The Ebola Web

Columbians race to stop an epidemic.

by Paul Hond Published Winter 2014-15
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Illustration by Michael Morgenstern

SIERRA LEONE - Three and a half hours from Freetown, in the district of Bombali, a car rolls along a dirt road and stops at a remote village. The entrance to the village is cordoned off with yellow police tape. Two soldiers in camouflage stand in front. Beyond the village lies dense rainforest.

The car doors open, and two women get out. One is Wafaa El-Sadr ’91PH, University Professor at Columbia and the director of two centers at the Mailman School of Public Health: ICAP, which works internationally to fight major health threats, and CIDER, the Center for Infectious Disease Epidemiologic Research.

What startles El-Sadr immediately is the silence. She has entered many African villages in her career, and always they are full of life: kids playing, people moving from house to house. But in this village, which has lost dozens of people to the Ebola virus, everyone is indoors. The village — a thousand people, most of them children — is under quarantine. El-Sadr has a word for how it feels: unnatural.

The other woman is Susan Strasser, the director of nursing for ICAP. Strasser has lived in Africa for most of her adult life. A Rochester native, she spent the past eight years in Zambia, where she was the director of an AIDS foundation, before coming to Columbia last July. It is late October now.

As a nurse, Strasser has been in some tough spots. She lived in South Africa during apartheid, and worked at a rural hospital in Zimbabwe, delivering babies at a time of rising HIV infections. But what’s happening in West Africa is unlike anything she has seen.

From the moment they boarded the plane bound for Sierra Leone, Strasser and El-Sadr had found themselves in a world completely dominated by Ebola. The flight attendants wore gloves and masks. There were vats of chlorinated water at the airport and at the hotel in Freetown. Everywhere they went, health officials took their temperature. Billboards reinforced the “no touch” mantra. It was strange, and very difficult, not to hug or shake hands. When you met people, you had to check your normal impulses and hold your hands together.

All the schools were closed, including medical schools and nursing schools. Though life continued in the city, there was a notable absence. Usually in developing countries during a humanitarian crisis you saw all the NGOs whizzing around in their logo-marked trucks. Not here. Fear and lack of expertise have kept agencies out. You know you’re watching history, Strasser would later say. You know you’re watching something very bad play out.

In Freetown, a port city of 1.2 million, El-Sadr and Strasser had met with local and international agencies to see what ICAP could do to help stop the epidemic. One meeting was with Sierra Leone’s chief nursing officer. In Stressor’s experience, Africans were very modest about their struggles, and so it was striking when the woman looked at her and said, “It’s been really hard.” That was telling. Hundreds of health workers had died of Ebola in West Africa. There were few doctors and nurses to begin with — years of war had seen to that — and now to care for patients was to risk your life.

El-Sadr and Strasser are accompanied to the quarantined village by John Redd ’94PH, an epidemiologist from the Centers for Disease Control and Prevention (CDC). Redd has been to this village many times.

The Americans show their IDs to the soldiers, who take their temperatures with a forehead thermometer — all normal — and admit them past the yellow tape. On the other side, the village chief, from ten feet away, greets them. Strasser asks him if the village has received food. Quarantined villages are supposed to get food from the UN World Food Programme, but the food doesn’t always make it. To enter a hunger-stricken village could cause unrest. The chief affirms that the food arrived.

El-Sadr and Strasser then meet, at a distance, with the pastor. The pastor’s wife died from Ebola. So did all his children. 

So did all his grandchildren. He is a broken man. It was horrible, Strasser will later recall, absolutely horrible. In the houses, people sit, just waiting, waiting. Waiting for the twenty-one days to pass, the limit for the virus’s incubation period.

There are other visitors in the village: two community-health workers serving as contact tracers. Contact tracing is one of the oldest ways to fight outbreaks of direct-contact diseases. The contact tracer’s job is to get the names of those who have had contact with a patient, find them, and monitor them for symptoms. The sooner you isolate a sick person, the more new cases you prevent.

Now a woman in a house tells one of the contact tracers that she is ill. This is not an easy thing to admit, given the awful fears: separation from one’s family, pariah status, unthinkable pain and suffering, a solitary death, an unsanctified burial. Still, the early symptoms of Ebola — fever, headache, fatigue, sore throat — are similar to other, less extreme diseases.

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