigger a hemorrhagic fever, with internal bleeding, but in most cases the biggest threat is dehydration, which can be addressed by clean water and basic drugs.
As Daniel Bausch, an infectious disease doctor at Tulane University, has said, “It’s not rocket science” — Ebola is as much about logistics as medicine. The key to defeating it is enough ambulances, enough hospital beds and a competent way to identify sick people, get them into care quickly before they infect others and then replenish the fluids they lose because of the virus.
This stands in stark contrast to the Somali famine, the endless wars in the Democratic Republic of Congo or South Sudan’s recent implosion — all extremely complex crises fueled by decades of reckless policies, regional intrigue and serious money to be made from chaos.
The fact that Ebola can be battled back so easily is what makes it so frustrating and depressing — and even at times maddening. I learned that my first day. I was driving through a village, looking for Ebola victims to profile (as journalists do in these circumstances), when some community volunteers waved me over to a small house with a rusted roof.
A family was assembled on the porch, and Isatu Sesay, a 16-year-old girl in a V-neck sweater, was sitting in a chair, looking woozy (picture above).
“She’s been vomiting all day,” her mother said. “She has diarrhea. She has fever. We keep waiting for an ambulance, but the ambulance don’t come.”
I glanced at my colleagues, who had been covering Ebola for months.
“What about giving her a ride?” I asked.
“No way,” they answered.
It would be extremely dangerous; she was clearly infectious and we might easily contract the disease.
Jaime, the translator, pulled me aside.
“Don’t get too emotional,” he warned. “The slightest mistake you do could be the biggest mistake you’ll ever make.”
It was quiet on the ride back to our hotel. In the streets of Freetown, Sierra Leone’s capital, people hauled tubs of soda, sacks of cement, bananas, melons, trousers, plastic pipes — an entire economy carried on the tops of heads.
It may be hard, thousands of miles away, to appreciate just how broken these places are. But Liberia, Guinea and Sierra Leone — the West African Ebola triumvirate — with 18,000 cases among them, are among the world’s least developed nations, definitely a factor in this Ebola crisis, though I am suspicious of making it too big of one. Other West African countries, like Mali, also very poor, and Nigeria, now being called “Africa’s Afghanistan” because of the intensity of its Islamist insurgency, wrapped up their Ebola outbreaks in a matter of weeks, with few deaths, showing it can be done.
The next day, when I drove back to the village, Isatu had descended to a different state. She was flat on her back, delirious, stains of dried black vomit on her jeans. The virus was gnawing through her. Her eyes were bolted open, as if something huge and monstrous were coming right at her.
Neighbors kept calling the Ebola hotline. No response. I couldn’t believe it, so I called myself.
“Good morning, Ebola response center,” said a cheery voice.
I provided Isatu’s name, address, age and symptoms.
“This is very urgent,” I added. “Do you have many cases like this?”
“O.K., sir, O.K.,” the operator replied.
Isatu was dead by sundown.
She was buried in a plastic sack in a shallow grave in a crowded graveyard.
As I watched, my guilt made me nauseated. It wasn’t simply that I hadn’t given her a ride. Had I been thinking straight, I could have at least run out to a local drugstore and bought some medicine to boost her survival chances until an ambulance arrived. It would have been so easy.
In so many stories I’ve covered about people in need, I struggle with when to step back, when to help out, how to be a so-called impartial observer, as I’m paid to be, but at the same time remain a decent human being. Here I failed.
The ambulance never came, I later found out, because some health workers went on strike that week for lack of pay. But even that didn’t make sense. The United States and other countries have injected hundreds of millions of dollars into the Ebola fight; every day, it seemed, another planeload of international experts arrived — Chinese epidemiologists, Cuban nurses, American microbiologists, British engineers. I kept hearing from aid workers that maybe this was the problem: Sierra Leone now had too many experts, too many sources of differing advice.
“It’s madness,” said Peter Simpson, a British paramedic operations manager who was recently in Sierra Leone. “You have 44 NGOs here and they’re all working in their silos.”
Mr. Simpson seemed to have an uncommon amount of common sense. When I spoke to him last, in mid-December, he was cooking up a plan to turn Freetown’s soccer stadium into a giant Ebola clinic because six months into its epidemic, Sierra Leone still doesn’t have enough hospital beds.
“WHY aren’t they using the biggest building in Sierra Leone?” he vented. “It’s got running water, flood lights, you could have 500 beds there in less than a month.” Until then, he said, “you give people anti-malarials, O.R.S.,” or oral rehydration salts, “bananas for fluid, the basics.”
I thought back to Isatu — all the frustrations, helplessness and anger I’d felt in Sierra Leone had been present in her, my first case. More than 6,000 people have died, but she was the one I won’t be able to forget. I unloaded my guilt on an editor in New York who offered a wise solution: Buy a bag of medicine and keep it in the car, just in case, which we did.
But we never found another Isatu. We found very sick people and people who had been successfully treated but no one in that feverish limbo Isatu had been in when she was calling for help.
The night I left, I grabbed my suitcase out of the back of our car. The bag of medicine was still there, untouched.
Jeffrey Gettleman is the East Africa bureau chief for The New York Times, who is currently writing a memoir.