STIGMA WINS: SALOME KARWAH AND LIBERIA’S FLAWED HEALTH SERVICE

by Eve Lacroix

On February 21st 2017, Ebola nurse Salome Karwah passed away due to childbirth complications. She was one of the Ebola fighters who were named TIME Magazine’s Person of the Year in 2014 for their tireless push to save lives and prevent the spread of the virus.

During the outbreak in Liberia, the Ebola virus claimed Salome’s family members, sparing only herself, her fiancé James Harris, and her sister Josephine Manley. After Salome’s infection and subsequent and seemingly miraculous recovery, she went straight into looking after other Ebola sufferers in the same Médecins Sans Frontières hospital she had herself been treated in. Being a survivor and having immunity as a result, she was able to to treat sufferers where others had to stay away for fear of being infected. She mused that she and the other survivors had ‘superpowers‘, and she, her sister and her fiance, along with other survivors, planned to reopen her family’s medical clinic so that they could continue their work.

Before the Ebola outbreak, Liberia had a total of four ambulances for its population of 4.1 million. As the number of infected and dying rose, the nation became reliant on ambulances supplied by charitable support from the US and elsewhere.

Médecins Sans Frontières hospital health promoter Ella Watson said of these this situation: “When you have countries where there’s no functioning disease surveillance system, it means that a virus can circulate for months in a rural area without anyone noticing. It wasn’t until a doctor was diagnosed that we realised we needed to investigate. (…) It will continue this way until better systems are put into place.”

Before the Ebola outbreak, Liberia had a total of four ambulances for its population of 4.1 million.

Liberia was lacking in protective suits, plastic buckets, body bags, and volunteers. It also lacked tools to monitor the virus and prevent its spread. This all was able to happen because Liberia’s government did not prioritise its health services. For years, residents had been dying from acute injuries and pregnancy complications. If you called a government ambulance, it might not come. Residents knew it was better to rely on private services such as taxis to get to the care they needed.

time-ebola-cover-person-of-the-year-141222-01

Photo credit: Jackie Nickerson, TIME

In the end, the 2014 Liberian Ebola outbreak claimed 11,310 people. Nurses, doctors and volunteers all risked their lives to stop the virus from spreading. Dr Philip Ireland was another example of someone who was both treated for Ebola and treated Ebola, but came out alive. When he was diagnosed, he was moved into an Ebola treatment facility, sharing a room with the man who likely infected him, and unsure whether or not he would recover. Talking to the Times afterward, he said: “I consider myself like somebody who’s come back from the dead.”

He also added: “Being a doctor in Liberia is just sacrificial from beginning to end. You’re not making anything. It’s almost like a volunteer job.”

When Dr. Ireland returned to treating patients, his facility was one of the ones with the most successful recovery rates, releasing over 2,000 survivors. Each one of them received a certificate certifying they were free of the virus.

Being a doctor in Liberia is just sacrificial from beginning to end. You’re not making anything. It’s almost like a volunteer job.

Sadly, that certificate of immunity was not enough to dispel Ebola-related stigma and save Salome Karwah’s life. After marrying her fiance and becoming Salome Harris, she gave birth to baby Destiny without problems. It was her second pregnancy, which ended with a caesarean section and a baby boy named Solomon, that went less well. Hours after being discharged from hospital she started having seizures and convulsions. Her husband and sister rushed her straight back to the hospital, but the staff knew she was an Ebola survivor, and were too fearful to treat her. Her sister Josephine Manley said: “They didn’t want contact with her fluids. They all gave her distance. No one would give her an injection. (…) She was stigmatised.”

A day later, Salome died.

It is a tragedy that Salome survived Ebola, only to lose her life because of stigma linked to the virus. She will be remembered for her work in helping others to survive the disease, and her death highlights how in the shadow of the Ebola health crisis, both virus-related stigma and standard of care in Liberia have yet to adequately improve.

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